Chronic Disease Management Research Articles

Nurse led models of care for outpatient substance use disorder treatment: A scoping review.

To map key characteristics and describe nurse led models of care for the treatment of persons with substance use disorders (SUDs) in the outpatient setting. A scoping review. Conducted in accordance with the JBI methodology. The PRISMA-ScR checklist was used. Pubmed, CINAHL Complete (EBSCOhost), Cochrane Library, APA PsycNet and Scopus were searched from 1999 to May 2022 and updated on 28 November 2023. A handsearch and a grey literature search was conducted. Title and abstract screening was performed on 774 articles resulting in 88 articles for full text screening. Full text screening yielded 13 articles that met inclusion criteria. Existing nurse-led models of care for SUDS are scarce and limited in scope, with the majority focused on treating opioid use disorder. Additional research is needed to develop, test, and implement efficacious nurse-led models of care for the treatment and management of SUDs. Nurse led models of care have demonstrated their efficacy and quality in the management of other chronic diseases. As we move forward with innovative solutions for individuals with addiction, nurse led models of care can be a mechanism to deliver high quality, evidence-based care for SUDs. SUDs are chronic diseases that impact individuals, families, and communities. SUDs require a biopsychosocial approach to treatment. Globally, nurses are well positioned to provide high quality care to mitigate the impact of SUDs. This scoping review mapped the extant literature on nurse led models of care for substance use disorder treatment in the outpatient setting finding that additional research is needed to develop, test and implement evidence-based interventions to care for individuals, families, and communities experiencing SUDs. PRISMA checklist for scoping reviews. No patient or public contribution were part of this study. Open Science Framework accessible at: https://doi.org/10.17605/OSF.IO/NSW7V.

IOT-Enabled Smart Healthcare: Developing Predictive Models for Chronic Disease Management Using Wearable Sensors

Abstract: Real-time monitoring and prediction models will be used to assess the efficiency of the IoT-enabled smart healthcare solutions in managing chronic diseases. From this study, in addition to the quantitative data, including the performance of the model, patient engagement, and cost savings, qualitative information obtained from the patients and healthcare professionals will be employed using a mixed-methods research approach. This collected rich data from surveys, performance measurements, real-time monitoring data, and cost analyses with 50 health professionals and 200 chronic disease patients. The results of the study indicate that predictive models, more particularly the Neural Network, enhanced the ability to identify cases of chronic illness with an accuracy of 92.4%. Extremely high patient satisfaction rates: 9.0 out of 10. Real-time monitoring shows hospital admissions falling by as much as 50% among those suffering with respiratory disease. Cost-benefit analysis also documented financial sustainability, with overall annual cost reduction at 43.3%. Soon after implementation, usage metrics also revealed that the average user uses it three times a day, while patient-provider interactions increased by 150%. This study highlights how IoT technologies would benefit patients' clinical conditions, improve chronic disease management, and save healthcare expenses.

Cost minimization analysis of chronic kidney disease management: Evaluating economic strategies for early intervention and treatment optimization

Chronic kidney disease is a common global health condition characterized by progressive loss of kidney function and significant cost burden on the healthcare system worldwide. The disease often coexists with conditions such as diabetes and hypertension, further complicates its management and increasing associated costs. Effective economic management, particularly in the early stages of CKD, is crucial for reducing long-term healthcare expenses and improving patient outcomes. This review examines the utility of cost minimization analysis (CMA) as a strategic tool for evaluating economic options in CKD management. CMA is an economic evaluation method that compares the costs of different therapeutic interventions that have demonstrated equivalent clinical effectiveness, thereby aiding healthcare providers and policymakers in identifying the most cost-efficient options to optimize resource utilization. This review highlights the economic impact of CKD, focusing on the increasing costs linked to advanced disease management and the essential role of early diagnosis and intervention in reducing these costs and explores various cost-effective strategies for CKD management, including pharmacological treatments, lifestyle modifications, and patient education, to identify approaches that are both clinically and economically advantageous. Additionally, the broader implications of cost minimization for healthcare policy, clinical decision-making, and resource allocation are discussed for their significance in a resource-limited healthcare setting. Evidence indicates that prioritizing cost-effective CKD management through early intervention and preventive care can significantly lower healthcare expenditures, slow the disease progression, and enhance patient’s quality of life. By adopting such strategies, healthcare systems can achieve better clinical outcomes and ensure financial sustainability.

