Interdisciplinary collaborative care model combined with family empowerment in patients with comorbid hypertension and diabetes: A study on blood pressure/glucose control and psychosocial adaptation based on the COM-B model

Interdisciplinary care is increasingly promoted to enhance satisfaction and outcomes for individuals with complex medical conditions, such as Parkinson's disease (PD). However, there is little research on the feasibility or efficacy of interdisciplinary care in clinical settings. And, while the use of an integrated team of allied health professionals has the potential to provide significant health benefits to individuals with PD, there are educational and logistical barriers to the use of interdisciplinary care in clinical settings. An interdisciplinary care model was described that aimed to facilitate these benefits and alleviate some of these known clinical feasibility challenges. Three cases are also provided to exemplify how this approach to collaborative care was used to address individual needs and to highlight some of the successes and challenges associated with the implementation of an interdisciplinary and person-centered care model via telehealth. These cases may help clinicians adopt techniques to facilitate greater collaboration across disciplines or aid in the development of a feasible interdisciplinary program in their own clinics. Further research is needed to further enhance individual outcomes and integrate other disciplines into the care team.

Testing for hepatitis C in hospital emergency departments (ED) and linkage to care to clinics have been reported to provide the most opportunity for screening patients and facilitating continuum of care. Treatment model initiatives have expanded to include telehealth services and open treatment capacity to non-physician providers, such as pharmacists. This study's objective was to assess the impact of implementing automated routine screening for hepatitis C virus (HCV) and a clinical pharmacist into the interdisciplinary care model on HCV diagnosis and treatment outcomes. This retrospective cohort study compared outcomes in a pre-intervention and post-intervention group. Patients were screened and diagnosed with HCV at Jersey City Medical Center (JCMC) and completed linkage to care at JCMC Center for Comprehensive Care. Interventions were the implementation of automated routine HCV screening in the ED and addition of a clinical pharmacist to the interdisciplinary patient care model. Primary endpoints analyzed the number of patients who have achieved sustained virologic response after 12 weeks of treatment (SVR12) and patients who have completed treatment with no reported record of SVR12. Secondary endpoints analyzed the number of patients lost to follow-up, appointment type, time spent in appointments, and clinical pharmacist specialist interventions. Data was collected as categorical variables and chi-squared tests assessed if there were differences between the two samples. Data was collected from 46 patients in the pre-intervention group and 37 patients in the post-intervention group. Patients consisted of mostly males. Ages ranged from 27 to 83 years old. Race included Black, White, Asian, and Other. This study's results showed the positive impact on implementation of routine screening, telehealth services, and an interdisciplinary team approach to HCV diagnosis and management. Given the timeframe, it also showed the potential positive impact on these interventions during a global pandemic.

Background: Hematoma development is the most common vascular access complication among post-cardiac catheterization patients. It requires safe and standardized nursing care protocol, as well as qualified and skilled health providers to obtain good outcomes of management. The vascular complications were severe and increased the length of stay in the hospital. Timely recognition and management can diminish their burden.
 Objectives
 
 To evaluate the effectiveness of Standardized Nursing Care Protocol Post cardiac catheterization to reduce hematoma development.
 To assess the association of hematoma development between procedure site (radial and femoral) and comorbidities (diabetes, hypertension, and obesity) among post-cardiac catheterized patients.
 
 Methodology: This quasi-experimental (post) study was conducted at Coronary Care Units at tertiary care hospitals in Karachi. In this study, a total of 108 post-cardiac catheterized patients participated. The patients were divided into two groups; the interventional group and the control group. In the control group, 54 post-cardiac catheterized patients were selected and data were taken based on inclusion criteria who received routine holistic nursing care post-procedure and have been discharged. Besides 54 patients participated in the interventional group who received Standardized Nursing Care Protocol post-cardiac catheterization including proper patient assessment, compression techniques, interventions pre, during and post sheath and TR-band removal to discharge instruction by the principal investigator (PI). The data was collected through patients’ assessment sheets and hematoma scales for the identification of hematoma development rate among post-cardiac catheterized patients. The non-probability consecutive sampling technique was accomplished for the collection of data.
 Findings: The rate of hematoma development in the (control) group was reflected at 18 (33.3 %) while after the implementation of the standardized nursing care protocol the rate of hematoma development was 9 (16.6%) in the (interventional) group out of 54 (50%) post-cardiac catheterized patients. There was a significant difference between the (control) and (interventional) groups regarding the rates of hematoma development post-cardiac catheterization i.e. the P values were 0.037 ˂ 0.05. Thus, the standardized nursing care protocol post-cardiac catheterization was effective in the reduction of hematoma development. Furthermore, the radial site procedure reflected fewer rates of hematoma development 8 (14.81%) as compared to the femoral site procedure 19 (35.1%) among post-cardiac catheterized out of 54 (50%). The P-value was 0.058 > 0.05 there was no association between hematoma development and procedure site in the (interventional and control) groups post-cardiac catheterization. Similarly, the P-value was greater than 0.05 hence there was no association between hematoma development and comorbidities (diabetes, hypertension, and obesity) post-cardiac catheterization.
 Conclusion: The implementation of Standardized Nursing Care Protocol post-cardiac catheterization was effective for the reduction of hematoma development in the (intervention) group while there was an association of hematoma development between the (control and interventional) groups. However, there was no association between hematoma development and site procedure (radial and femoral) and comorbidities (diabetes, hypertension, and obesity) post-cardiac catheterization.

