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"Multiple Chronic Conditions"

Benjamin H Han, Scott Sherman, Pia M Mauro, Silvia S Martins, James Rotenberg, Joseph J Palamar
BACKGROUND AND AIMS: The ageing United States (US) population is providing an unprecedented population of older adults who use recreational drugs. We aimed to estimate the trends in the prevalence of past-year use of cannabis, describe the patterns and attitudes, and determine correlates of cannabis use by adults age 50 and older. DESIGN: Secondary analysis of the National Survey on Drug Use and Health survey from 2006 to 2013, a cross-sectional survey given to a nationally representative probability sample of populations living in US households...
October 21, 2016: Addiction
Joseph Nimako-Boateng, Michael Owusu-Antwi, Priscilla Nortey
Dental diseases are common in man and range from a toothache to cancers of the head and neck. Dental conditions can affect our capacity to function effectively in areas such as smiling, chewing and speaking. The objective of this study was to describe the main types of dental conditions presenting at the University Hospital between January 2006 and December 2011 and to determine factors associated with the top five diagnosed conditions as well as the acute and chronic conditions. A retrospective review of all 5012 clinical records of dental patients visiting the dental unit within the period stated was carried out...
2016: SpringerPlus
Matthew L Maciejewski, Xiaojuan Mi, Lesley H Curtis, Judy Ng, Samuel C Haffer, Bradley G Hammill
BACKGROUND: Despite the persistence of significant disparities, few evaluations examine disparities in laboratory testing by race/ethnicity, age, sex, Medicaid eligibility, and number of chronic conditions for Medicare fee-for-service beneficiaries' newly prescribed medications. In Medicare beneficiaries initiating diuretics or digoxin, this study examined disparities in guideline-appropriate baseline laboratory testing and abnormal laboratory values. METHODS AND RESULTS: To evaluate guideline-concordant testing for serum creatinine and serum potassium within 180 days before or 14 days after the index prescription fill date, we constructed retrospective cohorts from 10 states of 99 711 beneficiaries who had heart failure or hypertension initiating diuretic in 2011 and 8683 beneficiaries who had heart failure or atrial fibrillation initiating digoxin...
October 18, 2016: Circulation. Cardiovascular Quality and Outcomes
Matthew L Maciejewski, Bradley G Hammill, Elizabeth A Bayliss, Laura Ding, Corrine I Voils, Lesley H Curtis, Virginia Wang
BACKGROUND: Medicare beneficiaries with multiple chronic conditions are typically seen by multiple providers, particularly specialists. Clinically appropriate referrals to multiple specialists may compromise the continuity of care for multiple chronic condition beneficiaries and create care plans that patients may find challenging to reconcile, which may impact patient outcomes. OBJECTIVE: The objective was to examine whether glycemic control or lipid control was associated with the number of prescribers of cardiometabolic medications...
October 14, 2016: Medical Care
Satya Surbhi, Kiraat D Munshi, Paula C Bell, James E Bailey
OBJECTIVES: First, to investigate the prevalence and types of drug therapy problems and medication discrepancies among super-utilizers, and associated patient characteristics. Second, to examine the outcomes of pharmacist recommendations and estimated cost avoidance through care transitions support focused on medication management. DESIGN: Retrospective analysis of the pharmacist-led interventions as part of the SafeMed Program. SETTING: A large nonprofit health care system serving the major medically underserved areas in Memphis, Tennessee...
October 6, 2016: Journal of the American Pharmacists Association: JAPhA
Shreya Kangovi, Nandita Mitra, Robyn A Smith, Raina Kulkarni, Lindsey Turr, Hairong Huo, Karen Glanz, David Grande, Judith A Long
OBJECTIVE: Growing interest in collaborative goal-setting has raised questions. First, are patients making the 'right choices' from a biomedical perspective? Second, are patients and providers setting goals of appropriate difficulty? Finally, what types of support will patients need to accomplish their goals? We analyzed goals and action plans from a trial of collaborative goal-setting among 302 residents of a high-poverty urban region who had multiple chronic conditions. METHODS: Patients used a low-literacy aid to prioritize one of their chronic conditions and then set a goal for that condition with their primary care provider...
September 25, 2016: Patient Education and Counseling
Meredith Greene, Amy C Justice, Kenneth E Covinsky
: As the number of older adults living with HIV continues to increase, understanding how to incorporate geriatric assessments within HIV care will be critical. Assessment of geriatric syndromes and physical function can be useful tools for HIV clinicians and researchers to help identify the most vulnerable older adults and to better understand the aging process in PLWH. This review focuses on the assessment of falls, frailty and physical function, first in the general population of older adults and includes a specific focus on use of these assessments in older adults living with HIV...