The patient's medical home: A meta-analysis of case studies exploring its impact on patient outcomes

This meta-analysis investigates the impact of the Patient's Medical Home (PMH) model on healthcare delivery, focusing on quality of care, patient satisfaction, accessibility, and cost-effectiveness. Utilizing a comprehensive search across multiple databases, studies relevant to the PMH model were identified and analyzed, adhering to strict inclusion and exclusion criteria. The findings reveal significant improvements in the adherence to practice guidelines for chronic disease management, patient satisfaction scores, access to primary care services, and reductions in overall healthcare costs, with a notable reduction in emergency department visits and hospital admissions. Despite moderate heterogeneity among studies, indicating variability in PMH implementation, the analysis underscores the PMH model's potential to enhance healthcare delivery. This study contributes to the growing body of evidence supporting the PMH model's effectiveness in improving healthcare outcomes and efficiency, advocating for its broader adoption and adaptation across diverse healthcare settings. The research highlights the importance of addressing implementation challenges to fully realize the PMH model's benefits, marking a significant step towards patient-centered, sustainable healthcare reform.

Effects of PACK training on the management of asthma and chronic obstructive pulmonary disease by primary care clinicians during 2 years of implementation in Florianópolis, Brazil: extended follow-up after a pragmatic cluster randomised controlled trial with a stepped-wedge design

BackgroundTraining primary care doctors and nurses to use Practical Approach to Care Kit (PACK) improved management of asthma and chronic obstructive pulmonary disease (COPD) in a previous randomised trial. The...

Comparative Analysis of Osteoarthritis Therapeutics: A Justification for Harnessing Retrospective Strategies via an Inverted Pyramid Model Approach

In this review, we seek to explore two distinct approaches to the clinical management of OA: a prospective approach, addressing primarily one’s genetic predisposition to OA and generating early intervention options, and the retrospective approach, aimed at halting or reversing OA progression post-symptom onset. The clinical management of OA remains challenging, largely due to the limited availability of preventative treatments and failure of existing therapies to modify or reverse the underlying pathophysiology. The prospective approach involves the identification of genetic markers associated with OA and utilizes in vitro and in vivo models to characterize the underlying disease mechanism. Further, this approach focuses on identifying genetic predispositions and unique molecular subtypes of OA to develop individualized treatment plans based on patient genotypes. While the current literature investigating this strategy has been notable, this approach faces substantial challenges, such as extensive time burdens and utilization of extensive genetic testing that may not be economically feasible. Additionally, there is questionable justification for such extensive investigations, given OA’s relatively low mortality rates and burden when contrasted with diseases like specific forms of cancer, which rely heavily on the prospective approach. Alternatively, the retrospective approach primarily focuses on intervention following symptom onset and aims to utilize novel therapeutics to slow or reverse the inflammatory cascade typically seen in disease progression. These treatments, like Hippo pathway inhibitors, have shown initial promise in halting OA progression and alleviating OA symptomology by modulating cellular processes to preserve articular cartilage. In comparison to the prospective approach, the retrospective strategy is likely more cost-effective, more widely applicable, and does not necessitate thorough and invasive genetic screening. However, this approach must still be weighed against the typical natural history of disease progression, which frequently results in total knee arthroplasty and unacceptable outcomes for 15–20% of patients. From a comparative analysis of these two approaches, this review argues that the retrospective strategy, with ideally lower time and economic burden and greater accessibility, offers a more reasonable and effective solution in the context of OA management. Using a similar approach to other management of chronic diseases, we suggest an “Inverted Pyramid” model algorithm, a structured research and development regimen that prioritizes generating widely effective therapies first, with subsequent refinement of treatments based on the development of patient resistance to these therapies. We argue that this strategy may reduce the need for total knee arthroplasty while improving patient outcomes and accessibility.

Comparison of the effect of self-care education with two methods, teach-back and smartphone application, on the adherence to treatment in patients with inflammatory bowel disease.

