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Fisher K, Carusone SC, Ganann R, Markle-Reid M, Northwood M, Sherifali D. Transforming healthcare by prioritizing qualitative and quantitative clinical trial evidence: evaluating the Aging, Community and Health Research Unit's Community Partnership Program for Older Adults (ACHRU-CPP). Trials 2025; 26:154. [PMID: 40361198 PMCID: PMC12070794 DOI: 10.1186/s13063-025-08839-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2024] [Accepted: 04/14/2025] [Indexed: 05/15/2025] Open
Abstract
BACKGROUND This study aimed to test the effectiveness and implementation of a complex integrated care intervention for older adults. We collected both quantitative and qualitative data, which is recommended in evaluating complex interventions to gain a comprehensive understanding of key success factors. Often, congruence is sought and considered desirable when integrating the findings from both data types. However, data are not always congruent, nor is it suboptimal when incongruence occurs, as we illustrate in this case study. We present the divergent findings from a large community-based implementation-effectiveness hybrid type II trial, and how the struggle to reconcile incongruent results yielded rich insights informing the next steps for translational research on the intervention being tested. METHODS Previous foundational research, including a pilot study and randomized controlled trial (RCT), showed promising results and supported proceeding with a multi-site pragmatic hybrid type II effectiveness-implementation RCT. This recent RCT was undertaken and quantitative and qualitative data were collected to inform the effectiveness and implementation evaluation. To synthesize the findings and guide integration of this large body of evidence, we developed a conceptual model which combined two existing frameworks: the Consolidated Framework for Implementation Research and Quintuple Aim. We used this model to identify the evidence and relate it to relevant implementation and intervention determinants/outcomes. We then synthesized the evidence to distall the main messages regarding the future of the intervention, which involved reconciling apparently discrepant findings from the quantitative and qualitative approaches. RESULTS The current RCT showed no statistically significant effect for participants for the primary (or secondary) outcomes yet the implementation evaluation consistently found perceived benefits of the intervention for patients, providers, and the healthcare system. Qualitative evidence was critical in understanding contextual factors potentially responsible for the absence of a treatment effect (e.g., COVID-19), strategies to overcome challenges experienced in participant engagement and intervention delivery, and recent policy/practice setting changes which showed strong alignment with the intervention and supported its future implementation. CONCLUSIONS With the goal of the hybrid type II effectiveness and implementation study in mind, stakeholders encouraged proceeding with a scalability assessment to consider the evidence from the current trial within the context of our prior research, the broader literature for similar interventions, and the ever-changing policy context. TRIAL REGISTRATION clinicaltrials.gov NCT03664583. Registration date: September 10, 2018.
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Affiliation(s)
- Kathryn Fisher
- Faculty of Health Sciences, Aging and Community Health Research Unit, School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
| | - Soo Chan Carusone
- Faculty of Health Sciences, Aging and Community Health Research Unit, School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Rebecca Ganann
- Faculty of Health Sciences, Aging and Community Health Research Unit, School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Maureen Markle-Reid
- Faculty of Health Sciences, Aging and Community Health Research Unit, School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Melissa Northwood
- Faculty of Health Sciences, Aging and Community Health Research Unit, School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Diana Sherifali
- Faculty of Health Sciences, Aging and Community Health Research Unit, School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
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Seakamela KP, Mashaba RG, Ntimana CB, Kabudula CW, Sodi T. Multimorbidity Management: A Scoping Review of Interventions and Health Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2025; 22:770. [PMID: 40427886 DOI: 10.3390/ijerph22050770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2025] [Revised: 04/16/2025] [Accepted: 04/28/2025] [Indexed: 05/29/2025]
Abstract
Multimorbidity, defined as the co-occurrence of two or more chronic conditions in an individual, has emerged as a worldwide public health concern contributing to mortality and morbidity. This complex health phenomenon is becoming increasingly prevalent worldwide, particularly as populations continue to age. Despite the growing burden of multimorbidity, the development and implementation of interventions published by scholars are still in their early stages with significant variability in strategies and outcomes. The variability in strategy and outcome may result from factors such as lack of infrastructure, socioeconomic status and lifestyle factors. The review aims to synthesize interventions designed to manage and mitigate multimorbidity and explore a range of approaches, including pharmacological treatments, lifestyle modifications, care coordination models, and technological innovations. The scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. It included 1,553,877 individuals with multimorbidity with no age restriction; in the studies that included gender difference, 463,339 male participants and 1,091,538 female participants were involved. Multimorbidity interventions were defined as strategies or programs designed to manage and improve the health and quality of life of individuals with multiple chronic conditions. Of the downloaded articles, those that met the inclusion criteria were published between 2012 and 2024. The final analysis included 100 articles from 3119 published articles, which resulted in 9 themes and 15 subthemes. Themes on the need for lifestyle and behavioural interventions, patient empowerment and engagement, multimorbidity management, health integration, pharmacotherapy optimization, community and policy interventions, healthcare system improvements, technology and digital health, as well as research and evidence-based practice interventions, emerged. The reviewed literature emphasizes the necessity of multidisciplinary approaches to effectively combat the growing public health challenge of multimorbidity.
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Affiliation(s)
- Kagiso P Seakamela
- Department of Pathology and Medical Sciences, Faculty of Health Sciences, School of Medicine, University of Limpopo, Sovenga, Polokwane 0727, South Africa
- Dikgale Mamabolo Mothiba (DIMAMO) Population Health Research Centre, University of Limpopo, Sovenga, Polokwane 0727, South Africa
| | - Reneilwe G Mashaba
- Dikgale Mamabolo Mothiba (DIMAMO) Population Health Research Centre, University of Limpopo, Sovenga, Polokwane 0727, South Africa
| | - Cairo B Ntimana
- Department of Pathology and Medical Sciences, Faculty of Health Sciences, School of Medicine, University of Limpopo, Sovenga, Polokwane 0727, South Africa
- Dikgale Mamabolo Mothiba (DIMAMO) Population Health Research Centre, University of Limpopo, Sovenga, Polokwane 0727, South Africa
| | - Chodziwadziwa W Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Tholene Sodi
- Department of Psychology, University of Limpopo, P/Bag X1106, Sovenga, Polokwane 0727, South Africa
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Northwood M, Chambers T, Fisher K, Ganann R, Markle-Reid M, Yous ML, Beleno R, Gaudet G, Gruneir A, Leung H, Lindsay C, Luebke K, Macartney G, Macatangay E, MacIntyre J, MacPhail C, Montelpare W, Morrison A, Shaffer L, St Pierre M, Tang F, Whiteside C. Readiness for scale up following effectiveness-implementation trial: results of scalability assessment of the Community Partnership Program for diabetes self-management for older adults with multiple chronic conditions. BMC Health Serv Res 2025; 25:284. [PMID: 39979911 PMCID: PMC11841316 DOI: 10.1186/s12913-025-12378-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Accepted: 02/05/2025] [Indexed: 02/22/2025] Open
Abstract
BACKGROUND Implementation research should assess the feasibility of scale up to bridge the evidence-practice gap for integrated care programs in the prevention and management of chronic conditions. Scalability assessment is the first critical step of scale up to determine the potential suitability of a promising health program to be adopted into routine practice and the fit of the program within local contexts. The Community Partnership Program (CPP), an integrated care intervention for older adults with diabetes and multiple chronic conditions, was designed at the outset with scale up in mind, and evaluated in an implementation-effectiveness randomized controlled trial across three Canadian provinces. The final phase of this program of research was to assess scalability and determine the critical factors and next steps for the development of a scale up plan. METHODS Multiple methods were used to assess the scalability of the CPP including collection and analysis of publicly available documents, synthesis of qualitative and quantitative evidence from studies of the CPP, semi-structured interviews with key informants, feedback and recommendations arising from working group meetings and knowledge exchange workshops to discuss and rate the scalability of the program. Data collection and analysis was informed by the Intervention Scalability Assessment Tool (ISAT); developed to support practitioners and policy makers in conducting systematic assessments of the suitability of health interventions for population scale-up in high-income countries. RESULTS Overall, the CPP received high scalability ratings from participants. A phased, horizontal implementation and scale up process was recommended, facilitating local adaptations, on-going program evaluation, and accumulation of evidence. Challenges to scale up were identified, including the need for further evidence of program effectiveness in other diverse settings and populations, and designated funding and adequate health human resources. CONCLUSIONS Participants agreed the CPP meets the needs of many older adults with diabetes and multiple chronic conditions; however, they suggested further tailoring of the program to support different ethnocultural groups and targeting the CPP to older adults with higher needs. The scalability assessment process was a practical method to generate concrete strategies to facilitate the uptake of the CPP into practice. TRIAL REGISTRATION Clinical Trials.gov Identifier NCT03664583. Registration date: September 10, 2018.
