Management Of Long-term Conditions Research Articles

Health and wellness could revolutionise our management of long-term neurological conditions

Health and wellness could revolutionise our management of long-term neurological conditions

The role of collective efficacy in long-term condition management: A metasynthesis.

Social networks have been found to have a valuable role in supporting the management of long‐term conditions. However, the focus on the quality and how well self‐management interventions work focus on individualised behavioural outcomes such as self‐efficacy and there is a need for understanding that focuses on the role of wider collective processes in self‐management support. Collective efficacy presents a potentially useful candidate concept in the development and understanding of self‐management support interventions. To date it has mainly been utilised in the context of organisations and neighbourhoods related to social phenomena such as community cohesion. Drawing on Bandura's original theorisation this meta‐synthesis explores how studies of collective efficacy might illuminate collective elements operating within the personal communities of people with long‐term conditions. A qualitative meta‐synthesis was undertaken. Studies published between 1998 and 2018 that examined collective efficacy in relation to health and well‐being using qualitative and mixed methods was eligible for inclusion. Timing of engagement with others, building trust in the group, and legitimising ongoing engagement with the group arised as central elements of collective efficacy. The two themes forming third order constructs were related to the presence of continuous interaction and ongoing relational work between members of the group. Collective efficacy can develop and be sustained over time in a range of situations where individuals may not have intense relationships with one another and have limited commitment and contact with one another. Extending this to the personal communities of people with long‐term conditions it may be the case that collective efficacy enables a number of engagement opportunities which can be oriented towards assisting with support from networks over a sustained length of time. This may include negotiating acceptable connections to resources and activities which in turn may help change existing practice in ways that improve long‐term condition management.

Life after QOF

Life after QOF

The impact of a combinatorial digital and organisational intervention on the management of long-term conditions in UK primary care: a non-randomised evaluation

BackgroundBetter management of long-term conditions remains a policy priority, with a focus on improving outcomes and reducing use of expensive hospital services. A number of interventions have been tested, but many have failed to show benefit in rigorous comparative research. In 2016, the NHS Test Beds scheme was launched to implement and test interventions combining digital technologies and pathway redesign in routine health care settings, with each intervention comprising multiple innovations to better realise benefit from their ‘combinatorial’ effect. We present the evaluation of one of the NHS Test Beds, which combined risk stratification algorithms, practice-based quality improvement and health monitoring and coaching to improve management of long-term conditions in a single health economy in the north-west of England.MethodsThe NHS Test Bed was implemented in one clinical commissioning group in the north-west of England (patient population 235,800 served by 36 general practices). Routine administrative data on hospital use (the primary outcome) and a selection of secondary outcomes (data from both hospital and primary care) were collected in the intervention site, and from a comparator area in the same region. We used difference-in-differences analysis to compare outcomes in the NHS Test Bed area and the comparator after initiation of the combinatorial intervention.ResultsTests confirmed the existence of parallel trends in the intervention and comparator sites for hospital outcomes for the period April 2016 to March 2017, and for some of the planned primary care outcomes. Based on 10 months of post-intervention secondary care data and 13 months post-intervention primary care data, we found no significant impact on primary outcomes between the intervention and comparator site, and a significant impact on only one secondary outcome.ConclusionA combinatorial digital and organisational intervention to improve the management of long-term conditions was implemented across a whole health economy, but we found no evidence of a positive impact on health care utilisation outcomes in hospital and primary care.

Flare to care – future management of long-term conditions

To promote citizens with long-term conditions as authors of their own health data and competent self-managers supported by specialist clinical guidance that is tailored to their situation through a novel technology-driven management solution. Through close collaborative working with patients, clinical commissioning groups and demand for an out-of-hospital experience, the inflammatory bowel disease (IBD) service at East Surrey Hospital (ESH) was radically redesigned. In 2014, a new model of care that put patients at the centre of the care pathway and opened access to all patients with IBD through telephone and email support enabled citizens …

Physical activity maintenance and digital health interventions in people with rheumatoid arthritis: a qualitative study

Purpose: Physical Activity (PA) improves function and health in people with Rheumatoid Arthritis (RA) and is recommended in clinical management guidelines. However, people with RA frequently do not meet PA recommendations. Allied health professionals (HCPs) are well placed to support PA participation but limited resources and increasing demand mean that novel ways to increase PA are needed. Digital Health interventions (DHI) are behaviour change interventions delivered through digital media, combining decision and/or emotional support with health information. DHIs are increasingly used in the management of long-term conditions (e.g. obesity management), however, their application to support PA maintenance in RA is in its infancy. Understanding the views of potential users and their HCPs is important to ensure the acceptability of DHIs. Therefore, this study aims to explore patients with RA and HCPs’ perceptions of the factors that influence PA maintenance and their views on the use of DHIs to support PA maintenance.