Self-care is one of the basic principles in the management of chronic diseases, which influences follow-up and adherence to treatment. Therefore, the current study was conducted with the aim of comparing the effect of teach-back (TB) and a smartphone application on adherence to treatment in patients with inflammatory bowel disease (IBD). The current clinical trial was conducted among 80 patients with IBD in Mashhad, Iran, in 2021-2022. Self-care education (diet, personal and social relationships, medications, sleep, physical activity, sexual relationships, etc.) was provided through TB method in one group and by using a smartphone application in another group. The control group only received the routine education. A checklist for demographic information and the adherence questionnaire in patients with chronic diseases were used for data collection. Patients' mean age was 38.73 ± 10.32 years. The majority of patients had ulcerative colitis (81%) and were married (67%). Mean and standard deviation score of adherence to treatment were the same in all three groups before the intervention (P = 0.668). The mean post-test scores of adherence to treatment in the TB, application, and control groups were 170.04 ± 14.19, 167.99 ± 11.59, and 159.60 ± 10.94, respectively. The difference was statistically significant (P = 0.003). A significant difference was observed in regards to the mean post-test scores of adherence to treatment between TB and control groups (P = 0.004) and app and control groups (P = 0.048). However, the difference between TB and app groups was not significant (P = 0.989). TB method and smartphone application have the same effect on adherence to treatment in patients with IBD. Due to the usability and cost-effectiveness of smartphone applications, this method can be used by health-care providers to educate this group of patients.

An integrated approach to enhance vaccine uptake in chronic patients – the VacciNetwork project

Abstract Issue/problem Individuals with chronic illnesses are at a higher risk of infections and their complications. Vaccinations are crucial in reducing this risk and their integration in chronic care pathways can enhance vaccine uptake, but it requires a collaborative approach and increased awareness in care personnel, caregivers and patients. Description of the problem The Local Health Authority of Rome 2 (ASL Roma 2, with approx. 1.3 million residents) initiated an active promotion plan for recommended vaccinations in chronic patients in January 2023, and a Clinical Vaccinology Workbook was produced to guide healthcare workers in promoting vaccinations across various care settings. The plan aims to establish collaborative agreements with hospitals and territorial structures that manage these patients, integrating vaccination plans with clinical and healthcare pathways for a more holistic approach to chronic disease management, a model that could benefit similar populations globally. Results Data was extracted from administrative databases regarding vaccinations performed in 2022 and 2023 on fragile subjects, i.e., those with a marked ‘risk condition’, aged ≥18 years. The results showed that vaccine uptake was more than doubled (6675 vs. 2041; +227%). Notably, vaccinations rose among those with oncological-hematological diseases (+212%), asplenia (+185%), chronic kidney failure or on dialysis (+190%) and those with an HIV infection (+160%). Increases were also significant in other immunocompromised conditions (+194%). Lessons The practice underlines the importance of targeted vaccination programs within chronic care management. Collaborative healthcare frameworks can significantly improve vaccination rates, reducing the burden of infectious diseases in high-risk populations. These results underscore the potential applicability of such a model in other regions and countries, highlighting the universal relevance of integrated healthcare solutions. Key messages • Collaborative, integrated frameworks between clinical and vaccination services can represent a model for increasing vaccine uptake in chronic disease patients. • Strategic partnerships and education in healthcare settings can improve vaccination rates and contribute to more holistic chronic disease management.

Primary care utilization in Bulgaria: some effects of the COVID-19 pandemic

Abstract Background Disruptions to primary care provision during the pandemic set back prior advancements in screening and chronic disease management. Delays in routine vaccination added to preexisting hesitancy and sustained the downward trend in vaccination rates. The study examines the magnitude and duration of primary care disruptions in Bulgaria between 2020 and 2022. Methods The impact of the pandemic on primary care is assessed using administrative data from the National Health Insurance Fund covering the annual number of primary care services. To evaluate the effect on healthcare utilization, the average number of check-ups per person during the pandemic is compared to a pre-pandemic period (2017-2019). Results After the onset of the pandemic, all visits declined significantly on an annual basis. In 2020, overall prophylactic check-ups dropped by 6-13% and remained lower than the baseline until 2022. Initial figures for 2023 suggest some recovery, while specific services are likely to experience an ongoing decrease. During the pandemic, the average number of prophylactic examinations for children fell between 6.9 and 9.3%. In 2022, there was a modest resumption, although these services did not reach the preceding levels. Adult prophylactic visits declined by approximately 10-12% between 2020 and 2021, but following a U-shaped pattern, they rebounded in 2022. Visits associated with chronic diseases experienced a drop of 7.8% in 2020 and continued to decrease in the next two years. Child vaccination was affected for a shorter period. In 2022, the coverage for most vaccine-preventable diseases was close to the pre-pandemic levels. However, the uptake of MMR and pneumococcal vaccines failed to demonstrate a clear path to recovery. Conclusions During the pandemic, a considerable drop in primary care utilization has been recorded. Effective recovery requires sustained service delivery and a rapid post-lockdown rebound to mitigate the negative impact on health outcomes. Key messages • Primary care needs additional recovery measures to prevent long-term harmful impacts on health outcomes. • Investing in service delivery innovations can boost resilience during disruptive events.