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Affiliation(s)
- Melissa Northwood
- Faculty of Health Sciences, Aging and Community Health Research Unit, School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
| | - Tracey Chambers
- Faculty of Health Sciences, Aging and Community Health Research Unit, School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Kathryn Fisher
- Faculty of Health Sciences, Aging and Community Health Research Unit, School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Rebecca Ganann
- Faculty of Health Sciences, Aging and Community Health Research Unit, School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Maureen Markle-Reid
- Faculty of Health Sciences, Aging and Community Health Research Unit, School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Marie-Lee Yous
- Faculty of Health Sciences, Aging and Community Health Research Unit, School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Ron Beleno
- Faculty of Health Sciences, Aging and Community Health Research Unit, School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Gary Gaudet
- Faculty of Health Sciences, Aging and Community Health Research Unit, School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Andrea Gruneir
- Department of Family Medicine Research Program, University of Alberta, 6-40 University Terrace, Edmonton, AB, T6G 2T4, Canada
| | - Helen Leung
- Carefirst Seniors and Community Services Association, 300 Silver Star Blvd., Scarborough, ON, M1V 0G2, Canada
| | - Craig Lindsay
- Faculty of Health Sciences, Aging and Community Health Research Unit, School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Kasia Luebke
- Ontario Health East, Ontario Health, 500-525 University Avenue, Toronto, ON, M5G 2L3, Canada
| | - Gail Macartney
- Margaret and Wallace McCain Chair in Human Development and Health, Department of Applied Human Sciences, Faculty of Science, University of Prince Edward Island, Room 122, Health Sciences Building, 550 University Avenue, Charlottetown, Prince Edward Island, C1A 4P3, Canada
| | - Ethel Macatangay
- Scarborough Health Network, Nephrology & Chronic Disease Management, 3050 Lawrence Ave. E, Scarborough, ON, M1P 2V5, Canada
| | - Janet MacIntyre
- Margaret and Wallace McCain Chair in Human Development and Health, Department of Applied Human Sciences, Faculty of Science, University of Prince Edward Island, Room 122, Health Sciences Building, 550 University Avenue, Charlottetown, Prince Edward Island, C1A 4P3, Canada
| | - Carolyn MacPhail
- Health PEI Primary Care and Chronic Disease, Community Health and Seniors Care, 223 Queen Street, PO Box 2000, Charlottetown, Prince Edward Island, C1A 6A5, Canada
| | - William Montelpare
- Margaret and Wallace McCain Chair in Human Development and Health, Department of Applied Human Sciences, Faculty of Science, University of Prince Edward Island, Room 122, Health Sciences Building, 550 University Avenue, Charlottetown, Prince Edward Island, C1A 4P3, Canada
| | - Allan Morrison
- Faculty of Health Sciences, Aging and Community Health Research Unit, School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Lisa Shaffer
- Faculty of Health Sciences, Aging and Community Health Research Unit, School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Martha St Pierre
- Department of Health and Wellness, Government of Prince Edward Island, 3rd floor Sullivan Building, 16 Fitzroy Street, PO Box 2000, Charlottetown, Prince Edward Island, C1A 7N8, Canada
| | - Frank Tang
- Faculty of Health Sciences, Aging and Community Health Research Unit, School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Catharine Whiteside
- Diabetes Action Canada, Toronto General Hospital, 200 Elizabeth Street, Eaton Building, Room 12E244, Toronto, ON, M5G 2C4, Canada
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Zhang Y, Stokes J, Anselmi L, Bower P, Xu J. Can integrated care interventions strengthen primary care and improve outcomes for patients with chronic diseases? A systematic review and meta-analysis. Health Res Policy Syst 2025; 23:5. [PMID: 39762867 PMCID: PMC11702112 DOI: 10.1186/s12961-024-01260-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 11/28/2024] [Indexed: 01/11/2025] Open
Abstract
BACKGROUND An increasing number of people live with chronic disease or multi-morbidity. Current consensus is that their care requires an integrated model bringing different professionals together to provide person-centred care. Although primary care has a central role in managing chronic disease, and integration may be important in strengthening this role, previous research has shown insufficient attention to the relationships between primary care and integration. This review summarizes primary care involvement in integrated care interventions and assesses the effect of those interventions on a range of measures of primary care functions and wider outcomes. METHODS We searched Medline and Embase using terms for "integrated care", "chronic disease" and "multimorbidity". We included integrated care interventions involving different levels of care organizations or different care sectors. Risk of bias was appraised, and the contents of integrated care interventions assessed using the Sustainable intEgrated care modeLs for multi-morbidity: delivery, FInancing and performancE (SELFIE) conceptual framework. Effectiveness of integrated care interventions was assessed using meta-analysis of primary care functions (access, continuity, comprehensiveness and coordination) and wider outcomes (patient health and mortality, hospital admissions and costs). Sub-group analyses were conducted for different types of primary care involvement. RESULTS From 17,752 studies screened, 119 studies on integrated care were identified, of which 69 interventions (58%) involved primary care. Meta-analyses showed significant beneficial effects on two measures of primary care function: access (effect size: 0.17, 95% CI 0.05-0.29) and continuity (effect size: 0.32, 95% CI 0.14-0.50). For wider outcomes, the only statistically significant effect was found on costs (effect size: 0.02, 95% CI 0.02-0.03). CONCLUSIONS Integrated care interventions involving primary care can have positive effects on strengthening primary care functions, but these benefits do not necessarily translate consistently to wider outcomes.
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Affiliation(s)
- Yuqi Zhang
- Health Organisation, Policy and Economics, School of Health Sciences, University of Manchester, Manchester, UK
| | - Jonathan Stokes
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
| | - Laura Anselmi
- Health Organisation, Policy and Economics, School of Health Sciences, University of Manchester, Manchester, UK
| | - Peter Bower
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Jin Xu
- China Center for Health Development Studies, Peking University, 38 Xueyuan Rd, Haidian District, Beijing, China.
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Yang C, Zhi J, Xu Y, Fan X, Wu X, Xu DR, Liao J. A Couple-Based Intervention for Chinese Older Adults With Type 2 Diabetes: A Randomized Clinical Trial. JAMA Netw Open 2025; 8:e2452168. [PMID: 39745703 PMCID: PMC11696449 DOI: 10.1001/jamanetworkopen.2024.52168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Accepted: 10/23/2024] [Indexed: 01/06/2025] Open
Abstract
Importance Spousal involvement in diabetes care is recommended theoretically, but effectiveness in clinical settings and among diverse populations is unclear. Objective To test the effect of a couple-based intervention among Chinese older patients with type 2 diabetes and their spouses. Design, Setting, and Participants This multicenter randomized clinical trial comprised 2 arms: a couple-based intervention arm and an individual-based control. The trial was conducted across 14 community health care centers in Guangzhou, China, between September 1, 2020, and June 30, 2022, and included patients with confirmed type 2 diabetes aged 55 years or older. Eligible partners were married to or cohabitated with the patients. Patients who previously participated in type 2 diabetes education courses were excluded, as were couples who both had diabetes, to make a clear distinction between patients and spouses. The data were analyzed between January 2023 and April 2024. Interventions The interventions consisted of 4 weekly group education sessions followed by behavior change booster telephone calls over 2 months that targeted either patients and spouses (ie, intervention arm) or patients alone (ie, control arm). Follow-up assessments were conducted at 6 and 12 months post intervention. Main Outcomes and Measures The primary outcome was hemoglobin A1c (HbA1c) levels for patients and quality of life for their spouses. Collective efficacy and behaviors were secondary outcomes for both patients and spouses. Group comparisons were conducted using multilevel models based on an intention-to-treat approach, with outcome measures assessed for both patients and their spouses. Results A total of 207 couples were included in the study, with 106 randomized to the intervention arm and 101 to the control arm. The mean (SD) age of patients was 66.0 (6.5) years, with 105 (50.7%) being men; spouses had similar demographics. Patients' HbA1c levels decreased in both arms over the 12-month follow-up, with no significant between-arm differences (β = -0.08; 95% CI, -0.57 to 0.42). Collective efficacy and collective behavior for patients increased after intervention but with a similar magnitude between arms. None of these measures showed between-arm differences among spouses in either arm. In subgroup analysis, decreases in HbA1c levels were constant and lasting in patients with high baseline HbA1c levels (≥8.0%) with a statistically significant difference. Conclusions and Relevance These findings show that the overall treatment effect of the couple-based intervention was weak. However, the couple-based intervention benefited patients with poor glucose control. Patients' glucose levels, spouses' availability to provide support, and couples' collaborative preferences for mutual or individual diabetes management should be considered in tailoring treatment strategies among older adults with type 2 diabetes. Trial Registration Chinese Clinical Trial Registry Identifier: ChiCTR1900027137.
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Affiliation(s)
- Conghui Yang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Sun Yat-sen Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-sen University, Guangzhou, China
| | - Jingyi Zhi
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Sun Yat-sen Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-sen University, Guangzhou, China
| | - Yingxin Xu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Sun Yat-sen Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-sen University, Guangzhou, China
| | - Xinyu Fan
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Sun Yat-sen Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-sen University, Guangzhou, China
| | - Xueji Wu
- Department of Integrated Profession Management, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Dong Roman Xu
- Acacia Lab for Implementation Research, Southern Medical University Institute for Global Health and Center for World Health Organization Studies, School of Health Management and Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Jing Liao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Sun Yat-sen Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-sen University, Guangzhou, China
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Ferrara L, Ardito V, Tozzi VD, Tarricone R. Economic Evaluations of Health Service Interventions Targeting Patients with Multimorbidities: A Scoping Literature Review. Int J Integr Care 2025; 25:3. [PMID: 39866291 PMCID: PMC11760752 DOI: 10.5334/ijic.8623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 01/14/2025] [Indexed: 01/28/2025] Open
Abstract
Introduction Multimorbid patients have been growing, leading to an exponential increase in healthcare costs and patterns of resource utilization. Despite the heightened interest toward integrated care programs as a response to the complex need of multimorbid patients, economic evaluations of these programs remain scarce. This work investigated the economic evaluations of service interventions targeting multimorbid patients, to identify the characteristics of these programs and the methods applied to their evaluation. Methods We conducted a scoping review of papers published between 2010 and 2021 on PubMed, Science Direct, EconLit and Web Of Science. The search strategy was built around three keyword blocks: service interventions, multimorbidity, economic evaluations. We selected economic evaluations of service interventions delivered through multiple care settings and targeting patients with 2+ chronic conditions. Results Twenty-five articles were included. Interventions were categorized as organizational-type versus patient-oriented. The selected studies often targeted patients with one chronic disease, associated with a mental disorder, like depression or anxiety. Included studies were mostly cost-utility analyses conducted with the healthcare perspective. Discussions and conclusions This work confirmed that economic evaluations of service interventions for multimorbid patients are limited in number. This could suggest that decision-making regarding the delivery of healthcare services for multimorbid patients may not always be based on a solid evidence base. More economic analyses are needed to inform evidence-based coverage decision-making.
