Home-based health promotion for chronically ill older persons: results of a randomized controlled trial of a critical reflection approach

McWilliam, Carol L.; Stewart, Moira; Brown, Judith Belle; McNair, Susan M; Donner, Allan; Desai, Kathryn; Coderre, Patricia; Galajda, Joanne

doi:10.1093/heapro/14.1.27

Cited by 39 publications

(34 citation statements)

References 88 publications

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“…107 The empowering partnering approach 32 has been tested in a large randomized controlled efficacy trial. 52 The intervention consisted of 12-16 interactions between 198 seniors requiring in-home services for a diversity of chronic diseases and trained study nurses. These dyads averaged 10.5 h of contact over a 22-week period, spending that time in critical reflection on the senior's life and health, their needs, expectations, goals and resources for optimizing health with chronic illness, their thoughts and ideas about strategies for pursuing health, and their experiences of doing this.…”

Section: Patients Persons or Partners: Where From Here?mentioning

confidence: 99%

Patients, persons or partners? Involving those with chronic disease in their care

McWilliam

2009

Chronic Illness

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Self-care management is essential for effective chronic disease management. Yet prevailing approaches of healthcare practitioners often undermine the efforts of those who require on-going medical attention for chronic conditions, emphasizing their status as patients, failing to consider their larger life experience as people, and most importantly, failing to consider them as people with the potential to be partners in their care. This article explores two approaches for professional-patient interaction in chronic disease management, namely, patient-centred care and empowering partnering, illuminating how professionals might better interact with chronically ill individuals who seek their care. The opportunities, challenges, theory and research evidence associated with each approach are explored. The advantages of moving beyond patient-centred care to the empowering partnering approach are elaborated. For people with chronic disease, having the opportunity to engage in the social construction of their own health as a resource for everyday living, the opportunity to experience interdependence rather than dependence/independence throughout on-going healthcare, and the opportunity to optimize their potential for self-care management of chronic disease are important justifications for being involved in an empowering partnering approach to their chronic disease management.

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Section: Patients Persons or Partners: Where From Here?mentioning

confidence: 99%

Patients, persons or partners? Involving those with chronic disease in their care

McWilliam

2009

Chronic Illness

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“…Results (McWilliam et al, 1999) of a randomized controlled trial to test the efficacy of a client-centered, client-driven approach to care management with frail chronically ill seniors receiving in-home care indicated that this approach achieved greater independence ( p = .0008), perceived ability to manage one's own health ( p = .0014), and quality of life ( p = .0006), and lessened information needs ( p = .0035) immediately postintervention (22 weeks), with patterns persisting at the 1-year follow-up. Findings also indicated cost savings, as individuals in the intervention used few services and spent fewer days in hospital (McWilliam et al, 1999).…”

Section: Literature Reviewmentioning

confidence: 94%

“…The provider survey included: the Work and Life Attitudes Survey (subscales 2, 4, and 5), capturing intrinsic motivation, perceived job characteristics that might give rise to job satisfaction, and job satisfaction, an overall satisfaction comprised of both intrinsic and extrinsic factors (Warr, Cook, & Wall, 1979); four Likert scales measuring perceived effectiveness in care goal attainment; Spreitzer's (1995) Empowerment Questionnaire, measuring personal empowerment; and the Provider's Health Promoting Effort Scale (McWilliam et al, 1996(McWilliam et al, , 1999, comprised of 35 100-mm visual linear analogue scales measuring providers' conscious attention to the client's health as a resource for everyday living and encouragement of client participation. The questionnaire for caregivers included: the 14-item abbreviated version of the Montgomery Burden Scale (Hooyman, Gonyea, & Montgomery, 1985, adapted by Chappell, Havens, Hollander, Miller, & imately 30 clients, informal caregivers, and providers in the intervention home care program (McCracken, 1988;Morse, 1991) during the implementation of the intervention were used to obtain a descriptive evaluation of the process.…”

Section: Data Collectionmentioning

confidence: 99%

Flexible Client-Driven In-Home Case Management: An Option to Consider

McWilliam

Stewart

Vingilis

et al. 2004

Care Management Journals

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Changes in health services and care needs have created high demand for case management of in-home services. To address this challenge, several models of case management have been used. Evaluations to date suggest that clients need different approaches for different circumstances at different times to optimize cost-effectiveness. Accordingly, one Canadian home care program adopted flexible client-driven case management engaging clients as partners in flexibly selecting either an integrated team, consumer-managed or brokerage model of case management in keeping with their preferences and abilities. Using an exploratory, multimeasure quasi-experimental design, a generic model of program evaluation, and both quantitative and qualitative methods, researchers identified challenges in implementing this intervention, policy impediments the clients characteristically in each of the three case management models, and client, provider, and caregiver outcomes of flexible, client-driven care. While further longitudinal investigation is needed findings suggest several important considerations for those interested in this option for care management. Alternative case management models do attract different client groups, and having a choice does not alter care costs or outcomes. Flexible client-driven case management may be experienced positively by case managers and other providers.

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“…Benzodiazepines are poorly metabolized, accumulation is associated with falls, confusion and respiratory depression, and unsupported withdrawal may precipitate rebound anxiety or confusional states. 112 Whilst the evidence base for these methods is slight, they may offer some scope for intervention with the phobic older person seeking (and getting) increased but inappropriate support at home from family, neighbours and community services. 109 The tendency to recognize those with the most severe symptoms is replicated in the provision of therapies.…”

Section: Anxietymentioning

confidence: 99%

Depression, anxiety and psychoses in later life: more challenges for primary care

Iliffe

Manthorpe

2002

Rev. Clin. Gerontol.

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The current focus on dementia risks eclipsing other mental health problems of later life. While the National Service Framework for Older People (NSF) has highlighted depression as an important disorder meriting special consideration,1 anxiety and psychoses in older people remain difficult problems for practitioners to manage. This paper reviews the prevalence and impact, recognition, complexity and prognosis and treatment for these three clinical problems, and proposes a framework for ‘good enough practice’

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Home-based health promotion for chronically ill older persons: results of a randomized controlled trial of a critical reflection approach

Abstract: SUMMARY

Cited by 39 publications

References 88 publications

Patients, persons or partners? Involving those with chronic disease in their care

Patients, persons or partners? Involving those with chronic disease in their care

Flexible Client-Driven In-Home Case Management: An Option to Consider

Depression, anxiety and psychoses in later life: more challenges for primary care

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