Effective Chronic Disease Management Research Articles

Using Chronic Kidney Disease as a Model Framework to Estimate Healthcare-Related Environmental Impact.

While the economic and clinical burden of chronic diseases are well documented, their environmental impact remains poorly understood. We developed a framework to estimate the environmental impact of a disease care pathway using chronic kidney disease (CKD) as an example. A life cycle assessment framework was developed for the CKD care pathway and validated by experts. Life cycle stages were characterised for resource utilisation based on a literature review and ecoinvent database inputs, in ten countries. The ReCiPe impact assessment method was used to calculate impacts across multiple environmental dimensions. At CKD stage5, kidney replacement therapies (KRT) have highest impact; emissions ranged between 3.5 and 43.9kg carbon dioxide equivalents (CO2e) per session depending on dialysis modality, and 336-2022kgCO2e for kidney transplant surgery, depending on donor type. Hospitalisations have a substantial environmental impact: a 1-day intensive care stay had highest impact (66.4-143.6kgCO2e), followed by a 1-day hospital stay (28.8-63.9kgCO2e) and an 8-h emergency room visit (14.4-27.5kgCO2e). Patient transport to and from healthcare sites was a key driver of environmental impact for all life cycle stages, representing up to 99.5% of total CO2e emissions. Full care pathways should be analysed alongside specific healthcare processes. Application of this framework enables quantification of the environmental benefits of preventative medicine and effective management of chronic diseases. For CKD, early diagnosis, and proactive management to reduce the need for KRT and hospitalisations could improve patient outcomes and reduce environmental burden.

Self-Management Among People Living With Endometriosis: A Qualitative Study.

Self-management is pivotal for effective chronic disease management. However, this concept remains unexplored among people with endometriosis, who often experience chronic pain and significant impacts on their quality of life. This research explored participants' experience managing endometriosis and their understanding and integration of self-management into their lives. Inductive reflexive thematic analysis was used to analyze transcripts from 15 semi-structured interviews among people with endometriosis. The themes captured many aspects of self-management and included (1) perceptions of control, (2) engaging in self-management behaviors, (3) active decision-makers versus recipients of care, (4) establishing a patient-provider partnership, and (5) support is vital. The extent to which participants engaged in self-management varied, however, is consistent with self-management literature for other chronic conditions suggesting that there is a role for self-management among people living with endometriosis.

Enhancing Health Literacy and Self-Care Abilities among Individuals with Chronic Diseases

Health literacy is an essential element in the effective management of chronic diseases. It provides a foundation for individuals to understand, evaluate, and utilize health information, thus enabling them to make well-informed decisions regarding their care. For individuals living with chronic conditions such as diabetes, heart disease, and hypertension, health literacy is not just about understanding their health needs; it is about empowering them to manage their conditions effectively, make informed healthcare decisions, and maintain a higher quality of life. This writing explores the multidimensional relationship between health literacy and self-care abilities among people with chronic diseases, examining the factors affecting health literacy, its impact on self-care, strategies for improvement, and the pivotal role of health professionals in this context.

(Invited) Battery-Free Wearable and Implantable Electronics for Chronic Disease Management

60% of Americans live with at least one chronic disease. These diseases and their associated comorbidities are now the leading causes of death in the United States. The effective management of complex chronic diseases requires body-wide, long-term, accurate, and continuous monitoring of multiple physiological signals from wearable and implantable devices to precisely determine the pathological state. Wearable physiological signal monitoring can dramatically reduce the demand for physician visits and increase patients' engagement and treatment adherence rates. Specifically, battery-free wearables and implantable electronics reduce device volume and mechanical stiffness, significantly improving wear comfort, which is highly desirable for next-generation wearable and implantable electronics. However, battery-free wearables and implantable electronics still face many challenges, mainly wireless energy and data transfer. To address these challenges, my research has been involved in the exploration of rational system design concepts, material and device fabrication innovation, and tailored algorithms to enable smart battery-free wearables and implantable electronics targeting next-generation chronic disease management.Here, I would like to discuss two of my developed technology platforms to elaborate on the concept of battery-free wearable and implantable systems. First, I will describe an RFID-based body area sensor network technology platform. This technology uses electromagnetic waves and RF antennas as energy and data transmission media and has broad applications in sleep tracking, workout monitoring, chronic wound healing, and inflammation management. Second, I will describe a triboelectric transducer-based implantable battery-free device. This technology platform uses ultrasound waves and triboelectric transducers as energy and data transmission media and has broad applications in implantable sensing. Overall, the developed technology platforms can assess multiple health outcomes and treatment responses to various chronic diseases. Ultimately, this technology will help reduce the burden of chronic diseases, lower medical costs, and provide a better quality of life for patients. (1,2,3,4)