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Affiliation(s)
- Lucia Ferrara
- Center for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Milan, Italy
| | - Vittoria Ardito
- Center for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Milan, Italy
| | - Valeria D. Tozzi
- Center for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Milan, Italy
| | - Rosanna Tarricone
- Center for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Milan, Italy
- Department of Social and Political Sciences, Bocconi University, Milan, Italy
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Smalls BL, Adegboyega AO, Ortz CL, Simon-Okube PE, Westgate PM, Schoenberg NE. Assessing the relationship between multimorbidity, psychosocial variables, and clinical outcomes among older adults living in rural Appalachia. J Health Psychol 2024:13591053241302131. [PMID: 39665410 DOI: 10.1177/13591053241302131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2024] Open
Abstract
The objective of this study was to assess the relationship between multimorbidity, psychosocial variables, and clinical outcomes among older adults with type 2 diabetes (T2D) in rural Appalachia. Point-of-care clinical data (e.g. A1c, systolic blood pressure, diastolic blood pressure) and self-reported survey data, that includes psychosocial factors (e.g. distress, depressive symptoms, social support, perceived stress), chronic conditions, and sociodemographic variables were obtained from older adults living in rural Appalachia. Clinical data and psychosocial variables were treated as outcome variables, whereas the number of comorbid conditions was treated as the predictor variable. Stress was significantly associated with multimorbidity (β = 0.24, SE = 0.08, p = 0.01). However, T2D distress, social support, disability, and depression did not have statistically significant relationships with multimorbidity. Further research should assess the role of stress on psychosocial factors and clinical outcomes in rural-dwelling older adults.
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Huang Y, Li S, Lu X, Chen W, Zhang Y. The Effect of Self-Management on Patients with Chronic Diseases: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2024; 12:2151. [PMID: 39517362 PMCID: PMC11544912 DOI: 10.3390/healthcare12212151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Revised: 10/15/2024] [Accepted: 10/25/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND Chronic diseases significantly impact global morbidity and mortality, affecting millions. Self-management interventions are crucial for improving patient health outcomes. This study explores the effects of self-management interventions on the quality of life (QOL), self-efficacy, depression, and anxiety of patients with chronic diseases. METHODS Relevant studies were searched from PubMed, EMBASE, and Web of Science. Two reviewers independently screened the literature, evaluated the risk of bias assessment, and extracted characteristics and outcomes among patients with chronic diseases. For each included study, we calculated the standardized mean difference (SMD) and 95% confidence interval (CI) of the main outcomes. When deemed feasible, the heterogeneity of the study was explored by meta-analysis and subgroup analysis. RESULTS Thirty-four studies involving a total of 7603 patients with chronic diseases were included. Self-management interventions significantly improved quality of life (Higher-better QOL and Lower-better QOL), self-efficacy, and reduced depression symptoms compared to usual care (95%CI 0.01 to 0.15, p = 0.03; 95%CI -0.49 to -0.08, p = 0.006; 95%CI 0.19 to 0.62, p < 0.001; 95%CI -0.23 to -0.07, p < 0.001). However, no significant effect was found for anxiety (95%CI -0.18 to 0.03, p = 0.18). In the heterogeneity analysis, Lower-better QOL and self-efficacy were all higher than 50% (I2 = 80%, 87%). After the subgroup analysis, the heterogeneity of Lower-better QOL and self-efficacy was less than 50% (I2 = 0%, 16.1%). Subgroup analyses revealed that studies with mean age greater than 60 years old and follow-up times greater than 6 months were more effective in improving patients' Lower-better QOL (p = 0.03, p = 0.004), whereas follow-up times less than 6 months were better at reducing patients' anxiety symptoms (p = 0.03). CONCLUSIONS Self-management interventions are more effective than routine care in managing chronic diseases, significantly improving patients' quality of life, self-efficacy, and reducing depressive symptoms, but they did not show significant improvements in anxiety symptoms. Overall, self-management interventions for chronic diseases can help patients adapt to the changes brought about by the disease and self-manage diseases to prevent disease progression.
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Affiliation(s)
- Yanfang Huang
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Sijia Li
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Xiuli Lu
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Weiqiang Chen
- School of Basic Medical Sciences, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Yun Zhang
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou 510006, China
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Li J, Li J, Long C, Ge A, Hei L, Yang Z, Li J, Qin X, Song X, Yuan B. Effectiveness of specialist involvement in case discussion conferences with primary healthcare providers on the management of type 2 diabetes patients: a study protocol for a cluster randomized controlled trial. Trials 2024; 25:721. [PMID: 39465442 PMCID: PMC11514827 DOI: 10.1186/s13063-024-08563-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2024] [Accepted: 10/17/2024] [Indexed: 10/29/2024] Open
Abstract
BACKGROUND In supporting primary healthcare in delivering high-quality care for individuals with type 2 diabetes mellitus (T2DM), previous research emphasized strategies to facilitate communication and collaboration between primary healthcare providers and hospitals. This study aims to evaluate the effectiveness of case discussion conferences between specialists from hospitals and primary healthcare providers in China on the optimization of diabetes management and the improvement of patient health outcomes. METHODS This study will be a parallel cluster randomized controlled trial in which primary healthcare institutions in Shouguang city and Shangsi County will be randomly allocated to the intervention and control groups. The intervention will involve regular case discussion conferences where attendants will meet to discuss complex cases with patients diagnosed with type 2 diabetes mellitus, exchange experiences, and seek and provide expert advice. Family doctor teams from primary healthcare institutions and specialists from secondary or tertiary hospitals will engage in these conferences. Data will be collected at baseline and at the 6- and 12-month follow-ups. The primary clinical outcome measures will focus on the changes in the HbA1c and FBG levels of patients under management. The secondary outcomes will include other physiological indicators, such as blood pressure, BMI, and cholesterol. The evaluation will extend to changes in the capabilities and behaviors of primary healthcare providers. Furthermore, the feasibility and adherence of this intervention will be thoroughly assessed. DISCUSSION This study is designed to generate robust evidence on the effectiveness of case discussion conferences, an interprofessional collaboration strategy, in enhancing diabetes care delivery in primary healthcare, with the ultimate goal of improving patient health outcomes. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2300078829. Registered on December 19, 2023. https://www.chictr.org.cn/showproj.html?proj=210293.
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Affiliation(s)
- Jia Li
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Jiawei Li
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Chao Long
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Aoqi Ge
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Luping Hei
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Zhikai Yang
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Juanjuan Li
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Xianjing Qin
- Health Policy Research Center, School of Information and Management, Guangxi Medical University, Nanning, China
| | - Xinlu Song
- Health Commission of Shouguang City, Weifang City, Shandong Province, China
| | - Beibei Yuan
- China Center for Health Development Studies, Peking University, Beijing, China.
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10
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Whittaker SL, Brusco NK, Hill KD, Taylor NF. Self-management Programs Within Rehabilitation Yield Positive Health Outcomes at a Small Increased Cost Compared With Usual Care: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2024; 105:1946-1960. [PMID: 38729404 DOI: 10.1016/j.apmr.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 04/09/2024] [Accepted: 05/02/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE To determine if self-management programs, supported by a health professional, in rehabilitation are cost effective. DATA SOURCES Six databases were searched until December 2023. STUDY SELECTION Randomized controlled trials with adults completing a supported self-management program while participating in rehabilitation or receiving health professional input in the hospital or community settings were included. Self-management programs were completed outside the structured, supervised therapy and health professional sessions. Included trials had a cost measure and an effectiveness outcome reported, such as health-related quality of life or function. Grading of Recommendations, Assessment, Development, and Evaluations was used to determine the certainty of evidence across trials included in each meta-analysis. Incremental cost-effectiveness ratios were calculated based on the mean difference from the meta-analyses of contributing health care costs and quality of life. DATA EXTRACTION After application of the search strategy, two independent reviewers determined eligibility of identified literature, initially by reviewing the title and/or abstract before full-text review. Using a customized form, data were extracted by one reviewer and checked by a second reviewer. DATA SYNTHESIS Forty-three trials were included, and 27 had data included in meta-analyses. Where self-management was a primary intervention, there was moderate certainty of a meaningful positive difference in quality-of-life utility index of 0.03 units (95% confidence interval, 0.01-0.06). The cost difference between self-management as the primary intervention and usual care (comprising usual intervention/therapy, minimal intervention [including education only], or no intervention) potentially favored the comparison group (mean difference=Australian dollar [AUD]90; 95% confidence interval, -AUD130 to AUD310). The cost per quality-adjusted life year (QALY) gained for self-management programs as a stand-alone intervention was AUD3000, which was below the acceptable willingness-to-pay threshold in Australia per QALY gained (AUD50,000/QALY gained). CONCLUSIONS Self-management as an intervention is low cost and could improve health-related quality of life.
