Changes in health-related quality of life before and after a 12-month enhanced primary care model among chronically ill primary care patients in Australia.

Abstract

Purpose: Evidence suggests that Patient-centred Medical Home (PCMH) model facilitates person-centred care and improves health-related quality of life for patients with chronic illness. This study aims to evaluate changes in health-related quality of life (HRQoL), before and after enrolment into a 12-month integrated care program called ‘WellNet’. Methods: This study includes 616 eligible consented patients aged 40 years and above with one or more chronic conditions from six general practices across Sydney, Australia. The WellNet program included a team of general practitioners (GPs) and clinical coordinators (CCs) providing patient-tailored care plans configured to individual risk and complexity. HRQoL was recorded using the validated EuroQol five dimensions five levels (EQ-5D-5L) instrument at baseline and 12 months. Additionally, patients diagnosed with osteoarthritis also reported HRQoL using short versions of Knee and/or Hip disability and osteoarthritis outcome scores (KOOSjr and HOOSjr). A case-series study design with repeated measures analysis of covariance (ANCOVA) was used to assess changes in mean differences of EQ-5D index scores after controlling for baseline covariates. Additionally, backward stepwise multivariable linear regression models were conducted to determine significant predictors of EQ-5D index scores at follow-up. Results: Out of 616 patients, 417 (68%) reported EQ-5D scores at follow-up. Almost half (48%) of the WellNet patients reported improved EQ-5D index scores at follow-up. After controlling for baseline covariates, the adjusted mean difference was statistically significant whilst also meeting the bare minimal clinically important difference (MCID) with a change of 0.03 (95% CI 0.01, 0.05). The multivariable regression models determined that baseline EQ-5D scores and positive diagnosis of a respiratory illness were significant predictors of HRQoL at follow-up. There were significant improvements across both KOOS and HOOS assessments, specifically, the pain and symptom scores in both scales met statistical significance in addition to meeting the MCID.Conclusion: Patient-tailored chronic disease management (CDM) plans designed by team of GPs and CDM clinical coordinators could lead to better HRQoL among primary care patients.

Counting the cost of premature mortality with progressively worse aortic stenosis in Australia: a clinical cohort study

“…First, we relaxed the assumption that patients with mild-to-moderate aortic stenosis have the same quality of life (utility score of 0•71) as patients with severe aortic stenosis, replacing this value with a recent estimate for chronically ill patients in Australia (utility score of 0•79). 19 Second, we applied a quality-of-life utility score of 0•55 derived from a US cohort based on Kansas City Cardiomyopathy Questionnaire scores for patients with intermediate-risk aortic stenosis receiving the next-generation SAPIEN 3 transcatheter heart valve inter vention. 20 Together, these values provide upper and lower bound estimates for our baseline QALY estimates.…”

“…Other datasets such as the health-related quality of life and the monetary value of health are all available from public sources. [17][18][19]…”

A conceptual model to manage multiple chronic conditions based on PDSA theory

“…Many countries and regions have developed an integrated management model of comorbidities in the elderly (Appendix 1) [11][12][13][14][15][16]. While the intervention effect is unclear [17][18][19], there is insu cient evidence for interventions associated with improved outcomes [20,21].…”

How Aware Are Family Physicians of the Social Life and Loneliness of Older People

“…The Age-Friendly Primary Health Care Center Guide developed by the World Health Organization (WHO) for primary health care center employees supports the health of older people (7). Moreover, physicians working in primary care should evaluate older patients within the discipline of family medicine to improve their health, provide treatment or care, and increase their quality of life (8,9 ). In this study, we examine older patients' perceptions of their social lives and loneliness and their family physicians' awareness of these issues.…”