Read by QxMD icon Read

chronic diseases, community trials, health systems, primary health care

Katie N Dainty, M Bianca Seaton, Ian R Drennan, Laurie J Morrison
OBJECTIVE: Community paramedicine (CP) is a model of community-based health care being used around the world. Our objective was to study the patient perspective and valuation of this type of program to understand its potential value for primary care innovation in the future. STUDY SETTING: The EPIC community paramedicine program is a partnership between primary care physicians and specially trained community paramedics, designed to provide in-home support for complex chronic disease patients in Ontario, Canada...
March 15, 2018: Health Services Research
Samantha Sabo, Catalina Denman Champion, Melanie L Bell, Elsa Cornejo Vucovich, Maia Ingram, Celina Valenica, Maria Del Carmen Castro Vasquez, Eduardo Gonzalez-Fagoaga, Jill Geurnsey de Zapien, Cecilia B Rosales
INTRODUCTION: Northern Mexico has among the highest rates of cardiovascular disease (CVD) and diabetes in the world. This research addresses core gaps in implementation science to develop, test and scale-up CVD risk-reduction interventions in diabetics through a national primary care health system. METHODS AND ANALYSIS: The Meta Salud Diabetes (MSD) research project is a parallel two-arm cluster-randomised clinical behavioural trial based in 22 (n=22) health centres in Sonora, Mexico...
March 12, 2018: BMJ Open
Julie Silverman, James Krieger, George Sayre, Karin Nelson
To describe community health workers (CHWs) roles in a diabetes self-management intervention. Retrospective qualitative inductive analysis of open text home visit encounter form from Peer Support for Achieving Independence in Diabetes (Peer AID), a randomized controlled trial in which low-income individuals with poorly controlled diabetes received either CHW home visits or usual care. Following visits, CHWs completed encounter forms documenting the health goal of the visit, the self-management strategies discussed and participant concerns...
March 1, 2018: Journal of Community Health
Nisha Bansal, Adam Szpiro, Kristi Reynolds, David H Smith, David J Magid, Jerry H Gurwitz, Frederick Masoudi, Robert T Greenlee, Grace H Tabada, Sue Hee Sung, Ashveena Dighe, Alan S Go
Importance: Chronic kidney disease (CKD) is common in adults with heart failure and is associated with an increased risk of sudden cardiac death. Randomized trials of participants without CKD have demonstrated that implantable cardioverter defibrillators (ICDs) decrease the risk of arrhythmic death in selected patients with reduced left ventricular ejection fraction (LVEF) heart failure. However, whether ICDs improve clinical outcomes in patients with CKD is not well elucidated. Objective: To examine the association of primary prevention ICDs with risk of death and hospitalization in a community-based population of potentially ICD-eligible patients who had heart failure with reduced LVEF and CKD...
February 5, 2018: JAMA Internal Medicine
Andrew Narva
Despite extensive clinical guidelines, innovative efforts to improve care, and well-funded efforts to raise awareness, limited progress has been made in reducing the burden of kidney disease in the United States, and the prevalence continues to increase worldwide. The Indian Health Service and the Centers for Disease Control and Prevention recently reported a 54% decrease in the incidence of kidney failure among American Indian and Alaska Native people with diabetes. This decrease in end-stage renal disease incidence was associated with a population health approach to diabetes care based in the community and the primary clinical setting...
March 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Maureen Markle-Reid, Jenny Ploeg, Kimberly D Fraser, Kathryn A Fisher, Amy Bartholomew, Lauren E Griffith, John Miklavcic, Amiram Gafni, Lehana Thabane, Ross Upshur
OBJECTIVES: To compare the effect of a 6-month community-based intervention with that of usual care on quality of life, depressive symptoms, anxiety, self-efficacy, self-management, and healthcare costs in older adults with type 2 diabetes mellitus (T2DM) and 2 or more comorbidities. DESIGN: Multisite, single-blind, parallel, pragmatic, randomized controlled trial. SETTING: Four communities in Ontario, Canada. PARTICIPANTS: Community-dwelling older adults (≥65) with T2DM and 2 or more comorbidities randomized into intervention (n = 80) and control (n = 79) groups (N = 159)...
February 2018: Journal of the American Geriatrics Society
John Wiggers, Kathleen McElwaine, Megan Freund, Libby Campbell, Jenny Bowman, Paula Wye, Luke Wolfenden, Danika Tremain, Daniel Barker, Carolyn Slattery, Karen Gillham, Kate Bartlem
BACKGROUND: Although clinical guidelines recommend the provision of care to reduce client chronic disease risk behaviours, such care is provided sub-optimally by primary healthcare providers. A study was undertaken to determine the effectiveness of an intervention in increasing community-based clinician implementation of multiple elements of recommended preventive care for four risk behaviours. METHODS: A three-group stepped-wedge trial was undertaken with all 56 community-based primary healthcare facilities in one health district in New South Wales, Australia...
