Berry Middel

Effects of case management for frail older people or those with chronic illness - a systematic review

Background:Financial constraints and quality requirements demand that interventions selected are most effective. A previous systematic review of the effectiveness of the patient advocacy case management model was not found. Objective:The objective of this study was to evaluate the effects of patient advocacy case management on service use and healthcare costs for impaired older people or adults with a chronic somatic disease living in the community. Methods:A literature search was conducted in Medline, CINAHL, and Cochrane databases. Included were English-language randomized controlled trials evaluating service use and costs of the patient advocacy case management model for people with a chronic somatic disease or for impaired older people living in the community. Results:Eight relevant studies were identified and included after evaluation of methodological quality. All studies concerned frail or impaired older people, and one study also included people with a somatic chronic disease. In none of the studies was evidence found for clinically relevant increase of service use and costs, whereas in two studies, it was reported that patient advocacy case management led to decreased service use and to savings in costs. Discussion:Patient advocacy case management does not increase service use and costs and was effective in decreasing service use and costs in two studies. These conclusions are an indication for quality improvement through the combination of its organizational benefits. Therefore, there should be more priority given to further implementation of patient advocacy case management for those with chronic illness and impaired older people. Nursing can play an important role in this development.

Efficacy of desmopressin in patients with multiple sclerosis suffering from bladder dysfunction: a meta-analysis

Objectivesu2002–u2002 The current review evaluates the safety and efficacy of desmopressin in patients with multiple sclerosis (MS) who suffer from both daytime and nocturnal voiding frequency and from incontinence.

Impact of fatigue on quality of life in patients with Parkinson's disease

Background and purpose:u2002 Fatigue is frequent and important in the lives of Parkinson’s disease (PD) patients. It is multidimensional, with physical and mental aspects. The aim of our study was to explore the impact of fatigue on quality of life (QoL) for PD patients.

The impact of sleep and mood disorders on quality of life in Parkinson's disease patients

Sleep disturbances are common and often severe in patients with Parkinson’s disease (PD) and their symptoms can be present at any time of day. The purpose of our study was to examine how excessive daytime sleepiness or poor nocturnal sleep quality and mood disorders influence the quality of life (QoL) in PD patients. Ninety-three PD patients from eastern Slovakia were recruited (49.5% males, mean age 68.0xa0±xa09.5xa0years, mean disease duration 6.1xa0±xa05.9xa0years). Sleep disturbances were measured using the Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI); QoL with the Parkinson’s Disease Quality of Life Questionnaire (PDQ-39); depression and anxiety with the Hospital Anxiety and Depression Scale (HADS) and disease severity with the Unified Parkinson’s Disease Rating Scale (UPDRS). χ2 test, bivariate correlations and multiple linear regressions were performed. PSQI and ESS had significant correlations with worse QoL (pxa0<xa00.01, pxa0<xa00.05, respectively). HADS-D (pxa0<xa00.01), HADS-A (pxa0<xa00.01), UPDRS (pxa0<xa00.01) and disease duration (pxa0<xa00.05) were also significantly related to worse QoL. In the linear regression analysis, however, only PSQI (pxa0<xa00.01), anxiety (pxa0<xa00.001) and UPDRS (pxa0<xa00.001) remained significant. The model with PSQI explained 74% of the variance, and the model with ESS explained 63% of the variance in PDQ-39 when analyses were performed separately. In an overall model, however, only PSQI remained significant, accounting for 82% of the variance in PDQ-39. Nighttime poor sleep and anxiety are important contributors leading to a worse QoL. As these are treatable conditions, they should be recognized by clinicians and managed properly.

Experienced stigmatization reduced quality of life of patients with a neuromuscular disease: a cross-sectional study

Objective: To examine the influence of stigma on the quality of life of patients with a neuromuscular disease. Design: Cross-sectional postal survey. Setting: Outpatient clinic of the Department of Neurology, University Hospital Groningen, the Netherlands. Subjects: Patients diagnosed with a neuromuscular disease. Measures: The Stigma Scale for Chronic Illness, the World Health Organization Quality of Life – abbreviated version questionnaires and some background and disease-related questions. The Stigma Scale for Chronic Illness was translated into Dutch according to international guidelines. The impact of stigma on quality of life was estimated using hierarchical multiple regression analysis after controlling for the extent of limitations and patient characteristics. Results: In total 235 patients (75% response rate) were diagnosed with neuromuscular disease and represented all four categories of the approximately 600 neuromuscular diseases. Most patients (86%) reported self stigma, while 64% reported to experience enacted stigma. Experienced quality of life was moderate to good. Stigma contributed to a unique and substantial extent to all domains of quality of life: explained variance for the impact of stigma on quality ranged from 0.13 (social relations) to 0.34 (physical functioning) for self stigma and from 0.09 (social relations) to 0.11 (physical and psychological health, and quality of the environment). Conclusion: Self stigma was a stronger predictor for poorer quality of life compared with enacted stigma. In other words: patients suffered more from shame and fear for discrimination (self stigma) than from the really experienced discrimination and exclusion (enacted stigma).