Background: Hepatitis C and chronic kidney disease (CKD) are significant global health burdens. Hemodialysis therapy can pose a risk of hepatitis C infection. Conditions related to Hepatitis C, such as hypertension and diabetes, have morbidity and mortality rates and can impact the outcomes of hepatitis C treatment. Objective: This study aimed to assess the efficacy of Elbasvir/Grazoprevir as hepatitis C therapy in hemodialysis patients with comorbid hypertension and diabetes mellitus. Methods: The target population for this study consists of hepatitis C-infected patients undergoing routine hemodialysis with comorbid hypertension and diabetes mellitus who were treated with Elbasvir/Grazoprevir. The data collected included demographic characteristics, comorbid conditions (hypertension and diabetes mellitus), cirrhosis status, and whether patients achieved Sustained Virologic Response (SVR). Multinomial logistic regression was used to calculate the odds ratio (OR). Results: From the population profile of the study, a total of 164 individuals were included, with the majority being under 60 years old. Patients with comorbid hypertension or diabetes mellitus achieved SVR rates of 95% and 83.3%, respectively, while patients with both comorbid conditions, hypertension, and diabetes mellitus, had an SVR rate of 74.07%. The multinomial logistic regression analysis showed that patients with both comorbid conditions (HT and DM) had a higher risk of failing to achieve SVR compared to patients without comorbid conditions, with an OR of 22.4, p = 0.005. Conclusion: Administering Elbasvir/Grazoprevir for hepatitis C therapy in hemodialysis patients with comorbid hypertension and/or diabetes mellitus carries a higher risk of SVR failure compared to those without comorbid conditions.

BackgroundHypertension and diabetes mellitus are independent risk factors for cardiovascular diseases. Due to the cardioprotective nature of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs), they are recommended for patients with comorbid hypertension and diabetes. However, poor adherence to ACEIs/ARBs among older adults is a major public health concern. This study aimed to assess the effectiveness of a telephonic motivational interviewing (MI) intervention conducted by pharmacy students among a nonadherent older population (≥ 65 years old) with diabetes and hypertension.MethodsPatients continuously enrolled in a Medicare Advantage Plan who received an ACEI/ARB prescription between July 2017 and December 2017 were identified. Group-based trajectory modeling (GBTM) was used to identify distinct patterns of ACEI/ARB adherence during the 1-year baseline period: adherent, gaps in adherence, gradual decline, and rapid decline in adherence. Patients from the three nonadherent trajectories were randomized into MI intervention or control group. The intervention consisted of an initial call and five follow-up calls administered by MI-trained pharmacy students and tailored to the baseline ACEI/ARB adherence trajectories. The primary outcome was adherence to ACEI/ARB during the 6- and 12-month periods post-MI implementation. The secondary outcome was discontinuation, defined as no refills for ACEI/ARB during the 6- and 12-month periods post-MI implementation. Multivariable regression analyses examined the impact of MI intervention on ACEI/ARB adherence and discontinuation while adjusting for baseline covariates.ResultsA total of 240 patients in the intervention group and 480 patients as randomly selected controls were included in this study. At 6 months, patients receiving the MI intervention had significantly better adherence (β = 0.06; p = 0.03) compared with the controls. Linear and logistic regression models also showed patients in the intervention group were more likely to be adherent than controls within 12 months of intervention implementation (β = 0.06; p = 0.02 and OR: 1.46; 95% CI 1.05–2.04, respectively). MI intervention did not have any significant impact on the ACEI/ARB discontinuation.ConclusionPatients who received the MI intervention were more likely to be adherent at 6 and 12 months following the intervention initiation, despite gaps in the follow-up calls due to COVID-19. Pharmacist-led MI intervention is an effective behavioral strategy to improve medication adherence among older adults and tailoring the intervention to past adherence patterns may enhance the intervention effectiveness.This study was registered with the United States National Institutes of Health (ClinicalTrials.gov identifier NCT03985098).Supplementary InformationThe online version contains supplementary material available at 10.1007/s40266-023-01008-6.