Impact of digital health literacy on public health: an umbrella review

Abstract Background Digital health literacy (DHL) is increasingly important for public health initiatives in the digital era. However, its impact on public health outcomes remains unclear. This umbrella review synthesizes evidence on relationships between DHL and public health. Methods Electronic databases were searched from 2010 to January 2024 for reviews evaluating associations between DHL and public health outcomes. Two independent reviewers screened records and extracted data. Results were narratively synthesized and screened respect quality using Amstrar 2 check list. Results 12 reviews met the inclusion criteria. Higher population DHL was consistently linked to positive health behaviors like preventive screening uptake, medical adherence, chronic disease management, and vaccination. However, lower DHL correlated with health disparities and exacerbated risk of mis/disinformation. DHL interventions improved eHealth skills and health status. Conclusions Digital Health Ltieracy shapes engagement with digital public health tools and programs. Integrating DHL assessments into planning can help identify at-risk groups and optimize interventions. Developing population DHL through education represents an avenue to advance health equity and resilience against digital health threats. However, more evidence and more digital maturity of tools appear to be necessary. Key messages • Digital Health Literacy as milestone of next health generation. • Health outcomes are clearly linked to digital and digital health literacy.

Predicting diabetes prognosis using machine learning techniques in a Hungarian clinical database

Abstract Background Chronic conditions such as type 2 diabetes mellitus have great impact on patients’ quality of life. Although clinical databases provide a perfect base for research aimed at improving diabetes care, analyzing such databases requires extensive pre-processing, mainly due to the large amount of unstructured data. Our study aimed to present the steps of generating a dataset from a large clinical database, and to apply machine learning-based analytical techniques regarding. Methods Data of the Clinical Center of University of Debrecen was used. To structure the unstructured data, regular expressions and natural language processing methods were used. The main machine learning models were as follows: Gradient Boosting Machines to predict the risk of complication development; Long Short-Term Memory Networks to forecast future health outcomes. All analysis and procedures were done using Python. Results The database contains approximately 1600 tables, with a total size of 1.9 terabytes, where the largest table is 21.07 gigabytes with approximately 44.64 million rows. The final dataset consisted of 40,332 patients. Most variables originate from the unstructured data, including complications and comorbidities of diabetes, as well as physical and laboratory parameters. Related to laboratory parameters, the number of measurements and the median value for every half-year were available. The diagnosis time of the complications’ occurrence is also presented. Machine learning methods were more accurate compared with traditional statistical methods in predicting the prognosis (p < 0.05). Discussion Our research highlights the importance of clinical data in chronic disease management. There are challenges in pre-processing and managing datasets, but machine learning-based methods are very efficient not only in extracting useful information from unstructured data but also in predicting the prognosis and identifying potential intervention points for better care. Key messages • Natural language processing can be used to obtain useful information from unstructured clinical data. • Using machine learning techniques on clinical data could improve diabates care.