Study on the Impact of Exercise Prescription on Medical Insurance Cost Control

This study examines the role of exercise prescriptions in controlling medical insurance costs amidst the increasing prevalence of chronic diseases and rising healthcare expenses. Exercise prescriptions are customized physical activity plans issued by healthcare professionals that aim to improve health outcomes and reduce the financial burden on healthcare systems. Using a mixed-methods approach, this research combines quantitative data from electronic health records (EHRs) with qualitative insights from interviews and focus groups involving healthcare providers, patients, and insurance professionals. The quantitative analysis shows significant health improvements among patients with exercise prescriptions, including a 20% reduction in hospitalization rates and a 15% decrease in medication usage. The cost-benefit analysis suggests that the annual cost of implementing an exercise prescription program is approximately $150,000, whereas the resulting healthcare savings amount to $250,000, leading to a net saving of $100,000. Participants in these programs also see a 12% reduction in insurance premiums due to decreased healthcare utilization and improved health outcomes. Qualitative insights highlight better patient engagement, stronger provider-patient relationships, and perceived benefits like enhanced physical fitness and more effective chronic disease management. However, challenges such as limited resources and insufficient coverage for exercise prescription services are noted. Case studies from the United Kingdom and the United States affirm the cost-effectiveness of exercise prescriptions, displaying significant health benefits and financial savings. The study concludes that exercise prescriptions are a cost-effective strategy for managing chronic diseases and reducing healthcare costs. It recommends integrating exercise prescriptions into routine clinical practice and supporting their adoption through strategic policies and incentives, paving the way for substantial health and economic gains for healthcare systems. Further research should investigate the long-term effects and ways to improve patient adherence to exercise prescriptions.

Addressing Thalassaemia Management from Patients' Perspectives: An International Collaborative Assessment.

Background and Objectives: The effective management of chronic diseases, particularly hereditary and rare diseases and thalassaemia, is an important indicator of the quality of healthcare systems. We aimed to assess healthcare services in different countries for thalassaemia patients by using publicly available health indicators and by surveying thalassaemia patients and their caregivers. Materials and Methods: We reviewed official worldwide databases from the WHO, World Bank, and scientific resources, and we used a structured patient-tailored self-completed questionnaire to survey thalassaemia patients and their caregivers in 2023. Results: A total of 2082 participants were surveyed (mean age, 27 years; males, 42%). About 1 in 4 respondents did not complete high-school education, while 24% had a bachelor's degree. About a third of respondents were married and were in either full- or part-time employment. The vast majority (~80%) had initiated transfusion therapy between 1 and 4 years of age. Only 42% reported no delays in receiving blood transfusion, while 47% reported occasional delays and 8% serious delays. About half of patients reported being very satisfied (11%) or satisfied (38%) with the quality of services provided, while 1 in 3 patients reported being unsatisfied or very unsatisfied, and that their access to treatment was difficult or very difficult due to traveling expenses and the high cost of treatment. Conclusions: Important improvements in the care of thalassaemia patients have been documented during the past few decades. Nevertheless, additional focus is required through national healthcare systems to effectively address the many unmet needs revealed by our recent survey, as well as to achieve satisfactory patient outcomes.

