Multi-morbidity: a system design challenge in delivering patient-centred care

Ceramidas, Dagmar M.; Glasgow, Nicholas

doi:10.1071/ah13003

Cited by 4 publications

(6 citation statements)

References 6 publications

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“…There is a knowledge gap regarding the relationship between patient activation and self‐management in instances of comorbidity and multimorbidity such as diabetes and chronic kidney disease (CKD). This gap is important given that multimorbidity is increasing globally and CKD commonly coexists with diabetes and is complex to manage. Moreover, greater understanding of how patient activation may influence performance of self‐care activities will be important in the design of interventions to increase self‐management.…”

Section: Introductionmentioning

confidence: 99%

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The association between patient activation and self‐care practices: A cross‐sectional study of an Australian population with comorbid diabetes and chronic kidney disease

Zimbudzi

Ranasinha

et al. 2017

Health Expectations

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ObjectiveThis study aimed to examine the association between performance of self‐care activities and patient or disease factors as well as patient activation levels in patients with diabetes and chronic kidney disease (CKD) in Australia.MethodsA cross‐sectional study was conducted among adults with diabetes and CKD (eGFR <60 mL/min/1.73m2) who were recruited from renal and diabetes clinics of four tertiary hospitals in Australia. Demographic and clinical data were collected, as well as responses to the Patient Activation Measure (PAM) and the Summary of Diabetes Self‐Care Activities (SDSCA) scale. Regression analyses were performed to determine the relationship between activation and performance of self‐care activities.ResultsA total of 317 patients (70% men) with a mean age of 66.9 (SD=11.0) years participated. The mean (SD) PAM and composite SDSCA scores were 57.6 (15.5) % (range 0‐100) and 37.3 (11.2) (range 0‐70), respectively. Younger age, being male, advanced stages of CKD and shorter duration of diabetes were associated with lower scores in one or more self‐care components. Patient activation was positively associated with the composite SDSCA score, and in particular the domains of general diet and blood sugar checking (P<.05), but not specific diet, exercising and foot checking.ConclusionIn people with diabetes and CKD, a high level of patient activation was positively associated with a higher overall level of self‐care. Our results identify subgroups of people who may benefit from tailored interventions to further improve their health outcomes. Further prospective studies are warranted to confirm present findings.

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Section: Introductionmentioning

confidence: 99%

“…This gap is important given that multimorbidity is increasing globally 25,26 and CKD commonly coexists with diabetes 27 and is complex to manage. Moreover, greater understanding of how patient activation may influence performance of self-care activities will be important in the design of interventions to increase self-management.…”

Section: Introductionmentioning

confidence: 99%

The association between patient activation and self‐care practices: A cross‐sectional study of an Australian population with comorbid diabetes and chronic kidney disease

Zimbudzi

Ranasinha

et al. 2017

Health Expectations

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“…The intervention addresses the aspects within the logic matrix with a specific focus on building self‐efficacy with community‐dwelling older adults. From the literature, we had found that successful self‐management for older people with LTC relies upon patient‐centred approaches (Ceramidas & Glasgow, ; Crowe et al., ); therefore, individual activities are encouraged and a programme manual and workbook were provided to facilitate attendees to reflect on values, do a stocktake of their satisfaction with domains of life functioning, identify areas they wished to change and assist setting of achievable goals to meet their needs to increase self‐management.…”

Section: Step 2: Identification Of Outcome Performance Objectives Anmentioning

confidence: 99%

“…The intervention addresses the aspects within the logic matrix with a specific focus on building self-efficacy with communitydwelling older adults. From the literature, we had found that successful self-management for older people with LTC relies upon patient-centred approaches (Ceramidas & Glasgow, 2013;Crowe et al, 2016); therefore, individual activities are encouraged and a programme manual and workbook were provided to facilitate…”

Section: Objectivesmentioning

confidence: 99%

Using intervention mapping to design a self‐management programme for older people with chronic conditions

et al. 2018

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Self‐management programmes provide strategies to optimise health while educating and providing resources for living with enduring illnesses. The current paper describes the development of a community‐based programme that combines a transdiagnostic approach to self‐management with mindfulness to enhance psychological coping for older people with long‐term multimorbidity. The six steps of intervention mapping (IM) were used to develop the programme. From a needs assessment, the objectives of the programme were formulated; the theoretical underpinnings then aligned to the objectives, which informed programme design, decisions on implementation, programme adoption and evaluation steps. Bandura's social cognitive theory informed the methods and practical strategies of delivery. Among the features addressed with participants are transdiagnostic dimensions such as fatigue, pain, breathlessness, sleep disturbances. The programme utilises mindfulness to aid coping and ameliorate the psychological distresses associated with chronicity. Findings from an initial feasibility study and subsequent pilot assisted in conceptualising our programme. In conclusion, applying IM gave the planners confidence the programme is robust and evidence‐based with clearly articulated links between the behavioural goals and design elements to obtain the desired outcomes.

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“…Diabetes and chronic kidney disease (CKD) are two of the most prevalent co‐existing chronic diseases in Australia, and are a common example of multi‐morbidity. Multi‐morbidity can be defined as the coexistence of two or more chronic conditions where one is not necessarily more central than the other .…”

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confidence: 99%

Models of care for co‐morbid diabetes and chronic kidney disease

Zimbudzi

Teede

et al. 2018

Nephrology

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The review outlines the development of a model of care for patients with diabetes mellitus and chronic kidney disease, involving the multiple stake holders. Other distinctive features of this model of care are routine screening for psychological morbidity; patient-support through a phone advice line; and focused primary health-care support in the management of diabetes and CKD. ABSTRACT:Diabetes and chronic kidney disease (CKD) are two of the most prevalent co-morbid chronic diseases in Australia. The increasing complexity of multi-morbidity, and current gaps in health-care delivery for people with co-morbid diabetes and CKD, emphasize the need for better models of care for this population. Previously, proposed published models of care for comorbid diabetes and CKD have not been co-designed with stake-holders or formally evaluated. Particular components of health-care shown to be effective in this population are interventions that: are structured, intensive and multifaceted (treating diabetes and multiple cardiovascular risk factors); involve multiple medical disciplines; improve self-management by the patient; and upskill primary health-care. Here we present an integrated patient-centred model of health-care delivery incorporating these components and co-designed with key stake-holders including specialist health professionals, general practitioners and Diabetes and Kidney Health Australia. The development of the model of care was informed by focus groups of patients and health-professionals; and semi-structured interviews of care-givers and health professionals. Other distinctives of this model of care are routine screening for psychological morbidity; patient-support through a phone advice line; and focused primary health-care support in the management of diabetes and CKD. Additionally, the model of care integrates with the patient-centred health-care home currently being rolled out by the Australian Department of Health. This model of care will be evaluated after implementation across two tertiary health services and their primary care catchment areas.

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Multi-morbidity: a system design challenge in delivering patient-centred care

Cited by 4 publications

References 6 publications

The association between patient activation and self‐care practices: A cross‐sectional study of an Australian population with comorbid diabetes and chronic kidney disease

The association between patient activation and self‐care practices: A cross‐sectional study of an Australian population with comorbid diabetes and chronic kidney disease

Using intervention mapping to design a self‐management programme for older people with chronic conditions

Models of care for co‐morbid diabetes and chronic kidney disease

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