Health literacy and individuals’ perception regarding Heart Failure management: patient perspective

Abstract Background Heart failure (HF) is a multidimensional disease that has a significant impact on the quality of life of people with this condition and the person’s level of health literacy is a key element in disease management. Therefore, this analysis aims to assess the correlation between the level of health literacy of people with HF and their level of concern about managing the disease, their perception about quality of life, and access to healthcare. Methods Cross-sectional study conducted through a survey among adults with HF, residents, and healthcare consumers in Portugal. The survey comprised 6 questions on health literacy (HLS-EU-Q6); 9 dimensions of concerns in HF management (4-level scale ranging from “not concerned” to “very concerned”); quality of life and access to healthcare perceptions (5-level scale ranging from “very bad” to “very good”). Concerns global score was calculated based on 9 dimensions of concerns about HF management. The statistical analysis included Spearman’s and Pearson’s correlations. Results A total of 428 responses were analysed. Respondents had a mean age of 70 years, 52.1% were men and 67.9% have secondary education. 47.0% of respondents perceived their access to healthcare as “good”, 63.3 % perceived their quality of life as “reasonable” and 61% have low levels of health literacy. Individuals with a higher health literacy level tended to have lower levels of concerns regarding HF management (r=-0.133; p = 0.006); individuals with a higher level of health literacy tended to have a better perception of their access to healthcare (ρ = 0.145; p = 0.003) and quality of life (ρ = 0.220; p < 0.001). Conclusions The findings reinforce that overcoming health literacy obstacles must continue to be a focus of healthcare systems and institutions to enhance healthcare access, quality of life, and chronic disease management. These efforts may result in better health outcomes, promote health equity and general well-being in this population. Key messages • Individuals with Heart Failure with higher levels of health literacy report less concerns about the management of their condition. • Individuals with Heart Failure and lower levels of health literacy have a worst perception of their access to healthcare and quality of life. Health literacy promotion must continue to be a priority.

Mapping patient pathways for NCDs from a policy perspective: a novel multinational initiative

Abstract Background Chronic diseases like CVD and DM pose global health challenges. Understanding patient pathways is vital for effective disease management and reducing morbidity and mortality. However, until now, comprehensive multinational mapping of patient pathways from a policy or regulatory perspective in the context of chronic disease has not been undertaken. Previous investigations into patient pathways mainly focused on the perspective of individual patients, assembling trajectories of those patients, but did not delve into how these pathways were designed. Methods Patient pathways for CVD and DM will be mapped across 11 countries: Belgium, Finland, France, Hungary, Iceland, Italy, Latvia, Poland, Romania, Slovenia, and Spain. Using a survey tool, detailed descriptions and diagrams of healthcare pathways will be collected, stratified by Kaiser Permanente health pyramid strata. Stakeholder interviews on policy and practice level will refine mappings and identify gaps in the policies. Results Preliminary findings reveal diverse healthcare trajectories and identified multiple gaps in disease management across countries. For many countries, a complete well-developed patient pathway was not found; instead, the pathways were rather fragmented and lacking for some strata of the health pyramid. These insights underscore the need for tailored interventions and enhanced care coordination to optimize continuity of care and patient outcomes. Conclusions Comprehensive patient pathway mapping offers a strategic framework to address gaps in chronic disease management. Our study emphasizes the importance of collaborative efforts in developing context-specific interventions and strengthening healthcare systems to improve public health outcomes. Key messages • Comprehensive patient pathway mapping reveals numerous gaps in global chronic disease management, prompting the need for enhanced strategies. • Collaborative efforts are key to addressing gaps in chronic disease care.

The role of cardiopulmonary rehabilitation in the recovery of right ventricular function and right ventricular-pulmonary artery coupling in convalescent COVID-19 patients