Meten van functioneringsproblemen én de beleving ervan bij mensen met Multiple Sclerose: de Multiple Sclerosis Impact Profile (MSIP)

SummaryThe assessment of problems in functioning and the subjective perception of these problems in people with Multiple Sclerosis: the Multiple Sclerosis Impact Profile (MSIP)People with Multiple Sclerosis (MS) perceive consequences of this chronic condition that are not limited to impairments in physical functioning but also have their impact on limitations in activities and restrictions in participation in life situations. There is a growing awareness among healthcare professionals that there is a meaningful difference between the objective problems in functioning and the subjective perception of these problems that should be followed by suitable care and support interventions.A measure for healthcare professionals and people with MS with the goal to evaluate the objective consequences of MS and the subjective perception of these consequences was until recently not available. The Multiple Sclerosis Impact Profile (MSIP) is a recently developed self-report measure for assessing the impact of MS on a broad spectrum of (potential) problems in functioning and the perception of these problems. The MSIP showed sound psychometric qualities and seemed to be a useful instrument in clinical practice for the health professional and for persons with MS.

[Embrace, a model for integrated elderly care].

UNLABELLEDnOngoing growth in health care expenditures and changing patterns in the demand for health care challenge societies worldwide. The Chronic Care Model (CCM), combined with classification for care needs based on Kaiser Permanente (KP) Triangle, may offer a suitable framework for change. The aim of the present study is to investigate the effectiveness of Embrace, a population-based model for integrated elderly care, regarding patient outcomes, service use, costs, and quality of care.nnnMETHODSnThe CCM and the KP Triangle were translated to the Dutch setting and adapted to the full elderly population living in the community. A randomized controlled trial with balanced allocation was designed to test the effectiveness of Embrace. Eligible elderly persons are 75 years and older and enrolled with one of the participating general practitioner practices. Based on scores on the INTERMED-Elderly Self-Assessment and Groningen Frailty Indicator, participants will be stratified into one of three strata: (A) robust; (B) frail; and (C) complex care needs. Next, participants will be randomized per stratum to Embrace or care as usual. Embrace encompasses an Elderly Care Team per general practitioner practice, an Electronic Elderly Record System, decision support instruments, and a self-management support and prevention program - combined with care and support intensity levels increasing from stratum A to stratum C. Primary outcome variables are patient outcomes, service use, costs, and quality of care. Data will be collected at baseline, twelve months after starting date, and during the intervention period.nnnDISCUSSIONnThis study could provide evidence for the effectiveness of Embrace.

SamenOud, een model voor geïntegreerde ouderenzorg

UNLABELLEDnOngoing growth in health care expenditures and changing patterns in the demand for health care challenge societies worldwide. The Chronic Care Model (CCM), combined with classification for care needs based on Kaiser Permanente (KP) Triangle, may offer a suitable framework for change. The aim of the present study is to investigate the effectiveness of Embrace, a population-based model for integrated elderly care, regarding patient outcomes, service use, costs, and quality of care.nnnMETHODSnThe CCM and the KP Triangle were translated to the Dutch setting and adapted to the full elderly population living in the community. A randomized controlled trial with balanced allocation was designed to test the effectiveness of Embrace. Eligible elderly persons are 75 years and older and enrolled with one of the participating general practitioner practices. Based on scores on the INTERMED-Elderly Self-Assessment and Groningen Frailty Indicator, participants will be stratified into one of three strata: (A) robust; (B) frail; and (C) complex care needs. Next, participants will be randomized per stratum to Embrace or care as usual. Embrace encompasses an Elderly Care Team per general practitioner practice, an Electronic Elderly Record System, decision support instruments, and a self-management support and prevention program - combined with care and support intensity levels increasing from stratum A to stratum C. Primary outcome variables are patient outcomes, service use, costs, and quality of care. Data will be collected at baseline, twelve months after starting date, and during the intervention period.nnnDISCUSSIONnThis study could provide evidence for the effectiveness of Embrace.

De Multiple Sclerosis Impact Profile (MSIP): een nieuw instrument voor het meten van functioneringsproblemen en de beleving ervan bij mensen met multiple sclerose

SamenvattingMensen met multiple sclerose (ms) ervaren gevolgen van deze chronische aandoening die niet alleen te maken hebben met het fysiek functioneren, maar ook met beperkingen in iemands handelen en belemmeringen in de deelname aan het maatschappelijke leven. Hulpverleners zijn zich er in toenemende mate van bewust dat mensen met ms waarschijnlijk de meeste baat hebben bij een geïntegreerde aanpak van deze gezondheidsproblemen. Ook groeit het inzicht dat er verschil bestaat tussen de objectieve functioneringsproblemen en de subjectieve beleving van deze problemen.