Assessment and Risk Prediction of Chronic Kidney Disease and Kidney Fibrosis Using Non-Invasive Biomarkers.

Effective management of chronic kidney disease (CKD), a major health problem worldwide, requires accurate and timely diagnosis, prognosis of progression, assessment of therapeutic efficacy, and, ideally, prediction of drug response. Multiple biomarkers and algorithms for evaluating specific aspects of CKD have been proposed in the literature, many of which are based on a small number of samples. Based on the evidence presented in relevant studies, a comprehensive overview of the different biomarkers applicable for clinical implementation is lacking. This review aims to compile information on the non-invasive diagnostic, prognostic, and predictive biomarkers currently available for the management of CKD and provide guidance on the application of these biomarkers. We specifically focus on biomarkers that have demonstrated added value in prospective studies or those based on prospectively collected samples including at least 100 subjects. Published data demonstrate that several valid non-invasive biomarkers of potential value in the management of CKD are currently available.

Machine learning framework to extract the biomarker potential of plasma IgG N-glycans towards disease risk stratification

Effective management of chronic diseases and cancer can greatly benefit from disease-specific biomarkers that enable informative screening and timely diagnosis. IgG N-glycans found in human plasma have the potential to be minimally invasive disease-specific biomarkers for all stages of disease development due to their plasticity in response to various genetic and environmental stimuli. Data analysis and machine learning (ML) approaches can assist in harnessing the potential of IgG glycomics towards biomarker discovery and the development of reliable predictive tools for disease screening. This study proposes an ML-based N-glycomic analysis framework that can be employed to build, optimise, and evaluate multiple ML pipelines to stratify patients based on disease risk in an interpretable manner. To design and test this framework, a published colorectal cancer (CRC) dataset from the Study of Colorectal Cancer in Scotland (SOCCS) cohort (1999–2006) was used. In particular, among the different pipelines tested, an XGBoost-based ML pipeline, which was tuned using multi-objective optimisation, calibrated using an inductive Venn-Abers predictor (IVAP), and evaluated via a nested cross-validation (NCV) scheme, achieved a mean area under the Receiver Operating Characteristic Curve (AUC-ROC) of 0.771 when classifying between age-, and sex-matched healthy controls and CRC patients. This performance suggests the potential of using the relative abundance of IgG N-glycans to define populations at elevated CRC risk who merit investigation or surveillance. Finally, the IgG N-glycans that highly impact CRC classification decisions were identified using a global model-agnostic interpretability technique, namely Accumulated Local Effects (ALE). We envision that open-source computational frameworks, such as the one presented herein, will be useful in supporting the translation of glycan-based biomarkers into clinical applications.

Effect of motivated physicians and elderly patients with hypertension or type 2 diabetes mellitus in prepared communities on health behaviours and outcomes: A population-based PS matched retrospective cohort study during five-year follow-up period.

Effective chronic disease management requires the active participation of patients, communities, and physicians. The objective of this study was to estimate the effectiveness of the Community-based Registration and Management for elderly patients with Hypertension or Type 2 Diabetes mellitus Project (CRMHDP) by using motivated primary care physicians and patients supported by prepared communities, to utilise healthcare and health outcomes in four cities in South Korea. We conducted a propensity score-matched retrospective cohort study using 2010-2011 as the baseline years, alongside a follow-up period until 2015/2016, based on the Korean National Health Insurance database. Both a CRMHDP group (n = 46,865) and a control group (n = 93,730) were applied against healthcare utilisation and difference-in-differences estimations were performed. For the health outcome analysis, the intervention group (n = 27,242) and control group (n = 54,484) were analysed using the Kaplan-Meier method and Cox proportional hazard regression. Results: The difference-in-differences estimation of the average annual clinic visits per person and the average annual days covered were 1.26 (95% confidence interval, 1.13-1.39) and 22.97 (95% CI, 20.91-25.03), respectively, between the intervention and control groups. The adjusted hazard ratio for death in the intervention group, compared to the control group, was 0.90 (95% CI, 0.86-0.93). For stroke and chronic renal failure, the adjusted hazard ratios for the intervention group compared to the control group were 0.94 (95% CI, 0.88-0.99) and 0.80 (95% CI 0.73-0.89), respectively. Our study suggests that for effective chronic disease management both elderly patients and physicians need to be motivated by community support.

