Shared decision making between older people with multimorbidity and GPs: a qualitative study DOI Creative Commons
Emily L. Brown, Leon Poltawski, Emma Pitchforth

et al.

British Journal of General Practice, Journal Year: 2022, Volume and Issue: 72(721), P. e609 - e618

Published: Feb. 16, 2022

Shared decision making (SDM), utilising the expertise of both patient and clinician, is a key feature good-quality care. Multimorbidity can complicate SDM, yet few studies have explored this dynamic for older patients with multimorbidity in general practice.To explore factors influencing SDM from perspectives GPs, to inform improvements personalised care.Qualitative study. General practices (rural urban) Devon, England.Four focus groups: two (aged ≥65 years multimorbidity) GPs. Data were coded inductively by applying thematic analysis.Patient acknowledgement clinician medicolegal vulnerability context multimorbidity, their recognition as barrier new finding. Medicolegal was unifying theme other reported barriers SDM. These included expectations GPs follow clinical guidelines, challenges encountered guidelines communicating uncertainty, limited self-efficacy Increasing consultation duration improving continuity viewed facilitators.Clinician perceptions are recognised should be addressed optimise delivery Greater awareness needed. Educating clinicians communication uncertainty core component training. The incorrect perception that most already effectively facilitate improve uptake care interventions.

Language: Английский

Multi-Morbidity and Polypharmacy in Older People: Challenges and Opportunities for Clinical Practice DOI Creative Commons

Pritti Aggarwal,

Stephen J Woolford, Harnish P. Patel

et al.

Geriatrics, Journal Year: 2020, Volume and Issue: 5(4), P. 85 - 85

Published: Oct. 28, 2020

Multi-morbidity and polypharmacy are common in older people pose a challenge for health social care systems, especially the context of global population ageing. They complex interrelated concepts that require early detection patient-centred shared decision making underpinned by multi-disciplinary team-led comprehensive geriatric assessment (CGA) across all settings. Personalised plans need to remain responsive adaptable needs wishes patient, enabling individual maintain their independence. In this review, we aim give an up-to-date account recognition management multi-morbidity person.

Language: Английский

Citations

123
The forecasted prevalence of comorbidities and multimorbidity in people with HIV in the United States through the year 2030: A modeling study DOI Creative Commons
Keri N. Althoff, Cameron Stewart, Elizabeth Humes

et al.

PLoS Medicine, Journal Year: 2024, Volume and Issue: 21(1), P. e1004325 - e1004325

Published: Jan. 12, 2024

Estimating the medical complexity of people aging with HIV can inform clinical programs and policy to meet future healthcare needs. The objective our study was forecast prevalence comorbidities multimorbidity among (PWH) using antiretroviral therapy (ART) in United States (US) through 2030.

Language: Английский

Citations

13
Heart Failure Nurses within the Primary Care Setting DOI Creative Commons
Loreena Hill, A. McNulty, James McMahon

et al.

Cardiac failure review, Journal Year: 2024, Volume and Issue: 10

Published: Feb. 9, 2024

Cardiology services within primary care often focus on disease prevention, early identification of illness and prompt referral for diagnosis specialist treatment. Due to advances in pharmaceuticals, implantable cardiac devices surgical interventions, individuals with heart failure are living longer, which can place a significant strain global healthcare resources. Heart nurses setting offer wealth clinical knowledge expertise across all phases the trajectory able support patients, family members other community services, including general practitioners. This review examines recently published evidence current potential future practice care.

Language: Английский

Citations

9
Interventions and management on multimorbidity: An overview of systematic reviews DOI

Yaguan Zhou,

Xiaochen Dai, Yujie Ni

et al.

Ageing Research Reviews, Journal Year: 2023, Volume and Issue: 87, P. 101901 - 101901

Published: March 9, 2023

Language: Английский

Citations

16
Management of antipsychotics in primary care: Insights from healthcare professionals and policy makers in the United Kingdom DOI Creative Commons
Alan Woodall, Aseel S. Abuzour, Samantha A. Wilson

et al.

PLoS ONE, Journal Year: 2024, Volume and Issue: 19(3), P. e0294974 - e0294974

Published: March 1, 2024

Introduction Antipsychotic medication is increasingly prescribed to patients with serious mental illness. Patients illness often have cardiovascular and metabolic comorbidities, antipsychotics independently increase the risk of cardiometabolic disease. Despite this, many are discharged primary care without planned psychiatric review. We explore perceptions healthcare professionals managers/directors policy regarding reasons for increasing prevalence management in care. Methods Qualitative study using semi-structured interviews 11 general practitioners (GPs), 8 psychiatrists, United Kingdom. Data was analysed thematic analysis. Results Respondents reported competency gaps that impaired ability manage antipsychotic medications, arising from inadequate postgraduate training professional development. GPs lacked confidence medications alone; psychiatrists skills address risks did not perceive this as their role. Communication barriers, lack integrated records, limited psychology provision, lowered expectation towards by professionals, pressure discharge hospital resulted becoming ‘trapped’ on antipsychotics, inhibiting opportunities deprescribe. Organisational contractual barriers between services exacerbate risk, socioeconomic deprivation access non-pharmacological interventions driving overprescribing. Professionals voiced fears censure if a catastrophic event occurred after stopping an antipsychotic. Facilitators overcome these were suggested. Conclusions People experience fragmented health system suboptimal Several could be taken improve population, but availability factors distress need change outcomes. The role professionals’ fear medicolegal or regulatory deprescribing new finding study.