August 22, 2017: Implementation Science: IS
Dalsone Kwarisiima, Moses R Kamya, Asiphas Owaraganise, Florence Mwangwa, Dathan M Byonanebye, James Ayieko, Albert Plenty, Doug Black, Tamara D Clark, Bridget Nzarubara, Katherine Snyman, Lillian Brown, Elizabeth Bukusi, Craig R Cohen, Elvin H Geng, Edwin D Charlebois, Theodore D Ruel, Maya L Petersen, Diane Havlir, Vivek Jain
INTRODUCTION: The 2015 WHO recommendation of antiretroviral therapy (ART) for all HIV-positive persons calls for treatment initiation in millions of persons newly eligible with high CD4+ counts. Efficient and effective care models are urgently needed for this population. We evaluated clinical outcomes of asymptomatic HIV-positive adults and children starting ART with high CD4+ counts using a novel streamlined care model in rural Uganda and Kenya. METHODS: In the 16 intervention communities of the HIV test-and-treat Sustainable East Africa Research for Community Health Study (NCT01864603), all HIV-positive individuals irrespective of CD4 were offered ART (efavirenz [EFV]/tenofovir disoproxil fumarate + emtricitabine (FTC) or lamivudine (3TC)...
July 21, 2017: Journal of the International AIDS Society
Barbara Schmidt, Kerrianne Watt, Robyn McDermott, Jane Mills
BACKGROUND: Better systems of care are required to address chronic disease in Indigenous people to ensure they can access all their care needs. Health research has produced evidence about effective models of care and chronic disease strategies to address Indigenous health, however the transfer of research findings into routine clinical practice has proven challenging. Complex interventions, such as those related to chronic disease, have many components that are often poorly implemented and hence rarely achieve implementation fidelity...
July 17, 2017: BMC Health Services Research
Andrew Farmer, Veronika Williams, Carmelo Velardo, Syed Ahmar Shah, Ly-Mee Yu, Heather Rutter, Louise Jones, Nicola Williams, Carl Heneghan, Jonathan Price, Maxine Hardinge, Lionel Tarassenko
BACKGROUND: We conducted a randomized controlled trial of a digital health system supporting clinical care through monitoring and self-management support in community-based patients with moderate to very severe chronic obstructive pulmonary disease (COPD). OBJECTIVE: The aim of this study was to determine the efficacy of a fully automated Internet-linked, tablet computer-based system of monitoring and self-management support (EDGE' sElf-management anD support proGrammE) in improving quality of life and clinical outcomes...
May 3, 2017: Journal of Medical Internet Research
Ofra Kalter-Leibovici, Dov Freimark, Laurence S Freedman, Galit Kaufman, Arnona Ziv, Havi Murad, Michal Benderly, Barbara G Silverman, Nurit Friedman, Tali Cukierman-Yaffe, Elad Asher, Avishay Grupper, Dorit Goldman, Miriam Amitai, Shlomi Matetzky, Mordechai Shani, Haim Silber
BACKGROUND: The efficacy of disease management programs in improving the outcome of heart failure patients remains uncertain and may vary across health systems. This study explores whether a countrywide disease management program is superior to usual care in reducing adverse health outcomes and improving well-being among community-dwelling adult patients with moderate-to-severe chronic heart failure who have universal access to advanced health-care services and technologies. METHODS: In this multicenter open-label trial, 1,360 patients recruited after hospitalization for heart failure exacerbation (38%) or from the community (62%) were randomly assigned to either disease management or usual care...
May 1, 2017: BMC Medicine
Alexandra Prados-Torres, Isabel Del Cura-González, Daniel Prados-Torres, Juan A López-Rodríguez, Francisca Leiva-Fernández, Amaia Calderón-Larrañaga, Fernando López-Verde, Luis A Gimeno-Feliu, Esperanza Escortell-Mayor, Victoria Pico-Soler, Teresa Sanz-Cuesta, Mª Josefa Bujalance-Zafra, Mariel Morey-Montalvo, José Ramón Boxó-Cifuentes, Beatriz Poblador-Plou, José Manuel Fernández-Arquero, Francisca González-Rubio, María D Ramiro-González, Carlos Coscollar-Santaliestra, Jesús Martín-Fernández, Mª Pilar Barnestein-Fonseca, José María Valderas-Martínez, Alessandra Marengoni, Christiane Muth
BACKGROUND: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management...
April 27, 2017: Implementation Science: IS
Samantha A Hollingworth, Maria Donald, Jianzhen Zhang, Bharat Phani Vaikuntam, Anthony Russell, Claire Jackson
AIM: To estimate potential savings for Australia's health care system through the implementation of an innovative Beacon model of care for patients with complex diabetes. METHODS: A prospective controlled trial was conducted comparing a multidisciplinary, community-based, integrated primary-secondary care diabetes service with usual care at a hospital diabetes outpatient clinic. We extracted patient hospitalisation data from the Queensland Hospital Admitted Patient Data Collection and used Australian Refined Diagnosis Related Groups to assign costs to potentially preventable hospitalisations for diabetes...