Preconception counselling

A woman’s health in the preconception period is important to ensure a healthy pregnancy and to support the wellbeing of her child. Encouraging positive behaviour change can help to establish a balanced lifestyle for a woman and her family. The first half of this article will cover the initial assessment and general advice that applies to all women who are planning a pregnancy. The second half will explore the preconceptual management of long-term health conditions, and will describe the relevance of genetic risk assessment in pre-pregnancy counselling.

Person-centred care in the physiotherapeutic management of long-term conditions: a critical review of components, barriers and facilitators

This is a pre-copyedited, peer-reviewed version of the following article Dukhu, S., Purcell, C. & Bulley, C. (2018) Person-centred care in the physiotherapeutic management of long-term conditions: a critical review of components, barriers and facilitators. International Practice Development Journal, 8 (2), [Article 2], which has been published in final form at https://doi.org/10.19043/ipdj.82.002 in the International Journal of Practice Development.

Shared decision making and experiences of patients with long-term conditions: has anything changed?

BackgroundMedication problems among patients with long-term conditions (LTCs) are well documented. Measures to support LTC management include: medicine optimisation services by community pharmacists such as the Medicine Use Review (MUR) service in England, implementation of shared decision making (SDM), and the availability of rapid access clinics in primary care. This study aimed to investigate the experience of patients with LTCs about SDM including medication counselling and their awareness of community pharmacy medication review services.MethodsA mixed research method with a purposive sampling strategy to recruit patients was used. The quantitative phase involved two surveys, each requiring a sample size of 319. The first was related to SDM experience and the second to medication counselling at discharge. Patients were recruited from medical wards at St. George’s and Croydon University Hospitals.The qualitative phase involved semi-structured interviews with 18 respiratory patients attending a community rapid access clinic. Interviews were audio-recorded and transcribed verbatim. Thematic analysis using inductive/deductive approaches was employed. Survey results were analysed using descriptive statistics.ResultsThe response rate for surveys 1 and 2 survey was 79% (n = 357/450) and 68.5% (240/350) respectively. Survey 1 showed that although 70% of patients had changes made to their medications, only 40% were consulted about them and two-thirds (62.2%) wanted to be involved in SDM. In survey 2, 37.5% of patients thought that medication counselling could be improved. Most patients (88.8%) were interested in receiving the MUR service; however 83% were not aware of it. The majority (57.9%) were interested in receiving their discharge medications from community pharmacies. The interviews generated three themes; lack of patient-centered care and SDM, minimal medication counselling provided and lack of awareness about the MUR service.ConclusionAlthough patients wanted to take part in SDM, yet SDM and medication counselling are not optimally provided. Patients were interested in the MUR service; however there was lack of awareness and referral for this service. The results propose community pharmacy as a new care pathway for medication supply and counselling post discharge. This promotes a change of health policy whereby community-based services are used to enhance the performance of acute hospitals.

Building the patient–clinician relationship through conversation based on narrative approaches

Building the patient–clinician relationship through conversation based on narrative approaches

Parents' and Health Professionals' Views of Collaboration in the Management of Childhood Long-term Conditions

PurposeTo explore how parents and health professionals view the concept and practice of collaboration in the management of childhood long-term conditions. Designs and MethodsA qualitative research approach was adopted; sixteen parents and six health professionals participated in either individual or group interviews. Data analysis was underpinned by the Framework approach and involved an iterative process of reading the transcribed data, identifying and refining key themes until a coherent picture emerged. ResultsTwo main concepts were identified: expectations of collaboration and mechanisms for collaboration. Health professionals' expectations of collaborative practice were influenced by their knowledge, experience and relative objectivity. They used relationship building with families as a key strategy for collaboration. Parents' expectations of collaboration varied and appeared to be influenced by their experience of living with their child's condition. Parents' needs were often unmet, particularly in relation to support with coordinating or accessing care on behalf of their child. Parents' strategies included resilience, assertiveness, determination and battling for what they needed. ConclusionParents and professionals valued collaboration as a concept but differed in their expectations of collaborative practice and adopted different mechanisms to foster meaningful collaboration. A better understanding of the unique needs and experiences of parents of a child with a long-term condition is key to developing positive collaborative practice. Practice ImplicationsCollaborative practice could be enhanced by health professionals' being more responsive to the full range of parent support needs, and being more pro-active about helping them work with the complexities of care systems.

