Integrated approaches to prevention and control of chronic conditions

Integrated approaches to prevention and control of chronic conditions. Chronic conditions currently account for more than 50% of the global disease burden, and this figure is projected to continue to rise. Yet, around the world, health care systems are not organized to provide effective and efficient care for chronic health problems. Health care systems have evolved around the concept of acute, infectious disease, and they perform best when addressing patients' acute and urgent symptoms. Without change, health care systems will grow increasingly inefficient and ineffective. Effective prevention, management, and rehabilitation of chronic conditions require an evolution of health care, away from a model that is focused on acute symptoms toward a coordinated, comprehensive system of care. The results of this shift include less waste and improved efficiency. Integrated health care models that transcend specific illnesses provide a feasible solution. The World Health Organization's Innovative Care for Chronic Conditions Framework provides a flexible but comprehensive model to build or redesign health systems in accord with local resources and demands

A systematic review and meta-analysis of the prevalence of chronic widespread pain in the general population.

Chronic widespread pain (CWP) is common and associated with poor general health. There has been no attempt to derive a robust prevalence estimate of CWP or assess how this is influenced by sociodemographic factors. This study therefore aimed to determine, through a systematic review and meta-analysis, the prevalence of CWP in the adult general population and explore variation in prevalence by age, sex, geographical location, and criteria used to define CWP. MEDLINE, Embase, CINAHL, and AMED were searched using a search strategy combining key words and related database-specific subject terms to identify relevant cohort or cross-sectional studies published since 1990. Included articles were assessed for risk of bias. Prevalence figures for CWP (American College of Rheumatology criteria) were stratified according to geographical location, age, and sex. Potential sources of variation were investigated using subgroup analyses and meta-regression. Twenty-five articles met the eligibility criteria. Estimates for CWP prevalence ranged from 0% to 24%, with most estimates between 10% and 15%. The random-effects pooled prevalence was 10.6% (95% confidence intervals: 8.6-12.9). When only studies at low risk of bias were considered pooled, prevalence increased to 11.8% (95% confidence intervals: 10.3-13.3), with reduced but still high heterogeneity. Prevalence was higher in women and in those aged more than 40 years. There was some limited evidence of geographic variation and cultural differences. One in 10 adults in the general population report chronic widespread pain with possible sociocultural variation. The possibility of cultural differences in pain reporting should be considered in future research and the clinical assessment of painful conditions

Cross-sectional associations between variations in ankle shape by statistical shape modeling, injury history, and race : the Johnston County Osteoarthritis Project

Rheumatology Research Foundation Medical Student Preceptorship Award (Lateef/Nelson), NIAMS K23 AR061406 (Nelson); NIH/NIAMS P60AR064166 and U01DP003206 (Jordan/Renner), NIH/NIAMS R01AR067743 (Golightly). The funders had no role in study design; collection, analysis, or interpretation of data; writing the manuscript or the decision to submit for publication.Peer reviewedPublisher PD

To integrate or not to integrate? Future considerations for chronic disease self-management programs in the health care system

Objective: The growing burden of chronic disease and the increasing realisation that the current health system is ill equipped to deal with this trend has resulted in a health policy shift away from the traditional medical model to a more patient centred approach. As such, chronic disease self-management programs (CDSMP) have emerged as a potentially important component within this approach. Policy and program trends at the international level highlight several critical factors that need to be considered by governments and health care providers alike if CDSMP are to be integrated within the broader health system. This study reviewed international and local policy literature and sought perspectives from key stakeholders to determine the value and potential for integrating a generic group-based CDSMP into the care continuum.Method: Prominent self-management policies were identified through a comprehensive literature search. Interviews were conducted with policy makers across Australia (n=20), health practitioners (n=20) and consumers (n=42) purposefully recruited from metropolitan and rural Victoria, representing key demographics of interest including low socioeconomic areas.Results: Whilst CDSMP were viewed as having significant potential to be integrated into the health sector it was identified that the delivery and content of CDSMP needs to be flexible in order to address the needs of people across the disease, age and care continuums. Critical issues to be addressed if CDSMP are to be successfully integrated include increasing the profile of self-management; actively engaging and training health practitioners in self-management and overcoming system barriers such as lack of integrated referral pathways and networks.Discussion: Policy directions at the national level suggest that self-management will be a centrepiece in forthcoming chronic disease initiatives. International evidence has highlighted the requirement for a &lsquo;suite&rsquo; of programs to adequately cater to different stages of the disease continuum, age groups, ethnic backgrounds and sociogeographical areas. Furthermore engagement with key stakeholders (particularly GPs) is identified as critical to ensure the successful integration of CDSMP into the health system.Conclusion: Evidence suggests that CDSMP is an important facet in improving care of people with chronic conditions. Findings from this study suggest that current infrastructure and policy direction, which have been found to be critical factors in facilitating integration of CDSMP into the health sector, are either absent or inadequate in Victoria. CDSMPs are currently lacking a sustainable workforce, referral infrastructure and specific policy. Such factors need to be addressed before the integration of CDSMP can be considered across the healthcare continuum in Victoria.<br /

Chronic disease self-management programs : perspectives on enablers and barriers to GP and patient engagement