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Affiliation(s)
- Sara L Whittaker
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria.
| | - Natasha K Brusco
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria
| | - Nicholas F Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria; Eastern Health, Allied Health Clinical Research Office, Box Hill, Victoria, Australia
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11
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Kamei T, Kawada A, Minami K, Takahashi Z, Ishigaki Y, Yamanaka T, Yamamoto N, Yamamoto Y, Suzuki Y, Watanabe T, Iijima K. Effectiveness of an interdisciplinary home care approach for older adults with chronic conditions: A systematic review and meta-analysis. Geriatr Gerontol Int 2024; 24:827-840. [PMID: 39021240 DOI: 10.1111/ggi.14931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 06/15/2024] [Accepted: 06/18/2024] [Indexed: 07/20/2024]
Abstract
The effectiveness of interdisciplinary home healthcare service consisting of at least two or more healthcare providers, such as a nurse, physician and physiotherapist, for community-dwelling older adults remains unclear. This systematic review assesses the effects of interdisciplinary home care on quality of life (QOL) and health outcomes in older adults with chronic conditions using validated tools. Databases were searched using CINAHL Plus with Full Text, PubMed, EMBASE, CENTRAL, PsycINFO, and OpenGrey from inception to January 25, 2021. Eligibility criteria included (i) an interdisciplinary home care approach, (ii) participants aged 65 years and older with chronic conditions, (iii) randomized controlled trials (RCTs), and (iv) original literature in English. The study reviewer's dyad independently screened the literature and assessed the study quality using the Cochrane's Risk of Bias 2 tool. The analysis employed qualitative and quantitative integration and Grading of Recommendations Assessment, Development, and Evaluation. This study included 13 RCTs with 4709 participants. Four RCTs indicated that interdisciplinary home healthcare services reduced hospital admissions during the initial 6 months after the start of home care interventions (risk ratio [RR] = 0.73; 95% confidence interval [CI] = 0.61-0.88; p < 0.001; I2 = 0%). However, evidence certainty was moderate; QOL and mortality showed low certainty; and institutionalization and adherence showed moderate certainty of evidence. This study suggests that the interdisciplinary home care approach reduces hospital admissions but lacks effects on other outcomes. More robust studies are required to evaluate this evidence. Geriatr Gerontol Int 2024; 24: 827-840.
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Affiliation(s)
- Tomoko Kamei
- Graduate School of Nursing Science, St Luke's International University, Tokyo, Japan
| | - Aki Kawada
- Graduate School of Nursing Science, St Luke's International University, Tokyo, Japan
| | - Kotoko Minami
- Graduate School of Nursing Science, St Luke's International University, Tokyo, Japan
| | - Zaiya Takahashi
- Department of Medical Education, Graduate School of Medicine, Chiba University, Chiba, Japan
| | | | - Takashi Yamanaka
- Department of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Noriko Yamamoto
- Department of Gerontological Homecare and Long-term Care Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuko Yamamoto
- Chiba Faculty of Nursing, Tokyo Healthcare University, Chiba, Japan
| | - Yusuke Suzuki
- Centre for Community Liaison and Patient Consultations, Nagoya University Hospital, Aichi, Japan
| | - Takamasa Watanabe
- Centre for Family Medicine Development, Japanese Health and Welfare Co-operative Federation, Tokyo, Japan
| | - Katsuya Iijima
- Institute for Future Initiatives, Institute of Gerontology, The University of Tokyo, Tokyo, Japan
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12
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Kayani Z, Willis A, Salisu-Olatunji SO, Jeffers S, Khunti K, Routen A. Reporting and representation of underserved groups in intervention studies for patients with multiple long-term conditions: a systematic review. J R Soc Med 2024; 117:302-317. [PMID: 38626808 PMCID: PMC11529669 DOI: 10.1177/01410768241233109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/19/2024] [Indexed: 10/25/2024] Open
Abstract
OBJECTIVES Globally, there is a growing number of people who are living with multiple long-term conditions (MLTCs). Due to complex management needs, it is imperative that research consists of participants who may benefit most from interventions. It is well documented that ethnic minority groups and lower socioeconomic status (SES) groups are at an increased risk of developing MLTCs. Therefore, the aim of this systematic review was to determine the level of reporting and representation of underserved groups (ethnic minority and low SES) in intervention studies addressing MLTCs. DESIGN Systematic review. Four databases including Cochrane Library, MEDLINE, CINAHL and Scopus were searched for intervention studies from North America or Europe published between January 1990 and July 2023. SETTING Hospital and community-based interventions. We included interventional studies focusing on improving MLTC-related outcomes. PARTICIPANTS Patients with MLTCs. MAIN OUTCOME MEASURES Total number of studies reporting on ethnicity and SES. Number and proportion of studies reporting by ethnic/SES group. RESULTS Thirteen studies met the inclusion criteria. Only 4 of 13 studies (31%) recorded and reported ethnicity information. Of these four studies that reported on ethnicity, three studies consisted of primarily White participants. Ethnic minority groups were underrepresented, but one study included a majority of African American participants. Moreover, 12 of 13 studies (92%) reported on SES with income and educational level being the primary measures used. SES representation of higher deprivation groups was varied due to limited data. CONCLUSIONS For ethnicity, there was a lack of reporting, and ethnic minority groups were underrepresented in intervention studies. For SES, there was a high level of reporting but the proportion of study samples from across the spectrum of SES varied due to the variety of SES measures used. Findings highlight a need to improve the reporting and representation of ethnic minority groups and provide more detailed information for SES through using consistent measures (e.g. education, income and employment) to accurately determine the distribution of SES groups in intervention studies of people with MLTCs.
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Affiliation(s)
- Zara Kayani
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester LE1 7RH, UK
| | - Andrew Willis
- HRB Clinical Research Facility & School of Public Health, University College Cork T12 WE28, Ireland
| | - Shukrat O Salisu-Olatunji
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester LE1 7RH, UK
| | - Shavez Jeffers
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester LE1 7RH, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester LE1 7RH, UK
- NIHR Applied Research Collaboration–East Midlands, University of Leicester, Leicester LE5 4PW, UK
| | - Ash Routen
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester LE1 7RH, UK
- NIHR Applied Research Collaboration–East Midlands, University of Leicester, Leicester LE5 4PW, UK
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13
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Yun JS, Kim K, Ahn YB, Han K, Ko SH. Holistic and Personalized Strategies for Managing in Elderly Type 2 Diabetes Patients. Diabetes Metab J 2024; 48:531-545. [PMID: 39091004 PMCID: PMC11307114 DOI: 10.4093/dmj.2024.0310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 07/11/2024] [Indexed: 08/04/2024] Open
Abstract
Due to increased life expectancy and lifestyle changes, the prevalence of diabetes among the elderly in Korea is continuously rising, as is the associated public health burden. Diabetes management in elderly patients is complicated by age-related physiological changes, sarcopenia characterized by loss of muscle mass and function, comorbidities, and varying levels of functional, cognitive, and mobility abilities that lead to frailty. Moreover, elderly patients with diabetes frequently face multiple chronic conditions that elevate their risk of cardiovascular diseases, cancer, and mortality; they are also prone to complications such as hyperglycemic hyperosmolar state, diabetic ketoacidosis, and severe hypoglycemia. This review examines the characteristics of and management approaches for diabetes in the elderly, and advocates for a comprehensive yet personalized strategy.
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Affiliation(s)
- Jae-Seung Yun
- Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyuho Kim
- Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yu-Bae Ahn
- Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Seung-Hyun Ko
- Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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14
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Mosteiro Miguéns DG, Rodríguez Fernández A, Zapata Cachafeiro M, Vieito Pérez N, Represas Carrera FJ, Novío Mallón S. Community Activities in Primary Care: A Literature Review. J Prim Care Community Health 2024; 15:21501319231223362. [PMID: 38197384 PMCID: PMC10785739 DOI: 10.1177/21501319231223362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 01/11/2024] Open
Abstract
Community health promotion activities are a useful tool for a proactive approach to healthy lifestyles. However, the implementation of these types of activities at health centers is not standardized. The aim of this review was to analyse the characteristics of community activities undertaken in the primary care setting and substantiate available evidence on their health impact. We conducted a bibliographic review until November 15th, 2023 in the TRIPDATABASE, MEDLINE, EMBASE, and DIALNET databases. We included original papers on interventions, community activities, and actions and/or social prescriptions which had been implemented in a Primary Care setting, included a group approach in at least one session, and described some type of evaluation of the intervention applied. Studies targeted at professionals and those without involvement of the primary care team were excluded. The search identified 1912 potential studies. We included a total of 30 studies, comprising 11 randomized clinical trials, 14 quasi-experimental studies, 1 cohort study, and 4 qualitative studies. The issues most frequently addressed in community activities were healthy habits, physical activity, cardiovascular diseases and diabetes. Community activities can improve the physical and psychological environment of their participants, as well as their level of knowledge about the issues addressed. That said, however, implementation of these types of interventions is not uniform. The existence of a professional community-activity liaison officer at health centers, who would help integrate the health system with the community sector, could serve to standardize implementation and maximize the health impact of these types of interventions.
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Affiliation(s)
| | - Almudena Rodríguez Fernández
- University of Santiago de Compostela, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER of Epidemiology and Public Health, CIBERESP) Instituto de Salud Carlos III, Madrid, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Maruxa Zapata Cachafeiro
- University of Santiago de Compostela, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER of Epidemiology and Public Health, CIBERESP) Instituto de Salud Carlos III, Madrid, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Natalia Vieito Pérez
- University Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
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15
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Khunti K, Chudasama YV, Gregg EW, Kamkuemah M, Misra S, Suls J, Venkateshmurthy NS, Valabhji J. Diabetes and Multiple Long-term Conditions: A Review of Our Current Global Health Challenge. Diabetes Care 2023; 46:2092-2101. [PMID: 38011523 PMCID: PMC10698221 DOI: 10.2337/dci23-0035] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/26/2023] [Indexed: 11/29/2023]
Abstract
Use of effective treatments and management programs is leading to longer survival of people with diabetes. This, in combination with obesity, is thus contributing to a rise in people living with more than one condition, known as multiple long-term conditions (MLTC or multimorbidity). MLTC is defined as the presence of two or more long-term conditions, with possible combinations of physical, infectious, or mental health conditions, where no one condition is considered as the index. These include a range of conditions such as cardiovascular diseases, cancer, chronic kidney disease, arthritis, depression, dementia, and severe mental health illnesses. MLTC has major implications for the individual such as poor quality of life, worse health outcomes, fragmented care, polypharmacy, poor treatment adherence, mortality, and a significant impact on health care services. MLTC is a challenge, where interventions for prevention and management are lacking a robust evidence base. The key research directions for diabetes and MLTC from a global perspective include system delivery and care coordination, lifestyle interventions and therapeutic interventions.
