The effects of intervention on frequent attenders' adherence to health regimens, depression, somatization and hypochondriasis

Abstract

Background and objective: Frequent attender is the largest group to whom health care resources are allocated. Therefore potential interventions should be targeted at this group. Nurse-based case management considers frequent attenders' (FAs') needs for care as a whole and thus may reduce the use of other health services operators' resources. The objective of this study is to evaluate the effects of nurse-led case management on adherence to health regimens, depression, somatization and hypochondriasis in FAs. Methods: The study is a quasi-experimental intervention trial, carried out as a prospective 2-year follow-up design with an intervention group (n = 285) and a control group (n = 435). The hypothesis was that nurse-led case management based intervention would have a positive impact on FAs' adherence to health regimens, somatization, hypochondriasis, and depression. The intervention patients received nurse-led case management which included an evaluation of patient needs and resources, an individualized care plan, the coordination of multidisciplinary services, and support for self-management. The control patients received the usual care, which means patient support and education during visits to the health center. The data were collected from at least 18 years of age frequent attenders by self-reported instruments: the Adherence of Chronic Disease Inventory, the Whiteley Index, the Symptom Checklist-90-R and Beck Depression Inventory, and one-and two-year follow-ups between October 2008 and May 2011. Results: The intervention had an uplifting effect on the FAs' mood, and there was a statistically significant difference between the intervention patients and the control patients (p = .03). Intervention reduced somatization with FAs, and it improved FAs' adherence to health regimens, but there was not a statistically significant difference between groups. Hypochondriasis increased in the intervention group compared to the control group after intervention (p = .01). Conclusions: Nurse-led case management has a positive effect on FAs' depression symptoms, somatization, and adherence to health regimens. The results will be useful in developing effective nurse-led interventions and support methods for FAs with complex long-term health conditions. Hypochondriasis increased in the intervention group although the purpose was for the community matron to discuss with FAs and reduce their concerns.

Association between perceived health and adherence to treatment after percutaneous coronary intervention: A long‐term follow‐up study

“…Previous evidence suggests that a decreased level of PH is a common problem among post‐PCI patients (De Smedt et al, 2020; Ejheisheh et al, 2020). This is noteworthy, because reduced PH has been suggested to be associated with morbidity and mortality, and is strongly connected with hospital re‐admissions, new vascular events (Rumsfeldt et al, 2014, Hanssen et al, 2015), institutionalisation and healthcare use (Hirsikangas et al, 2017; Prättälä et al, 2011; Yang et al, 2020). Thus, research that provides information on how the determinants of PH are associated with adherence to treatment is of paramount important.…”

The effects of health coaching on frequent attenders’ adherence to health regimens and lifestyle factors: a quasi‐experimental study

“…To our knowledge, the effects of health coaching among frequent attenders have not been studied previously. Some studies have examined the effects of health education on frequent attenders (24)(25)(26). However, the definition of health education used in those works differs from that of health coaching, which is understood as a method of health education and promotion that enhances patient's wellbeing and facilitates the achievement of their healthrelated goals (27).…”

The effects of intervention on the quality of life, sense of coherence and daily activities of frequent attenders

“…[1,3,[5][6][7] Visits to the university hospital were also considered, and patients who had made four or more outpatient visits to the university hospital per year were also defined as FAs. [6][7][8] In order to develop healthcare services, the aim was to study the use of health services as a whole, and that is why we also included specialized care in our study.…”

“…[4] The need that FAs have for support and information on health care professionals is more than that of the general population. In this study, an FA is defined as a patient who has at least eight visits per year to the GP, according to previous studies in Finland, [1,3,[5][6][7] or at least four visits per year to the university hospital. [6][7][8] The care of FAs should be considered as a comprehensive approach rather than GPs just helping in acute situations.…”

“…It is necessary to take into account FAs' need for holistic care. [7] Case management is used to describe different approaches with the goal to improve the coordination and organization of services for patients with complex care needs. [9] Nurses play an important role in the care to improve and maintain the health of FAs.…”