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Lilley, Erin K., and Adam Jogee. "The Future of Chronic Conditions Management in NSW: Integrated Care for People with Chronic Conditions." International Journal of Integrated Care 17, no. 3 (2017): 86. http://dx.doi.org/10.5334/ijic.3198.
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Scruggs, Brenda. "Chronic Health Care." Home Health Care Management & Practice 22, no. 1 (2009): 43–48. http://dx.doi.org/10.1177/1084822309340299.
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The traditional acute health care model works well for acute injuries and illnesses but is unlikely to achieve good outcomes in managing chronic health care conditions. Positive outcomes in chronic illness management requires multiple referrals from the primary care provider for a multidisciplinary team, relinquished control by the health care providers as they coach the patient into the active role of self-care life skills and daily management of their health, and active learning, participation, and accountability of the patient.
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Williams, Mark D. "Practical and measurable definitions of care coordination, care management, and case management." Translational Behavioral Medicine 10, no. 3 (2020): 664–66. http://dx.doi.org/10.1093/tbm/ibaa001.
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Abstract Integrated behavioral health is a population-based approach that acknowledges the chronic nature of most mental illnesses and the need for services beyond those delivered in face-to-face visits. These services have been referred to by different and confusing names with over 40 definitions of care coordination concepts in the literature. Kilbourne et al. in a recent article in this journal divided these tasks into three groups: care coordination, care management and case management with associated definitions provided as used in the veterans affairs system. In this commentary, while drawing on over a decade of experience in implementing care management models in the Mayo clinic system of care, I will suggest we need to be even more specific with these definitions. I propose these terms be linked to critical and measurable tasks in the management of chronic conditions, thus allowing those administrating or researching these interventions to better assess fidelity, processes and outcomes when a model is applied to a population of patients with chronic conditions in an integrated setting.
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O'Halloran, Julie, Graeme C. Miller, and Helena Britt. "Defining chronic conditions for primary care with ICPC-2." Family Practice 21, no. 4 (2004): 381–86. http://dx.doi.org/10.1093/fampra/cmh407.
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Abstract Background. With the increasing prevalence of chronic conditions, there is need for a standardized definition of chronicity for use in research, to evaluate the population prevalence and general practice management of chronic conditions. Objectives. Our aims were to determine the characteristics required to define chronicity, apply them to a primary care classification and provide a defined codeset of chronic conditions. Methods. A literature review evaluated characteristics used to define chronic conditions. The final set of characteristics was applied to the International Classification of Primary Care-Version 2 (ICPC-2) through more specific terms available in ICPC-2 PLUS, an extended terminology classified to ICPC-2. A set of ICPC-2 rubrics was delineated as representing chronic conditions. Results. Factors found to be relevant to a definition of chronic conditions for research were: duration; prognosis; pattern; and sequelae. Within ICPC-2, 129 rubrics were described as ‘chronic’, and another 20 rubrics had elements of chronicity. Duration was the criterion most frequently satisfied (98.4% of chronic rubrics), while 88.2% of rubrics met at least three of the four criteria. Conclusion. Monitoring the prevalence and management of chronic conditions is of increasing importance. This study provided evidence for multifaceted definitions of chronicity. While all characteristics examined could be used by those interested in chronicity, the list has been designed to identify chronic conditions managed in Australian general practice, and is therefore not a nomenclature of all chronic conditions. Subsequent analysis of chronic conditions using pre-existing data sets will provide a baseline measure of chronic condition prevalence and management in general practice.
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Lambert, Susan. "Chronic Condition Self-Management: A primary health care change management problem." Australian Journal of Primary Health 11, no. 2 (2005): 70. http://dx.doi.org/10.1071/py05024.
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Australian general practitioners are recognising the need to implement some form of chronic condition management program to better service and cope with the ever-increasing number of patients presenting with chronic conditions. Chronic Condition Self-Management (CCSM) is one such program. In this paper it is argued that the basis of CCSM is a multi-disciplinary, care-team approach, and that implementation of such an approach represents a paradigm shift in primary health care service delivery. This equates to a significant innovation in primary health care service that, in economic terms, aims to increase primary health care outputs. Although general practitioners are at the centre of the change they cannot implement the change without the participation and collaboration of the other stakeholders. These stakeholders include other health service providers, the Divisions of General Practice, the Department of Health and Ageing, and the patient. This paper presents a general practice business model to illustrate the relationships between stakeholders in the primary health care sector and to identify the impact of CCSM on these relationships. The organisational and business issues that need to be addressed to promote the uptake of CCSM are also identified.
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Hickson, Louise, Gitte Keidser, Carly Meyer, and Elizabeth Convery. "The Chronic Care Model and Chronic Condition Self-Management: An Introduction for Audiologists." Seminars in Hearing 40, no. 01 (2019): 007–25. http://dx.doi.org/10.1055/s-0038-1676780.
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AbstractHearing health care is biomedically focused, device-centered, and clinician-led. There is emerging evidence that these characteristics—all of which are hallmarks of a health care system designed to address acute, rather than chronic, conditions—may contribute to low rates of help-seeking and hearing rehabilitation uptake among adults with hearing loss. In this review, we introduce audiologists to the Chronic Care Model, an organizational framework that describes best-practice clinical care for chronic conditions, and suggest that it may be a viable model for hearing health care to adopt. We further introduce the concept of chronic condition self-management, a key component of chronic care that refers to the knowledge and skills patients use to manage the effects of a chronic condition on all aspects of daily life. Drawing on the chronic condition evidence base, we demonstrate a link between the provision of effective self-management support and improved clinical outcomes and discuss validated methods with which clinicians can support the acquisition and application of self-management skills in their patients. We examine the extent to which elements of chronic condition self-management have been integrated into clinical practice in audiology and suggest directions for further research in this area.
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Munten, Guus. "Control in chronic condition self-care management." Nederlands Tijdschrift voor Evidence Based Practice 13, no. 2 (2015): 12–13. http://dx.doi.org/10.1007/s12468-015-0015-4.
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Doherty, K. V., E. H. Walters, L. Tierney, K. Elliott, M. Annear, and A. L. Robinson. "TOWARD EFFECTIVE MANAGEMENT OF CHRONIC RESPIRATORY CONDITIONS IN RESIDENTIAL AGED CARE." Innovation in Aging 1, suppl_1 (2017): 742. http://dx.doi.org/10.1093/geroni/igx004.2678.
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Jaramillo, Carlos A., Syed H. A. Faruqui, Mary J. Pugh, and Adel Alaeddini. "Mining Major Transitions of Chronic Conditions in Patients with Multiple Chronic Conditions." Methods of Information in Medicine 56, no. 05 (2017): 391–400. http://dx.doi.org/10.3414/me16-01-0135.
