Factorial validation of the patient assessment of chronic illness care (PACIC) and PACIC short version (PACIC-S) among cardiovascular disease patients in the Netherlands

Objective: The Chronic Care Model (CCM) has achieved widespread acceptance and reflects the core elements of patient-centred care in chronic diseases such as cardiovascular diseases (CVD). In the Netherlands the extent to which CVD patients receive care congruent with the CCM is unknown. The main objectives of this study were to validate the 20-item Patient Assessment of Chronic Illness Care (PACIC) and the 11-item (PACIC-S) in the Netherlands among

Self-management abilities, physical health and depressive symptoms among patients with cardiovascular diseases, chronic obstructive pulmonary disease, and diabetes

AbstractObjectiveThis study aimed to identify the predictive role of direct resources (educational level and marital status) and self-management abilities on physical health and depressive symptoms in patients with cardiovascular diseases (CVD), diabetes, or chronic obstructive pulmonary disease (COPD).MethodsOur cross-sectional questionnaire-based study included 1570 CVD patients, 917 COPD patients, and 412 patients with diabetes.ResultsPhysical health and depressive symptoms of COPD patients was lower than those of CVD and diabetic patients. Correlation analyses indicated that self-management abilities were strong indicators for physical health and depressive symptoms (all p<0.001). This relationship was strongest for depressive symptoms. Self-management abilities were related to educational level in all groups (all p<0.001). Regression analyses revealed that self-management abilities were strong predictors of physical health and depressive symptoms in all three patient groups (all p<0.001).ConclusionThis research showed that self-management abilities are strong predictors of physical health and depressive symptoms.Practice implicationsInterventions that improve self-management abilities may counteract a decline in physical health and depressive symptoms. Such interventions may be important tools in the prevention of the loss of self-management abilities, because they may motivate people who are not yet experiencing serious problems

Is "disease management" the answer to our problems? No! Population health management and (disease) prevention require "management of overall well-being".

BACKGROUND: Disease management programs based on the chronic care model have achieved successful and long-term improvement in the quality of chronic care delivery and patients’ health behaviors and physical quality of life. However, such programs have not been able to maintain or improve broader self-management abilities or social well-being, which decline over time in chronically ill patients. Disease management efforts, population health management initiatives and innovative primary care solutions are still mainly focused on clinical and functional outcomes and health behaviors (e.g., smoking cessation, exercise, and diet) failing to address individuals’ overall quality of life and well-being. Individuals’ ability to achieve well-being can be assessed with great specificity through the application of social production function (SPF) theory. This theory asserts that people produce their own well-being by trying to optimize the achievement of instrumental goals (stimulation, comfort, status, behavioral confirmation, affection) that provide the means to achieve the larger, universal goals of physical and social well-being. DISCUSSION: A shift in focus from the management of physical function, disease limitations, and lifestyle behaviors alone to an approach that fosters self-management abilities such as self-efficacy and resource investment as well as overall quality of life, is urgently needed. Disease management interventions should be aimed at adequately addressing all difficulties chronically ill patients face in life, such as the effects of pain and fatigue on the ability to maintain a job and social life and to participate in activities promoting physical and social well-being. Patients’ ability to maintain engagement in stimulating work and social activities with the people who are important to them may be even more important than aspects of disease self-management such as blood pressure or glycemic control. Interventions should aim to make chronically ill patients capable of managing their own well-being and adequately addressing their needs in a broader sense. SUMMARY: So, is disease management the answer to our problems in the time of aging populations and increased prevalence of unhealthy lifestyles, chronic illnesses, and comorbidity? No! Effective (disease) prevention, disease management, patient-centered care, and high-quality chronic care and/or population health management calls for management of overall well-being

The influence of social capital and socio-economic conditions on self-rated health among residents of an economically and health-deprived South African township

BACKGROUND: Surprisingly few studies have investigated the interplay of multiple factors affecting self-rated health outcomes and the role of social capital on health in developing countries, a prerequisite to strengthening our understanding of the influence of social and economic conditions on health and the most effective aid. Our study aimed to identify social and economic conditions for health among residents of an economically and health-deprived community. METHODS: Data were gathered through a survey administered to respondents from 1,020 households in Grahamstown a suburb in the Eastern Cape, South Africa (response rate 97.9%). We investigated the influence of social and economic conditions (education, employment, income, social capital, housing quality and neighborhood quality) on self-rated health. We used ordinal logistic regression analyses to identify the relationship of these conditions and self-rated health. RESULTS: Our study found that education and social capital positively correlated with health; unemployment, poor educational level and advanced age negatively correlated. We found no significant correlations between self-rated health and housing quality, neighbourhood quality, income, gender, or marital status. CONCLUSION: We highlight the possible impacts of social capital, employment, and education on health, and suggest that health outcomes may be improved through interventions beyond the health system: creating job opportunities, strengthening social capital, bettering educational systems, and promoting educational access. Policymakers should consider the benefits of such programmes when addressing health outcomes in financially distressed districts