Putting function first: redesigning the primary care management of long-term conditions.

Long-term conditions comprise the biggest burden on the NHS, involving more than half of all GP consultations, 65% of out-patient visits, and 70% of inpatient bed days.1 Their prevalence rises with age, affecting 50% of people by the age of 50 years and 80% by the age of 65 years. As older people accumulate more long-term conditions, they become increasingly frail and are at higher risk of falls, disability, admission to hospital, and the need for long-term care. In order to address this burden, a revolution is needed in their primary care management. Physical capability, or ‘physical functioning’, describes an individual’s capacity to undertake physical tasks of everyday living. Care and support are needed when a person is no longer able to manage tasks such as washing, dressing, and feeding. Indeed, failure to get to the toilet on time is a frequent reason for admission to residential care.2 Maintaining physical function is one of the most important factors for quality of life among older adults and a central goal for all people with long-term conditions. Physical inactivity is one of the strongest predictors of physical disability in older people, and physically active people have better levels of physical and psychosocial functioning. Although normal ageing leads to a decline in physical fitness, this decline is much worse if a person has a sedentary occupation or lifestyle. However, the detrimental effects of prolonged sitting on mortality can be ameliorated by 60–75 minutes of moderate-intensity physical activity per day, …

Re-imagining the role of the physiotherapist when managing people with long-term conditions

ABSTRACTThe rising prevalence of long-term conditions (LTCs) is placing increasing pressures on healthcare systems. With the future prospect that more individuals will experience multiple comorbidities, LTCs are becoming a growing concern. This article aims to discuss the challenges faced by and the opportunities afforded to physiotherapists when caring for people with LTCs. It highlights the complexity of managing people with LTCs and the demands faced by physiotherapists when working within a transitioning healthcare service that necessitates cost-effective yet, sustainable care. It considers ways that interventions can be optimized to not only support individuals with LTCs to improve their quality of life, but live an existence that has meaning and purpose. It also explores health promotion strategies that could be influential in changing the future healthcare landscape, by helping to prevent the occurrence of LTCs. The wider intention is to facilitate discussion of the future role of the physiotherapy profession in LTC management, in the hope that a shared vision can be created that is inspiring and transformative. A vision that imagines a physiotherapy service that is resilient to change and contemporary in approach, which continues to evolve to support the changing needs of people with LTCs.

Long-term condition management in adults with intellectual disability in primary care: a systematic review.

BackgroundAdults with intellectual disabilities have higher morbidity and earlier mortality than the general population. Access to primary health care is lower, despite a higher prevalence of many long-term conditions.AimTo synthesise the evidence for the management of long-term conditions in adults with intellectual disabilities and identify barriers and facilitators to management in primary care.Design & settingMixed-methods systematic review.MethodSeven electronic databases were searched to identify both quantitative and qualitative studies concerning identification and management of long-term conditions in adults with intellectual disability in primary care. Both the screening of titles, abstracts, and full texts, and the quality assessment were carried out in duplicate. Findings were combined in a narrative synthesis.ResultsFifty-two studies were identified. Adults with intellectual disabilities are less likely than the general population to receive screening and health promotion interventions. Annual health checks may improve screening, identification of health needs, and management of long-term conditions. Health checks have been implemented in various primary care contexts, but the long-term impact on outcomes has not been investigated. Qualitative findings highlighted barriers and facilitators to primary care access, communication, and disease management. Accounts of experiences of adults with intellectual disabilities reveal a dilemma between promoting self-care and ensuring access to services, while avoiding paternalistic care.ConclusionAdults with intellectual disabilities face numerous barriers to managing long-term conditions. Reasonable adjustments, based on the experience of adults with intellectual disability, in addition to intervention such as health checks, may improve access and management, but longer-term evaluation of their effectiveness is required.

