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

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...
March 31, 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
M A Riddell, J A Dunbar, P Absetz, R Wolfe, H Li, M Brand, Z Aziz, B Oldenburg
BACKGROUND: The 2013 Global Burden of Disease Study demonstrated the increasing burden of diabetes and the challenge it poses to the health systems of all countries. The chronic and complex nature of diabetes requires active self-management by patients in addition to clinical management in order to achieve optimal glycaemic control and appropriate use of available clinical services. This study is an evaluation of a "real world" peer support program aimed at improving the control and management of type 2 diabetes (T2DM) in Australia...
2016: BMC Public Health
N S Prashanth, Maya Annie Elias, Manoj Kumar Pati, Praveenkumar Aivalli, C M Munegowda, Srinath Bhanuprakash, S M Sadhana, Bart Criel, Maryam Bigdeli, Narayanan Devadasan
BACKGROUND: India has the distinction of financing its healthcare mainly through out-of-pocket expenses by individual families contributing to catastrophic health expenditure and impoverishment. Nearly 70 % of the expenditure is on medicines purchased at private pharmacies. Patients with chronic ailments are especially affected, as they often need lifelong medicines. Over the past years in India, there have been several efforts to improve drug availability at government primary health centres...
2016: BMC Health Services Research
Lisa Whitehead, Philippa Seaton
BACKGROUND: Long-term conditions and their concomitant management place considerable pressure on patients, communities, and health care systems worldwide. International clinical guidelines on the majority of long-term conditions recommend the inclusion of self-management programs in routine management. Self-management programs have been associated with improved health outcomes; however, the successful and sustainable transfer of research programs into clinical practice has been inconsistent...
May 16, 2016: Journal of Medical Internet Research
Lisa Dolovich, Doug Oliver, Larkin Lamarche, Gina Agarwal, Tracey Carr, David Chan, Laura Cleghorn, Lauren Griffith, Dena Javadi, Monika Kastner, Jennifer Longaphy, Dee Mangin, Alexandra Papaioannou, Jenny Ploeg, Parminder Raina, Julie Richardson, Cathy Risdon, P Lina Santaguida, Sharon Straus, Lehana Thabane, Ruta Valaitis, David Price
BACKGROUND: Healthcare systems are not well designed to help people maintain or improve their health. They are generally not person-focused or well-coordinated. The objective of this study is to evaluate the effectiveness of the Health Teams Advancing Patient Experience: Strengthening Quality (Health TAPESTRY) approach in older adults. The overarching hypothesis is that using the Health TAPESTRY approach to achieve better integration of the health and social care systems into a person's life that centers on meeting a person's health goals and needs will result in optimal aging...
April 5, 2016: Implementation Science: IS
Perry Foley, Dori Steinberg, Erica Levine, Sandy Askew, Bryan C Batch, Elaine M Puleo, Laura P Svetkey, Hayden B Bosworth, Abigail DeVries, Heather Miranda, Gary G Bennett
INTRODUCTION: Obesity continues to disproportionately affect medically vulnerable populations. Digital health interventions may be effective for delivering obesity treatment in low-resource primary care settings. METHODS: Track is a 12-month randomized controlled trial of a digital health weight loss intervention in a community health center system. Participants are 351 obese men and women aged 21 to 65years with an obesity-related comorbidity. Track participants are randomized to usual primary care or to a 12-month intervention consisting of algorithm-generated tailored behavior change goals, self-monitoring via mobile technologies, daily self-weighing using a network-connected scale, skills training materials, 18 counseling phone calls with a Track coach, and primary care provider counseling...
May 2016: Contemporary Clinical Trials
Anna P Ralph, Clancy Read, Vanessa Johnston, Jessica L de Dassel, Kerstin Bycroft, Alice Mitchell, Ross S Bailie, Graeme P Maguire, Keith Edwards, Bart J Currie, Adrienne Kirby, Jonathan R Carapetis
BACKGROUND: Rheumatic heart disease (RHD), caused by acute rheumatic fever (ARF), is a major health problem in Australian Aboriginal communities. Progress in controlling RHD requires improvements in the delivery of secondary prophylaxis, which comprises regular, long-term injections of penicillin for people with ARF/RHD. METHODS/DESIGN: This trial aims to improve uptake of secondary prophylaxis among Aboriginal people with ARF/RHD to reduce progression or worsening of RHD...
