Rethinking health-care systems: a focus on chronicity

Allotey, Pascale; Reidpath, Daniel D.; Yasin, Shajahan; Chan, Carina Ka Yee; Aikins, Ama de‐Graft

doi:10.1016/s0140-6736(10)61856-9

Cited by 86 publications

(71 citation statements)

References 9 publications

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“…If these rates are compared to the OECD average, it is possible to see that Spain is below the average, except for the case of colorectal cancer mortality rate, diabetes lower extremity amputation rates, in-hospital fatality rates of acute myocardial infarction and ischaemic stroke. Chronicity is emerging as a new concept that provides a better framework for understanding the implications of chronic health conditions and polypathology for the affected persons, their families and caregivers, and for health systems and societies (Allotey et al, 2011). At the micro level, this concept represents a focus on persons living with chronic conditions and their health and social needs encouraging person-centered care in which self-management responsibilities cannot be avoided.…”

Section: Chronicity and Polypathologymentioning

confidence: 99%

Pathways towards chronic care-focused healthcare systems: Evidence from Spain

et al. 2012

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AcknowledgementsThe authors are thankful to Mauricio Avendano-Pabón, Anna Maresso and Marta TraperoBertran for helpful comments on a preliminary version of this work, and Jonathan Cylus for his data support. Manuel García-Goñi research was supported by the project "La innovación en servicios y las interacciones entre servicios públicos y privados: el caso de la sanidad", financed by the Spanish Ministry of Science and Innovation. Any errors are the authors' responsibility. 2 AbstractIncreasing health care expenditures is a matter of concern in many countries, particularly in relation to the underlying drivers of such escalation which include ageing, medical innovation, and changes in the burden of disease e.g. prevalence of chronic diseases. Most health care systems in developed countries have been designed to 'cure' acute episodes, rather than to 'manage' chronic conditions, and thereby they are not adequately and efficiently organized to respond to the changing needs and preferences of consumers. New models of chronic care provision have been developed to respond to the changing burden of disease and there are already practical experiences in different countries showing their advantages but also the difficulties in their implementation. In this paper, we focus on the Spanish experience in terms of policy changes and pilot studies directed at testing the viability of transiting towards chronic care models. In particular, we utilize a framework that identifies and analyses the 10 key pre-conditions of high performing chronic-care based healthcare systems and apply it to the current Spanish NHS. We find that the design of the Spanish National Health System already meets some of those pre-conditions. However, other features are still in their early stages of development or being applied in restricted geographical and clinical contexts. We propose a pathway to walk the crucial challenge of the transition towards an optimal health system focused on chronic care. Given the current evidence and trends, we expect that the pathway for developing a chronicity strategy for the Spanish NHS will significantly transform its current healthcare delivery model in the next few years.

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Section: Chronicity and Polypathologymentioning

confidence: 99%

Pathways towards chronic care-focused healthcare systems: Evidence from Spain

et al. 2012

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“…1 The number of people who undergo HD has accompanied the growth of CKD diagnosis, which is a public health problem throughout the world, a nontransmissible chronic disease mainly arising from hypertension and diabetes mellitus. 2 The CKD and its treatment lead to significant changes for people, such as restrictions on fluid and food intake; itching; cramps; tiredness; decline in bodily functions; sleep disorders; sterility; changes in family structure; uncertainty about the future; changes in social life; time spent with the treatment; difficulties with transportation to the HD unit; changes in work activities; and financial problems. [3][4][5][6] These changes require adaptation and are characterized as stressors.…”