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SummaryObjectives: Evolution of multiple chronic conditions (MCC) follows a complex stochastic process, influenced by several factors including the inter-relationship of existing conditions, and patient-level risk factors. Nearly 20% of citizens aged 18 years and older are burdened with two or more (multiple) chronic conditions (MCC). Treatment for people living with MCC currently accounts for an estimated 66% of the Nation’s healthcare costs. However, it is still not known precisely how MCC emerge and accumulate among individuals or in the general population. This study investigates major patterns of MCC transitions in a diverse population of patients and identifies the risk factors affecting the transition process.Methods: A Latent regression Markov clustering (LRMCL) algorithm is proposed to identify major transitions of four MCC that include hypertension (HTN), depression, Post- Traumatic Stress Disorder (PTSD), and back pain. A cohort of 601,805 individuals randomly selected from the population of Iraq and Afghanistan war Veterans (IAVs) who received VA care during three or more years between 2002-2015, is used for training the proposed LRMCL algorithm.Results: Two major clusters of MCC transition patterns with 78% and 22% probability of membership respectively were identified. The primary cluster demonstrated the possibility of improvement when the number of MCC is small and an increase in probability of MCC accumulation as the number of co- morbidities increased. The second cluster showed stability (no change) of MCC overtime as the major pattern. Age was the most significant risk factor associated with the most probable cluster for each IAV.Conclusions: These findings suggest that our proposed LRMCL algorithm can be used to describe and understand MCC transitions, which may ultimately allow healthcare systems to support optimal clinical decision- making. This method will be used to describe a broader range of MCC transitions in this and non-VA populations, and will add treatment information to see if models including treatments and MCC emergence can be used to support clinical decision-making in patient care.
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Pearson, William S., Kavitha Bhat-Schelbert, and Janice C. Probst. "Multiple Chronic Conditions and the Aging of America." Journal of Primary Care & Community Health 3, no. 1 (2011): 51–56. http://dx.doi.org/10.1177/2150131911414577.
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Background: As the United States population ages, chronic conditions are becoming more prevalent and our healthcare system is faced with increasing costs. This aging population with increased multiple chronic conditions coupled with increased burden of disease will provide a challenge to primary care physicians to provide quality care that is cost-effective. Therefore, we examined national data to study the impact of chronic conditions, age and caregiving on lifestyle burden. Methods: Cross-sectional data from the 2009 Behavioral Risk Factor Surveillance System were analyzed for the presence of 9 chronic health conditions, including angina/coronary heart disease (CHD), arthritis, asthma, cancer, diabetes, heart attack, hypertension, obesity, and stroke, and average number of chronic conditions among persons 50 years of age and older. Lifestyle burden, measured by activity limitation, required use of assistive devices, and/or serving in a caregiving capacity was measured and stratified by number of chronic conditions. Results: All conditions except obesity and asthma increased with each age category. By age 70, the majority of adults had hypertension (60.7%) and arthritis (55.0%). Prevalence of activity limitations and use of assistive devices increased as did the numbers of chronic conditions. Discussion: These findings point to a changing population of patients for primary care physicians that will require treatment of multiple chronic conditions as well as increased burden of disease. As this population grows, workloads for primary care physicians will increase and could likely lead to inefficient care and possibly inadequate payment for the required level of management. Therefore, the current challenge facing our healthcare system is to evaluate existing models of care for older patients and to develop new models that are cost-effective while at the same time providing fair reimbursement for increased management.
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Silva, Thiago Privado da, Laura Johanson da Silva, Benedita Maria Rêgo Deusdará Rodrigues, Ítalo Rodolfo Silva, Marialda Moreira Chistoffel, and Joséte Luzia Leite. "Care management for the hospitalized child with chronic cancer pain: intervening conditions." Revista Brasileira de Enfermagem 72, suppl 1 (2019): 181–88. http://dx.doi.org/10.1590/0034-7167-2017-0514.
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ABSTRACT Objective: To understand the intervening conditions of care management for the hospitalized child with chronic cancer pain. Method: Qualitative research, anchored in the methodological and theoretical frameworks, respectively, Grounded Theory and Complex Thinking. The semi-structured interview and non-participant observation were used to collect the data. Twenty-one health professionals, organized in three sample groups: nurses; nursing technicians; and professionals of the multiprofessional health staff. Results: They emerged as intervening conditions of care management: human resources and materials, teamwork, absenteeism, professional relocation, professional qualification, family, playful, dialogue, empathy and caring relationship. Conclusion: It was understood as limiting conditions for care management: deficits of human resources and materials, absenteeism, ineffective teamwork, professional relocation, and insufficient professional qualification. On the other hand, they were presented as facilitating conditions: adequate professional knowledge, effective teamwork, dialogue, empathy, playful and affective relationship with the child.
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Lawn, Sharon, Sara Zabeen, David Smith, et al. "Managing chronic conditions care across primary care and hospital systems: lessons from an Australian Hospital Avoidance Risk Program using the Flinders Chronic Condition Management Program." Australian Health Review 42, no. 5 (2018): 542. http://dx.doi.org/10.1071/ah17099.
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Objective The study aimed to determine the impact of the Flinders Chronic Condition Management Program for chronic condition self-management care planning and how to improve its use with Bendigo Health’s Hospital Admission Risk Program (HARP). Methods A retrospective analysis of hospital admission data collected by Bendigo Health from July 2012 to September 2013 was undertaken. Length of stay during admission and total contacts post-discharge by hospital staff for 253 patients with 644 admissions were considered as outcome variables. For statistical modelling we used the generalised linear model. Results The combination of the HARP and Flinders Program was able to achieve significant reductions in hospital admissions and non-significant reduction in emergency department presentations and length of stay. The generalised linear model predicted that vulnerable patient groups such as those with heart disease (P = 0.037) and complex needs (P < 0.001) received more post-discharge contacts by HARP staff than those suffering from diabetes, renal conditions and psychosocial needs when they lived alone. Similarly, respiratory (P < 0.001), heart disease (P = 0.015) and complex needs (P = 0.050) patients had more contacts, with an increased number of episodes than those suffering from diabetes, renal conditions and psychosocial needs. Conclusion The Flinders Program appeared to have significant positive impacts on HARP patients that could be more effective if high-risk groups, such as respiratory patients with no carers and respiratory and heart disease patients aged 0–65, had received more targeted care. What is known about the topic? Chronic conditions are common causes of premature death and disability in Australia. Besides mental and physical impacts at the individual level, chronic conditions are strongly linked to high costs and health service utilisation. Hospital avoidance programs such as HARP can better manage chronic conditions through a greater focus on coordination and integration of care across primary care and hospital systems. In support of HARP, self-management interventions such as the Flinders Program aim to help individuals better manage their medical treatment and cope with the impact of the condition on their physical and mental wellbeing and thus reduce health services utilisation. What does this paper add? This paper sheds light on which patients might be more or less likely to benefit from the combination of the HARP and Flinders Program, with regard to their impact on reductions in hospital admissions, emergency department presentations and length of stay. This study also sheds light on how the Flinders Program could be better targeted towards and implemented among high-need and high-cost patients to lessen chronic disease burden on Australia’s health system. What are the implications for practitioners? Programs targeting vulnerable populations and applying evidence-based chronic condition management and self-management support achieve significant reductions in potentially avoidable hospitalisation and emergency department presentation rates, though sex, type of chronic condition and living situation appear to matter. Benefits might also accrue from the combination of contextual factors (such as the Flinders Program, supportive service management, clinical champions in the team) that work synergistically.