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Affiliation(s)
- Kamlesh Khunti
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, U.K
| | - Yogini V. Chudasama
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, U.K
| | - Edward W. Gregg
- School of Population Health, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Monika Kamkuemah
- Innovation Africa and Department of Architecture, Faculty of Engineering, Built Environment and Information Technology, University of Pretoria, Pretoria, South Africa
| | - Shivani Misra
- Division of Metabolism, Digestion and Reproduction, Imperial College London, London, U.K
- Department of Diabetes and Endocrinology, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, U.K
| | - Jerry Suls
- Institute for Health System Science, Feinstein Institutes for Medical Research Northwell Health, New York, NY
| | - Nikhil S. Venkateshmurthy
- Public Health Foundation of India, New Delhi, India
- Centre for Chronic Disease Control, New Delhi, India
| | - Jonathan Valabhji
- Division of Metabolism, Digestion and Reproduction, Imperial College London, London, U.K
- Department of Diabetes and Endocrinology, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, U.K
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16
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Camargo-Plazas P, Robertson M, Alvarado B, Paré GC, Costa IG, Duhn L. Diabetes self-management education (DSME) for older persons in Western countries: A scoping review. PLoS One 2023; 18:e0288797. [PMID: 37556399 PMCID: PMC10411808 DOI: 10.1371/journal.pone.0288797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/04/2023] [Indexed: 08/11/2023] Open
Abstract
Diabetes mellitus is a chronic metabolic health condition affecting millions globally. Diabetes is a growing concern among aging societies, with its prevalence increasing among those aged 65 and above. Enabling disease self-management via relevant education is part of high-quality care to improve health outcomes and minimize complications for individuals living with diabetes. Successful diabetes self-management education (DSME) programs usually require tailoring for the intended audience; however, there is limited literature about the preferences of older persons in Western countries concerning DSME. As such, a broad overview of DSME for older persons was an identified need. To map the available evidence on DSME for persons aged 65 years and older in Western countries, the JBI methodology for conducting and reporting scoping reviews was used. In this scoping review, we considered all studies about DSME for older persons with T1D and T2D in Western countries where lifestyles, risks, prevention, treatment of diabetes, and approaches to self-management and DSME are similar (e.g., North America, Western and Northern Europe and Australasia). Systematic keyword and subject heading searches were conducted in 10 databases (e.g., MEDLINE, JBI EBP) to identify relevant English language papers published from 2000 to 2022. Titles and abstracts were screened to select eligible papers for full-text reading. Full-text screening was done by four independent reviewers to select studies for the final analysis. The review identified 2,397 studies, of which 1,250 full texts were screened for eligibility. Of the final 44 papers included in the review, only one included participants' understanding of DSME. The education programs differed in their context, design, delivery mode, theoretical underpinnings, and duration. Type of research designs, outcome measures used to determine the effectiveness of DSME, and knowledge gaps were also detailed. Overall, most interventions were effective and improved clinical and behavioural outcomes. Many of the programs led to improvements in clinical outcomes and participants' quality of life; however, the content needs to be adapted to older persons according to their culture, different degrees of health literacy, preference of education (e.g., individualized or group), preference of setting, degree of frailty and independence, and comorbidities. Few studies included the voices of older persons in the design, implementation, and evaluation of DSME programs. Such experiential knowledge is vital in developing educational programs to ensure alignment with this population's preferred learning styles, literacy levels, culture, and needs-such an approach could manifest more substantive, sustained results.
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Affiliation(s)
| | | | - Beatriz Alvarado
- Department of Public Health Sciences, School of Medicine, Queen’s University, Kingston, ON, Canada
| | | | | | - Lenora Duhn
- School of Nursing, Queen’s University, Kingston, ON, Canada
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17
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Robertson M, Paré GC, Costa I, Alvarado B, Duhn L, Plazas PC. "I Could Have Stood a Little More Education Rather than Just: 'Hey, you're Diabetic Man, Make the Best out of It'": Revisioning Diabetes Self-Management Education for Older Adults. Res Aging 2023; 45:563-573. [PMID: 36415978 PMCID: PMC10285423 DOI: 10.1177/01640275221138968] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2025]
Abstract
Objectives: Providing diabetes self-management education (DSME) in an evidence-based format that is accessible and tailored to the population needs is crucial for individuals living with diabetes mellitus. Our qualitative study explores the experiences of older adults living with diabetes while residing in a rural setting. Methods: Adults aged 65 or older and residing in a rural area of Ontario completed a photovoice activity and semi-structured interviews to illustrate their experience of living with diabetes and accessing DSME. Results: Fourteen participants (11 males; mean age = 74 years) completed the photovoice activity and interview. Four main themes were identified pertaining to learning about diabetes education, the depth and breadth of learning, applying knowledge to daily life, and engaging older adults in DSME. Discussion: Diabetes self-management education should account for older adults' preferences in learning about diabetes and self-management to promote access to evidence-based information, bolster knowledge and self-management efficacy, and improve disease control.
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Affiliation(s)
| | | | - Idevania Costa
- School of Nursing, Lakehead University, Thunder Bay, ON, Canada
| | - Beatriz Alvarado
- Department of Public Health Sciences, Queen’s University,Kingston, ON, Canada
| | - Lenora Duhn
- School of Nursing, Queen’s University, Kingston, ON, Canada
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18
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Mirzaei T, Ravari A, Hosseini F, Hassanshahi E. Comparison of the Effect of Education Using Team-based Learning Method and Lecture Method on Controlling Diabetes in the Elderly: A Quasi-Experimental Study. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2023; 11:201-209. [PMID: 37489223 PMCID: PMC10363271 DOI: 10.30476/ijcbnm.2023.97837.2210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 06/03/2023] [Accepted: 06/26/2023] [Indexed: 07/26/2023]
Abstract
Background Patient education is considered as an essential part of diabetes control. This research is conducted to compare the effect of education using team-based learning (TBL) method and lecture method on blood pressure (BP), serum levels of fasting blood sugar (FBS), glycosylated hemoglobin (HbA1c), and Body mass index (BMI) in the elderly with diabetes. Methods This quasi-experimental study was conducted on 61 elderly patients with type 2 diabetes in diabetes clinics in Rafsanjan, during October 2018 to January 2019. Patients were selected using simple random sampling. They were divided into two groups of TBL and lecture-based learning. For each group, educational content was presented through 2-hour sessions held once a week for 1 months. FBS, HbA1c, BMI, and BP were measured at baseline and 3 months after the intervention. Data were analyzed through SPSS 21, using Chi-square test, independent t-test, and paired t-test; A P-value<0.05 was considered as significant. Results After the intervention, the TBL group had a significant decrease in systolic and diastolic BP compared to the lecture group (P<0.001). Before and 3 months after the intervention in the TBL group, there was a significant decrease between the means of FBS (P=0.01), HbA1c (P<0.001), and systolic and diastolic BP (P<0.001), but in the lecture group, only the systolic BP showed a significant decrease (P<0.001). Conclusion TBL method had more effects on controlling diabetes type 2 in the elderly than the lecture method. It is suggested that health providers should consider TBL for the education of the elderly with diabetes.
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Affiliation(s)
- Tayebeh Mirzaei
- Geriatric Care Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Ali Ravari
- Geriatric Care Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Fatemeh Hosseini
- Geriatric Care Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Department of Community Health Nursing, School of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Elham Hassanshahi
- Geriatric Care Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
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19
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Geerlings AD, Janssen Daalen JM, Ypinga JHL, Bloem BR, Meinders MJ, Munneke M, Darweesh SKL. Case management interventions in chronic disease reduce anxiety and depressive symptoms: A systematic review and meta-analysis. PLoS One 2023; 18:e0282590. [PMID: 37058492 PMCID: PMC10104285 DOI: 10.1371/journal.pone.0282590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 02/18/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND There is no systematic insight into the effect of case management on common complications of chronic diseases, including depressive symptoms and symptoms of anxiety. This is a significant knowledge gap, given that people with a chronic disease such as Parkinson Disease or Alzheimer's Disease have identified care coordination as one of their highest priorities. Furthermore, it remains unclear whether the putative beneficial effects of case management would vary by crucial patient characteristics, such as their age, gender, or disease characteristics. Such insights would shift from "one size fits all" healthcare resource allocation to personalized medicine. OBJECTIVE We systematically examined the effectiveness of case management interventions on two common complications associated PD and other chronic health conditions: Depressive symptoms and symptoms of anxiety. METHODS We identified studies published until November 2022 from PubMed and Embase databases using predefined inclusion criteria. For each study, data were extracted independently by two researchers. First, descriptive and qualitative analyses of all included studies were performed, followed by random-effects meta-analyses to assess the impact of case management interventions on anxiety and depressive symptoms. Second, meta-regression was performed to analyze potential modifying effects of demographic characteristics, disease characteristics and case management components. RESULTS 23 randomized controlled trials and four non-randomized studies reported data on the effect of case management on symptoms of anxiety (8 studies) or depressive symptoms (26 studies). Across meta-analyses, we observed a statistically significant effect of case management on reducing symptoms of anxiety (Standardized Mean Difference [SMD] = - 0.47; 95% confidence interval [CI]: -0.69, -0.32) and depressive symptoms (SMD = - 0.48; CI: -0.71, -0.25). We found large heterogeneity in effect estimates across studies, but this was not explained by patient population or intervention characteristics. CONCLUSIONS Among people with chronic health conditions, case management has beneficial effects on symptoms of depressive symptoms and symptoms of anxiety. Currently, research on case management interventions are rare. Future studies should assess the utility of case management for potentially preventative and common complications, focusing on the optimal content, frequency, and intensity of case management.