Abstract Introduction Coronavirus disease-19 (COVID-19) is predominantly a respiratory disease, but simultaneous cardiovascular impairment has been documented, even in the post-acute phase. Subclinical right ventricular (RV) dysfunction is often described and mainly attributed to parenchymal lung damage (ARDS) or pulmonary vascular complications such as pulmonary embolism. Cardiopulmonary rehabilitation programs play an integral part in the long-term management of chronic cardiovascular and pulmonary diseases and lately have been proven useful in managing post-COVID-19 sequelae. Purpose The aim of this study is to assess the impact of a post-COVID-19 rehabilitation program in the recovery of right ventricular function and right ventricular-pulmonary artery coupling in convalescent COVID-19 patients. Methods 40 convalescent COVID-19 patients were evaluated one and three months after the acute phase of the disease. 30 subjects participated in a 3-month cardiopulmonary rehabilitation program (study group) and 10 did not (control group). Right ventricular function echocardiographic parameters (right ventricular global longitudinal strain (RVGLS) and pulmonary artery systolic pressure (PASP)) were evaluated and right ventricular-arterial coupling (RVAC) was estimated via the RVGLS/PASP ratio. Results A total of 40 patients were included in this study, of whom 30 underwent cardiopulmonary rehabilitation. There were no major differences in the prevalence of cardiovascular risk factors between the two groups. When examining right ventricular parameters at baseline, RVGLS (Rehabilitation: -23.1 (4.1) % vs. No rehabilitation: -23.0 (4.7) %, p=0.94) and PASP (Rehabilitation: 28 (6) mmHg vs. No rehabilitation: 25 (4) mmHg, p=0.08) did not differ statistically between the two groups. RVAC was also similar at baseline (Rehabilitation: -0.96 (0.28) %/mmHg vs. No rehabilitation: -0.86 (0.27) %/mmHg, p=0.30). At follow-up, patients who underwent cardiopulmonary rehabilitation exhibited a significant improvement in RVGLS (from Τ0: -23.1 (4.2) % to T1: -24.3 (4) %, p<0.001), PASP (from T0: 28 (6) mmHg to T1: 27 (5) mmHg, p=0.016), and RVAC (from T0: -0.86 (0.27) %/mmHg to T1: -0.93 (0.26) %/mmHg, p<0.001). In the no rehabilitation group, RVGLS (from T0: -23.0 (4.7) % to T1: -23.2 (4.4) %, p=0.19), PASP (from T0: 25 (4) mmHg to T1: 25 (4) mmHg, p=0.17), and RVAC (from T0: -0.96 (0.28) %/mmHg to T1: -0.96 (0.27) %/mmHg, p=0.60) were not significantly altered at follow-up. We detected a statistically significant interaction of intervention with RVGLS (p=0.024) and RVAC (p=0.012) (Figure 1). Conclusion Subclinical right ventricular dysfunction is present in convalescent COVID-19 patients. Cardiopulmonary rehabilitation can accelerate the improvement of RVAC by mediating both the RV afterload reduction (PASP) and improving RV function.Figure 1

Awareness and perceptions of cardiologists towards systemic inflammation in atherosclerotic cardiovascular disease: A multi-national survey across 5 geographical regional sub-groups

Abstract Background Despite improvement in the management of atherosclerotic cardiovascular disease and chronic kidney disease (ASCVD+CKD), cardiovascular (CV) mortality remains unacceptably high. Evidence suggests that systemic inflammation (SI) is one of the key drivers for disease progression, yet clinical perceptions towards SI amongst cardiologists is poorly understood. Purpose FLAME-ASCVD (systemic inFLAMmation and rolE of hsCRP as a biomarker in AtheroSclerotic CardioVascular Disease) survey assessed cardiologist’s perceptions and awareness towards the role of SI and high sensitivity C-reactive protein (hsCRP) in patients (pts.) with ASCVD+CKD. Overall results were reported earlier1 and here we present results by sub-groups across 5 geographical regions. Methods This was a multinational, cross-sectional, online survey-based study conducted during March-May 2023. Eligible participants were cardiologists (interventional and general) who treated ≥15 ASCVD+CKD pts./month and practiced for ≥3 years. To minimize selection bias, specific study objective was not disclosed until eligibility criteria was met. An online questionnaire was used. Analysis included 5 sub-groups: Europe (EU: France, Germany, Italy, UK), Asia Pacific (AP: Australia, India), East Asia (EA: China, Japan), LatAm (LA: Brazil), Middle East (ME: Saudi Arabia). Descriptive statistics were used. Results Of the 1755 respondents, 602 eligible cardiologists (~60/country) completed the survey across the EU (n=241), AP (n=121), EA (n=120), LA (n=60), and ME (n=60). Hypertension, hyperlipidaemia, and lifestyle (diet/exercise) were consistently amongst the top 3-5 CV risk factors discussed with pts, across all regions. SI as a CV risk factor was discussed consistently less across regions (overall 10th at 43%, ³9th across regions, EU: 30%) (Table 1). Across regions, >70% of cardiologists acknowledged an intention to consider testing for SI, with the lowest being in the EU at 46%. Of those in the EU who did not consider testing, 53% (n=129) cited lack of medication as the reason. Across all regions, SI was consistently perceived as a risk factor for recurrent CV events (³65%) and residual inflammatory risk (47-85%), yet a noticeable proportion (52-92%) cardiologists acknowledged a need to learn more about SI in ASCVD+CKD (highest in ME, 92%). While overall (aided: 47% [n= 571]; unaided: 24%) considered hsCRP test for SI, few variations were observed (EA/AP/EU, aided: 55/52/33 and unaided: 22/24/03) (Table 2). Proven efficacy of hsCRP test, availability of medication for SI, and guideline recommendation were acknowledged as unmet needs to inform clinical care in ASCVD+CKD. Conclusion In this survey across regional sub-groups, discussion of SI as a CV risk factor was consistently low. Barring few noticeable variations in testing patterns in EU, perceptions towards SI were generally consistent. There is a need for better understanding and guidance on SI and hsCRP testing in practice.