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Sav, Adem, Michelle A. King, Fiona Kelly, et al. "Self-management of chronic conditions in a rural and remote context." Australian Journal of Primary Health 21, no. 1 (2015): 90. http://dx.doi.org/10.1071/py13084.
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Living in a rural or remote environment presents unique challenges for people with chronic conditions, mainly those created by limited health-care services and the physical and emotional isolation. Yet, research on how people self-manage their chronic conditions in such locations is limited. This study aims to contribute to research and clinical practice by describing the ways in which a diverse group of rural and remote people with a range of chronic conditions, and their unpaid carers, self-manage their conditions. Using semi-structured in-depth interviews, data was collected from a sample of 32 participants, residing in one of two regions of Australia: Mount Isa/North West region of Queensland and the Northern Rivers area of New South Wales. Our findings suggest that although self-managing in a rural and remote context requires many of the lifestyle changes necessary in urban areas, the uniqueness of the rural lifestyle and the limited availability of health care results in, at times, creative forms of self-management. Health-care professionals and policy makers need to be cognisant of the ways in which rural and remote residents modify self-management strategies to suit their needs, and help them develop self-management plans tailored to the realities of their rural environment.
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Ciere, Y., R. van der Vaart, A. E. van der Meulen-De Jong, et al. "Implementation of an eHealth self-management care path for chronic somatic conditions." Clinical eHealth 2 (2019): 3–11. http://dx.doi.org/10.1016/j.ceh.2019.04.001.
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Sama, Srikar, and Alekhya Gajjala. "Impact of COVID-19 on chronic disease management." International Journal of Research in Medical Sciences 9, no. 8 (2021): 2510. http://dx.doi.org/10.18203/2320-6012.ijrms20213110.
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Routine care for chronic disease is an ongoing major challenge. We aimed to evaluate the impact of COVID-19 on routine care for chronic diseases. A deeper understanding helps to increase the health system’s resilience and adequately prepare for the next waves of the pandemic. Diabetes, heart failure, chronic kidney disease, and hypertension were the most impacted conditions due to the reduction in access to care. It is important routine care continues in spite of the pandemic, to avoid a rise in non-COVID-19-related morbidity and mortality. This is a review article discussing the potential impact of COVID-19 on chronic disease management.
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Lewis, Rachel. "End-of-life care in non-malignant conditions." InnovAiT: Education and inspiration for general practice 11, no. 1 (2018): 41–47. http://dx.doi.org/10.1177/1755738017736910.
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End-of-life care refers to the care of patients with progressive, incurable conditions and considered to be in the last year of life. Approximately 75% of end-of-life patients will die from non-malignant conditions. There are significant challenges, both in the identification of patients with chronic disease who are nearing the end of life and in the provision of high-quality palliative care in this group. This article explores the role of GPs in the management of end-of-life care in the most common non-malignant conditions, including management of symptoms and advance care planning.
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Harvey, Peter W., and Barbara M. Docherty. "Sisyphus and self-management: the chronic condition self-management paradox." Australian Health Review 31, no. 2 (2007): 184. http://dx.doi.org/10.1071/ah070184.
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Chronic condition self-management is promoted internationally as not only a possible solution to the health problems of our increasingly chronically ill and ageing population, but as part of a new wave of consumer-led and volunteer-managed health care initiatives. Consumers are now indicating that they want to be more involved in the management of their lives and their health care options, while, especially in rural and smaller communities in Australia, a shortage of clinicians means that health care is rapidly changing. This emphasis on self-management raises crucial questions about where consumer action and control in health care should end and where clinical and medical intervention might begin. Hence, as in the case of Sisyphus and his rock, the self-management process is a difficult and demanding one that poses major challenges and loads for health system reformers and represents a struggle in which new difficulties are constantly emerging. This paper examines some implications of new self-management approaches to chronic illness from an ideological perspective and highlights key elements that underpin the effort to promote health-related lifestyle change. While peer-led self-management programs may assist certain individuals to live engaged and meaningful lives, the essential social and economic determinants of health and wellbeing mean that these programs are not the answer to our urgent need for major reform in the health care arena. Rather, selfmanagement, from an ideological perspective, represents a minor adjustment to the fabric of our health system.
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McGough, Peter, Susan Kline, and Louise Simpson. "Team care approach to population health and care management." International Journal of Health Governance 22, no. 2 (2017): 93–103. http://dx.doi.org/10.1108/ijhg-11-2016-0048.
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Purpose As the US health system moves to value-based care and aligns payment with quality, the role of the primary care provider (PCP) is becoming ever more important. The purpose of this paper is to outline a successful population health and care management strategy depending on accountable teams to standard workflow and agreed upon process and outcome measures in order to achieve the triple aim of improved health, patient experience, and value. Design/methodology/approach Two major areas of focus for primary care are ensuring that all patients receive appropriate evidence-based screening and prevention services and coordinating the care of patients with chronic conditions. The former initiative will promote the general health and well-being of patients, while the latter is a key strategy for achieving better outcomes and reducing costs for patients with chronic conditions. Findings To achieve these goals while managing a busy practice requires that the authors leverage the PCP by engaging clinical and non-clinical team members in the care of their patient population. It is essential that each team member’s role be clearly defined and ensures they are working at the top of their scope. Originality/value This initiative was successful because of the compelling objectives, the buy-in generated by using Lean methodology and engaging the team in the design process, use of multiple feedback mechanisms including stories, dashboards, and patient feedback, and the positive impact on providers, staff, and patients.
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D’Antrassi, Pierluigi, Miloš Ajčević, Kira Stellato, et al. "Personalized support for chronic conditions." Applied Clinical Informatics 07, no. 03 (2016): 633–45. http://dx.doi.org/10.4338/aci-2016-01-ra-0011.