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Affiliation(s)
- Angelika D. Geerlings
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jules M. Janssen Daalen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan H. L. Ypinga
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bastiaan R. Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marjan J. Meinders
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marten Munneke
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sirwan K. L. Darweesh
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, Nijmegen, The Netherlands
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20
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Yous ML, Ganann R, Ploeg J, Markle-Reid M, Northwood M, Fisher K, Valaitis R, Chambers T, Montelpare W, Légaré F, Beleno R, Gaudet G, Giacometti L, Levely D, Lindsay C, Morrison A, Tang F. Older adults' experiences and perceived impacts of the Aging, Community and Health Research Unit-Community Partnership Program (ACHRU-CPP) for diabetes self-management in Canada: a qualitative descriptive study. BMJ Open 2023; 13:e068694. [PMID: 37019487 PMCID: PMC10083734 DOI: 10.1136/bmjopen-2022-068694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
OBJECTIVES To assess the experiences and perceived impacts of the Aging, Community and Health Research Unit-Community Partnership Program (ACHRU-CPP) from the perspectives of older adults with diabetes and other chronic conditions. The ACHRU-CPP is a complex 6-month self-management evidence-based intervention for community-living older adults aged 65 years or older with type 1 or type 2 diabetes and at least one other chronic condition. It includes home and phone visits, care coordination, system navigation support, caregiver support and group wellness sessions delivered by a nurse, dietitian or nutritionist, and community programme coordinator. DESIGN Qualitative descriptive design embedded within a randomised controlled trial was used. SETTING Six trial sites offering primary care services from three Canadian provinces (ie, Ontario, Quebec and Prince Edward Island) were included. PARTICIPANTS The sample was 45 community-living older adults aged 65 years or older with diabetes and at least one other chronic condition. METHODS Participants completed semistructured postintervention interviews by phone in English or French. The analytical process followed Braun and Clarke's experiential thematic analysis framework. Patient partners informed study design and interpretation. RESULTS The mean age of older adults was 71.7 years, and the mean length of time living with diabetes was 18.8 years. Older adults reported positive experiences with the ACHRU-CPP that supported diabetes self-management, such as improved knowledge in managing diabetes and other chronic conditions, enhanced physical activity and function, improved eating habits, and opportunities for socialisation. They reported being connected to community resources by the intervention team to address social determinants of health and support self-management. CONCLUSIONS Older adults perceived that a 6-month person-centred intervention collaboratively delivered by a team of health and social care providers helped support chronic disease self-management. There is a need for providers to help older adults connect with available health and social services in the community. TRIAL REGISTRATION NUMBER ClinicalTrials.gov ID: NCT03664583; Results.
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Affiliation(s)
- Marie-Lee Yous
- School of Nursing, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Rebecca Ganann
- School of Nursing, Aging, Community and Health Research Unit, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Jenny Ploeg
- School of Nursing, Aging, Community and Health Research Unit, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Maureen Markle-Reid
- School of Nursing, Aging, Community and Health Research Unit, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Melissa Northwood
- School of Nursing, Aging, Community and Health Research Unit, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Kathryn Fisher
- School of Nursing, Aging, Community and Health Research Unit, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Ruta Valaitis
- School of Nursing, Aging, Community and Health Research Unit, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Tracey Chambers
- School of Nursing, Aging, Community and Health Research Unit, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - William Montelpare
- Department of Applied Human Sciences, Faculty of Science, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - France Légaré
- VITAM Centre de recherche en santé durable, Université Laval, Quebec, Quebec, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
| | - Ron Beleno
- School of Nursing, Aging, Community and Health Research Unit, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Gary Gaudet
- Department of Applied Human Sciences, Faculty of Science, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Luisa Giacometti
- School of Nursing, Aging, Community and Health Research Unit, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Deborah Levely
- School of Nursing, Aging, Community and Health Research Unit, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Craig Lindsay
- School of Nursing, Aging, Community and Health Research Unit, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Allan Morrison
- Department of Applied Human Sciences, Faculty of Science, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Frank Tang
- School of Nursing, Aging, Community and Health Research Unit, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
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21
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de Oliveira JL, Dal Sasso Mendes K, de Almeida LY, de Almeida JCP, Souza Gonçalves J, Strobbe S, de Souza J. Mental Health Care in Primary Health Care: An Integrative Review. Issues Ment Health Nurs 2023; 44:329-337. [PMID: 37015019 DOI: 10.1080/01612840.2023.2189954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
In this study, we analyzed recent studies on mental health approaches developed in primary health care to identify the emphasis of such interventions, their technical feasibility for the setting in question, and their levels of evidence. An integrative review was conducted of primary studies from the LILACS, PubMed, Embase, CINAHL, and Web of Science databases using the PRISMA search strategy. Nineteen studies were identified with a high level of evidence that contribute to the advancement of knowledge in the area. However, academic, cultural, and linguistic barriers still need to be overcome to facilitate sharing of such interventions' findings and protocols.
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Affiliation(s)
- Jaqueline Lemos de Oliveira
- Department of Psychiatric Nursing and Human Sciences, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, Brazil
| | - Karina Dal Sasso Mendes
- Department of General and Specialized Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, Brazil
| | - Leticia Yamawaka de Almeida
- Center for Studies, Research and Practice in Primary Health Care, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Jamila Souza Gonçalves
- Department of Psychiatric Nursing and Human Sciences, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, Brazil
| | - Stephen Strobbe
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Jacqueline de Souza
- Department of Psychiatric Nursing and Human Sciences, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, Brazil
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Northwood M, Shah AQ, Abeygunawardena C, Garnett A, Schumacher C. Care Coordination of Older Adults With Diabetes: A Scoping Review. Can J Diabetes 2023; 47:272-286. [PMID: 36517260 DOI: 10.1016/j.jcjd.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/26/2022] [Accepted: 11/08/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Care coordination is a common intervention to support older adults with diabetes and their caregivers, and provides individualized, integrated health and social care. However, the optimal approach of care coordination is not well described. In this scoping review we synthesized evidence regarding the implementation of traditional and virtual care coordination for older adults with diabetes to inform future research and best practices. METHODS The Joanna Briggs Institute scoping review methods were used. A systematic search was conducted in CINAHL, Embase, EmCare, and Medline, as well as a targeted grey literature search, and a hand-search of reference lists. Screening and data extraction were completed by 3 independent reviewers. RESULTS Forty-two articles were included in the synthesis. Included studies operationalized care coordination in different ways. The most commonly implemented elements of care coordination were regular communication and monitoring. In contrast, coordination between health-care teams and the community, individualized planning, and caregiver involvement were less often reported. Outcomes to evaluate the impact of care coordination were predominantly diabetes-centric, and less often person-centred. In addition, evidence indicates that older adults value a trusting relationship with their care coordinator. CONCLUSIONS Studies assessing care coordination for older adults with diabetes have shown positive outcomes. To inform best practices, future intervention research for this population should focus on evaluating the impact of comprehensive care planning, system navigation across the health and social care sectors, the care coordinator and patient relationship and caregiver support.
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Affiliation(s)
- Melissa Northwood
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - Aimun Qadeer Shah
- School of Interdisciplinary Science, Life Sciences Program, McMaster University, Hamilton, Ontario, Canada
| | - Charith Abeygunawardena
- School of Nursing, Accelerated Nursing Program, McMaster University, Hamilton, Ontario, Canada
| | - Anna Garnett
- Arthur Labatt Family School of Nursing, Health Sciences, Western University, London, Ontario, Canada
| | - Connie Schumacher
- School of Nursing, Faculty of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
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Matthews KS, Rennoldson SC, Fraser SD. Influence of health-system change on treatment burden: a systematic review. Br J Gen Pract 2023; 73:e59-e66. [PMID: 36253115 PMCID: PMC9591018 DOI: 10.3399/bjgp.2022.0066] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 07/13/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Treatment burden is a patient-centred concept describing the effort required of people to look after their health and the impact this has on their functioning and wellbeing. High treatment burden is more likely for people with multiple long-term conditions (LTCs). Validated treatment burden measures exist, but have not been widely used in practice or as research outcomes. AIM To establish whether changes in organisation and delivery of health systems and services improve aspects contributing to treatment burden for people with multiple LTCs. DESIGN AND SETTING Systematic review of randomised controlled trials (RCTs) investigating the impact of system-level interventions on at least one outcome relevant to previously defined treatment burden domains among adults with ≥2 LTCs. METHOD The Embase, Ovid MEDLINE, and Web of Science electronic databases were searched for terms related to multimorbidity, system-level change, and treatment burden published between January 2010 and July 2021. Treatment burden domains were derived from validated measures and qualitative literature. Synthesis without meta-analysis (SWiM) methodology was used to synthesise results and study quality was assessed using the Cochrane risk-of-bias (version 2) tool. RESULTS The searches identified 1881 articles, 18 of which met the review inclusion criteria. Outcomes were grouped into seven domains. There was some evidence for the effect of system-level interventions on some domains, but the studies exhibited substantial heterogeneity, limiting the synthesis of results. Some concern over bias gave low confidence in study results. CONCLUSION System-level interventions may affect some treatment burden domains. However, adoption of a standardised outcome set, incorporating validated treatment burden measures, and the development of standard definitions for care processes in future research would aid study comparability.
