Helping chronically ill or disabled people into work: what can we learn from international comparative analyses?

This project has added to knowledge in five main areas: It has mapped the range and types of policies and interventions that have been implemented in Canada, Denmark, Norway, Sweden and the UK that may influence employment chances for chronically ill and disabled people. By doing so it has added to understanding about what has actually been tried in each country and what might be considered in others. It has refined a typology of the focussed interventions that have been identified, based on the underlying programme logic of the intervention, which aids strategic thinking about national efforts to help chronically ill and disabled people into work. It has produced systematic reviews of the impact of the focussed interventions on the employment chances of chronically ill and disabled people and demonstrated the use of the typology in helping to interpret the results of the evaluations. The project’s empirical analyses of individual-level data have identified how chronically ill people from different socio-economic groups have fared in the labour markets of the five countries over the past two decades. It has then tested these findings against hypotheses about the impact of macro-level labour market policies on chronically ill people to provide insights into the influence of the policy context. The project has contributed to methodological development in evidence synthesis and the evaluation of natural policy experiments. By studying a small number of countries in great depth, we gained greater understanding of the policies and interventions that have been tried in these countries to help chronically ill and disabled people into work, against the backdrop of the wider labour market and macro-economic trends in those countries. We then integrated evidence from the wider policy context into the findings of systematic reviews of effectiveness of interventions, to advance interpretation of the natural policy experiments that have been implemented in these countries

Integrated Management of Chronically ill Patients: Nurse-client interactions and follow-up care

Follow-up care ensurescontinuity of client care, gives room for provider-client interactions and sustains self-management measures in the client with chronic illness. This study examined nurse-client interactions and follow-up care in integrated management of the chronically ill patient. 240 nurses were selected from secondary and tertiary health institutions in Anambra State of Nigeria using purposive sampling technique. Two research questions and two null hypotheses guided the study. The instrument used for data collection was questionnaire on nursing interventions in integrated management of chronically ill patients. Standard descriptive statistics was used to summarize the variables. Mean scores were used to answer the research questions while chi-square test was adopted in testing the hypotheses at 0.01 level of significance. The result indicated high level of nurse-client interaction (mean = 3.1368) but average level of follow-up care (mean =2.1556) of clients by nurses. Client's medical diagnosis was observed to have significant influence on nurse – client interaction; also nurse-client interactions was found to differ significantly across the levels of health care institutions

The Influence of Chronic Illness on Mental Health: Does the Age of the Patient Matter?

It is no secret that battling a chronic illness can impact an individual’s mental health, all while simultaneously harming their physical health. Although many say that this connection between chronic illness and mental health is obvious, we may still wonder whether chronically ill young adults have a harder time coping with chronic illness and mental health. Does the age of the chronically ill patient matter? Are chronically ill young adults more likely to suffer from poor mental health than older chronically ill individuals? I hypothesize that the older the chronically ill patient, the better their reported mental health will be. To test this assumption, this study analyzes data from the 2010 National Health Interview Survey (NHIS) using a subset of 4,257 chronically ill individuals aged 18 through 85. I Control for race, labor force status, and sex, the results from the analyses align with findings from previous literature (Fässberg et al. 2016; Gallant, Spitze and Grove 2010). The findings support my age hypothesis as well as also provide insight on how not being in the labor force also affects chronically ill patient’s mental health

Does trust in health care influence the use of complementary and alternative medicine by chronically ill people?

BACKGROUND: People's trust in health care and health care professionals is essential for the effectiveness of health care, especially for chronically ill people, since chronic diseases are by definition (partly) incurable. Therefore, it may be understandable that chronically ill people turn to complementary and alternative medicine (CAM), often in addition to regular care. Chronically ill people use CAM two to five times more often than non-chronically ill people. The trust of chronically ill people in health care and health care professionals and the relationship of this with CAM use have not been reported until now. In this study, we examine the influence of chronically ill people's trust in health care and health care professionals on CAM use. METHODS: The present sample comprises respondents of the 'Panel of Patients with Chronic Diseases' (PPCD). Patients (≥25 years) were selected by GPs. A total of 1,625 chronically ill people were included. Trust and CAM use was measured by a written questionnaire. Statistical analyses were t tests for independent samples, Chi-square and one-way analysis of variance, and logistic regression analysis. RESULTS: Chronically ill people have a relatively low level of trust in future health care. They trust certified alternative practitioners less than regular health care professionals, and non-certified alternative practitioners less still. The less trust patients have in future health care, the more they will be inclined to use CAM, when controlling for socio-demographic and disease characteristics. CONCLUSION: Trust in future health care is a significant predictor of CAM use. Chronically ill people's use of CAM may increase in the near future. Health policy makers should, therefore, be alert to the quality of practising alternative practitioners, for example by insisting on professional certification. Equally, good quality may increase people's trust in public health care

Scaling Up: Bringing the Transitional Care Model Into the Mainstream

Describes features of an innovative care management intervention to facilitate elderly, chronically ill patients' transitions among providers and settings; the adopting organization; and the external environment that affect its translation into practice

How Is the Affordable Care Act Leading to Changes in Medicaid Today? State Adoption of Five New Options

Examines state takeup of five Medicaid options under federal healthcare reform, including early expansion of coverage, funding to upgrade eligibility systems and disease prevention, health homes for the chronically ill, and integration of dual eligibles

Patient Education and Consumer Activation in Chronic Disease

Presents suggestions from experts on patient and provider education, health behavior change, and information technologies for strategies, tactics, and activities for helping the chronically ill become active participants in their health and health care

Caregiver burden and chronic illness among aging adults: an analysis of the factors moderating levels of caregiver burden/stress in caregivers.

The purpose of this study is to analyze the relationship between chronic illness among the elderly population of United States and the caregiving burden/stress among the caregivers for this population. This study's literature is supplemented by various psychological, sociological and gerontological research. This study analyzes data obtained from political and social research survey data (Thamer, 2000); a national cross-section of adults consisting of 1,663 participants, with a chronic illness and adults who provided informal caregiving services of which 680 were neither chronically ill nor caregivers, 189 were caregivers but not chronically ill, 559 were chronically ill but not caregivers, and 235 were chronically ill caregivers. The objective of this survey was to assess public awareness of chronic care issues and the level of support for chronic care policy initiatives, examine experiences and needs of chronically ill Americans concerning health care and other assistance, and evaluate experiences and needs of informal caregivers

How Engaged Are Consumers in Their Health and Health Care, and Why Does It Matter?

Summarizes findings on U.S. patients' ability to manage their health and health care by income level, education, Medicaid status, and health status. Examines access to care by level of engagement among the chronically ill. Discusses policy implications

Gauging the Generosity of Employer-Sponsored Insurance: Differences Between Households With and Without a Chronic Condition

We develop an empirical method to assess the generosity of employer-sponsored insurance across groups within the U.S. population. A key feature of this method is its simplicity – it only requires data on out-of-pocket (OOP) health care spending and total health care spending and does not require detailed knowledge of health insurance benefit design. We apply our method to assess whether households with a chronically ill member have more or less generous insurance relative to households with no chronically ill members. We find that the chronically ill have less generous insurance coverage than the non-chronically ill. Additional analyses suggest that the reason for this less generous coverage is not that households with a chronically ill member are in different, less generous plans, on average. Rather, households with a chronically ill member have higher spending on certain types of medical services (e.g., pharmaceutical drugs) that are covered less generously by insurance. Given recent work on value-based insurance design and coinsurance as an obstacle to medication adherence, our findings suggest that the current design of health plans may put the health and financial well-being of the chronically ill at risk.