Management of complex chronic disease: facing the challenges in the Canadian health-care system

Tsasis, Peter; Bains, Jatinder

doi:10.1258/hsmr.2008.008001

Cited by 30 publications

(20 citation statements)

References 22 publications

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“…Community-based in-home care represents an important and growing component of healthcare delivery [22,23]. Home care users are typically vulnerable older adults with multiple chronic morbidities and, as such, are at heightened risk of functional decline and frequent use of acute, emergency and long-term care services.…”

Section: Introductionmentioning

confidence: 99%

The relative impact of chronic conditions and multimorbidity on health-related quality of life in Ontario long-stay home care clients

et al. 2016

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Clinically important negative effects on HRQL were observed for clients with a previous diagnosis of stroke, osteo- and rheumatoid arthritis, or CHF, as well as with increasing levels of multimorbidity. Findings provide baseline preference-based HRQL scores for home care clients with different diagnoses and may be useful for identifying, targeting and evaluating care strategies toward populations with significant HRQL impairments.

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Section: Introductionmentioning

confidence: 99%

The relative impact of chronic conditions and multimorbidity on health-related quality of life in Ontario long-stay home care clients

et al. 2016

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“…The inherent trade-off to living longer is the greater likelihood of aging with one or more chronic illnesses [2,3]. Health care systems, with their acute, episodic orientation are limited in their capacity to provide care for patients with ongoing and fluctuating chronic care needs [3,4]. …”

Section: Introductionmentioning

confidence: 99%

A qualitative descriptive study on the alignment of care goals between older persons with multi-morbidities, their family physicians and informal caregivers

et al. 2013

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BackgroundGoal setting is a recommended approach in clinical care that can help individuals with multi-morbidities and their caregivers manage chronic conditions. In this paper, the types of goals that were important for older persons with multi-morbidities were explored from the perspectives of patients, their caregivers and physicians. Comparisons of goals were made across each patient, caregiver and physician triad to determine alignment.MethodsThe study was a qualitative descriptive study facilitated through semi-structured one-on-one interviews. The study took place between May and October 2012 at a Family Health Team located in Ontario, Canada. The sample included 28 family medicine patients, their informal caregivers and family physicians. Socio-demographic data were analyzed via descriptive statistics in SPSS Version 17. Open ended questions pertaining to patient goals of care were analyzed thematically using NVivo9. Themes were derived on patient care goals for each of the participant groups (patients, caregivers and family physicians). Following this, alignment of goals across each of the triads was examined. Goal alignment was defined as concurrence on at least one goal by all three parties in a particular triad (i.e., patient, caregiver and family physician).ResultsJust over half of the patients were male (56%); they had an average age of 82.3 years and 4.61 health conditions. Most of the caregivers were female (82%); and 61% were a spouse of the care recipient. At the aggregate level, common goals expressed among patients, caregivers and family physicians were the maintenance of functional independence of patients and the management of their symptoms or functional challenges. Despite these common goals at the aggregate level, little alignment of goals was found when looking across patient-caregiver and physician triads. Lack of alignment tended to occur when patients had unstable or declining functional or cognitive health; when safety threats were noted; and when enhanced care services were required.ConclusionsThe data suggest that goal divergence tends to occur when patients are less medically stable. While goal divergence may be expected due to the different roles and responsibilities of each of the players involved, these perspectives should be illuminated when building care plans. Further research is required to observe the extent to which goal setting occurs in family practice as well as how it can be embedded as a standard of practice.

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“…19,20 Formal care providers are usually provided by paid medically trained professionals such as physicians, physical therapists, occupational therapists, nurses, speech language pathologists, social workers, psychologists, and personal attendants. Informal care providers are typically unpaid individuals with minimal previous formal training in health care.…”

Section: Introductionmentioning

confidence: 99%

Social networks and secondary health conditions: The critical secondary team for individuals with spinal cord injury

Guilcher

Casciaro

Lemieux‐Charles

et al. 2012

The Journal of Spinal Cord Medicine

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ObjectivesTo describe the structure of informal networks for individuals with spinal cord injury (SCI) living in the community, to understand the quality of relationship of informal networks, and to understand the role of informal networks in the prevention and management of secondary health conditions (SHCs).DesignMixed-method descriptive study.SettingOntario, CanadaParticipantsCommunity-dwelling adults with an SCI living in OntarioInterventions/methodsThe Arizona Social Support Interview Survey was used to measure social networks. Participants were asked the following open-ended questions: (1) What have been your experiences with your health care in the community? (2) What have been your experiences with care related to prevention and/or management of SHCs?, (3)What has been the role of your informal social networks (friends/family) related to SHCs?ResultsFourteen key informant interviews were conducted (6 men, 8 women). The overall median for available informal networks was 11.0 persons (range 3–19). The informal network engaged in the following roles: (1) advice/validating concerns; (2) knowledge brokers; (3) advocacy; (4) preventing SHCs; (5) assisting with finances; and (6) managing SHCs. Participants described their informal networks as a “secondary team”; a critical and essential force in dealing with SHCs.ConclusionsWhile networks are smaller for persons with SCI compared with the general population, these ties seems to be strong, which is essential when the roles involve a level of trust, certainty, tacit knowledge, and flexibility. These informal networks serve as essential key players in filling the gaps that exist within the formal health care system.

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Management of complex chronic disease: facing the challenges in the Canadian health-care system

Cited by 30 publications

References 22 publications

The relative impact of chronic conditions and multimorbidity on health-related quality of life in Ontario long-stay home care clients

The relative impact of chronic conditions and multimorbidity on health-related quality of life in Ontario long-stay home care clients

A qualitative descriptive study on the alignment of care goals between older persons with multi-morbidities, their family physicians and informal caregivers

Social networks and secondary health conditions: The critical secondary team for individuals with spinal cord injury

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