Complex Care Needs in Multiple Chronic Conditions: Population Prevalence and Characterization in Primary Care. A Study Protocol

Iglesias, Francisco Hernansanz; Celada, Clara Alavedra; Navarro, Carmen Berbel; Morales, Lidia Palau; Visús, Núria Albi; Valverde, Cristina Cobo; Dorado, Vanessa Matias; Muñoz, Maria Luisa Martínez; Blay, Carles; Ramírez, Esther Limón; Villaroel, Raimon Milà; Jordana, N. Montellà; Bonet-Simó, Josep Maria

doi:10.5334/ijic.3292

Cited by 15 publications

(12 citation statements)

References 27 publications

(31 reference statements)

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“…In healthcare, we are faced with an epidemic of chronic pathologies, disability, and complex health needs, particularly in the older adult population [1]. This phenomenon has led to the emergence of concepts such as 'comorbidity', 'multimorbidity' and, more recently, 'clinical complexity' and 'complex chronic patient' (CCP) [2]. The latter is an emerging concept that aims to group intertwined conditions such as multimorbidity, frailty, ageing, and/or sarcopenia.…”

Section: Introductionmentioning

confidence: 99%

Complex chronic patients as an emergent group with high risk of intracerebral haemorrhage: an observational cohort study

Lorman-Carbo¹,

Clúa-Espuny²,

Muria-Subirats³

et al. 2021

BMC Geriatr

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Background Demographic aging is a generalised event and the proportion of older adults is increasing rapidly worldwide with chronic pathologies, disability, and complexity of health needs. The intracerebral haemorrhage (ICH) has devastating consequences in high risk people. This study aims to quantify the incidence of ICH in complex chronic patients (CCP). Methods This is a multicentre, retrospective and community-based cohort study of 3594 CCPs followed up from 01/01/2013 to 31/12/2017 in primary care without a history of previous ICH episode. The cases were identified from clinical records encoded with ICD-10 (10th version of the International Classification of Diseases) in the e-SAP database of the Catalan Health Institute. The main variable was the ICH episode during the study period. Demographic, clinical, functional, cognitive and pharmacological variables were included. Descriptive and logistic regression analyses were carried out to identify the variables associated with suffering an ICH. The independent risk factors were obtained from logistic regression models, ruling out the variables included in the HAS-BLED score, to avoid duplication effects. Results are presented as odds ratio (OR) and 95% confidence interval (CI). The analysis with the resulting model was also stratified by sex. Results 161 (4.4%) participants suffered an ICH episode. Mean age 87 ± 9 years; 55.9% women. The ICH incidence density was 151/10000 person-years [95%CI 127–174], without differences by sex. Related to subjects without ICH, presented a higher prevalence of arterial hypertension (83.2% vs. 74.9%; p = 0.02), hypercholesterolemia (55.3% vs. 47.4%, p = 0.05), cardiovascular disease (36.6% vs. 28.9%; p = 0.03), and use of antiplatelet drugs (64.0% vs. 52.9%; p = 0.006). 93.2% had a HAS-BLED score ≥ 3. The independent risk factors for ICH were identified: HAS-BLED ≥3 [OR 3.54; 95%CI 1.88–6.68], hypercholesterolemia [OR 1.62; 95%CI 1.11–2.35], and cardiovascular disease [OR 1.48 IC95% 1.05–2.09]. The HAS_BLED ≥3 score showed a high sensitivity [0.93 CI95% 0.89–0.97] and negative predictive value [0.98 (CI95% 0.83–1.12)]. Conclusions In the CCP subgroup the incidence density of ICH was 5–60 times higher than that observed in elder and general population. The use of bleeding risk score as the HAS-BLED scale could improve the preventive approach of those with higher risk of ICH. Trial registration This study was retrospectively registered in ClinicalTrials.gov (NCT03247049) on August 11/2017.

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Section: Introductionmentioning

confidence: 99%

Complex chronic patients as an emergent group with high risk of intracerebral haemorrhage: an observational cohort study

Lorman-Carbo¹,

Clúa-Espuny²,

Muria-Subirats³

et al. 2021

BMC Geriatr

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“…This patient profile makes up between 3% and 5% of the population and consumes a large percentage of resources since they are responsible for 20% to 40% of hospital admissions. A percentage of 40% are admitted three times a year or more, and 13% are five times or more [9,10].…”

