Background The best management of hypertension in frail oldest-old (≥80 years of age) remains unclear while lacking guidelines providing specific recommendations.Aim, Objectives To investigate guideline use in general practitioners (GPs) and if guideline use relates to different decisions when managing hypertension in frail oldest-old.Design/Setting Cross-sectional study.Methods GPs participated in a survey with case-vignettes of frail oldest-old varying in systolic blood pressure (SBP) and cardiovascular disease (CVD). GPs in Europe, Brazil, Israel and New Zealand were invited. We compared the percentage of GPs using guidelines per country and further stratified on the most frequently mentioned guidelines. To adjust for patient characteristics (SBP, CVD and GP’s gender, years of experience and prevalence of oldest-old in their practice), we used a mixed-effects regression model accounting for clustering within countries.Results Overall, 2,543 GPs from 29 countries were included. About 60% reported to use guidelines. Higher guideline use was found in female (p=0.031) and less-experienced GPs (p<0.001). Across countries, we found a large variation in guidelines use, ranging from 25% to 90% of the GPs. However, there was no difference in decisions about treatment hypertension in frail oldest-old patients between GPs that used or not used guidelines nor which guideline they used.Conclusion Many GPs reported using guidelines to manage hypertension in frail oldest-old patients, however guideline users did not decide differently from non-users. Instead of focusing on the fact if GPs use guidelines or not, we as a scientific community should put an emphasis on what guidelines suggest in frail and oldest-old patients.
Szlenk-Czyczerska E, Kurpas D. Indicators of integrated care for patients with chronic cardiovascular disease in ambulatory care [published online as ahead of print
Visits of chronically ill patients account for 80% of primary care consultations. Approximately 15–38% of patients have three or more chronic diseases, and 30% of hospitalisations result from the deteriorating clinical condition of these patients. The burden of chronic disease and multimorbidity is increasing in combination with the growing population of elderly people. However, many interventions found to be effective in health service studies fail to translate into meaningful patient care outcomes across multiple contexts. With the growing burden of chronic diseases, healthcare providers, health policymakers, and other healthcare system stakeholders are re-examining their strategies and opportunities for more effective prevention and clinical interventions. The study aimed to find the best practice guidelines and policies influencing effective intervention and making it possible to personalize prevention strategies. Apart from clinical treatment, it is essential to increase the effectiveness of non-clinical interventions that could empower chronic patients to increase their involvement in therapy. The review focuses on the best practice guidelines and policies in non-medical interventions and the barriers to and facilitators of their implementation into everyday practice. A systematic review of practice guidelines and policies was conducted to answer the research question. The authors screened databases and included 47 full-text recent studies in the qualitative synthesis.
Wiktorzak K et al, 2022 Building knowledge capacity among patients and healthcare professionals to strengthen coordinated care in Poland using the experiences of the Scirocco Exchange project.
Background. A growing number of patients with chronic cardiovascular disease (CVD) creates a growing demand for homecare. Personal and professional limitations, health issues, and lack of systemic support of informal care providers are major causes of insufficient care models for chronically ill patients in home environments. This study aimed to identify the sociodemographic variables that are associated with the needs and increasing occupational burnout observed among home care providers.Methods. This study reports on 161 informal home care providers of patients with CVDs. The research was conducted in the homes of patients, using the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS), the Maslach Burnout Inventory (MBI), and a structured interview questionnaire developed by the authors. Spearman’s rank correlation coefficient test and logistic regression were used for analyses.Results. The majority of the participants were female (70.2%; n=113). We found that younger care providers were less likely to report unmet needs (p = 0.011), and less likely to report burnout as measured by the MBI Emotional Exhaustion (p = 0.010) and Depersonalization (p = 0.009) subscales. Care providers with primary education were more likely to report burnout on the MBI Depersonalization subscale (p = 0.028). In addition, care providers who worked more often reported higher levels of met needs (p = 0.022), and burnout as measured on the MBI Depersonalization (p = 0.005) and Emotional Exhaustion (p = 0.018) subscales. Subjects residing in urban areas were more likely to report unmet needs (p = 0.007), and were also more likely to report burnout as measured on the MBI Emotional Exhaustion (p = 0.006) subscale.Conclusion. Older care providers who are unemployed and reside in cities and unemployed should be targeted with directed programmes to determine the category of unmet needs, and for personalized support. Care providers with these demographic characteristics should be targeted for occupational burnout prevention programmes.
Background. A growing number of patients with chronic cardiovascular disease (CVD) creates a growing demand for homecare. Personal and professional limitations, health issues, and lack of systemic support of informal care providers are major causes of insufficient care models for chronically ill patients in home environments. This study aimed to identify the sociodemographic variables that are associated with the needs and increasing occupational burnout observed among home care providers.
Methods. This study reports on 161 informal home care providers of patients with CVDs. The research was conducted in the homes of patients, using the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS), the Maslach Burnout Inventory (MBI), and a structured interview questionnaire developed by the authors. Spearman’s rank correlation coefficient test and logistic regression were used for analyses.
Results. The majority of the participants were female (70.2%; n=113). We found that younger care providers were less likely to report unmet needs ( p = 0.011), and less likely to report burnout as measured by the MBI Emotional Exhaustion ( p = 0.010) and Depersonalization ( p = 0.009) subscales. Care providers with primary education were more likely to report burnout on the MBI Depersonalization subscale ( p = 0.028). In addition, care providers who worked more often reported higher levels of met needs ( p = 0.022), and burnout as measured on the MBI Depersonalization ( p = 0.005) and Emotional Exhaustion ( p = 0.018) subscales. Subjects residing in urban areas were more likely to report unmet needs ( p = 0.007), and were also more likely to report burnout as measured on the MBI Emotional Exhaustion ( p = 0.006) subscale.
Conclusion. Older care providers who are unemployed and reside in cities and unemployed should be targeted with directed programmes to determine the category of unmet needs, and for personalized support. Care providers with these demographic characteristics should be targeted for occupational burnout prevention programmes.
Keywords: informal caretaker, met and unmet needs, growing burnout.
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