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SummarySolutions for improving management of chronic conditions are under the attention of healthcare systems, due to the increasing prevalence caused by demographic change and better survival, and the relevant impact on healthcare expenditures. The objective of this study was to propose a comprehensive architecture of a mHealth system aimed at boosting the active and informed participation of patients in their care process, while at the same time overcoming the current technical and psychological/clinical issues highlighted by the existing literature.After having studied the current challenges outlined in the literature, both in terms of technological and human requirements, we focused our attention on some specific psychological aspects with a view to providing patients with a comprehensive and personalized solution. Our approach has been reinforced through the results of a preliminary assessment we conducted on 22 patients with chronic conditions. The main goal of such an assessment was to provide a preliminary understanding of their needs in a real context, both in terms of self-awareness and of their predisposition toward the use of IT solutions.According to the specific needs and features, such as mindfulness and gamification, which were identified through the literature and the preliminary assessment, we designed a comprehensive open architecture able to provide a tailor-made solution linked to specific individuals’ needs.The present study represents the preliminary step towards the development of a solution aimed at enhancing patients’ actual perception and encouraging self-management and selfawareness for a better lifestyle. Future work regards further identification of pathology-related needs and requirements through focus groups including all stakeholders in order to describe the architecture and functionality in greater detail.Citation: Lasorsa I, D’Antrassi P, Ajčević M, Stellato K, Di Lenarda A, Marceglia S, Accardo A. Personalized support for chronic conditions: a novel approach for enhancing self-management and improving lifestyle
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Nash, David B. "Care Coordination: A Crucial Element in Managing Chronic Conditions." Population Health Management 13, S1 (2010): S—1—S—1. http://dx.doi.org/10.1089/pop.2010.1371.
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Allegrante, John P., Martin T. Wells, and Janey C. Peterson. "Interventions to Support Behavioral Self-Management of Chronic Diseases." Annual Review of Public Health 40, no. 1 (2019): 127–46. http://dx.doi.org/10.1146/annurev-publhealth-040218-044008.
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A majority of the US adult population has one or more chronic conditions that require medical intervention and long-term self-management. Such conditions are among the 10 leading causes of mortality; an estimated 86% of the nation's $2.7 trillion in annual health care expenditures goes toward their treatment and management. Patient self-management of chronic diseases is increasingly essential to improve health behaviors, health outcomes, and quality of life and, in some cases, has demonstrated effectiveness for reducing health care utilization and the societal cost burden of chronic conditions. This review synthesizes the current state of the science of chronic disease self-management interventions and the evidence for their effectiveness, especially when applied with a systematic application of theories or models that account for a wide range of influences on behavior. Our analysis of selected outcomes from randomized controlled trials of chronic disease self-management interventions contained in 10 Cochrane systematic reviews provides additional evidence to demonstrate that self-management can improve quality of life and reduce utilization across several conditions.
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Young, Charlotte E., Frances M. Boyle, and Allyson J. Mutch. "Are Care Plans Suitable for the Management of Multiple Conditions?" Journal of Comorbidity 6, no. 2 (2016): 103–13. http://dx.doi.org/10.15256/joc.2016.6.79.
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Background Care plans have been part of the primary care landscape in Australia for almost two decades. With an increasing number of patients presenting with multiple chronic conditions, it is timely to consider whether care plans meet the needs of patients and clinicians. Objectives To review and benchmark existing care plan templates that include recommendations for comorbid conditions, against four key criteria: (i) patient preferences, (ii) setting priorities, (iii) identifying conflicts and synergies between conditions, and (iv) setting dates for reviewing the care plan. Design Document analysis of Australian care plan templates published from 2006 to 2014 that incorporated recommendations for managing comorbid conditions in primary care. Results Sixteen templates were reviewed. All of the care plan templates addressed patient preference, but this was not done comprehensively. Only three templates included setting priorities. None assisted in identifying conflicts and synergies between conditions. Fifteen templates included setting a date for reviewing the care plan. Conclusions Care plans are a well-used tool in primary care practice, but their current format perpetuates a single-disease approach to care, which works contrary to their intended purpose. Restructuring care plans to incorporate shared decision-making and attention to patient preferences may assist in shifting the focus back to the patient and their care needs.
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Petrovic, Kimberly. "Nursing Care Management of Older Adults With HIV/AIDS and Chronic Depression." Care Management Journals 7, no. 3 (2006): 115–20. http://dx.doi.org/10.1891/cmj-v7i3a002.
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Older adults with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and chronic depression constitute a growing population of individuals in need of quality nursing care management. Although the small amounts of research currently available focus on both middle-aged and older adults living with these chronic conditions, this article offers specific suggestions for the nursing care of older adults who have been diagnosed with HIV, have experienced the progression of HIV to AIDS, and who have lived with chronic depression prior to the onset of HIV/AIDS. Given the increasingly significant role that nurses play in the lives of older adults with chronic health conditions, this article aims to provide nurses with a number of interventions associated with 10 nursing diagnoses pertinent to the care of older adults with HIV/AIDS and chronic depression.
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Kosharskyy, Boleslav. "Intravenous Infusions in Chronic Pain Management." May 2013 3;16, no. 3;5 (2013): 231–49. http://dx.doi.org/10.36076/ppj.2013/16/231.
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In the United States, millions of Americans are affected by chronic pain, which adds heavily to national rates of morbidity, mortality, and disability, with an ever-increasing prevalence. According to a 2011 report titled Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research by the Institute of Medicine of the National Academies, pain not only exacts its toll on people’s lives but also on the economy with an estimated annual economic cost of at least $560 - 635 billion in health care costs and the cost of lost productivity attributed to chronic pain. Intravenous infusions of certain pharmacologic agents have been known to provide substantial pain relief in patients with various chronic painful conditions. Some of these infusions are better, and although not necessarily the first therapeutic choice, have been widely used and extensively studied. The others show promise, however are in need of further investigations. This article will focus on non-opiate intravenous infusions that have been utilized for chronic painful disorders such as fibromyalgia, neuropathic pain, phantom limb pain, post-herpetic neuralgia, complex regional pain syndromes (CRPS), diabetic neuropathy, and central pain related to stroke or spinal cord injuries. The management of patients with chronic pain conditions is challenging and continues to evolve as new treatment modalities are explored and tested. The following intravenous infusions used to treat the aforementioned chronic pain conditions will be reviewed: lidocaine, ketamine, phentolamine, dexmedetomidine, and bisphosphonates. This overview is intended to familiarize the practitioner with the variety of infusions for patients with chronic pain. It will not, however, be able to provide guidelines for their use due to the lack of sufficient evidence. Key words: Intravenous infusions in chronic pain management, bisphosphonates, phentolamine, ketamine, lidocaine, Dexmedetomidine, chronic pain
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Kuebler, Kim, Charles Champ, and Dellarie Shilling. "National Clinical Graduate Nursing Faculty: Management of Multiple Chronic Conditions." Journal of Doctoral Nursing Practice 11, no. 1 (2018): 79–87. http://dx.doi.org/10.1891/2380-9418.11.1.79.