January 27, 2016: Trials
Hastings T Banda, Kevin Mortimer, George A F Bello, Grace B Mbera, Ireen Namakhoma, Rachael Thomson, Moffat J Nyirenda, Brian Faragher, Jason Madan, Rasmus Malmborg, Berthe Stenberg, James Mpunga, Beatrice Mwagomba, Elvis Gama, Katherine Piddock, Stephen B Squire
BACKGROUND: In developing countries like Malawi, further investigation is rare after patients with chronic cough test negative for tuberculosis. Chronic airways disease has presentations that overlap with tuberculosis. However, chronic airways disease is often unrecognised due to a lack of diagnostic services. Within developing countries, referral systems at primary health care level are weak and patients turn to unskilled informal health providers to seek health care. Delayed diagnosis and treatment of these diseases facilitates increased severity and tuberculosis transmission...
2015: Trials
Barbara Schmidt, Sandra Campbell, Robyn McDermott
OBJECTIVES: To explore how a client-centred Chronic Care model was implemented by Indigenous Health Workers (IHWs) at participating sites in a trial of IHW-led case management. To understand the experiences of engaging with the model from the perspective of the IHWs, health team members and clients. METHODS: The review was conducted within a cluster randomised trial of the model in six remote Indigenous communities in north Queensland over 18 months. Content analysis was undertaken on 377 project records of health worker activity...
April 2016: Australian and New Zealand Journal of Public Health
Kerry K Hall, Anne B Chang, Theo P Sloots, Jennie Anderson, Anita Kemp, Jan Hammill, Michael Otim, Kerry-Ann F O'Grady
BACKGROUND: Despite the burden of acute respiratory illnesses (ARI) among Aboriginal and Torres Strait Islander children being a substantial cause of childhood morbidity and associated costs to families, communities and the health system, data on disease burden in urban children are lacking. Consequently evidence-based decision-making, data management guidelines, health resourcing for primary health care services and prevention strategies are lacking. This study aims to comprehensively describe the epidemiology, impact and outcomes of ARI in urban Aboriginal and Torres Strait Islander children (hereafter referred to as Indigenous) in the greater Brisbane area...
2015: BMC Pediatrics
Arvind Raghu, Devarsetty Praveen, David Peiris, Lionel Tarassenko, Gari Clifford
BACKGROUND: The incidence of chronic diseases in low- and middle-income countries is rapidly increasing both in urban and rural regions. A major challenge for health systems globally is to develop innovative solutions for the prevention and control of these diseases. This paper discusses the development and pilot testing of SMARTHealth, a mobile-based, point-of-care Clinical Decision Support (CDS) tool to assess and manage cardiovascular disease (CVD) risk in resource-constrained settings...
2015: BMC Medical Informatics and Decision Making
Hanaa F Elkhenini, Kourtney J Davis, Norman D Stein, John P New, Mark R Delderfield, Martin Gibson, Jorgen Vestbo, Ashley Woodcock, Nawar Diar Bakerly
BACKGROUND: Real-world data on the benefit/risk profile of medicines is needed, particularly in patients who are ineligible for randomised controlled trials conducted for registration purposes. This paper describes the methodology and source data verification which enables the conduct of pre-licensing clinical trials of COPD and asthma in the community using the electronic medical record (EMR), NorthWest EHealth linked database (NWEH-LDB) and alert systems. METHODS: Dual verification of extracts into NWEH-LDB was performed using two independent data sources (Salford Integrated Record [SIR] and Apollo database) from one primary care practice in Salford (N = 3504)...
2015: BMC Medical Informatics and Decision Making
Polly Hitchcock Noël, Raquel Lozano Romero, Michaela Robertson, Michael L Parchman
BACKGROUND: A recent systematic review suggests that practice facilitation (PF) is a robust intervention for implementing evidence-based preventive care guidelines in primary care, but the ability of PF to improve chronic illness care remains unclear. AIMS: To examine the specific activities and Chronic Care model (CCM) components that primary care practices implemented and sustained in response to a 12-month PF intervention. METHODS: The ABC trial tested the effectiveness of PF to improve care for diabetes in 40 small community-based primary care practices that were randomized to "initial" or "delayed" intervention arms...
2014: Quality in Primary Care
Ian R Drennan, Katie N Dainty, Paul Hoogeveen, Clare L Atzema, Norm Barrette, Gillian Hawker, Jeffrey S Hoch, Wanrudee Isaranuwatchai, Jane Philpott, Chris Spearen, Walter Tavares, Linda Turner, Melissa Farrell, Tom Filosa, Jennifer Kane, Alex Kiss, Laurie J Morrison
BACKGROUND: The incidence of chronic diseases, including diabetes mellitus (DM), heart failure (HF) and chronic obstructive pulmonary disease (COPD) is on the rise. The existing health care system must evolve to meet the growing needs of patients with these chronic diseases and reduce the strain on both acute care and hospital-based health care resources. Paramedics are an allied health care resource consisting of highly-trained practitioners who are comfortable working independently and in collaboration with other resources in the out-of-hospital setting...
December 2, 2014: Trials
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