TM6-O-09 Introduction: Limited evidence suggests that persons with comorbid conditions such as diabetes, hypertension, congestive heart failure, dysrhythmia, and respiratory illness are at increased risk of adverse cardiovascular morbidity and mortality associated with ambient air pollution. Methods: We collected information on over 10 million emergency department visits from 41 hospitals from 1993 through 2004. Visits for several cardiovascular disease subgroups were examined in relation to daily levels of ambient pollutants using a case-crossover framework. Heterogeneity of the pollution risk estimates was examined for the following comorbid conditions, identified using secondary diagnostic codes from billing records: diabetes, hypertension, congestive heart failure (CHF), dysrhythmia, atherosclerosis, chronic obstructive pulmonary disease (COPD), upper respiratory infections, pneumonia, and asthma. Results: In preliminary analyses using visits from 1993 through 2000, we observed stronger associations of air pollution with cardiac dysrhythmia visits among patients with comorbid hypertension and diabetes than among patients without these comborbid conditions (eg, for nitrogen dioxide: odds ratio [OR] per 20-ppb increase: 1.144; 95% CI, 1.036–1.262 among visits with comorbid diabetes vs. OR per 20-ppb increase: 1.012; 95% CI, 0.987–1.038 among visits without comorbid diabetes; P value assessing heterogeneity of the pollution estimates: 0.019). Similar evidence of effect modification was observed for peripheral and cerebrovascular disease and CHF visits by comorbid COPD. Evidence of effect modification by comorbid diabetes and hypertension was primarily observed in relation to particulate matter (PM10), nitrogen dioxide, and carbon monoxide, while evidence of effect modification by comorbid COPD was also observed in response to ozone. Results for the expanded time period, as well as results for speciated particle data, will be presented. Discussion: These findings provide further evidence of increased susceptibility to adverse cardiovascular events associated with ambient air pollution among persons with comorbid hypertension, diabetes, and COPD.

Interdisciplinary aerodigestive care model improves risk, cost, and efficiency

ObjectiveThe rising burden of non-communicable diseases (NCDs), including mental health disorders (MHDs) such as anxiety and depression, poses a significant public health challenge globally. Evidence suggests that both diabetes and hypertension, the two most prevalent NCDs, are linked to a higher prevalence of MHDs. However, there is a lack of evidence on prevalence of generalised anxiety disorder (GAD) and depression among adults living with both diabetes and hypertension in Bangladesh. We aimed to assess the prevalence of GAD and depression and explore the associated factors among adults living with diabetes and hypertension comorbidity in rural Bangladesh.DesignWe implemented a cross-sectional study.SettingThe study was conducted in Chirirbandar, a sub-district of Dinajpur, Bangladesh.ParticipantsWe interviewed a total of 387 adults living with diabetes and hypertension comorbidity.Primary outcome measuresWe had two primary outcome measures: GAD and depression. Individuals scoring ≥10 on the General Anxiety Disorder-7 scale were considered as having GAD and individuals scoring ≥10 on the Patient Health Questionnaire-9 scale were considered as having depression. The outcome variables were dichotomised based on these scores.ResultsThe prevalence of GAD was 7.24% (95% CI 5.04 to 10.29). Education level (grades 5–9) (adjusted OR (AOR): 3.40, 95% CI 1.26 to 9.19) and household wealth status (highest wealth tertile) (AOR: 0.12, 95% CI 0.02 to 0.62) were associated with GAD. The prevalence of depression was 17.83% (95% CI 14.32 to 21.98). Socioeconomic factors associated with depression included unemployment (AOR: 3.26, 95% CI 1.05 to 10.10) and household wealth status (highest wealth tertile) (AOR: 0.45, 95% CI 0.21 to 0.98). Higher odds of depression were also observed among participants with controlled hypertension (AOR: 3.88, 95% CI 1.81 to 8.35). Other factors, such as tobacco use, dietary diversity and physical activity, were not associated with GAD or depression.ConclusionA high prevalence of GAD and depression was observed among adults living with diabetes and hypertension comorbidity. The findings from the study emphasise the need for integration of mental health services into the existing non-communicable disease care. The identified factors associated with GAD or depression should be considered to develop targeted interventions for people with hypertension and diabetes comorbidity in Bangladesh.