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Xu L, Cui J, Li M, Wu Q, Liu M, Xu M, Shi G, Yin J, Yang J. Association Between Serum Asprosin and Diabetic Nephropathy in Patients with Type 2 Diabetes Mellitus in the Community: A Cross-Sectional Study. Diabetes Metab Syndr Obes 2022; 15:1877-1884. [PMID: 35757196 PMCID: PMC9215350 DOI: 10.2147/dmso.s361808] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/09/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To explore the association between serum asprosin and diabetic nephropathy (DN) in patients with type 2 diabetes mellitus (T2DM) in the community. Methods In this cross-sectional study, we retrospectively collected the clinical data of T2DM patients from a community health service center in southeastern Shanxi Province between November 2019 and July 2021. Logistic regression analysis was used to calculate the odds ratio (OR) and the 95% confidence interval (95% CI) of asprosin levels on the risk of DN. Results Among 498 T2DM patients included in this study, 221 had microalbuminuria, 105 had massive albuminuria, and 172 did not have any signs of nephropathy. Serum asprosin level was positively correlated with diastolic blood pressure, body mass index, triglycerides, aspartate aminotransferase, alanine aminotransferase, creatinine, ACR and albumin-to-creatinine ratio (all P < 0.05) and negatively correlated with low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, fasting plasma glucose, HbA1c and estimated glomerular filtration rate (all P < 0.05). After adjusting for covariates, increased asprosin was associated with diabetic nephropathy (all OR = 2.560, 95% CI: 1.1592-4.116; P < 0.001). Conclusion The risk of DN significantly increases with serum asprosin levels, especially among female patients.
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Affiliation(s)
- Linxin Xu
- First Clinical Medical College, Shanxi Medical University, Taiyuan, People’s Republic of China
- Department of Endocrinology, First Hospital of Shanxi Medical University, Shanxi Medical University, Taiyuan, Shanxi, 030001, People’s Republic of China
| | - Junfang Cui
- Department of Geratology, First Hospital of Shanxi Medical University, Shanxi Medical University, Taiyuan, 030001, People’s Republic of China
| | - Mina Li
- Department of Endocrinology, First Hospital of Shanxi Medical University, Shanxi Medical University, Taiyuan, Shanxi, 030001, People’s Republic of China
| | - Qianqian Wu
- Department of Endocrinology, First Hospital of Shanxi Medical University, Shanxi Medical University, Taiyuan, Shanxi, 030001, People’s Republic of China
| | - Ming Liu
- Department of Endocrinology, First Hospital of Shanxi Medical University, Shanxi Medical University, Taiyuan, Shanxi, 030001, People’s Republic of China
| | - Minggang Xu
- Department of Endocrinology, Changzhi Second People’s Hospital, Changzhi, 046000, People’s Republic of China
| | - Guoliang Shi
- Department of Endocrinology, Changzhi Second People’s Hospital, Changzhi, 046000, People’s Republic of China
| | - Jianhong Yin
- Department of Endocrinology, First Hospital of Shanxi Medical University, Shanxi Medical University, Taiyuan, Shanxi, 030001, People’s Republic of China
| | - Jing Yang
- First Clinical Medical College, Shanxi Medical University, Taiyuan, People’s Republic of China
- Department of Endocrinology, First Hospital of Shanxi Medical University, Shanxi Medical University, Taiyuan, Shanxi, 030001, People’s Republic of China
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25
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Izquierdo V, Pazos-Couselo M, González-Rodríguez M, Rodríguez-González R. Educational programs in type 2 diabetes designed for community-dwelling older adults: A systematic review. Geriatr Nurs 2022; 46:157-165. [PMID: 35700683 DOI: 10.1016/j.gerinurse.2022.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 12/14/2022]
Abstract
AIMS This systematic review aimed to assess the effectiveness of educational interventions in type 2 diabetes specifically designed for community-dwelling older adults. METHODS In accordance with PRISMA guidelines, a systematic search of studies published between 2010 and 2021 was conducted across five electronic databases and manual sources. The study protocol was previously registered in PROSPERO (CRD42021288236). RESULTS Twelve papers matched the inclusion criteria and were appraised using MERSQI. The features of the educational programs were heterogeneous, and none complied with the ten suggested standards for diabetes self-management education and support. Comprehensive gerontological assessment was not considered. Outcomes included biomedical, psychosocial, behavioral, and knowledge measures. HbA1c and knowledge showed improvements with a high certainty level according to GRADE. CONCLUSIONS Structured DSME programs aimed at older adults have great potential, however there is still room to improve. Applying the principles of a comprehensive gerontological approach and the standards for DSME as continuous monitoring and support could increase their benefits.
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Affiliation(s)
- Veronica Izquierdo
- Faculty of Nursing, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Marcos Pazos-Couselo
- Faculty of Nursing, University of Santiago de Compostela, Santiago de Compostela, Spain; Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain; Research Methods (RESMET), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
| | | | - Raquel Rodríguez-González
- Faculty of Nursing, University of Santiago de Compostela, Santiago de Compostela, Spain; Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain; Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
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Interprofessional Collaboration and Diabetes Management in Primary Care: A Systematic Review and Meta-Analysis of Patient-Reported Outcomes. J Pers Med 2022; 12:jpm12040643. [PMID: 35455759 PMCID: PMC9029958 DOI: 10.3390/jpm12040643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 02/05/2023] Open
Abstract
The global spread of diabetes poses serious threats to public health requiring a patient-centered approach based both on interprofessional collaboration (IPC) given by the cooperation of several different health professionals, and patients’ perspective through the assessment of Patient-Reported Outcomes (PROs). The aim of the present study is to evaluate the impact of interprofessional collaboration interventions, for the management of type 2 diabetes in primary care settings, through PROs. A systematic review and meta-analysis was conducted querying the PubMed, Scopus and Embase databases. Out of the 1961 papers initially retrieved, 19 met the inclusion criteria. Interprofessional collaboration is significantly associated with an increase in both patient’s satisfaction (SMD 0.32 95% CI 0.05–0.59) and in the mental well-being component of the HRQoL (SMD 0.18; 95% CI 0.06–0.30), and there was also promising evidence supporting the association between an interprofessional approach and an increase in self-care and in generic and specific quality-of-life. No statistical differences were found, supporting the positive impact on IPC interventions on the physical component of the HRQoL, depression, emotional distress, and self-efficacy. In conclusion, the effect of IPC impacts positively on the few areas assessed by PROMs. Policymakers should promote the widespread adoption of a collaborative approach as well as to endorse an active engagement of patients across the whole process of care.
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Ploeg J, Markle-Reid M, Valaitis R, Fisher K, Ganann R, Blais J, Chambers T, Connors R, Gruneir A, Légaré F, MacIntyre J, Montelpare W, Paquette JS, Poitras ME, Riveroll A, Yous ML. The Aging, Community and Health Research Unit Community Partnership Program (ACHRU-CPP) for older adults with diabetes and multiple chronic conditions: study protocol for a randomized controlled trial. BMC Geriatr 2022; 22:99. [PMID: 35120457 PMCID: PMC8814798 DOI: 10.1186/s12877-021-02651-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Older adults (≥65 years) with diabetes and multiple chronic conditions (MCC) (> 2 chronic conditions) experience reduced function and quality of life, increased health service use, and high mortality. Many community-based self-management interventions have been developed for this group, however the evidence for their effectiveness is limited. This paper presents the protocol for a randomized controlled trial (RCT) comparing the effectiveness and implementation of the Aging, Community and Health Research Unit-Community Partnership Program (ACHRU-CPP) to usual care in older adults with diabetes and MCC and their caregivers. METHODS We will conduct a cross-jurisdictional, multi-site implementation-effectiveness type II hybrid RCT. Eligibility criteria are: ≥65 years, diabetes diagnosis (Type 1 or 2) and at least one other chronic condition, and enrolled in a primary care or diabetes education program. Participants will be randomly assigned to the intervention (ACHRU-CPP) or control arm (1:1 ratio). The intervention arm consists of home/telephone visits, monthly group wellness sessions, multidisciplinary case conferences, and system navigation support. It will be delivered by registered nurses and registered dietitians/nutritionists from participating primary care or diabetes education programs and program coordinators from community-based organizations. The control arm consists of usual care provided by the primary care setting or diabetes education program. The primary outcome is the change from baseline to 6 months in mental functioning. Secondary outcomes will include, for example, the change from baseline to 6 months in physical functioning, diabetes self-management, depressive symptoms, and cost of use of healthcare services. Analysis of covariance (ANCOVA) models will be used to analyze all outcomes, with intention-to-treat analysis using multiple imputation to address missing data. Descriptive and qualitative data from older adults, caregivers and intervention teams will be used to examine intervention implementation, site-specific adaptations, and scalability potential. DISCUSSION An interprofessional intervention supporting self-management may be effective in improving health outcomes and client/caregiver experience and reducing service use and costs in this complex population. This pragmatic trial includes a scalability assessment which considers a range of effectiveness and implementation criteria to inform the future scale-up of the ACHRU-CPP. TRIAL REGISTRATION Clinical Trials.gov Identifier NCT03664583 . Registration date: September 10, 2018.