October 7, 2016: Virulence
Jerôme Jean Jacques van Dongen, Iris Gerarda Josephine Habets, Anna Beurskens, Marloes Amantia van Bokhoven
BACKGROUND: The number of people with multiple chronic conditions increases as a result of ageing. To deal with the complex health-care needs of these patients, it is important that health-care professionals collaborate in interprofessional teams. To deliver patient-centred care, it is often recommended to include the patient as a member of the team. OBJECTIVE: To gain more insight into how health-care professionals and patients, who are used to participate in interprofessional team meetings, experience and organize patient participation in the team meetings...
October 7, 2016: Health Expectations: An International Journal of Public Participation in Health Care and Health Policy
Onil Bhattacharyya, Michael Schull, Kaveh Shojania, Vicky Stergiopoulos, Gary Naglie, Fiona Webster, Ricardo Brandao, Tamara Mohammed, Jennifer Christian, Gillian Hawker, Lynn Wilson, Wendy Levinson
Integrating care for people with complex needs is challenging. Indeed, evidence of solutions is mixed, and therefore, well-designed, shared evaluation approaches are needed to create cumulative learning. The Toronto-based Building Bridges to Integrate Care (BRIDGES) collaborative provided resources to refine and test nine new models linking primary, hospital and community care. It used mixed methods, a cross-project meta-evaluation and shared outcome measures. Given the range of skills required to develop effective interventions, a novel incubator was used to test and spread opportunities for system integration that included operational expertise and support for evaluation and process improvement...
2016: Healthcare Quarterly
Charissa Levy, Sue Balogh, Emmi Perkins
In today's demographic landscape, with its aging population and increasing number of individuals who are living with multiple chronic conditions and comorbidities, the healthcare system is tasked with responding to the needs of medically complex individuals. However, the pressures arising from this emerging demographic are felt not only within the acute care sector at the point of medical crisis but along the entire continuum of the healthcare system. Rehabilitative care plays a key role in that continuum by providing the process through which individuals are engaged in interventions to address their functional (both cognitive and physical) and psychosocial care goals to help them carry on with the business of living...
2016: Healthcare Quarterly
Zhi Li, Yi-Pu Zhao, Xiu-Ying Hu
BACKGROUND: The prevalence of hypertension increases with aging. Medication non-adherence is an important reason for the failure to control hypertension effectively, which increases the risks of cardiovascular and cerebrovascular incidents and of mortality. Multimorbidity is common among the elderly and has become a WHO-supported priority of research worldwide. While recent research suggests an association between multimorbidity and medication non-adherence, the results are not yet conclusive...
October 2016: Hu Li za Zhi the Journal of Nursing
Ellen K Cromley, Maureen Wilson-Genderson, Allison R Heid, Rachel A Pruchno
Multimorbidity, the presence of two or more chronic conditions in an individual, presents a major challenge for meeting the health care needs of older adults. This study advances understanding of multiple chronic conditions by using local colocation quotients to reveal spatial associations for five chronic conditions (arthritis, diabetes, heart disease, hypertension, and pulmonary disease) in a statewide panel of older adults in New Jersey. Among adults with three or more conditions, large concentrations of Arthritis-Heart Disease-Pulmonary Disease, Arthritis-Hypertension-Pulmonary Disease, and Diabetes-Heart Disease-Hypertension were observed, each triad located in different regions of the state...
October 2, 2016: Journal of Applied Gerontology: the Official Journal of the Southern Gerontological Society
Catherine Hudon, Maud-Christine Chouinard, Mireille Lambert, Isabelle Dufour, Cynthia Krieg
OBJECTIVE: Frequent users of healthcare services are a vulnerable population, often socioeconomically disadvantaged, who can present multiple chronic conditions as well as mental health problems. Case management (CM) is the most frequently performed intervention to reduce healthcare use and cost. This study aimed to examine the evidence of the effectiveness of CM interventions for frequent users of healthcare services. DESIGN: Scoping review. DATA SOURCES: An electronic literature search was conducted using the MEDLINE, Scopus and CINAHL databases covering January 2004 to December 2015...