Aims &amp; rationale/Objectives : Chronic disease self-management programs (CDSMP) are increasingly being integrated into the health system to improve the care of people with chronic conditions. Despite activity at both policy and program levels, GPs as the \u27gatekeepers\u27 to the health system have generally not been well informed or engaged in this process. This study, in collaboration with 3 Victorian Divisions of General Practice, sought both GP and patient perspectives on enablers and barriers to engagement in self-management programs.Methods : Interviews were conducted with GPs (n=20) and consumers (n=45) purposefully recruited from metropolitan and rural Victoria, representing key demographics of interest including low socioeconomic areas.Principal findings : Lack of education/information and uncertainty about the effectiveness of self-management programs were key barriers for both GP and patient engagement. Programs that were sustainable and utilised existing community resources were viewed as enablers to increase uptake. GP and patient preferences for disease specific or generic CDSMP differed.Discussion : Outcomes from the recent Council of Australian Governments\u27 meeting suggest that self-management will be a centerpiece in forthcoming chronic disease initiatives. International evidence has highlighted the need for GP and patient engagement as critical in ensuring the recruitment of a critical mass of individuals to participate in CDSMP to ensure the sustainability of such initiatives. Insight from this study indicates that GPs and patients are not well informed about self-management, have different preferences to current policy trends and identifies several other barriers which need to be addressed if CDSMP are to be successful.Implications : Identification of barriers and enablers of GP and patient engagement in self-management is essential in shaping current policy initiatives and delivery of future programs. This is supported by international evidence which indicates strongly that GP engagement in particular is crucial to the success of these programs.Presentation type : Paper <br /

First Qualification Study of Serum Biomarkers as Indicators of Total Body Burden of Osteoarthritis

BACKGROUND: Osteoarthritis (OA) is a debilitating chronic multijoint disease of global proportions. OA presence and severity is usually documented by x-ray imaging but whole body imaging is impractical due to radiation exposure, time and cost. Systemic (serum or urine) biomarkers offer a potential alternative method of quantifying total body burden of disease but no OA-related biomarker has ever been stringently qualified to determine the feasibility of this approach. The goal of this study was to evaluate the ability of three OA-related biomarkers to predict various forms or subspecies of OA and total body burden of disease. METHODOLOGY/PRINCIPAL FINDINGS: Female participants (461) with clinical hand OA underwent radiography of hands, hips, knees and lumbar spine; x-rays were comprehensively scored for OA features of osteophyte and joint space narrowing. Three OA-related biomarkers, serum hyaluronan (sHA), cartilage oligomeric matrix protein (sCOMP), and urinary C-telopeptide of type II collagen (uCTX2), were measured by ELISA. sHA, sCOMP and uCTX2 correlated positively with total osteophyte burden in models accounting for demographics (age, weight, height): R(2) = 0.60, R(2) = 0.47, R(2) = 0.51 (all p<10(-6)); sCOMP correlated negatively with total joint space narrowing burden: R(2) = 0.69 (p<10(-6)). Biomarkers and demographics predicted 35-38% of variance in total burden of OA (total joint space narrowing or osteophyte). Joint size did not determine the contribution to the systemic biomarker concentration. Biomarker correlation with disease in the lumbar spine resembled that in the rest of the skeleton. CONCLUSIONS/SIGNIFICANCE: We have suspected that the correlation of systemic biomarkers with disease has been hampered by the inability to fully phenotype the burden of OA in a patient. These results confirm the hypothesis, revealed upon adequate patient phenotyping, that systemic joint tissue concentrations of several biomarkers can be quantitative indicators of specific subspecies of OA and of total body burden of disease

Evaluation of the Children's Palliative Care Programme (CPCP). A jointly funded programme of work arising from Palliative Care for Children with Life-limiting Conditions - A National Policy. Summary Report.

Aims of the evaluation were: - To evaluate the inputs, outputs, progress and, where possible, outcomes of the CPCP - To review the extent to which the programme is operating as a national service in terms of coverage and coordination - To assess the contribution of the CPCP towards the implementation of Palliative Care for Children with Life-limiting Conditions in Ireland–A National Policy (DOHC 2009) Methodology The evaluation consisted of three phases over a two year period. Phase One included a literature review, development of research design/tools, ethical approval and stakeholder consultation. Phase Two, a process evaluation, comprised a survey of service providers as well as stakeholder interviews and focus groups. The final summative evaluation phase consisted of an E-survey of service providers and parents; interviews and/or focus groups with parents, service providers, service managers, stakeholders, and the training provider; and a secondary analysis of feedback from training participants. Findings The CPCP had four anticipated outcomes and the collective evidence confirmed that the new services are widely understood to be adding significant value to service provision for children with life-limiting conditions and their families across all four outcomes. Recommendations The report includes a set of 20 recommendations. Six recommendations are resource dependent including additional staff resources, ongoing funding of the education programme, and improved respite and bereavement care. Seven are structural/ organisational in nature and include strengthening and maximising the future role of the CPCP, further integration of services, and a review and reconfiguration of the National Development Committee for Children’s Palliative Care. Two recommendations are administrative consisting of the provision of administrative support and making the best use of communication tools. The remaining five are on governance, training needs and progressing the development of the next phase of children’s palliative care, including priority setting. Conclusion This research has shown that the three key elements of the CPCP have been welcomed by parents, front line services and stakeholders. The initiatives have improved the level and quality of care being provided to children with life-limiting conditions and their families. The education component has also been widely accepted by the full range of healthcare staff who provide care for this cohort of children and their families. The CPCP has also had a very positive impact on the implementation of national policy. The report identifies challenges and areas for improvement and draws on the collective evidence gathered to provide a series of recommendations which will enable the setting of key priorities for the future