Inter-relationships between cardiovascular, renal and metabolic diseases: Underlying evidence and implications for integrated interdisciplinary care and management.

Cardiovascular, renal and metabolic (CaReMe) diseases are individually among the leading global causes of death, and each is associated with substantial morbidity and mortality. However, as these conditions commonly coexist in the same patient, the individual risk of mortality and morbidity is further compounded, leading to a considerable healthcare burden. A number of pathophysiological pathways are common to diseases of the CaReMe spectrum, including neurohormonal dysfunction, visceral adiposity and insulin resistance, oxidative stress and systemic inflammation. Because of the shared pathology and common co-occurrence of the CaReMe diseases, the value of managing these conditions holistically is increasingly being realized. A number of pharmacological and non-pharmacological approaches have been shown to offer simultaneous metabolic, cardioprotective and renoprotective benefits, leading to improved patient outcomes across the CaReMe spectrum. In addition, increasing value is being placed on interdisciplinary team-based and coordinated care models built on greater integration between specialties to increase the rate of early diagnosis and adherence to practice guidelines, and improve clinical outcomes. This interdisciplinary approach also facilitates integration between primary and specialty care, improving the patient experience, optimizing resources, and leading to efficiencies and cost savings. As the burden of CaReMe diseases continues to increase, implementation of innovative and integrated care delivery models will be essential to achieve effective and efficient chronic disease management and to ensure that patients benefit from the best care available across all three disciplines.

A Nationwide Chronic Disease Management Solution via Clinical Decision Support Services: Software Development and Real-Life Implementation Report.

The increasing population of older adults has led to a rise in the demand for health care services, with chronic diseases being a major burden. Person-centered integrated care is required to address these challenges; hence, the Turkish Ministry of Health has initiated strategies to implement an integrated health care model for chronic disease management. We aim to present the design, development, nationwide implementation, and initial performance results of the national Disease Management Platform (DMP). This paper's objective is to present the design decisions taken and technical solutions provided to ensure successful nationwide implementation by addressing several challenges, including interoperability with existing IT systems, integration with clinical workflow, enabling transition of care, ease of use by health care professionals, scalability, high performance, and adaptability. The DMP is implemented as an integrated care solution that heavily uses clinical decision support services to coordinate effective screening and management of chronic diseases in adherence to evidence-based clinical guidelines and, hence, to increase the quality of health care delivery. The DMP is designed and implemented to be easily integrated with the existing regional and national health IT systems via conformance to international health IT standards, such as Health Level Seven Fast Healthcare Interoperability Resources. A repeatable cocreation strategy has been used to design and develop new disease modules to ensure extensibility while ensuring ease of use and seamless integration into the regular clinical workflow during patient encounters. The DMP is horizontally scalable in case of high load to ensure high performance. As of September 2023, the DMP has been used by 25,568 health professionals to perform 73,715,269 encounters for 16,058,904 unique citizens. It has been used to screen and monitor chronic diseases such as obesity, cardiovascular risk, diabetes, and hypertension, resulting in the diagnosis of 3,545,573 patients with obesity, 534,423 patients with high cardiovascular risk, 490,346 patients with diabetes, and 144,768 patients with hypertension. It has been demonstrated that the platform can scale horizontally and efficiently provides services to thousands of family medicine practitioners without performance problems. The system seamlessly interoperates with existing health IT solutions and runs as a part of the clinical workflow of physicians at the point of care. By automatically accessing and processing patient data from various sources to provide personalized care plan guidance, it maximizes the effect of evidence-based decision support services by seamless integration with point-of-care electronic health record systems. As the system is built on international code systems and standards, adaptation and deployment to additional regional and national settings become easily possible. The nationwide DMP as an integrated care solution has been operational since January 2020, coordinating effective screening and management of chronic diseases in adherence to evidence-based clinical guidelines.