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The purpose of this project is to compare clinical graduate nursing faculty self-perceived knowledge with actual knowledge on the management of symptomatic multiple chronic conditions (MCCs) through a psychometrically reliable and valid 46-item objective examination. Methodology included three separate e-mail communications to more than 800 U.S.-based graduate nursing school or program chairs, deans, or directors encouraging faculty participation. One hundred and six respondents initiated the survey and over half of the participants withdrew from completing in its entirety, making it difficult to correlate self-perceived knowledge with actual knowledge. The results, however, show an overall mean score of below average pass rate. This study has been performed in undergraduate, graduate, and clinical graduate nursing faculty—suggesting a serious concern in clinical nursing education and clinical practice to meet the complex care needs of the largest, fastest-growing, and costliest U.S. patient population—those with MCCs.
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Ploeg, Jenny, Marie-Lee Yous, Kimberly Fraser, et al. "HEALTHCARE PROVIDERS’ EXPERIENCES IN CARING FOR OLDER ADULTS WITH MULTIPLE CHRONIC CONDITIONS." Innovation in Aging 3, Supplement_1 (2019): S317—S318. http://dx.doi.org/10.1093/geroni/igz038.1160.
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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.
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Thorne, Sally, Della Roberts, and Richard Sawatzky. "Unravelling the Tensions Between Chronic Disease Management and End-of-Life Planning." Research and Theory for Nursing Practice 30, no. 2 (2016): 91–103. http://dx.doi.org/10.1891/1541-6577.30.2.91.
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An increasing appreciation for the burden that chronic conditions represent for people and for societies has triggered an evolving body of popular and professional conceptualizations of the nature of the chronic disease challenge. In this discussion article, we trace the trajectory of thinking about chronic illness care, surfacing underlying assumptions and drivers that have shaped current dominant models of service delivery. We note significant gaps in these conceptualizations, especially with respect to the reality that many chronic conditions are life limiting. Contrasting chronic disease theorizing with the conversations that have arisen around end-of-life care for other kinds of health conditions, we argue for a shift in our thinking to accommodate the implications of life limitation in our service delivery planning. We see significant leadership potential in optimizing the role nurses can play across the chronic disease trajectory by integrating the healthy optimism of self-care management with the profound compassion of a person-centered palliative approach.
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Baird, Lisa Garland, та Kimberly Fraser. "Home Care Case Managersʼ Integrated Care of Older Adults With Multiple Chronic Conditions". Professional Case Management 23, № 4 (2018): 165–89. http://dx.doi.org/10.1097/ncm.0000000000000286.
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Harvey, Peter W., John Petkov, Inge Kowanko, Yvonne Helps, and Malcolm Battersby. "Chronic condition management and self-management in Aboriginal communities in South Australia: outcomes of a longitudinal study." Australian Health Review 37, no. 2 (2013): 246. http://dx.doi.org/10.1071/ah12165.
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Objectives. This paper describes the longitudinal component of a larger mixed methods study into the processes and outcomes of chronic condition management and self-management strategies implemented in three Aboriginal communities in South Australia. The study was designed to document the connection between the application of structured systems of care for Aboriginal people and their longer-term health status. Methods. The study concentrated on three diverse Aboriginal communities in South Australia; the Port Lincoln Aboriginal Health Service, the Riverland community, and Nunkuwarrin Yunti Aboriginal Health Service in the Adelaide metropolitan area. Repeated-measure clinical data were collected for individual participants using a range of clinical indicators for diabetes (type 1 and 2) and related chronic conditions. Clinical data were analysed using random effects modelling techniques with changes in key clinical indicators being modelled at both the individual and group levels. Results. Where care planning has been in place longer than in other sites overall improvements were noted in BMI, cholesterol (high density and low density lipids) and HbA1c. These results indicate that for Aboriginal patients with complex chronic conditions, participation in and adherence to structured care planning and self-management strategies can contribute to improved overall health status and health outcomes. Conclusions. The outcomes reported here represent an initial and important step in quantifying the health benefits that can accrue for Aboriginal people living with complex chronic conditions such as diabetes, heart disease and respiratory disease. The study highlights the benefits of developing long-term working relationships with Aboriginal communities as a basis for conducting effective collaborative health research programs. What is known about the topic? Chronic condition management and self-management programs have been available to Aboriginal people in a range of forms for some time. We know that some groups of patients are keen to engage with care planning and self-management protocols and we have anecdotal evidence of this engagement leading to improved quality of life and health outcomes for Aboriginal people. What does this paper add? This paper provides early evidence of sustained improvement over time for a cohort of Aboriginal people who are learning to deal with a range of chronic illnesses through accessing structured systems of support and care. What are the implications for practitioners? This longitudinal evidence of improved outcomes for Aboriginal people is encouraging and should lead on to more definitive studies of outcomes accruing for people engaged in structured systems of care. Not only does this finding have implications for the overall management of chronic illness in Aboriginal communities, but it points the way to how health services might best invest their resources and efforts to improve the health status of people with chronic conditions and, in the process, close the gap between the life expectancy of Aboriginal people and that of other community groups in Australia.
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Consonery-Fairnot, Dorothy. "Rise in Chronic Conditions Indicates Greater Need for Case Management." Professional Case Management 16, no. 3 (2011): 107–8. http://dx.doi.org/10.1097/ncm.0b013e318212fb87.
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Lopez-Vargas, Pamela, Allison Tong, Sally Crowe, et al. "Research priorities for childhood chronic conditions: a workshop report." Archives of Disease in Childhood 104, no. 3 (2018): 237–45. http://dx.doi.org/10.1136/archdischild-2018-315628.
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BackgroundChronic conditions are the leading cause of mortality, morbidity and disability in children. However, children and caregivers are rarely involved in identifying research priorities, which may limit the value of research in supporting patient-centred practice and policy.ObjectiveTo identify priorities of patients, caregivers and health professionals for research in childhood chronic conditions and describe the reason for their choices.SettingAn Australian paediatric hospital and health consumer organisations.MethodsRecruited participants (n=73) included patients aged 8 to 14 years with a chronic condition (n=3), parents/caregivers of children aged 0 to 18 years with a chronic condition (n=19), representatives from consumer organisations (n=13) and health professionals including clinicians, researches (n=38) identified and discussed research priorities. Transcripts were thematically analysed.ResultsSeventy-eight research questions were identified. Five themes underpinned participants’ priorities: maintaining a sense of normality (enabling participation in school, supporting social functioning, promoting understanding and acceptance), empowering self-management and partnership in care (overcoming communication barriers, gaining knowledge and skills, motivation for treatment adherence, making informed decisions, access and understanding of complementary and alternative therapies),strengthening ability to cope (learning to have a positive outlook, preparing for home care management, transitioning to adult services), broadening focus to family (supporting sibling well-being, parental resilience and financial loss, alleviating caregiver burden), and improving quality and scope of health and social care (readdressing variability and inequities, preventing disease complications and treatment side effects, identifying risk factors, improving long-term outcomes, harnessing technology, integrating multidisciplinary services).ConclusionResearch priorities identified by children, caregivers and health professionals emphasise a focus on life participation, psychosocial well-being, impact on family and quality of care. These priorities may be used by funding and policy organisations in establishing a paediatric research agenda.