2016: BMJ Open
Kasey R Boehmer, Ian G Hargraves, Summer V Allen, Marc R Matthews, Christina Maher, Victor M Montori
BACKGROUND: The needs of the growing population of complex patients with multiple chronic conditions calls for a different approach to care. Clinical teams need to acknowledge, respect, and support the work that patients do and the capacity they mobilize to enact this work, and to adapt and self-manage. Tools that enable this approach to care are needed. METHODS: Using user-centered design principles, we set out to create a discussion aid for use by patients, clinicians, and other health professionals during clinical encounters...
2016: BMC Health Services Research
Rebecca J Bartlett Ellis, Janet L Welch
AIMS AND OBJECTIVES: This meta-ethnographic study identified behaviors associated with taking medications and medication adherence reported in qualitative studies of adults with chronic kidney disease (CKD) and co-existing multiple chronic conditions (MCCs). BACKGROUND: To inform medication adherence interventions, information is needed to clarify the nature of the relationships between behaviors that support medication-taking and medication adherence in MCCs. STUDY DESIGN: Meta-ethnographic review and synthesis...
September 20, 2016: Journal of Clinical Nursing
Mayra Tisminetzky, Han-Yang Chen, David D McManus, Jerry Gurwitz, Edgard Granillo, Jorge Yarzebski, Joel M Gore, Robert J Goldberg
There are limited contemporary data available describing recent trends in the magnitude and characteristics of patients who are rehospitalized multiple times after hospital discharge for an acute myocardial infarction (AMI). We reviewed the medical records of 4,480 residents of the Worcester, Massachusetts, metropolitan area, who were discharged from 3 Central Massachusetts medical centers after an AMI in 6 biennial periods from 2001 to 2011 and were followed for all-cause and cause-specific hospital readmissions over the subsequent 6 months...
October 15, 2016: American Journal of Cardiology
F Tetzlaff, A Singer, E Swart, B-P Robra, M L H Herrmann
Introduction and Aim: The growing number of people suffering from chronic diseases and multimorbidity is associated with an increased risk of polypharmacy. The aims of the study are to estimate the prevalence of polypharmacy and to analyse its determinants in the transition from in- to outpatient care. Furthermore, we estimate the risk of a potential inappropriate medication (PIM) and its determinants. Methods: The analyses are based on the data of a German statutory health insurance (AOK Saxony-Anhalt) of the third quarter of 2009...
September 16, 2016: Das Gesundheitswesen
Rishi Agrawal, Matt Hall, Eyal Cohen, Denise M Goodman, Dennis Z Kuo, John M Neff, Margaret O'Neill, Joanna Thomson, Jay G Berry
OBJECTIVES: To assess characteristics associated with health care spending trends among child high resource users in Medicaid. METHODS: This retrospective analysis included 48 743 children ages 1 to 18 years continuously enrolled from 2009-2013 in 10 state Medicaid programs (Truven MarketScan Medicaid Database) also in the top 5% of all health care spending in 2010. Using multivariable regression, associations were assessed between baseline demographic, clinical, and health services characteristics (using 2009-2010 data) with subsequent health care spending (ie, transiently, intermittently, persistently high) from 2011-2013...
September 15, 2016: Pediatrics
Deborah Morrison, Karolina Agur, Stewart Mercer, Andreia Eiras, Juan I González-Montalvo, Kevin Gruffydd-Jones
The term multimorbidity is usually defined as the coexistence of two or more chronic conditions within an individual, whereas the term comorbidity traditionally describes patients with an index condition and one or more additional conditions. Multimorbidity of chronic conditions markedly worsens outcomes in patients, increases treatment burden and increases health service costs. Although patients with chronic respiratory disease often have physical comorbidities, they also commonly experience psychological problems such as depression and anxiety...
September 15, 2016: NPJ Primary Care Respiratory Medicine
Courtney R Lyles, Andrea Altschuler, Neetu Chawla, Christine Kowalski, Deanna McQuillan, Elizabeth Bayliss, Michele Heisler, Richard W Grant
BACKGROUND: Complex patients with multiple chronic conditions often face significant challenges communicating and coordinating with their primary care physicians. These challenges are exacerbated by the limited time allotted to primary care visits. OBJECTIVE: Our aim was to employ a user-centered design process to create a tablet tool for use by patients for visit discussion prioritization. METHODS: We employed user-centered design methods to create a tablet-based waiting room tool that enables complex patients to identify and set discussion topic priorities for their primary care visit...
2016: JMIR MHealth and UHealth
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