Tools for self- or peer-assessment of interprofessional competencies of healthcare students: a scoping review.

Healthcare professionals are expected to demonstrate competence in the effective management of chronic disease and long-term health and rehabilitation needs. Care provided by groups of collaborating professionals is currently well recognized as a more effective way to support people living with these conditions than routine, single-profession clinical encounters. Clinical learning contexts provide hands-on opportunities to develop the interprofessional competencies essential for health professional students in training; however, suitable assessment tools are needed to support student attainment of interprofessional competencies with self-assessment espoused as an important component of learning. A structured approach was taken to locate and review existing tools used for the self-assessment and peer assessment of students' competencies relevant to interprofessional practice. A range of self- and/or peer assessment approaches are available, including formally structured tools and less structured processes inclusive of focus groups and reflection. The identified tools will usefully inform discussion regarding interprofessional competency self- and peer assessment options by healthcare students participating in a broad range of clinical learning contexts. Self- and/or peer assessment is a useful approach for those seeking to effectively enhance interprofessional learning and measure the attainment of related competencies.

Batteryless implantable device with built-in mechanical clock for automated and precisely timed drug administration.

Adherence to medication plays a crucial role in the effective management of chronic diseases. However, patients often miss their scheduled drug administrations, resulting in suboptimal disease control. Therefore, we propose an implantable device enabled with automated and precisely timed drug administration. Our device incorporates a built-in mechanical clock movement to utilize a clockwork mechanism, i.e., a periodic turn of the hour axis, enabling automatic drug infusion at precise 12-h intervals. The actuation principle relies on the sophisticated design of the device, where the rotational movement of the hour axis is converted into potential mechanical energy and is abruptly released at the exact moment for drug administration. The clock movement can be charged either automatically by mechanical agitations or manually by winding the crown, while the device remains implanted, thereby enabling the device to be used permanently without the need for batteries. When tested using metoprolol, an antihypertensive drug, in a spontaneously hypertensive animal model, the implanted device can deliver drug automatically at precise 12-h intervals without the need for further attention, leading to similarly effective blood pressure control and ultimately, prevention of ventricular hypertrophy as compared with scheduled drug administrations. These findings suggest that our device is a promising alternative to conventional methods for complex drug administration.

Point-of-care testing of four chronic disease biomarkers in blood based on a low cost and low system complexity microfluidic chip with integrated oxygen-sensitive membrane

Point-of-care testing (POCT) of multiple chronic disease biomarkers is crucial for effective prevention and management of chronic diseases. Here, we developed a sensing platform based on microfluidics chip and oxygen-sensitive membrane (OSM), which utilized enzymatic oxygen consumption and OSM based signal conversion for portable detection of glucose, total cholesterol, uric acid, and triglyceride in blood. Their detection limits were 0.04 mM, 0.07 mM, 0.01 mM, and 0.05 mM, respectively, meeting clinical requirements. To avoid the reliance on laboratory equipment, a handheld mini centrifuge modified from a toy fan was developed for plasma separation and a smartphone was used for signal acquisition. In addition, signal conversion based OSM simplified reagent composition. Dry storage of reagents on the chip simplified operations and improved the stability of reagents. For chronic disease biomarkers in blood, the results obtained by our chips were consistent with commercial kits. We believe that this sensitive, low-cost, equipment-free sensing platform has a significant potential in self-management of chronic diseases.

Causal Paradigm Between Common Comorbidities of Cardiovascular and Metabolism-Related Diseases in Elderly: Evidence from Cross-Sectional and Mendelian Randomization Studies.