Evidence-based strategies addressing comorbid hypertension and diabetes are needed among minority communities. We analyzed the outcome of blood pressure (BP) control using pooled data from two community health worker interventions in New York City conducted between 2011 and 2019, focusing on participants with comorbid hypertension and diabetes. The adjusted odds of controlled BP (< 140/90 mmHg) for the treatment group were significant compared with the control group (odds ratio = 1.4; 95% confidence interval = 1.1, 1.8). The interventions demonstrated clinically meaningful reductions in BP among participants with comorbid hypertension and diabetes.

Polypharmacy and its associated factors among patients with co-morbid hypertension and diabetes in a municipal hospital in Ghana

BackgroundA person’s self-efficacy plays a critical role during the chronic management process of a health condition. Assessment of self-efficacy for patients with heart diseases is essential for healthcare professionals to provide tailored interventions to help patient to manage the disease.ObjectiveTo translate and test the psychometric properties of the Chinese version of Cardiac Self-efficacy Scale (C-CSES) as a disease-specific instrument for patients with coronary heart disease (CHD) in mainland China.MethodsThe original English version of the CSES was translated into Chinese using a forward-backward translation approach. A convenience sample consisting of 224 Chinese patients with CHD were recruited from a university-affiliated hospital in Shiyan, China. The C-CSES and the General Self-efficacy Scale (GSES) were used in this study. The factor structure, convergent and discriminative validities, and internal consistency of the C-CSES were evaluated.ResultsThe confirmatory factor analysis (CFA) supported a three-factor high-order structure of the C-CSES with model fit indexes (RMSEA = 0.084, CFI = 0.954, NNFI = 0.927, IFI = 0.954 and χ 2 /df = 2.572). The C-CSES has good internal consistency with a Cronbach’s alpha of 0.926. The convergent validity of the C-CSES was established with significantly moderate correlations between the C-CSES and the Chinese version of the GSES (p < 0.001). The C-CSES has also shown good discriminative validity with significant differences of cardiac self-efficacy being found between patients with and without comorbidities of hypertension, diabetes, or heart failure.ConclusionThe empirical data supported that the C-CSES is a valid and reliable disease-specific instrument for assessing the self-efficacy of Chinese patients with CHD.

BackgroundHealth-related quality of life (HRQoL) has been used to assess subjects’ prognosis and recovery following hip fracture. However, evidence is mixed regarding the effectiveness of interventions to improve HRQoL of elders with hip fracture. The purposes of this study were to identify distinct HRQoL trajectories and to evaluate the effects of two care models on these trajectories over 12 months following hip-fracture surgery.MethodsFor this secondary analysis, data came from a randomized controlled trial of subjects with hip fracture receiving three treatment care models: interdisciplinary care (n = 97), comprehensive care (n = 91), and usual care (n = 93). Interdisciplinary care consisted of geriatric consultation, discharge planning, and 4 months of in-home rehabilitation. Comprehensive care consisted of interdisciplinary care plus management of malnutrition and depressive symptoms, fall prevention, and 12 months of in-home rehabilitation. Usual care included only in-hospital rehabilitation and occasional discharge planning, without geriatric consultation and in-home rehabilitation. Mental and physical HRQoL were measured at 1, 3, 6, and 12 months after discharge by the physical component summary scale (PCS) and mental component summary scale (MCS), respectively, of the Medical Outcomes Study Short Form 36, Taiwan version. Latent class growth modeling was used to identify PCS and MCS trajectories and to evaluate how they were affected by the interdisciplinary and comprehensive care models.ResultsWe identified three quadratic PCS trajectories: poor PCS (n = 103, 36.6 %), moderate PCS (n = 96, 34.2 %), and good PCS (n = 82, 29.2 %). In contrast, we found three linear MCS trajectories: poor MCS (n = 39, 13.9 %), moderate MCS (n = 84, 29.9 %), and good MCS (n = 158, 56.2 %). Subjects in the comprehensive care and interdisciplinary care groups were more likely to experience a good PCS trajectory (b = 0.99, odds ratio [OR] = 2.69, confidence interval [CI] = 7.24–1.00, p = 0.049, and b = 1.32, OR = 3.75, CI = 10.53–1.33, p = 0.012, respectively) than those who received usual care. However, neither care model improved MCS.ConclusionsThe interdisciplinary and comprehensive care models improved recovery from hip fracture by increasing subjects’ odds for following a trajectory of good physical functioning after hospitalization.Trial registrationClinicalTrials.gov (NCT01350557)