A systematic review of chronic disease management interventions in primary care

BackgroundPrimary and community care are key settings for the effective management of long term conditions. We aimed to evaluate the pattern of health outcomes in chronic disease management interventions for adults with physical health problems implemented in primary or community care settings.MethodsThe methods were based on our previous review published in 2006. We performed database searches for articles published from 2006 to 2014 and conducted a systematic review with narrative synthesis using the Cochrane Effective Practice and Organisation of Care taxonomy to classify interventions and outcomes. The interventions were mapped to Chronic Care Model elements. The pattern of outcomes related to interventions was summarized by frequency of statistically significant improvements in health care provision and patient outcomes.ResultsA total of 9589 journal articles were retrieved from database searches and snowballing. After screening and verification, 165 articles that detailed 157 studies were included. There were few studies with Health Care Organization (1.9% of studies) or Community Resources (0.6% of studies) as the primary intervention element. Self-Management Support interventions (45.8% of studies) most frequently resulted in improvements in patient–level outcomes. Delivery System Design interventions (22.6% of studies) showed benefits in both professional and patient-level outcomes for a narrow range of conditions. Decision Support interventions (21.3% of studies) had impact limited to professional-level outcomes, in particular use of medications. The small number of studies of Clinical Information System interventions (8.9%) showed benefits for both professional- and patient-level outcomes.ConclusionsThe published literature has expanded substantially since 2006. This review confirms that Self-Management Support is the most frequent Chronic Care Model intervention that is associated with statistically significant improvements, predominately for diabetes and hypertension.

Government 'will consider' PSNC proposals for long-term condition management as part of pharmacy contract

Government 'will consider' PSNC proposals for long-term condition management as part of pharmacy contract

Moral Economy and Moral Capital in the Community of Clinical Practice.

This New Zealand study used focused ethnography to explore the activities of communities of clinical practice (CoCP) in a community-based long-term conditions management program within a large primary health care clinic. CoCP are the informal vehicles by which patient care was delivered within the program. Here, we describe the CoCP as a micro-level moral economy within which values such as trust, respect, authenticity, reciprocity, and obligation circulate as a kind of moral capital. As taxpayers, citizens who become patients are credited with moral capital because the public health system is funded by taxes. This moral capital can be paid forward, accrued, banked, redeemed, exchanged, and forfeited by patients and their health care professionals during the course of a patient's journey. The concept of moral capital offers another route into the "black box" of clinical work by providing an alternative theoretic for explaining the relational aspects of patient care.

A systematic review of the effectiveness of self-management interventions in people with multiple sclerosis at improving depression, anxiety and quality of life.

BackgroundSelf-management interventions have become increasingly popular in the management of long-term health conditions; however, little is known about their impact on psychological well-being in people with Multiple Sclerosis (MS).PurposeTo examine the effectiveness of self-management interventions on improving depression, anxiety and health related quality of life in people with MS.MethodA structured literature search was conducted for the years 2000 to 2016. The review process followed the PRISMA guidelines, and is registered with PROSPERO (no. CRD42016033925).ResultsThe review identified 10 RCT trials that fulfilled selection criteria and quality appraisal. Self-management interventions improved health-related quality of life in 6 out of 7 studies, with some evidence of improvement in depression and anxiety symptoms.ConclusionAlthough the results are promising more robust evaluation is required in order to determine the effectiveness of self-management interventions on depression, anxiety and quality of life in people with MS. Evaluation of the data was impeded by a number of methodological issues including incomplete content and delivery information for the intervention and the exclusion of participants representing the disease spectrum. Recommendations are made for service development and research quality improvement.

Interventions by healthcare professionals to improve management of physical long-term conditions in adults who are homeless: a systematic review protocol

IntroductionPeople experiencing homelessness are at increased risk of, and have poorer outcomes from, a range of physical long-term conditions (LTCs). It is increasingly recognised that interventions targeting people who are...

Management and prevalence of long‐term conditions in primary health care for adults with intellectual disabilities compared with the general population: A population‐based cohort study

In the UK, general practitioners/family physicians receive pay for performance on management of long-term conditions, according to best-practice indicators. Management of long-term conditions was compared between 721 adults with intellectual disabilities and the general population (n=764,672). Prevalence of long-term conditions was determined, and associated factors were investigated via logistic regression analyses. Adults with intellectual disabilities received significantly poorer management of all long-term conditions on 38/57 (66.7%) indicators. Achievement was high (75.1%-100%) for only 19.6% of adults with intellectual disabilities, compared with 76.8% of the general population. Adults with intellectual disabilities had higher rates of epilepsy, psychosis, hypothyroidism, asthma, diabetes and heart failure. There were no clear associations with neighbourhood deprivation. Adults with intellectual disabilities receive poorer care, despite conditions being more prevalent. The imperative now is to find practical, implementable means of supporting the challenges that general practices face in delivering equitable care.