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Gill, Michael. "Augmented care: An alternative model of care for people with chronic disease." International Journal of Care Coordination 20, no. 1-2 (2017): 5–7. http://dx.doi.org/10.1177/2053434517711416.
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This opinion piece challenges the concept of ‘patient’ and discusses an alternative aspect to delivering health care for those with chronic disease. Chronic conditions are defined by the World Health Organisation (WHO), as illnesses requiring ongoing management over a long period of time and may address a wide range of health issues. Success is highly dependent upon optimised patient empowerment. I argue that it is not health care that really matters but opportunities to build upon optimising wellness. This leads to the idea where I suggest that current health system rigidities inadvertently promote illness.
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Jackson, Terri. "A proposal for managed care payment options for patients with chronic conditions." Australian Health Review 19, no. 1 (1996): 27. http://dx.doi.org/10.1071/ah960027.
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This paper proposes an episode of care payment system for patients with chronicillnesses, extending earlier published work on this model of ambulatory care (Duckett& Jackson 1993). The payment system relies on annual voluntary enrolment andsome marginal broadening of Medicare coverage in exchange for patients? willingnessto participate in an ambulatory managed care arrangement. In the context ofAustralian health ministers? enthusiasm for managed care, the proposal embodiesan intermediate policy approach which supports greater health care efficiency whileminimising the prospect for reductions in patient autonomy or serious distortionsin patterns of care. The policy is not designed to be applied population-wide, butto address the issues involved with a resource-intensive patient group, those requiringongoing management of chronic conditions.
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Navarro, Olga, Marta Escrivá, Raquel Faubel, and Vicente Traver. "Empowering Patients Living With Chronic Conditions Using Video as an Educational Tool: Scoping Review." Journal of Medical Internet Research 23, no. 7 (2021): e26427. http://dx.doi.org/10.2196/26427.
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Background Video is used daily for various purposes, such as leisure, culture, and even learning. Currently, video is a tool that is available to a large part of the population and is simple to use. This audio-visual format has many advantages such as its low cost, speed of dissemination, and possible interaction between users. For these reasons, it is a tool with high dissemination and educational potential, which could be used in the field of health for learning about and management of chronic diseases by adult patients. Objective The following review determines whether the use of health educational videos by adult patients with chronic diseases is effective for their self-management according to the literature. Methods An electronic literature search of the PubMed, CINAHL, and MEDLINE (via the EBSCOhost platform) databases up to April 2020 was conducted. The systematic scoping review followed the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) methodology. Results After reviewing 1427 articles, 12 were selected as the most consistent with the proposed inclusion criteria. After their review, it was found that the studies showed that video is effective as a tool for improving care related to chronic diseases. Conclusions Video is effective in improving the care and quality of life for patients with chronic diseases, whether the initiative for using video came from their health care professionals or themselves.
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Erickson, Cecelia DuPlessis, Patricia L. Splett, Sara Stoltzfus Mullett, and Mary Bielski Heiman. "The Healthy Learner Model for Student Chronic Condition Management—Part I." Journal of School Nursing 22, no. 6 (2006): 310–18. http://dx.doi.org/10.1177/10598405060220060201.
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A significant number of children have chronic health conditions that interfere with normal activities, including school attendance and active participation in the learning process. Management of students’ chronic conditions is complex and requires an integrated system. Models to improve chronic disease management have been developed for the medical system and public health. Programs that address specific chronic disease management or coordinate school health services have been implemented in schools. Lacking is a comprehensive, integrated model that links schools, students, parents, health care, and other community providers. The Healthy Learner Model for chronic condition management identifies seven elements for creating, implementing, and sustaining an efficient and effective, comprehensive community-based system for improving the management of chronic conditions for school children. It has provided the framework for successful chronic condition management in an urban school district and is proposed for replication in other districts and communities.
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Van de Velde, Dominique, Freya De Zutter, Ton Satink, et al. "Delineating the concept of self-management in chronic conditions: a concept analysis." BMJ Open 9, no. 7 (2019): e027775. http://dx.doi.org/10.1136/bmjopen-2018-027775.
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ObjectivesSelf-management is a concept frequently used within healthcare but lacks consensus. It is the aim of this study to clarify the concept.DesignConcept analysis according to Walker and Avant, comprises eight steps: select concept, determine purpose, identify uses, determine defining attributes, identify model case, identify additional cases, identify antecedents and consequences and define empirical referents. Sources used: PubMed, Scopus and Web of Science.ResultsTen attributes delineating the concept have been identified and organised into three groups. Group (a): person-oriented attributes: the person must (1) actively take part in the care process, (2) take responsibility for the care process and (3) have a positive way of coping with adversity. Group (b): person-environment-oriented attributes: (4) the person must be informed about the condition, disease and treatment and self-management, (5) should be individualised, which entails expressing needs, values and priorities, (6) requires openness to ensure a reciprocal partnership with healthcare providers and (7) demands openness to social support. Finally, Group (c): summarising attributes: self-management (8) is a lifetime task, (9) assumes personal skills and (10) encompasses the medical, role and emotional management.ConclusionsThe findings of this study recognise the complexity of the concept, but also show the need for further investigation to make the concept more measurable. Clarity about the concept will enhance understanding and facilitate implementation in self-management programmes for chronic conditions.
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Martin, Carmel, Meherun Nisa, and Robyn Attewell. "Chronic Care in Adulthood and Old Age: Physical and Psychosocial Management in General Practice Encounters." Australian Journal of Primary Health 6, no. 1 (2000): 57. http://dx.doi.org/10.1071/py00006.
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Managing chronic physical disease straddles two paradigms of care - the biomedical and the psychosocial. To respond to the challenges of the ageing population with increasing chronic disease, general practitioners need to understand the impact of their collective processes of care. The research objective is to compare general practitioner consultations identified by a diagnosis of chronic physical condition with those with a psychological diagnosis and both chronic physical and psychological diagnoses. The method used is a retrospective analysis of a national sample of general practitioners (GPs) who documented their consultations. In consultations where chronic physical conditions were managed, general practitioners documented few psychosocial or physical support interventions including referrals. These consultations were with an older age group, who had multiple diagnoses with high levels of continuity. This pattern persisted whether or not psychological conditions were also managed in the same encounter. In consultations where psychological diagnoses, without a chronic physical diagnosis, were managed, GPs documented high levels of psychosocial support interventions. General practitioners are less likely to document psychological and physical support care in chronic physical disease consultations than all other types of consultation. This analysis has limitations due to incomplete data and cross-sectional design, however, the study raises questions about the comprehensiveness of care in the past and provides a baseline against which to measure the impact of current reforms for complex chronic conditions.
