Ontario health technology assessment series
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Ont Health Technol Assess Ser · Jan 2013
ReviewOptimizing chronic disease management mega-analysis: economic evaluation.
As Ontario's population ages, chronic diseases are becoming increasingly common. There is growing interest in services and care models designed to optimize the management of chronic disease. ⋯ Chronic diseases are the leading cause of death and disability in Ontario. They account for a third of direct health care costs across the province. This study aims to evaluate the cost-effectiveness of health care interventions that might improve the management of chronic diseases. The evaluated interventions led to lower costs and better quality of life than usual care. Offering these options could reduce costs per patient. However, the studies used in this analysis were of medium to very low quality, and the methods had many limitations.
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Ont Health Technol Assess Ser · Jan 2013
Review Meta AnalysisChronic disease patients' experiences with accessing health care in rural and remote areas: a systematic review and qualitative meta-synthesis.
Rurality can contribute to the vulnerability of people with chronic diseases. Qualitative research can identify a wide range of health care access issues faced by patients living in a remote or rural setting. ⋯ People who live in a rural area may feel more vulnerable--that is, more easily harmed by their health problems or experiences with the health care system. Qualitative research looks at these experiences from the patient's point of view. We found 3 broad concerns in the studies we looked at. The first was geography: needing to travel long distances for health care can make care hard to reach, especially if transportation is difficult or the weather is bad. The second concern was availability of health professionals: rural areas often lack health care services. Patients may also feel powerless in "referral games" between rural and urban providers. People with low education or without others to help them may find navigating care more difficult. When rural services are available, patients like seeing clinicians who have known them for a long time, and like how familiar clinicians treat them as a whole person. The third concern was rural culture: patients may feel like outsiders in city hospitals or clinics. As well, in rural communities, people may share a feeling of self-reliance and community belonging. This may make them more eager to take care of themselves and each other, and less willing to seek distant care. Each of these factors can increase or decrease patient vulnerability, depending on how health services are provided.
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Ont Health Technol Assess Ser · Jan 2013
Review Meta AnalysisExperiences of patient-centredness with specialized community-based care: a systematic review and qualitative meta-synthesis.
Specialized community-based care (SCBC) endeavours to help patients manage chronic diseases by formalizing the link between primary care providers and other community providers with specialized training. Many types of health care providers and community-based programs are employed in SCBC. Patient-centred care focuses on patients' psychosocial experience of health and illness to ensure that patients' care plans are modelled on their individual values, preferences, spirituality, and expressed needs. ⋯ More and more, to reduce bed shortages in hospitals, health care systems are providing programs called specialized community-based care (SCBC) to patients with chronic diseases. These SCBC programs allow patients with chronic diseases to be managed in the community by linking their family physicians with other community-based health care providers who have specialized training. This report looks at the experiences of patients and health care providers who take part in SCBC programs, focusing on psychological and social factors. This kind of lens is called patient-centred. Three themes came up in our analysis: patients' health beliefs affect how they take part in SCBC interventions; patients' experiences with care in the community differ from their experiences with care in the hospital; patients and providers value the role of nurses differently. The results of this analysis could help those who provide SCBC programs to better meet patients' needs.
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Ont Health Technol Assess Ser · Jan 2013
ReviewSelf-management support interventions for persons with chronic disease: an evidence-based analysis.
Self-management support interventions such as the Stanford Chronic Disease Self-Management Program (CDSMP) are becoming more widespread in attempt to help individuals better self-manage chronic disease. ⋯ Self-management support interventions are becoming more common as a structured way of helping patients learn to better manage their chronic disease. To assess the effects of these support interventions, we looked at the results of 10 studies involving a total of 6,074 people with various chronic diseases, such as arthritis and chronic pain, chronic respiratory diseases, depression, diabetes, heart disease, and stroke. Most trials focused on a program called the Stanford Chronic Disease Self-Management Program (CDSMP). When compared to usual care, the CDSMP led to modest, short-term improvements in pain, disability, fatigue, depression, health distress, self-rated health, and health-related quality of life, but it is not possible to say whether these changes were clinically important. The CDSMP also increased how often people undertook aerobic exercise, how often they practiced stress/pain reduction techniques, and how often they communicated with their health care practitioners. The CDSMP did not reduce the number of primary care doctor visits, emergency department visits, the number of days in hospital, or the number of times people were hospitalized. In general, there was high uncertainty around the quality of the evidence, and more research is needed to better understand the effect of self-management support on long-term outcomes and on important clinical outcomes, as well as to better identify who could benefit most from self-management support interventions like the CDSMP.
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Ont Health Technol Assess Ser · Jan 2013
ReviewContinuity of care to optimize chronic disease management in the community setting: an evidence-based analysis.
This evidence-based analysis reviews relational and management continuity of care. Relational continuity refers to the duration and quality of the relationship between the care provider and the patient. Management continuity ensures that patients receive coherent, complementary, and timely care. There are 4 components of continuity of care: duration, density, dispersion, and sequence. ⋯ There is low quality evidence that: Higher continuity of care is associated with decreased health service utilization.There is insufficient evidence on the relationship of continuity of care with disease-specific outcomes.There is an association between high continuity of care and patient satisfaction, particularly among patients with chronic diseases.