Section: Introductionmentioning

confidence: 99%

Quality of Life and Dependence Degree of Chronic Patients in a Chronicity Care Model

et al. 2020

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Background: The complex chronic patient is a person with one or several long-term diseases, the clinical management of which are considered difficult and related to cognitive or functional impairment. The chronicity care model deeply affects the quality of life and degree of dependence. Objectives: The objective of this study was to analyse the perceived quality of life and dependence degree in complex chronic patients within a chronicity care model in the Autonomous Communities of Cantabria and the Balearic Islands (Spain). Design: This was a multicentred, transversal, descriptive, and observational study on a cohort of 206 chronic patients included in a chronicity care program. Methods: Patients’ sociodemographic variables, integral valuation, nurse follow-up records, nursing outcomes classification (NOC)/nursing interventions classification (NIC), nurse diagnoses, and hospitalization data were analysed. A descriptive analysis of all data was carried out. The bivariate analysis assessed the relation between covariables and the overall scoring in European Quality of Life Scale (EuroQuol-5D), Barthel, Braden, and Chronic Patient eXperience Assessment Instrument (IEXPAC in the Spanish abbreviation). A multivariate linear regression analysis was conducted. Results: The mean age was 79.4 years (standard deviation (SD) = 9.12; range: 39–94). A percentage of 79.3% of the study population shows functional impairment in one or more activities of daily life. A percentage of 83.3% of patients showed a physical dependence. There is a significant relationship between the gender and kinship degree of the caregiver (χ2 = 18.2; p = 0.001). An overall mean score of 55.38 points in EuroQuol-5D was obtained, along with a 36.87-point satisfaction with the care given in IEXPAC. The overall score correlated positively and significantly with Barthel, Braden, and IEXPAC. The dependence levels improved slightly in the observed patients, which was a very significant outcome in statistical terms (t = 2.08; p = 0.039). A percentage of 66% (R2 = 0.66) of the score variability at the Barthel index could be predicted from Braden scale scoring. Conclusions: Dependence is not only affected by the related pathology, but also by the effect on mobility and daily-life activities, which cause a worse perception of the quality of life. The health-care model based on the case management nurse is having positive effects, especially on dependence and patients with ulcer issues.

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“…34 – 37 Additionally, it should be noted that there are complexity classification systems in development, identified through two protocols. 38 , 39 …”

Section: Discussionmentioning

confidence: 99%

“…[34][35][36][37] Additionally, it should be noted that there are complexity classification systems in development, identified through two protocols. 38,39 These classification systems represent a small number of developed countries. The lack of articles from developing settings is particularly relevant given the applicability of complexity classifications in optimising resource utilisation.…”

Section: Main Findingsmentioning

confidence: 99%

A systematic review of classifications systems to determine complexity of patient care needs in palliative care

2021

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Background: Providing the right care for each individual patient is a key element of quality palliative care. Complexity is a relatively new concept, defined as the nature of patients’ situations and the extent of resulting needs. Classifying patients according to the complexity of their care needs can guide integration of services, anticipatory discussions, health service planning, resource management and determination of needs for specialist or general palliative care. However, there is no consistent approach to interpreting and classifying complexity of patient needs. Aim: The aim of this article is to identify and describe classification systems for complexity of patient care needs in palliative care. Design: Narrative systematic review (PROSPERO registration number CRD42020182102). Data sources: MEDLINE, Embase, CINAHL and PsychINFO databases were searched without time limitations. Articles were included that described classification systems for complexity of care requirements in populations with palliative care needs. Results: In total, 4301 records were screened, with nine articles identified reporting the use of patient classification systems in populations with palliative care needs. These articles included the use of six classification systems: HexCom, Perroca Scale, AN-SNAP, Hui Major Criteria, IDC-Pal and PALCOM. These systems were heterogenous in the manner they determined complexity of care needs. The HexCom and IDC-Pal systems contained items that covered all domains of complexity as described by Hodiamont; personal, social support, health care team and environment. Conclusion: Although six classification systems have been developed, they access differing aspects of care needs and their application has been limited. The HexCOM and IDC-Pal systems offer the broadest determinations of complexity from an individual perspective. Further research is needed to apply these systems to populations external to those in which they were developed, and to appreciate how they may integrate with, and impact, clinical care.

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Complex Care Needs in Multiple Chronic Conditions: Population Prevalence and Characterization in Primary Care. A Study Protocol

Cited by 15 publications

References 27 publications

Complex chronic patients as an emergent group with high risk of intracerebral haemorrhage: an observational cohort study

Complex chronic patients as an emergent group with high risk of intracerebral haemorrhage: an observational cohort study

Quality of Life and Dependence Degree of Chronic Patients in a Chronicity Care Model

A systematic review of classifications systems to determine complexity of patient care needs in palliative care

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