Primary Care-Based Chronic Kidney Disease Management.

Primary Care-Based Chronic Kidney Disease Management.

Adapting a cultural dance program to prevent cognitive decline: insights from experts and educators

Abstract Leveraging activities such as cultural dance shows promise as an effective basis for chronic disease prevention and management with at-risk populations. In fact, recent WHO reports and resolutions advocate utilizing cultural context to achieve health equality. Hula, the Native Hawaiian indigenous dance has been successfully utilized in interventions with statistically significant improvement in medication resistant hypertension management and heart disease prevention. In this study, Alzheimer’s Disease and Related Dementia (ADRD) experts and kumu hula (hula experts and educators) provide insights to developing a hula-based lifestyle program for prevention of cognitive decline. Informant interviews were used to collect information for developing a hula-based program for individuals with mild cognitive impairment from 4 ADRD experts and clinicians, and 4 kumu hula. The 60-90 minute semi-structured interviews were conducted, recorded, then transcribed. Separate thematic analysis allowed distinct themes for each group to emerge. Themes with greatest between group alignment informed the adaptation of an existing hula-based chronic disease intervention. The clinical and cultural experts were unanimous on multiple themes. First, a hula-based program was well positioned to promote social functioning. Second, hula facilitated integrated multi-dimensional benefits including physical, cognitive, social, and cultural. Third, facilitating learning included: repetition done in creative forms; utilization of aids such as dance notation and audio recordings; and educational approaches such as project-based learning. Cultural activities such as dance have been underutilized in health promotion initiatives. A significant challenge in health promotion programs is engagement and retention of participants. Cultural dance programs are popular and can be effective interventions, particularly when both clinical and cultural experts are engaged in program development. Key messages • Inclusion of clinical and cultural experts in health promotion program development leads to unique collaboration and impactful insights. • ADRD clinicians and Hawaiian cultural dance educators identify social, cultural, physical, and cognitive benefits of hula as instrumental for individuals with mild cognitive impairment.

Who took care of patients with diabetes during the COVID-19-pandemic? A registry-based study

Abstract Background The rise of people with chronic diseases strains our healthcare system. Chronic disease management programs (CDMP) provide accessible care for patients with a chronic disease, aiming to prevent further development of the disease and avoid the need for (more costly and severe) hospital treatments. During the COVID-19 pandemic, CDMP provided at general practices (GP) for diabetic patients were downscaled. It remains unknown whether this downsizing led to increased care in other healthcare settings. We examined the changes in healthcare utilization by Dutch diabetic patients in 2020 and 2021 compared to 2019 regarding; 1) CDMP consultations, 2) hospital care for diabetes and 3) regular GP care. Methods In this retrospective observational study, data from electronic health records of GPs, participating in Nivel Primary Care Database, of 15,247 Dutch diabetic patients who were enrolled in CDMP, were linked to hospital claims data. Differences in healthcare utilization in 2020 and 2021 compared to 2019 were assessed quarterly using regression analyses. Results Results show that CDMP care was notably lower in 2020 and 2021, compared to 2019 (-35%). From Q1 2021 onwards, patients received more hospital care for diabetes (+13%) and regular GP care increased from Q3 2020 onwards (+14%). Compared to 2019, reduced CDMP contacts in 2020 were significantly associated (p = 0.001) with increased regular GP care in 2021. In the short-term, decreased CDMP in the first half of 2021 was significantly associated with increased regular GP care (p = 0.033) and hospital care (p = 0.037) in the second half of 2021. Conclusions Temporarily downscaling CDMP care during the COVID-19-pandemic was associated with increased hospital and regular GP care for diabetic patients. These findings contribute to making informed decisions regarding measures during future pandemics. Key messages • Chronic disease management programs at GPs appear to be effective in preventing disease exacerbations, and may help prevent (expensive) utilization of hospital care. • This research prompts further investigation into the desirability of CDMPs among patients, GPs, hospitals and policymakers, crucial for assessing undesirable healthcare shifts in diabetic patients.