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Affiliation(s)
- Jenny Ploeg
- School of Nursing, Aging, Community and Health Research Unit, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Room HSc3N25, Hamilton, Ontario, L8S 4K1, Canada.
| | - Maureen Markle-Reid
- School of Nursing, Aging, Community and Health Research Unit, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Room HSc3N25, Hamilton, Ontario, L8S 4K1, Canada
| | - Ruta Valaitis
- School of Nursing, Aging, Community and Health Research Unit, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Room HSc3N25, Hamilton, Ontario, L8S 4K1, Canada
| | - Kathryn Fisher
- School of Nursing, Aging, Community and Health Research Unit, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Room HSc3N25, Hamilton, Ontario, L8S 4K1, Canada
| | - Rebecca Ganann
- School of Nursing, Aging, Community and Health Research Unit, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Room HSc3N25, Hamilton, Ontario, L8S 4K1, Canada
| | - Johanne Blais
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, 1050, avenue de la Médecine, Local 4617, Québec, G1V 0A6, Canada
| | - Tracey Chambers
- School of Nursing, Aging, Community and Health Research Unit, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Room HSc3N25, Hamilton, Ontario, L8S 4K1, Canada
| | - Robyn Connors
- Department of Applied Human Sciences, Faculty of Science, University of Prince Edward Island, Room 111, Steel Building, 550 University Avenue, Charlottetown, Prince Edward Island, C1A 4P3, Canada
| | - Andrea Gruneir
- Department of Family Medicine Research Program, University of Alberta, 6-40 University Terrace, Edmonton, Alberta, T6G 2T4, Canada
| | - France Légaré
- VITAM-Centre de recherche en santé durable, Université Laval, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec City, QC, G1J 0A4, Canada and Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, G1K 7P4, Canada
| | - Janet MacIntyre
- Faculty of Nursing, Room 116, Health Sciences Building, University of Prince Edward Island, 550 University Avenue, Charlottetown, Prince Edward Island, C1A 4P3, Canada
| | - William Montelpare
- Margaret and Wallace McCain Chair in Human Development and Health, Department of Applied Human Sciences, Faculty of Science, Room 122, Health Sciences Building, University of Prince Edward Island, 550 University Avenue, Charlottetown, Prince Edward Island, C1A 4P3, Canada
| | - Jean-Sébastien Paquette
- Groupe de Médecine de Famile Universitaire (GMF-U) du Nord de Lanaudière and Department of Family Medicine and Emergency Medicine, Faculty of Medicine Université Laval, Pavillon Ferdinand-Vandry, 1050, Avenue de la Médecine, Local 4617, Québec, G1V 0A6, Canada
| | - Marie-Eve Poitras
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke - Campus Saguenay, 305 Rue Saint Vallier, Chicoutimi, QC, G7H 5H6, Canada
| | - Angela Riveroll
- Department of Applied Human Sciences, Faculty of Science, University of Prince Edward Island, Room 115, Steel Building, 550 University Avenue, Charlottetown, Prince Edward Island, C1A 4P3, Canada
| | - Marie-Lee Yous
- School of Nursing, Aging, Community and Health Research Unit, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Room HSc3N25, Hamilton, Ontario, L8S 4K1, Canada
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Dobrow L, Estrada I, Burkholder-Cooley N, Miklavcic J. Potential Effectiveness of Registered Dietitian Nutritionists in Healthy Behavior Interventions for Managing Type 2 Diabetes in Older Adults: A Systematic Review. Front Nutr 2022; 8:737410. [PMID: 35141261 PMCID: PMC8819057 DOI: 10.3389/fnut.2021.737410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/03/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose A systematic review was conducted to assess how the involvement of a registered dietitian nutritionist (RDN) in healthy behavior interventions (HBIs) potentially affects outcomes in older adults with type 2 diabetes (T2D). Methods Literature was searched for primary research published between 2016 and 2020 on HBI involving a RDN affecting outcomes in older adults with T2D. Evaluations of hemoglobin A1c (HbA1c), blood glucose, blood pressure, cholesterol, anthropometry, body composition, medication usage, healthcare cost, and self-efficacy and/or adherence to healthy behaviors outcomes were selected for inclusion. All the literature included were summarized, evaluated for certainty of evidence criteria, and assessed for bias. Results A total of 12 studies were included for assessment. Involvement of a RDN in HBI was shown to reduce HbA1c, fasting blood glucose, low-density lipoprotein (LDL) cholesterol, and blood pressure and improve lean body mass, body mass index (BMI), and self-efficacy in populations of older adults with T2D. Compared to older adults with T2D receiving HBI involving RDNs, patients receiving usual care may incur higher healthcare costs or longer hospital stays. There was a high certainty of evidence for a RDN involvement in HBI with regard to reduction in HbA1c. There was a moderate certainty of evidence for a RDN involvement in HBI with regard to favorable changes in weight or body composition and cardiometabolic health outcomes. Statistically significant improvements in outcomes were usually sustained in follow-up after conclusion of HBI. Conclusion RDNs may play an integral role in HBIs resulting in improved glycemic control, weight management, cardiovascular outcomes, and presumably comorbidity management. RDNs are important facilitators of diet education and nutrition assessment, which are essential in T2D management and should, therefore, be considered for routine inclusion in interprofessional teams for improved outcomes in older adults with T2D.
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Affiliation(s)
- Laurel Dobrow
- Schmid College of Science and Technology, Chapman University, Orange, CA, United States
| | - Isabella Estrada
- Schmid College of Science and Technology, Chapman University, Orange, CA, United States
| | | | - John Miklavcic
- Schmid College of Science and Technology, Chapman University, Orange, CA, United States
- School of Pharmacy, Chapman University, Irvine, CA, United States
- *Correspondence: John Miklavcic
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Eriksen CU, Kamstrup–Larsen N, Birke H, Helding SAL, Ghith N, Andersen JS, Frølich A. Models of care for improving health-related quality of life, mental health, or mortality in persons with multimorbidity: A systematic review of randomized controlled trials. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2022; 12:26335565221134017. [PMID: 36325259 PMCID: PMC9618762 DOI: 10.1177/26335565221134017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Objectives To categorize and examine the effectiveness regarding health-related quality of life (HRQoL), mental health, and mortality of care models for persons with multimorbidity in primary care, community care, and hospitals through a systematic review. Methods We searched PubMed, Embase, and Cochrane Central Register of Controlled Trials up to May 2020. One author screened titles and abstracts, and to validate, a second author screened 5% of the studies. Two authors independently extracted data and assessed risk of bias using the tool by the Cochrane Effective Practice and Organisation of Care group. Study inclusion criteria were (1) participants aged ≥ 18 years with multimorbidity; (2) referred to multimorbidity or two or more specific chronic conditions in the title or abstract; (3) randomized controlled design; and (4) HRQoL, mental health, or mortality as primary outcome measures. We used the Foundation Framework to categorize the models and the PRISMA-guideline for reporting. Results In this study, the first to report effectiveness of care models in patients with multimorbidity in hospital settings, we included 30 studies and 9,777 participants with multimorbidity. 12 studies were located in primary care, 9 in community care, and 9 in hospitals. HRQoL was reported as the primary outcome in 12 studies, mental health in 17 studies, and mortality in three studies-with significant improvements in 5, 14, and 2, respectively. The studies are presented according to settings. Conclusions Although 20 of the care models reported positive effects, the variations in populations, settings, model elements, and outcome measures made it difficult to conclude on which models and model elements were effective.
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Affiliation(s)
- Christian U Eriksen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Denmark
| | - Nina Kamstrup–Larsen
- The Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; AND Innovation and Research Center for Multimorbidity, Slagelse Hospital, Region Zealand, Denmark
| | - Hanne Birke
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Denmark
| | - Sofie A L Helding
- Rigshospitalet and DanTrials ApS, Juliane Marie Centre, Kobenhavn, Denmark; Zero Phase 1 Unit, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Denmark
| | - Nermin Ghith
- Research Group for Genomic Epidemiology, National Food Institute, Technical University of Denmark, Denmark
| | - John S Andersen
- The Research Unit for General Practice, Department of Public Health, University of Copenhagen, Denmark
| | - Anne Frølich
- The Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; AND Innovation and Research Center for Multimorbidity, Slagelse Hospital, Region Zealand, Denmark
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Jiwani R, Dennis B, Bess C, Monk S, Meyer K, Wang J, Espinoza S. Assessing acceptability and patient experience of a behavioral lifestyle intervention using fitbit technology in older adults to manage type 2 diabetes amid COVID-19 pandemic: A focus group study. Geriatr Nurs 2021; 42:57-64. [PMID: 33248357 PMCID: PMC7933081 DOI: 10.1016/j.gerinurse.2020.11.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 01/01/2023]
Abstract
Type 2 diabetes (T2D) contributes to reduced quality of life in older adults, especially in those with comorbidities such as being overweight or obese. Personal fitness technology (Fitbit ®) has the potential to improve the management of T2D. Using a semi-structured interview guide, focus groups were conducted to explore participants' acceptability and experiences following a behavioral lifestyle intervention that integrated Fitbit in overweight/obese older adults with T2D amid the COVID-19 pandemic which began during the time of this study. Focus group transcripts were transcribed and analyzed using thematic analysis. Eighteen (18) of the 20 participants completed the program and focus group interviews. Overall, we observed high acceptability of the program, and participants reported favorable experiences such as increased knowledge of health behaviors, improved diabetes management, and improved quality of life following the behavioral lifestyle intervention, even under stressful life circumstances from COVID-19.
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Affiliation(s)
- Rozmin Jiwani
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA; Geriatric Research, Education & Clinical Center (GRECC), South Texas Veterans Health Care System, San Antonio, Texas, USA.
| | - Brittany Dennis
- Graduate School of Biomedical Sciences, University of Texas Health Science Center at San Antonio, San Antonio,Texas, USA; Center on Smart and Connected Health Technologies at University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Chandler Bess
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Siler Monk
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Kylie Meyer
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Jing Wang
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA; Center on Smart and Connected Health Technologies at University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Sara Espinoza
- Geriatric Research, Education & Clinical Center (GRECC), South Texas Veterans Health Care System, San Antonio, Texas, USA; Department of Medicine, Division of Geriatrics, Gerontology & Palliative Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA; Sam & Ann Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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