BACKGROUND.Little is known about associations between low physical activity (PA) and its correlates and outcomes in solid organ transplant recipients. This systematic review with meta-analysis ...examined correlates and outcomes associated with low PA (ie, not meeting individual study’s definition of being physically active) following solid organ transplantation.
METHODS.We searched PubMed, CINAHL, PsycINFO, and EMBASE from inception to February 2016 to identify peer-reviewed data-based articles. Articles published in English, German, Spanish, French, Italian, Portuguese, or Dutch that examined correlates or outcomes associated with low PA in adult single, solid organ transplant recipients were included. Studies’ quality was assessed using a 14-item checklist. Pooled odds ratios and 95% confidence intervals were computed for correlates and outcomes examined in ≥5 studies.
RESULTS.Of 7401 publications screened, 34 studies met inclusion criteria and were included in the overall synthesis with 15 included in the meta-analysis. Most focused on renal transplantation (n = 18, 53%) and used cross-sectional designs (n = 26, 77%). Of 30 correlates examined, condition-related (n = 11), social/economic-related (n = 9), patient-related (n = 4), healthcare system-related (n = 3), and treatment-related (n = 3), only 4 were examined ≥5 times and included in meta-analyses. None were significantly related to low PA. Of 19 outcomes assessed, only physical health-related quality of life was examined ≥5 times. Low PA was significantly associated with low physical health-related quality of life (odds ratio = 0.172, 95% confidence interval = 0.08–0.37).
CONCLUSIONS.We found few studies examining most correlates and outcomes related to low PA despite growing evidence that improving PA might be an effective intervention in improving posttransplant outcomes.
Abstract Background In Northwestern Switzerland, recent legislation tackles the needs of community-dwelling older adults by creating Information and Advice Centers (IACs). IACs are a new service in ...the community that aims to assess the needs and provide information on age-related issues to community-dwelling older adults and their families. Previous studies reported difficulties in reaching community-dwelling older adults for community-based programs. We aimed to: 1) systematically identify implementation strategies to promote the IAC among community care providers, older adults and informal caregivers; 2) monitor the delivery of these strategies by the IAC management; and 3) describe the impact of those strategies on reach of community-dwelling older adults. This study was conducted as part of the TRANS-SENIOR project. Methods As part of the INSPIRE feasibility assessment, we conducted a pre-test post-test study between March and September 2022. The sample included 8,840 older adults aged 65 + visiting/calling or being referred to the IAC for the first time. Implementation strategies were selected using implementation mapping and organized in bundles for each group of community care providers and older adults/caregivers. Our evaluation included: estimation of fidelity to the delivery of implementation strategies and bundles by the IAC management and their coverage; referral source of older adults to the IAC; and impact of the strategies on reach of the IAC on the 65 + population living in the care region. Adaptations to the strategies were documented using the FRAME-IS. Descriptive statistics were calculated and reported. Results Seven implementation strategies were selected and organized in bundles for each community care provider and older adults and their caregivers. The lowest fidelity score was found in implementation strategies selected for nursing homes whereas the highest score corresponded to strategies targeting older adults and caregivers. “Informational visits” was the strategy with the lowest coverage (2.5% for nursing homes and 10.5% for hospitals and specialized clinics). The main referral sources were self-referrals and referrals by caregivers, followed by nursing homes. The IAC reach among the 65 + population was 5.4%. Conclusion We demonstrated the use of implementation mapping to select implementation strategies to reach community-dwelling older adults. The reach was low suggesting that higher fidelity to the delivery of the strategies, and reflection on the causal pathway of the implementation strategies might be needed.
Abstract
Background
Unmet needs for home support occur when any support services perceived by older people as needed are not being received. Not meeting these needs can negatively impact older ...adults’ quality of life, and increase health care utilization, hospitalizations, institutionalizations, or death. To date there is no consensus in how to define and assess these unmet needs. In parallel, previous research of factors associated with unmet needs for home support has mostly focused on factors at the micro level. Thus, this paper aims to identify the prevalence of unmet needs for home support among a home-dwelling older population and the factors at the macro, meso and micro levels contributing to them.
Methods
Using an ecological approach we identified multi-level factors associated with the presence of unmet needs for home support among the home-dwelling older population (aged 75+) in Switzerland. This is a secondary cross-sectional analysis of the INSPIRE Population Survey of home-dwelling older adults (n = 8,508) living in Basel-Landschaft in Switzerland, conducted as part of the TRANS-SENIOR Project. Prevalence of perceived unmet needs for home support was self-reported, using a dichotomized question. Multiple logistic regression analyses were performed to investigate the associations of factors at each level with unmet needs for home support.