Section: Introductionmentioning

confidence: 99%

Clinical variables, lifestyle and coping in hemodialysis

Bertolin¹

2016

Invest Educ Enferm

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Objective. To verify the relationship between coping strategies of people with chronic kidney disease undergoing hemodialysis and their clinical variables and lifestyle habits. Methods. It was developed a cross-sectional study that used the Coping Strategies Inventory of Folkman and Lazarus and a semi-structured questionnaire for collecting clinical variables and lifestyles of patients undergoing hemodialysis in the Urology and Nephrology Institute of São Jose do Rio Preto-SP (Brazil). Results. Participants were 107 adults undergoing hemodialysis, with an average age of 51 years; 62.4% were men. The main causes of chronic kidney disease were chronic glomerulonephritis, diabetes mellitus, undetermined cause and hypertension. The most reported coping strategies were focused on emotion. There were greater coping scores among people who had diabetes, those who had leisure and those who referred religion. People who exercised and those who had undergone renal transplantation had more positive coping. Conclusion. Clinical variables of people undergoing hemodialysis can be sources of stress, and lifestyle habits are associated with coping strategies to mitigate the effects of stress.Key words: psychological adaptation; chronic renal failure; hemodialysis; stress; nursing. Variables clínicas, estilos de vida y enfrentamiento en personas con hemodiálisesObjetivo. Identificar la relación entre las estrategias del afrontamiento de las personas con enfermedad renal crónica en hemodiálisis y las variables clínicas y de estilos de vida. Métodos. Se desarrolló un estudio transversal en el que se utilizó el Inventario de Estrategias del Afrontamiento del Folkman y Lazarus y un cuestionario semiestructurado para la recolección de las variables clínicas y de estilos de vida de pacientes con tratamiento de hemodiálisis del Instituto de Urología y Nefrología de São José do Rio Preto (Brasil). Resultados. Participaron 107 personas en hemodiálisis con un promedio de edad de 51 años; 62.4% hombres. Las principales causas de la enfermedad renal crónica fueron la glomerulonefritis crónica, la diabetes Mellitus, la causa indeterminada y la hipertensión arterial. Las estrategias de afrontamiento más reportadas se centraron en la emoción. Se obtuvieron puntajes más altos de afrontamiento en las personas con diabetes, con tiempo libre, y los que practicaban una religión. Las personas que practicaban ejercicio y quienes habían sido sometidos a trasplante renal referían afrontamiento más positivo. Conclusión. Las variables clínicas de las personas en hemodiálisis pueden ser fuentes de estrés; por el contrario, los estilos de vida están asociados con las estrategias de afrontamiento para atenuar los efectos del estrés.

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“…(3) In particular in the context of non-transmissible chronic diseases, the process of adaptation consists of psychological, social and physiological adjustment throughout the course of the disease, resulting in an interaction between demands of the disease and treatment and the individual's skill to respond to these demands. (4,5) Upon receiving a diagnosis of a non-transmissible chronic disease, such as type 2 diabetes mellitus, people confront new situations that require an individual assessment and must choose how to deal with such situations. So begins the psychological adaptation process.…”

Section: Introductionmentioning

confidence: 99%

Adaptação psicológica e aceitação do diabetesmellitus tipo 2

et al. 2015

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Conflicts of interest: none reported. Study makes up the project entitled Impact of a care program for people with diabetes mellitus focused on educational interventions in the family and social support. AbstractObjective: To evaluate individuals' psychological adaptation to type 2 diabetes mellitus throughout acceptance of the disease and its relation with perceived stress and values of glycated hemoglobin (A 1c ) before and after group educational intervention. Methods: Quasi-experimental study developed at outpatient unit that included 77 participants who fulfilled inclusion criteria. The study instruments were a questionnaire that obtained sociodemographic variables and the Acceptance of Disease Scale and Perceived Stress Scale, both applied during interviews before and after group education intervention using Diabetes Conversations Maps. Results: Interviewed patients showed improvements in the acceptance of the disease after educational intervention. We observed an inverse relation between acceptance of the disease, perceived stress, and the mean glycated hemoglobin (A 1c ) value before and after the intervention. Conclusion: Acceptance of type 2 diabetes can improve after a group educational intervention. A high score for acceptance of the disease was related to a low score for perceived stress and lower mean glycated hemoglobin (A 1c ) value. ResumoObjetivo: Avaliar a adaptação psicológica de pessoas com diabetes mellitus tipo 2 através da aceitação da doença e sua relação com o estresse percebido e valores de hemoglobina glicada A 1c , antes e após intervenções educativas em grupo. Métodos: Estudo quase-experimental desenvolvido em unidade ambulatorial, e incluiu 77 pessoas que atenderam aos critérios de inclusão. Os instrumentos de pesquisa foram: questionário com variáveis sociodemográficas, Escala de Aceitação da Doença e Escala de Estresse Percebido, que foram aplicados por entrevistas antes e após intervenções educativas em grupo, utilizando Mapas de Conversação em Diabetes. Resultados: Os pacientes entrevistados apresentaram melhora da aceitação da doença após as intervenções. Verificou-se relação inversa entre a aceitação da doença, o estresse percebido e a média de hemoglobina glicada A 1c , antes e após as intervenções. Conclusão: A aceitação da doença pode melhorar após intervenções educativas em grupo. Maiores escores de aceitação da doença foram relacionados a menores escores de estresse percebido e a menores médias de hemoglobina glicada A 1c .Clinical Trials registry number: NCT01387633

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Rethinking health-care systems: a focus on chronicity

Cited by 86 publications

References 9 publications

Pathways towards chronic care-focused healthcare systems: Evidence from Spain

Pathways towards chronic care-focused healthcare systems: Evidence from Spain

Clinical variables, lifestyle and coping in hemodialysis

Adaptação psicológica e aceitação do diabetesmellitus tipo 2

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