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Askerud, Anna, and Jenny Conder. "Patients' experiences of nurse case management in primary care: a meta-synthesis." Australian Journal of Primary Health 23, no. 5 (2017): 420. http://dx.doi.org/10.1071/py17040.
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The health system in New Zealand and Australia requires health practitioners to prepare for the challenge of long-term conditions. Wagner’s 1998 Chronic Care Model advocates a move away from the traditional acute model of primary health care to a model that addresses the long-term episodic nature of chronic disease. Nurse case management has been developed over the last 2 decades as a means to coordinate health services for people with long-term conditions. This meta-synthesis combines the results of 15 qualitative research studies that have a similar research question regarding peoples’ perceptions of nurse case management. The research synthesises the experiences of people with long-term conditions on the quality of care under a nurse case management model of primary health care. Over 1000 people were represented across the studies, and the results suggest that people had a high degree of confidence and trust in their nurse case manager, were better able to manage their health conditions with nurse case management support, and had better access to appropriate health care. This research suggests that nurse case management is an effective model of care and may contribute to improved quality of life and better health care for those with long-term health conditions.
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Chittoria, Ravi K. "Telemedicine for wound management." Indian Journal of Plastic Surgery 45, no. 02 (2012): 412–17. http://dx.doi.org/10.4103/0970-0358.101330.
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ABSTRACTThe escalating physiological, psychological, social and financial burdens of wounds and wound care on patients, families and society demand the immediate attention of the health care sector. Many forces are affecting the changes in health care provision for patients with chronic wounds, including managed care, the limited number of wound care therapists, an increasingly ageing and disabled population, regulatory and malpractice issues, and compromised care. The physician is also faced with a number of difficult issues when caring for chronic wound patients because their conditions are time consuming and high risk, represent an unprofitable part of care practice and raise issues of liability. Telemedicine enhances communication with the surgical wound care specialist. Digital image for skin lesions is a safe, accurate and cost-effective referral pathway. The two basic modes of telemedicine applications, store and forward (asynchronous transfer) and real-time transmission (synchronous transfer, e.g. video conference), are utilized in the wound care setting. Telemedicine technology in the hands of an experienced physician can streamline management of a problem wound. Although there is always an element of anxiety related to technical change, the evolution of wound care telemedicine technology has demonstrated a predictable maturation process.
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Johnston, Mark, and Brian Johnson. "Health Self-Management and Care Coordination by People With Disabilities and Chronic Health Conditions." American Journal of Occupational Therapy 71, no. 4_Supplement_1 (2017): 7111500035p1. http://dx.doi.org/10.5014/ajot.2017.71s1-po3071.
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Vogeli, Christine, Alexandra E. Shields, Todd A. Lee, et al. "Multiple Chronic Conditions: Prevalence, Health Consequences, and Implications for Quality, Care Management, and Costs." Journal of General Internal Medicine 22, S3 (2007): 391–95. http://dx.doi.org/10.1007/s11606-007-0322-1.
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Johnston, K. J., and J. M. Hockenberry. "PATIENT CONTINUITY OF CARE AND PHYSICIAN MANAGEMENT OF OLDER ADULTS WITH COMPLEX CHRONIC CONDITIONS." Innovation in Aging 1, suppl_1 (2017): 756. http://dx.doi.org/10.1093/geroni/igx004.2733.
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Vaz, Elenice Maria Cecchetti, Neusa Collet, Emília Gallindo Cursino, et al. "Challenges in Primary Care Regarding Children and Adolescents With Chronic Conditions in Brazil." Qualitative Health Research 29, no. 13 (2019): 1978–87. http://dx.doi.org/10.1177/1049732319847961.
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The coordination of primary care is pivotal to the management of chronic conditions. However, current systems may not be as efficient or effective as one would hope. This article addresses to the managers and health teams in the primary care setting and their challenges regarding children and adolescents with chronic conditions in Brazil. A qualitative study was conducted with 26 primary care professionals and managers using thematic content analysis. The results showed a scarcity of specialists for referrals and a lack of professional training for dealing with this specific group of patients. It is necessary to improve health information systems to ensure the continuity of care. Current health care of children and adolescents with chronic conditions is neither efficient nor effective. For this type of care to be comprehensive, the health needs of this population must be addressed and the operational structure of the health care network must be strengthened.
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Polenick, Courtney A., Sarah D. Stanz, Amanda N. Leggett, Donovan T. Maust, Nancy A. Hodgson, and Helen C. Kales. "Stressors and Resources Related to Medication Management: Associations With Spousal Caregivers’ Role Overload." Gerontologist 60, no. 1 (2018): 165–73. http://dx.doi.org/10.1093/geront/gny130.
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Abstract Background and Objectives Managing medications can be stressful for spousal caregivers, but little is known about particular aspects of medication management that are most consequential for caregiving outcomes. We examined care stressors and resources related to medication management, their associations with role overload among spousal caregivers, and whether these links vary by care recipients’ number of chronic health conditions and dementia status. Research Design and Methods This cross-sectional study included 377 spousal caregivers of adults aged 65 and older from the 2011 National Health and Aging Trends Study and National Study of Caregiving. Linear regressions were estimated to evaluate how medication-related stressors (ordering medication, keeping track of medications, giving injections) and resources (medication reminder systems, shared medication management within the spousal dyad) are associated with caregivers’ role overload. Care recipients’ number of chronic health conditions and dementia status were considered as moderators. Models controlled for caregivers’ sociodemographic characteristics, chronic health conditions, and other care tasks. Results Caregivers who administered injections reported more role overload, whereas those who worked with care recipients to jointly manage medications reported less role overload. Keeping track of medications was linked to caregivers’ greater role overload when care recipients had 5 or more chronic health conditions. Finally, care recipients’ use of medication reminder systems was linked to less role overload for caregivers of a partner with dementia. Discussion and Implications Devising strategies to assist spousal caregivers in the more onerous components of medication management and promote resources that mitigate medication-related stress may improve caregiver well-being.
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Greiver, Michelle, Kimberly Wintemute, Babak Aliarzadeh, et al. "Implementation of data management and effect on chronic disease coding in a primary care organisation: A parallel cohort observational study." Journal of Innovation in Health Informatics 23, no. 3 (2016): 580. http://dx.doi.org/10.14236/jhi.v23i3.843.