April 23, 2017: Primary Care Diabetes
Elizabeth Baker, Francis Fatoye
BACKGROUND AND OBJECTIVE: Chronic obstructive pulmonary disease is increasing in prevalence and constitutes a major cause of morbidity and mortality globally. As well as contributing to a significant decline in health status in many patients, this condition creates a considerable burden on healthcare providers. Self-management interventions are frequently implemented in community settings to limit the impact of chronic obstructive pulmonary disease on everyday life of individuals and to manage pressure on health systems...
June 2017: International Journal of Nursing Studies
Susan M Smith, Gráinne Cousins, Barbara Clyne, Shane Allwright, Tom O'Dowd
BACKGROUND: Shared care has been used in the management of many chronic conditions with the assumption that it delivers better care than primary or specialty care alone; however, little is known about the effectiveness of shared care. OBJECTIVES: To determine the effectiveness of shared care health service interventions designed to improve the management of chronic disease across the primary/specialty care interface. This is an update of a previously published review...
February 23, 2017: Cochrane Database of Systematic Reviews
Pascal Geldsetzer, Joel M Francis, Nzovu Ulenga, David Sando, Irene A Lema, Eric Mboggo, Maria Vaikath, Happiness Koda, Sharon Lwezaula, Janice Hu, Ramadhani A Noor, Ibironke Olofin, Elysia Larson, Wafaie Fawzi, Till Bärnighausen
BACKGROUND: Home delivery of antiretroviral therapy (ART) by community health workers (CHWs) may improve ART retention by reducing the time burden and out-of-pocket expenditures to regularly attend an ART clinic. In addition, ART home delivery may shorten waiting times and improve quality of care for those in facility-based care by decongesting ART clinics. This trial aims to determine whether ART home delivery for patients who are clinically stable on ART combined with facility-based care for those who are not stable on ART is non-inferior to the standard of care (facility-based care for all ART patients) in achieving and maintaining virological suppression...
February 22, 2017: BMC Health Services Research
Fernan Gonzalez Bernaldo de Quiros, Adriana R Dawidowski, Silvana Figar
OBJECTIVES: In this study, we aimed: 1) to conceptualize the theoretical challenges facing health information systems (HIS) to represent patients' decisions about health and medical treatments in everyday life; 2) to suggest approaches for modeling these processes. METHODS: The conceptualization of the theoretical and methodological challenges was discussed in 2015 during a series of interdisciplinary meetings attended by health informatics staff, epidemiologists and health professionals working in quality management and primary and secondary prevention of chronic diseases of the Hospital Italiano de Buenos Aires, together with sociologists, anthropologists and e-health stakeholders...
February 1, 2017: Methods of Information in Medicine
(no author information available yet)
BACKGROUND: Seniors with chronic diseases such as heart failure have complex care needs. They are vulnerable to their condition deteriorating and, without timely intervention, may require multiple emergency department visits and/or repeated hospitalizations. Upon discharge, the transition from the emergency department to home can be a vulnerable time for recovering patients with disruptions in the continuity of care. Remote monitoring of heart failure patients using home telemonitoring, coupled with clear communication protocols between health care professionals, can be effective in increasing the safety and quality of care for seniors with heart failure discharged from the emergency department...
December 18, 2016: JMIR Research Protocols
Milo A Puhan, Elena Gimeno-Santos, Christopher J Cates, Thierry Troosters
BACKGROUND: Guidelines have provided positive recommendations for pulmonary rehabilitation after exacerbations of chronic obstructive pulmonary disease (COPD), but recent studies indicate that postexacerbation rehabilitation may not always be effective in patients with unstable COPD. OBJECTIVES: To assess effects of pulmonary rehabilitation after COPD exacerbations on hospital admissions (primary outcome) and other patient-important outcomes (mortality, health-related quality of life (HRQL) and exercise capacity)...
December 8, 2016: Cochrane Database of Systematic Reviews
Simon R Knowles, Chantal F Ski, Robyn Langham, Emmet O'Flaherty, David R Thompson, Susan L Rossell, Gaye Moore, Ya-Seng Arthur Hsueh, David J Castle
BACKGROUND: Chronic kidney disease (CKD) and end-stage kidney disease (ESKD) are serious and growing health problems with enormous impact on psychological and social functioning. Despite high rates of comorbid depression and anxiety in these patient populations, and the adverse impact these have upon treatment adherence, quality of life, social connectedness and healthcare costs there has been little attention focused on the prevention or management of these problems. Thus, our aim was to evaluate the Dialysis Optimal Health Program (DOHP) that adopts a person-centred approach and engages collaborative therapy to educate and support those diagnosed with ESKD who are commencing dialysis...
2016: Trials
Fetch more papers »
Fetching more papers... Fetching...
Read by QxMD. Sign in or create an account to discover new knowledge that matter to you.
Remove bar
Read by QxMD icon Read

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"