Language: Английский

Citations

7
Advancing multimorbidity management in primary care: a narrative review DOI Creative Commons
Chanchanok Aramrat, Yanee Choksomngam, Wichuda Jiraporncharoen

et al.

Primary Health Care Research & Development, Journal Year: 2022, Volume and Issue: 23

Published: Jan. 1, 2022

Multimorbidity, defined as the coexistence of two or more chronic conditions in same individual, is becoming a crucial health issue primary care. Patients with multimorbidity utilize care at higher rate and have mortality rates poorer quality life compared to patients single diseases.

Language: Английский

Citations

25
My Goals Are Not Their Goals: Barriers and Facilitators to Delivery of Patient-Centered Care for Patients with Multimorbidity DOI Open Access
Linnaea Schuttner, Stacey Hockett Sherlock, Carol Simons

et al.

Journal of General Internal Medicine, Journal Year: 2022, Volume and Issue: 37(16), P. 4189 - 4196

Published: May 23, 2022

Language: Английский

Citations

24
Living with multimorbidity: A qualitative exploration of shared experiences of patients, family caregivers, and healthcare professionals in managing symptoms in the United States DOI Creative Commons
Anna Peeler, Katie E. Nelson,

Vidisha Agrawalla

et al.

Journal of Advanced Nursing, Journal Year: 2024, Volume and Issue: 80(6), P. 2525 - 2539

Published: Jan. 10, 2024

Abstract Aims To elicit experiences of patients, family caregivers, and healthcare professionals in intermediate care units (IMCUs) an academic medical centre Baltimore, MD related to the challenges intricacies multimorbidity management inform development a symptom toolkit. Design Experience‐based co‐design. Methods Between July October 2021, patients aged 55 years older with admitted IMCUs at Maryland, USA were recruited interviewed person. Interdisciplinary working IMCU virtually. Participants asked questions about their role recognizing treating symptoms, factors affecting quality life, burden trajectory over time, strategies that have not worked for managing symptoms. An inductive thematic analysis approach was used analysis. Results Twenty‐three interviews conducted: 9 2 12 professionals. Patients' mean age 67.5 (±6.5) years, half ( n = 5) Black or Hispanic, average number comorbidities 3.67. Five major themes affect emerged: (1) patient–provider relationship; (2) open honest communication; (3) accessibility resources during hospitalization discharge; (4) caregiver support, training, education; (5) coordination follow‐up care. Conclusion Patients, often similar goals but different priorities management. It is imperative identify shared target holistic interventions consider patient improve outcomes. Implications Profession and/or Patient Care Impact This paper addresses paucity research experience disease people living multimorbidity. We found communication priorities. Understanding differing will help better design support so can best possible life. Reporting Method adhered Consolidated Criteria Qualitative Studies (COREQ) guidelines our reporting. Public Contribution study has been designed implemented public involvement throughout process, including community advisory board engagement project proposal phase interview guide development, member checking data collection phases. The method we chose, experience‐based co‐design, emphasizes importance engaging members act as experts own life challenges. In coming phases study, be involved developing testing new intervention, informed by these qualitative co‐design events,

Language: Английский

Citations

5
Easier Said Than Done: Healthcare Professionals’ Barriers to the Provision of Patient-Centered Primary Care to Patients with Multimorbidity DOI Open Access
Sanne Jannick Kuipers, Anna P. Nieboer, Jane Murray Cramm

et al.

International Journal of Environmental Research and Public Health, Journal Year: 2021, Volume and Issue: 18(11), P. 6057 - 6057

Published: June 4, 2021

Patient-centered care (PCC) has the potential to entail tailored primary delivery according needs of patients with multimorbidity (two or more co-existing chronic conditions). To make for these patient centered, insight on healthcare professionals’ perceived PCC implementation barriers is needed. In this study, were investigated using a constructivist qualitative design based semi-structured interviews nine general and nurse practitioners from seven practices in Netherlands. Purposive sampling was used, interview content analyzed generate themes representing experienced barriers. Barriers identified all eight dimensions (patient preferences, information education, access care, physical comfort, emotional support, family friends, continuity transition, coordination care). They include difficulties achieving mutual understanding between professionals, lack training education new skills, data protection laws that impede adequate documentation sharing, time pressure, conflicting financial incentives. These pose true challenges effective, sustainable at patient, organizational, national levels. Further improvement needed overcome

Language: Английский

Citations

27
Care coordination across healthcare systems: development of a research agenda, implications for practice, and recommendations for policy based on a modified Delphi panel DOI Creative Commons
Susanne Hempel, David A. Ganz, Sonali Saluja

et al.

BMJ Open, Journal Year: 2023, Volume and Issue: 13(5), P. e060232 - e060232

Published: May 1, 2023

For large, integrated healthcare delivery systems, coordinating patient care across systems with providers external to the system presents challenges. We explored domains and requirements for coordination by professionals developed an agenda research, practice policy.The modified Delphi approach convened a 2-day stakeholder panel moderated virtual discussions, preceded followed online surveys.The work addresses systems. introduced common scenarios differentiated recommendations large (main) organisation that contribute additional care.The composition included health service providers, decision makers, patients community, researchers. Discussions were informed rapid review of tested approaches fostering collaboration, facilitating improving communication systems.The study planned formulate research agenda, implications policy.For recommendations, we found consensus developing measures shared care, exploring professionals' needs in different evaluating experiences. Agreed educating about issues specific main system, within roles responsibilities all involved parties, helping better understand pros cons within-system out-of-system care. Policy supporting time high overlap engage regularly sustaining support high-need patients.Recommendations from created foster further policy innovations cross-system coordination.

Language: Английский

Citations

11