Comorbidity is a common problem among elderly people, significantly damaging individuals' health and healthcare systems. However, observational studies may be susceptible to residual confounding factors and bias. The present study aimed to assess the causal effect of common chronic disease comorbidity using the Mendelian randomization (MR) approach. Data for the present study were obtained from a community survey conducted between 2018 and 2020 in four counties in Ganzhou City, southern China. A cross-sectional survey was conducted using a multi-stage stratified random sampling method. A total of 1756 valid questionnaires were collected to analyze common chronic disease comorbidities. Genetic variants associated with hypertension, diabetes, stroke, and hyperlipidemia-related factors were selected as instrumental variables for univariate and multivariate MR analyses. The self-reported prevalence of chronic disease in the older adult population in Southern China was 68.1%, with hypertension (46.1%), diabetes (10.5%), and hyperlipidemia (8.5%) being the three most common conditions. The prevalence of chronic disease comorbidity was 20.7% among the 12 chronic diseases studied. Hypertension was identified as a predictor of diabetes (OR [95% CI]: 1.114 [1.049, 1.184], p < 0.001), and diabetes mellitus was equally identified as a risk factor for hypertension (OR [95% CI]: 1.118 [1.069, 1.187], p < 0.001). Furthermore, high triglyceride levels were identified as a risk factor for hypertension (OR [95% CI]: 1.262 [1.129, 1.411], p < 0.001). In contrast to intracranial hemorrhages, hypertension had a significant impact on ischemic stroke (OR [95% CI]: 1.299 [1.161, 1.454], p < 0.001). The causal association between multiple cardiovascular and metabolism-related diseases is mediated by hypertension, with a bidirectional cause-and-effect relationship between hypertension and diabetes. Hypertension is a risk factor for ischemic stroke, and the hyperlipidemia-related factor triglycerides (TG) influence hypertension. Therefore, prioritizing hypertension prevention and control in the elderly is critical for effective chronic disease management.

The contribution of nursing expertise to the management of complex comorbidities in internal medicine setting: a systematic review

The burden of comorbidities is on the rise, and nursing has long been recognized as having a crucial role in assisting individuals to manage long-term conditions. Over the past ten years, a growing number of chronic disease delivery models have given nurses great opportunities to develop roles and abilities focused on effective chronic disease management. We have conducted both electronic and manual searches within the potential databases to find relevant studies. Studies from the years 2010-2023 were included. Case reports with limited sample sizes, no descriptive statistics, review papers, and meta-analyses were excluded from this review. A quality assessment for all included studies was performed. Final inclusion resulted in a total of eight studies. Cardiovascular diseases, hypertension, and diabetes were the comorbidities reported by the majority of the studies, while chronic obstructive pulmonary disease, end-stage renal disease, and metastatic cancer were reported by each study. Overall, the findings suggest that nurses play a significant role in the management of comorbidities among patients, further improving patient outcomes, reducing readmissions and hospital costs, and preventing complications. The care of patients with complicated medical and social needs is coordinated through the employment of a wide range of interventions in an internal medicine setting. Nurse-led interventions /programs can play a vital part in reducing the burden of rising comorbidities among patients. However, the role of nurses in the internal medicine setting needs to be highlighted further by evidence-based research.

(Invited) smart Wearable Electronics for Chronic Disease Management

60% of Americans live with at least one chronic disease. These diseases and associated comorbidities are now the leading causes of death in the United States. Effective management of complex chronic diseases requires body-wide, long-term, accurate, and continuous monitoring of multiple physiological signals from wearable devices to precisely determine the pathological state. These wearable physiological signal monitoring can dramatically reduce the demand of physician visiting and increase patients’ engagement and treatment adherence rate. Although wearable bioelectronic devices have shown huge potential in chronic disease management, existing technology still mostly relies on rigid chip components, where the interface between chips and skin/tissue has been a bottleneck that limits the system performance (noise, robustness etc). To address these challenges, my research has been involved in the exploration of rational system design concepts, material and device fabrication innovation, and tailored algorithms to enable smart wearable electronics that targets next-generation chronic disease management.Here I would like to discuss two of my developed technology platforms to elaborate the concept of smart wearables. First, I will describe a body area sensor network technology platform. In the system design concept side, this technology utilizes a novel wireless hybridization strategy and an unconventional detuned RFID working regime that provide an ideal skin interface. In the material/device side, this system integrates several skin-conforming polymer-based soft devices (ring oscillators, RF diodes, antennas, transistors etc.) as an integrated soft multimode sensing sticker. (1,2) Next, I will describe a wireless closed-loop smart bandage that can accelerate and monitor the wound healing process. (3) Such smart bandage also integrates new design concepts (wireless, battery-free design that combines both sensing and stimulation), novel materials (low-impedance, high-toughness, and tunable adhesion hydrogel as skin interface) and closed-loop control algorithms. Overall, the developed technology platform could assess multiple health outcomes and treatment responses to various chronic diseases. Ultimately, this technology will help to reduce chronic disease burden, lower medical costs, and provide a better quality of life for patients.