Effectiveness of Internet + E-Coach chronic disease management on blood glucose, lipid levels, liver function, and quality of life in patients with chronic diabetic retinopathy: a comparative study

ObjectiveThis study aims to explore the effect of Internet + E-Coach chronic disease system intervention on fasting blood glucose (FPG), 2-hour postprandial blood glucose(2hPG), fasting serum insulin (FINS), triglyceride (TG), alanine transaminase (ALT) and quality of life in patients with chronic diabetic retinopathy.Methods208 patients with chronic diabetic retinopathy who were treated in the hospital from March 2021 to March 2023 are chosen and separated into two groups by random number Table 104 patients in the control group received routine continuous intervention, and the research group received Internet + E-Coach chronic disease system intervention. The cognition of disease related knowledge, blood related indicators inflammatory factor levels and improvement of life quality between the two groups before intervention, 6 and 12 months after intervention were compared.ResultsBefore the intervention, the comparison between the two groups in disease related knowledge scores, blood glucose, blood lipid, liver function indicators, inflammatory factor, and low vision quality of life scale (CLVQOL) scores was with P > 0.05. After 6 and 12 months of intervention, the research group had significantly higher scores for basic blood glucose intervention, healthy diet, reasonable exercise, and correct medication use compared to the control group (P < 0.05). FPG, 2hPG, TG and ALT in the research group were lower than those in the control group. FINS were higher in the control group, with P < 0.05. Interleukin-6 (IL-6), tumor necrosis factor (TNF-α), and hypersensitive C-reactive protein (Hs-CRP) in the research group were obviously lower than those in the control group (P < 0.05). The scores of far vision, movement and light perception, adjustment ability, reading and fine work, and daily living ability in the research group were higher than those in the control group, with P < 0.05.ConclusionThe intervention of Internet + E-Coach chronic disease system can improve the knowledge of chronic diabetic retinopathy patients about their own condition, stabilize the levels of blood sugar, blood lipid and liver function indicators, reduce the inflammatory reaction of the body, and improve the quality of life.

Right-Siting Care and Decongesting Specialist Outpatient Clinics - A Singapore Case Study

Abstract Issue Globally, Specialist Outpatient Clinics (SOCs) face a growing burden due to rising chronic diseases. This strain on resources leads to long appointment wait times (LAWTs), delaying diagnoses and treatments. This is particularly of concern in countries with rapidly ageing populations such as Singapore. Description The Right-Site Care Program is a healthcare transformation initiative implemented by individual healthcare clusters within Singapore to improve access to timely SOC care by directing patients to the most appropriate care level (right-siting). This transitions stable chronic disease patients to primary care providers (PCPs) for ongoing management. A standardised approach utilises evidence-based guidelines for patient selection, followed by identification and transfer of suitable patients to PCPs. This multi-center program offers a real-world example of healthcare system optimisation for chronic disease management. Results A multi-source data analysis, including program reports and peer-reviewed studies from participating healthcare clusters, was conducted to evaluate program impact. The analysis focused on LAWTs, patient outcomes and implementation challenges. Right-siting yielded mixed results across various conditions. Right-sited patients had better survival rates, likely due to closer monitoring and management of chronic conditions with higher total outpatient attendance frequencies. (1) Improvements were particularly significant for diabetes mellitus patients who successfully transitioned to PCPs. (2) However, challenges such as patient scepticism about PCP competence and a preference for specialist care have been identified. (3) Lessons learned Right-siting care can improve patient outcomes for certain chronic diseases. The program’s impact varied across different chronic diseases, highlighting the need for tailored strategies. Educational interventions addressing patient concerns can facilitate smoother patient transitions and program success. Key messages • Right-siting care shows promise, with improved patient outcomes for conditions like diabetes mellitus. • Patient education is crucial to overcome patient scepticism and preference for specialists.