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Background Consistent and standardized coding for chronic conditions is associated with better care; however, coding may currently be limited in electronic medical records (EMRs) used in Canadian primary care.Objectives To implement data management activities in a community-based primary care organisation and to evaluate the effects on coding for chronic conditions.Methods Fifty-nine family physicians in Toronto, Ontario, belonging to a single primary care organisation, participated in the study. The organisation implemented a central analytical data repository containing their EMR data extracted, cleaned, standardized and returned by the Canadian Primary Care Sentinel Surveillance Network (CPCSSN), a large validated primary care EMR-based database. They used reporting software provided by CPCSSN to identify selected chronic conditions and standardized codes were then added back to the EMR. We studied four chronic conditions (diabetes, hypertension, chronic obstructive pulmonary disease and dementia). We compared changes in coding over six months for physicians in the organisation with changes for 315 primary care physicians participating in CPCSSN across Canada.Results Chronic disease coding within the organisation increased significantly more than in other primary care sites. The adjusted difference in the increase of coding was 7.7% (95% confidence interval 7.1%–8.2%, p < 0.01). The use of standard codes, consisting of the most common diagnostic codes for each condition in the CPCSSN database, increased by 8.9% more (95% CI 8.3%–9.5%, p < 0.01).Conclusions Data management activities were associated with an increase in standardized coding for chronic conditions. Exploring requirements to scale and spread this approach in Canadian primary care organisations may be worthwhile.
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Perry, Margaret. "Anaemia in primary care: iron deficiency and anaemia of chronic disease." Practice Nursing 32, no. 9 (2021): 358–62. http://dx.doi.org/10.12968/pnur.2021.32.9.358.
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Iron deficiency anaemia and anaemia of chronic disease are commonly seen in primary care. Margaret Perry discusses how to recognise, diagnose and manage these conditions This article will look at iron deficiency anaemia and anaemia of chronic disease. Both are problems encountered frequently at a global scale and in the primary care setting. Both conditions can potentially affect any age, although anaemia of chronic disease is more common among older adults. It is hoped that the information provided will give general practice nurses and nurse prescribers greater confidence in the recognition, diagnosis, and management of these conditions, to improve patient care.
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Nishimoto, Corina Lemos Jamal, and Elysângela Dittz Duarte. "Family organization for the care of children with chronic conditions, discharged from the neonatal intensive care unit." Texto & Contexto - Enfermagem 23, no. 2 (2014): 318–27. http://dx.doi.org/10.1590/0104-07072014001330013.
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A qualitative study that aimed to examine family organization for the care of children with chronic conditions, discharged from the Neonatal Intensive Care Unit (NICU). The subjects were 12 relatives of children with chronic health conditions. Data were collected through genograms, ecomaps and semi-structured interviews, developed based on the Family Management Style Framework theoretical model and analyzed using thematic content analysis. The organization of families is related to the ongoing care requirements of the children, considering the routines of care established in the period immediately after discharge from the hospital and continuing up to the present. It was established that families access their social networks to handle the required care.
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Dall’Oglio, Immacolata, Giulia Gasperini, Claudia Carlin, et al. "Self-Care in Pediatric Patients with Chronic Conditions: A Systematic Review of Theoretical Models." International Journal of Environmental Research and Public Health 18, no. 7 (2021): 3513. http://dx.doi.org/10.3390/ijerph18073513.
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Background: To improve outcomes in children and young adults (CYAs) with chronic conditions, it is important to promote self-care through education and support. Aims: (1) to retrieve the literature describing theories or conceptual models of self-care in CYAs with chronic conditions and (2) to develop a comprehensive framework. Methods: A systematic literature search was conducted on nine databases, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All peer-reviewed papers describing a theory or a conceptual model of self-care in CYAs (0–24 years) with chronic conditions were included. Results: Of 2674 records, 17 met the inclusion criteria. Six papers included a theory or a model of self-care, self-management, or a similar concept. Six papers developed or revised pre-existing models or theories, while five papers did not directly focus on a specific model or a theory. Patients were CYAs, mainly with type 1 diabetes mellitus and asthma. Some relevant findings about self-care in CYAs with neurocognitive impairment and in those living with cancer may have been missed. Conclusions: By aggregating the key elements of the 13 self-care conceptual models identified in the review, we developed a new overarching model emphasizing the shift of self-care agency from family to patients as main actors of their self-management process. The model describes influencing factors, self-care behaviors, and outcomes; the more patients engaged in self-care behaviors, the more the outcomes were favorable.
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Bishop, Tara F., Patricia P. Ramsay, Lawrence P. Casalino, Yuhua Bao, Harold A. Pincus, and Stephen M. Shortell. "Care Management Processes Used Less Often For Depression Than For Other Chronic Conditions In US Primary Care Practices." Health Affairs 35, no. 3 (2016): 394–400. http://dx.doi.org/10.1377/hlthaff.2015.1068.
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Horsburgh, Margaret, Janine Bycroft, Faith Mahony, et al. "The feasibility of assessing the Flinders Programme of Patient Self-Management in New Zealand primary care settings." Journal of Primary Health Care 2, no. 4 (2010): 294. http://dx.doi.org/10.1071/hc10294.
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INTRODUCTION: The Flinders ProgramTM has been adopted in New Zealand as a useful and appropriate approach for self-management with primary care clients who have chronic conditions. The Flinders ProgramTM has not been evaluated in New Zealand settings. AIM: To assess the feasibility of undertaking a substantive long-term trial to gauge the effectiveness of primary care nurses using the Flinders ProgramTM to improve health outcomes for New Zealand populations. METHODS: A pilot study was undertaken considering four components of feasibility of conducting a long-term trial: practice recruitment, participant recruitment, delivery of the intervention and outcome measures. This included comparing 27 intervention and 30 control patients with long-term health conditions with respect to change in self-management capacityPartners in Health (PIH) scalequality of care using the Patient Assessment of Chronic Illness Care (PACIC) scale and self-efficacy across six months. Intervention participants received care planning with practice nurses using the Flinders ProgramTM in general practices, while control participants received usual care in comparable practices. RESULTS: General practice and participant recruitment was challenging, together with a lack of organisational capacity and resources in general practice for the Flinders ProgramTM. The measures of self-management capacity (PIH), quality of care (PACIC) and self-efficacy were useful and valuable primary outcome measures. DISCUSSION: The overall findings do not support a substantive trial of the Flinders ProgramTM in primary care. Difficulties associated with participant recruitment and ability of practice nurses to undertake the Flinders ProgramTM within general practice need to be resolved. KEYWORDS: Self-management; long-term conditions; chronic conditions; chronic illness; primary care; nurses