Recognizing and Tackling Inhaler Technique Decay in Asthma and Chronic Obstructive Pulmonary Disesase (COPD) Clinical Practice.

A poor inhaler technique continues to represent a substantial barrier to effective asthma and chronic obstructive pulmonary disease management. It can result in perceived lack of treatment effectiveness even with apparent adherence to a prescribed regimen of inhaled maintenance therapies, potentially resulting in an unnecessary change or escalation of treatment. Many patients are not trained to inhaler mastery in real-world practice; furthermore, even where mastery is initially achieved, an ongoing assessment and education are seldom maintained. In this review, we present an overview of the evidence for deterioration of the inhaler technique over time after training, investigate the factors that contribute to this deterioration, and explore innovative approaches to addressing the problem. We also propose steps forward drawn from the literature and our clinical insights.

Prevalence and determinants of depression among community- dwelling older adults with chronic diseases

The older population continues to grow globally, and data related to the prevalence of depressive symptoms among this population in Malaysia is scarce. Thus, this study aimed to determine the prevalence and determinants of depression symptoms among community-dwelling older adults in Malaysia. A cross-sectional study was conducted among 220 outpatients with chronic diseases. The level of depression was operationalized using the Malay version of the Geriatric Depression Scale. The prevalence of depression among community-dwelling older adults was 16.4%. Female (OR =8.86, 95% CI=1.10–7.53, p=0.03), Chinese ethnic group (OR=4.73, 95% CI= 1.04– 21.48, p=0.04), multimorbidity (OR=3.36, 95% CI=1.07–12.60, p=0.04) and presence of pain (OR=6.67, 95% CI=2.41–18.45, p&amp;lt;0.01) were associated to depressive symptoms. However, higher resilience was associated with lower risk of depressive symptoms in this population (OR=0.88, 95% CI=0.88–0.93, p&amp;lt;0.01). The prevalence of depressive symptoms among older adults with chronic diseases is higher than in previous data. Early identification of depression in this population is crucial for effective chronic disease management.

Provider and Patient Experiences of Delays in Primary Care During the Early COVID-19 Pandemic.

The necessary suspension of nonacute services by healthcare systems early in the COVID-19 pandemic was predicted to cause delays in routine care in the United States, with potentially serious consequences for chronic disease management. However, limited work has examined provider or patient perspectives about care delays and their implications for care quality in future healthcare emergencies. This study explores primary care provider (PCP) and patient experiences with healthcare delays during the COVID-19 pandemic. PCPs and patients were recruited from four large healthcare systems in three states. Participants underwent semistructured interviews asking about their experiences with primary care and telemedicine. Data were analyzed using interpretive description. Twenty-one PCPs and 65 patients participated in interviews. Four main topics were identified: (1) types of care delayed, (2) causes for delays, (3) miscommunication contributing to delays, and (4) patient solutions to unmet care needs. Both patients and providers reported delays in preventive and routine care early in the pandemic, driven by healthcare system changes and patient concerns about infection risk. Primary care practices should develop plans for care continuity and consider new strategies for assessing care quality for effective chronic disease management in future healthcare system disruptions.