Background:Recent surveys have showed that asthma control still remains suboptimal. Family members have an extensive impact on the level of asthma control in school-age children. Family empowerment has a positive impact on the quality of life of school-age children with asthma. This study aimed to determine the efficacy of family empowerment on asthma control in school-age children.Materials and Methods:Forty-five children with asthma (6–12 years) and their parents were enrolled in a pediatric asthma clinic during their follow-up visits. The family empowerment program consisted of self-directed educational material, lectures (a nurse-focused format), group interaction (a learner-focused format), group discussions, and demonstration of educational films. The primary outcome was change in asthma control measured by the C-ACT questionnaire.Results:In this study, 45 patients were enrolled and randomly divided into two groups: intervention (n=23) and control (n=22). Demographic variables including age and sex were not significantly different between the two groups. There were no significant differences in pre-test asthma control scores between the intervention and control groups at pre-test (p=0.82). However, there was a significant difference in asthma control scores between the intervention and control groups at post-test (p<0.001). In the intervention group, in which children experienced family empowerment, asthma control scores were significantly higher at post-test compared to pre-test (p<0.001).Conclusion:Family empowerment significantly improved asthma control in school-age pediatric patients. This program could be proposed for proper asthma control and complication-reducing management of the disease. This program is recommended more broadly for other age groups.

BackgroundHospitalization can be associated with an increased risk for nosocomial complications in older adults secondary to multimorbidity and the hospital environment. The complexity of care for older adults requires an interdisciplinary care team. The Geriatric Division at Hackensack University Medical Center, Hackensack, USA has incorporated various quality improvement frameworks to build an integrated interdisciplinary care model to improve health outcomes for hospitalized older adults.Description of care modelThe Geriatric Quality Council (GQC), an interdisciplinary team, has developed a geriatric care model, incorporating the HELP Program, Joint Commission Disease-Specific Care (DSC) certification, Patient Safety and Quality Department, and most recently, the Age-Friendly Health System. GQC creates interventions to improve care quality, oversees all care model activities, and monitors quality metrics. The interdisciplinary nature of this council allows for the exchange of ideas on intervention feasibility when planning and implementing interventions. This approach can be the key to successful implementation when planning trans-departmental interventions or quality improvement processes.Implementation and data monitoringOur model uses a time series design that enables the GQC to monitor trends in real-time. This allows prompt identification of any roadblocks in the intervention’s implementation. Timely changes are made to overcome barriers and meet the goal. This process continues until the intervention is fully implemented and the target goals are reached. Active tracking of the intervention’s implementation is retired after consistency in numbers is attained.ConclusionImplementing our care model has helped improve clinical outcomes for hospitalized older adults at HUMC. Our approach suggests integrating quality improvement processes under the supervision of an interdisciplinary council. This allows timely interventions, access to resources, team engagement, dissemination of knowledge across various subspecialties, and sustainability. We recommend utilizing such strategies to improve and sustain care for older adults in the acute care setting.

The concept of nursing has exceeded its traditional boundaries and has become an essential element of interdisciplinary care. The constantly evolving healthcare sector, in the face of increasingly complex patient needs and medical advancements, has necessitated a paradigm shift in this profession. Nursing, which combines patient care, education, and advocacy, plays a pivotal role in this transformation. The works presented in the monograph demonstrate the dynamic changes in interdisciplinary nursing as an approach that integrates knowledge and skills from various fields to provide patients with the highest quality of care. Interdisciplinary nurses see each patient as a whole and tailor their care to their needs. They recognize the interrelationships between the physical, psychological, social, and spiritual aspects of a patient’s health to provide holistic and patient-centered care. Interdisciplinary nursing care and the changing roles and responsibilities of nurses emphasize their contributions to care coordination, health promotion, and patient education. The research conducted covers all aspects of modern health care and its impact on the well-being of patients and the health care system. The work highlights the challenges of implementing and maintaining interdisciplinary health care models and the need for ongoing education and professional development. It introduces readers to the dynamic world of interdisciplinary nursing care.