Individualized Plans of Care to Improve Outcomes Among Children and Adults With Chronic Illness: A Systematic Review

Lion, K. Casey; Mangione-Smith, Rita; Britto, Maria T.

doi:10.1891/1521-0987.15.1.11

Cited by 28 publications

(25 citation statements)

References 19 publications

(91 reference statements)

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“…There is room for improvement since care planning discussions were noted by patients as reactive, rather than anticipatory and limited by time constraints [18]. The current literature is inconclusive on what components need to be included in a care plan to affect clinical outcomes in a positive manner [6]. One study on care plans included an element of goal setting with the patient and detailed information about lifestyle behaviors where self-management resulted in improved clinical core values of patients [9].…”

Section: Discussionmentioning

confidence: 99%

“…Various academic bodies, including the American Academy of Family Physicians, endorse the use of an individualized care plan as a key element of the patient-centered medical home [6]. Studies have shown improvement in clinical outcomes secondary to the use of care plans [7–10].…”

Section: Introductionmentioning

confidence: 99%

“…Studies have shown improvement in clinical outcomes secondary to the use of care plans [7–10]. A systematic review suggests that including care plans as part of a larger intervention to address chronic illnesses results in improved outcomes; however, there is limited evidence to evaluate care plans as a single intervention [6]. …”

Section: Introductionmentioning

confidence: 99%

“…The structure of care plans are varied and more evidence is needed to determine the components necessary to result in improved outcomes [6]. Personalized therapy for patients with diabetes can improve adherence and treatment outcomes [11].…”

Section: Introductionmentioning

confidence: 99%

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Saucier

Ansa

Coffin

et al. 2017

EJPCH

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Purpose This cross sectional study examines patients’ knowledge, attitudes and beliefs about a diabetic care management plan (DCMP) that was developed to provide patient education on diabetes guidelines and display individual diabetic core measures. Secondary objectives included a comparison of diabetic core measures [hemoglobin A1C (HbA1C), systolic and diastolic blood pressure (SBP, DBP), low-density lipoprotein (LDL) and urine microalbumin (Um)] before and after DCMP implementation. We hypothesize this tool will contribute to patients’ awareness of current disease status, diabetes knowledge and diabetic core value improvement over time. Methods A consecutive sample of 102 adult patients with diabetes mellitus type 2 in a primary care setting participated. Patients’ perspectives on the care plan and knowledge about diabetes was collected via survey after care plan implementation. A comparison of selected diabetic core measures was conducted at baseline and post-DCMP. Descriptive statistics summarized survey response and diabetic core measures. A repeated measures ANOVA was used to assess change in diabetic core measures over time. Results Participants understood the DCMP (96%), found it important because it explained their laboratory results and medications (89%) and believed it would help them to have better diabetic control (99%). There was a significant interaction between time and being at goal pre-DCMP for HbA1c, SBP and LDL. Patients not at goal pre-DCMP for the above measures decreased significantly over time (P = <0.01 for HbA1c, SBP and LDL). Participants at goal for all diabetic core measures increased pre- to post-DCMP from 13% to 20% (P = 0.28). Conclusion Patients perceived the diabetic care management plan favorably and their diabetic core measurements improved over time. This simple and reproducible self-management intervention can enhance self-management in a patient population with diabetes mellitus type 2.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Saucier

Ansa

Coffin

et al. 2017

EJPCH

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“…While comprehensive biopsychosocial assessment is beyond the scope of this position paper and detailed elsewhere (Turk & Melzack, ), several aspects most relevant to exercise prescription are discussed. The initial assessment provides an opportunity to lay the foundation for a positive clinician–patient therapeutic alliance, which refers to a sense of collaboration, understanding and support between the clinician and the patient and is a key factor in determining rehabilitation outcomes (Ferreira et al, ; Lion, Mangione‐Smith, & Britto, ). Patient‐centred communication engages the patient and strengthens the therapeutic alliance (Ferreira et al, ; Lion et al, ) and should commence in the initial assessment and be ongoing throughout treatment.…”

Section: Applying a Biopsychosocial Approach To Exercise Treatmentmentioning

confidence: 99%

Exercise for chronic musculoskeletal pain: A biopsychosocial approach

Booth

Moseley

Schiltenwolf

et al. 2017

Musculoskeletal Care

280

197

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Chronic musculoskeletal pain (CMP) refers to ongoing pain felt in the bones, joints and tissues of the body that persists longer than 3 months. For these conditions, it is widely accepted that secondary pathologies or the consequences of persistent pain, including fear of movement, pain catastrophizing, anxiety and nervous system sensitization appear to be the main contributors to pain and disability. While exercise is a primary treatment modality for CMP, the intent is often to improve physical function with less attention to secondary pathologies. Exercise interventions for CMP which address secondary pathologies align with contemporary pain rehabilitation practices and have greater potential to improve patient outcomes above exercise alone. Biopsychosocial treatment which acknowledges and addresses the biological, psychological and social contributions to pain and disability is currently seen as the most efficacious approach to chronic pain. This clinical update discusses key aspects of a biopsychosocial approach concerning exercise prescription for CMP and considers both patient needs and clinician competencies. There is consensus for individualized, supervised exercise based on patient presentation, goals and preference that is perceived as safe and non-threatening to avoid fostering unhelpful associations between physical activity and pain. The weight of evidence supporting exercise for CMP has been provided by aerobic and resistance exercise studies, although there is considerable uncertainty on how to best apply the findings to exercise prescription. In this clinical update, we also provide evidence-based guidance on exercise prescription for CMP through a synthesis of published work within the field of exercise and CMP rehabilitation.

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Clinical Pharmacology and the Individualized Approach to Treatment

Rieder

2015

Optimizing Treatment for Children in the Developing World

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Individualized Plans of Care to Improve Outcomes Among Children and Adults With Chronic Illness: A Systematic Review

Cited by 28 publications

References 19 publications

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Untitled

Exercise for chronic musculoskeletal pain: A biopsychosocial approach

Clinical Pharmacology and the Individualized Approach to Treatment

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