Validation of an instrument for the assessment of patient-centred care among patients with multimorbidity in the primary care setting: the 36-item patient-centred primary care instrument

Abstract Background Validated instruments are needed to assess the delivery of patient-centred care (PCC) to patients with multimorbidity in the primary care setting. Eight dimensions of PCC have been identified: respect for patients’ preferences, access to care, emotional support, information and education, involvement of family and friends, continuity and secure transition between health care settings, physical comfort, and coordination of care. The main objective of this study was to validate an instrument for the assessment of PCC among patients with multimorbidity in the primary care setting: the 36-item patient-centred primary care (PCPC) instrument. Methods We included patients with multimorbidity from seven health care practices in the region of Tilburg, the Netherlands. All patients enrolled in at least two chronic care programmes (involving diagnosis of and treatment for combinations of diabetes, asthma and/or chronic obstructive pulmonary disease, cardiovascular diseases and conditions, and age-related frailty) were selected from the practices’ data registries and included as eligible participants. A total of 216 patients with multimorbidity filled in the study questionnaire (55% response rate). We tested the instrument using structural equation modelling, and examined its validity and reliability. Results Confirmatory factor analyses revealed good indices of fit and overall internal consistency, as represented by Cronbach’s alpha values. All eight dimensions of PCC were related positively to satisfaction with care (all p ≤ 0.001). Patients with multimorbidity who experienced joint decision making and responsibility taking in the primary care setting also had significantly higher scores for all eight PCC dimensions, indicating the instrument’s construct validity. Conclusions We conclude that the psychometric properties of the 36-item PCPC instrument are good. Based on these results the PCPC instrument seems a promising tool for the assessment of PCC among patients with multimorbidity in the primary care setting

Needs for Aging in Place:Views of Older Moroccan Adults in the Netherlands

BACKGROUND AND OBJECTIVES: Due to health and/or financial limitations, older migrants may become especially dependent on their neighborhoods, highlighting the importance of investigating their experiences. We explored older Moroccan adults' views on the relative importance of neighborhood resources for aging in place.RESEARCH DESIGN AND METHODS: Thirty Moroccans aged ≥ 65 years residing in Amsterdam, Rotterdam, The Hague, and Utrecht were interviewed and asked to perform a ranking task developed with the combined quantitative and qualitative Q methodology. They ranked the relative importance of 38 statements representing the World Health Organization's eight global age-friendly cities domains, with explanation of their reasoning. By-person factor analysis was performed to identify factors representing distinct viewpoints, which were interpreted with reference to the interviewees' comments.RESULTS: Four viewpoints were identified: "home sweet home"; "connected, well-informed, and engaged"; "suitable and affordable living"; and "a lively neighborhood." The perceived importance of neighborhood resources for aging in place differed among viewpoints.DISCUSSION AND IMPLICATIONS: Older Moroccan adults prioritize different neighborhood resources for aging in place. Our findings suggest that their diverse needs can be satisfied by enabling family to live in close proximity, providing diverse, inclusive neighborhoods with affordable, suitable housing, understandable information, social/cultural activities, and care services for vulnerable groups. Future studies may build on our findings to explore older (migrant) adults' views on needs for aging in place in the Netherlands and other western countries.</p

Access to livelihood assets among youth with and without disabilities in South Africa: Implications for health professional education

Purpose. This study compared access to 5 livelihood assets among disabled and non-disabled youth, to inform health professionals on inequities related to disability and to monitor the transformation agenda aimed at creating an inclusive society. Methods. Fieldworkers interviewed 989 youth (18 - 35 years; 523 (52.9%) disabled youth (DY), 466 (47.1%) non-disabled youth (NDY)) at 9 sites in 5 South African provinces. Descriptive statistics were used to describe demographic characteristics and livelihood assets. Chi-squared and t-tests were used for comparisons. Results. Doctors at hospitals and nurses at clinics are health professionals most frequently seen. Far fewer DY than NDY attended and completed school. Unemployment was markedly more common among DY than among NDY. Barriers to accessing employment for DY were poor health and lack of skills development, and a lack of job opportunities for NDY. Both groups received the same amount of support from immediate household members, but significantly more NDY received support from extended family, friends, partners, and neighbours. They spent significantly more time engaging in all free-time activities. NDY reported more access to bathrooms, phone, and newspapers, as well as public services and the business sector. Participation and access were limited for both groups because of inaccessible public transport. Conclusion. This paper shows that DY have a greater struggle to access livelihood assets than non-disabled peers. The Disability Studies Academic Programme at the University of Cape Town is an initiative that seeks to take specific focused action with disability organisations in order to address the inequities faced by disabled youth to ensure their inclusion in development to the same degree as their non-disabled peers