Results
4.3% of participants reported unmet needs for home support, with a median age of 81 years. 45.1% had private health insurance and 6.3% needed additional government support. Being a recipient of other type of government support (OR = 1.65; 95% CI = 1.17–2.29) (macro-); the use of transportation services (OR = 1.74; 95% CI = 1.15–2.57) (meso-); and feeling depressed (OR = 1.40; 95% CI = 1.06–1.85) or abandoned (OR = 2.60; 95% CI = 1.96–3.43) (micro-) increased odds of having perceived unmet needs for home support. Having a private health insurance (macro-) (OR = 0.63; 95% CI = 0.49–0.80), speaking Swiss-German (OR = 0.44; 95% CI = 0.24–0.88) or German (OR = 0.47; 95% CI = 0.24–0.98), having a high level of education primary (OR = 0.48; 95% CI = 0.24–1.02); secondary (OR = 0.49; 95% CI = 0.25–1.03); tertiary (OR = 0.38; 95% CI = 0.19–0.82); other (OR = 0.31 (0.12–0.75), having a high score of self-perceived health status score ≥ 76 (OR = 0.42; 95% CI = 0.20–0.96) and having informal care (OR = 0.57; 95% CI = 0.45–0.73), among others (micro-) were associated with decreased odds of having perceived unmet needs for home support.
Conclusion
Our study findings highlight the role of socio-economical inequality in the perception of unmet needs for home support in home-dwelling older adults. In order to address unmet needs in home-dwelling older adults, healthcare leaders and policy makers should focus on strategies to reduce socio-economic inequalities at the different levels in this population.
Implementation science methods and a theory-driven approach can enhance the understanding of whether, how, and why integrated care for frail older adults is successful in practice. In this study, we ...aimed to perform a contextual analysis, develop a logic model, and select preliminary implementation strategies for an integrated care model in newly created information and advice centers for older adults in Canton Basel-Landschaft, Switzerland.
We conducted a contextual analysis to determine factors which may influence the integrated care model and implementation strategies needed. A logic model depicting the overall program theory, including inputs, core components, outputs and outcomes, was designed using a deductive approach, and included stakeholders' feedback and preliminary implementation strategies.
Contextual factors were identified (e.g., lack of integrated care regulations, existing community services, and a care pathway needed). Core components of the care model include screening, referral, assessment, care plan creation and coordination, and follow-up. Outcomes included person-centred coordinated care experiences, hospitalization rate and symptom burden, among others. Implementation strategies (e.g., nurse training and co-developing educational materials) were proposed to facilitate care model adoption.
Contextual understanding and a clear logic model should enhance the potential for successful implementation of the integrated care model.
The effect of age on health outcomes in kidney transplantation remains inconclusive. This study aimed to analyze the relationship between age at time of kidney transplantation with mortality, graft ...loss and self-rated health status in adult kidney transplant recipients.
This study used data from the Swiss Transplant Cohort Study and included prospective data of kidney transplant recipients between 2008 and 2017. Time-to-event analysis was performed using Cox' regression analysis, and -in the case of graft loss- competing risk analysis. A random-intercept regression model was applied to analyse self-rated health status.
We included 2,366 kidney transplant recipients. Age at transplantation linearly predicted mortality. It was also predictive for graft loss, though nonlinearly, showing that recipients aged between 35 and 55 years presented with the lowest risk of experiencing graft loss. No relationship of age with self-rated health status was detected.
Higher mortality in older recipients complies with data from the general population. The non-linear relationship between age and graft loss and the higher scored self-rated health status at all follow-up time-points compared to the pre-transplant status -regardless of age- highlight that age alone might not be an accurate measure for risk prediction and clinical decision making in kidney transplantation.
Background
Poor adherence to medications is a significant problem that leads to increased morbidity, mortality, and health care costs. Recommended approaches to address medication adherence vary, and ...existing practice guidelines are unclear.
Purpose
This review evaluated clinical practice guidelines designed to help health care providers address patients’ medication adherence.
Method
Multiple search methods were used to identify national or international guidelines addressing medication adherence. We included guidelines published in English, as well as guidelines with an English-language summary or translation.
Results
We identified 23 guidelines of varying detail and quality. Recommendations were categorized as assessment strategies (
n
= 20 guidelines); educational strategies (
n
= 18); behavioral strategies (
n
= 17); therapeutic relationship, communication, and provider factors (
n
= 19); and addressing outside influences/co-morbidities (
n
= 10).
Conclusion
Future guidelines should be more clearly guided by research findings and comparative effectiveness methods. When implemented, guidelines will facilitate health care providers and health systems in supporting optimal adherence and improved health outcomes.
Abstract only Trust is associated with better patient outcomes, such as better medication adherence and improved patient satisfaction. However, the association between trust and level of chronic ...illness management (CIM) has not yet been addressed. We assessed the hypothesis that level of CIM will be associated with trust in the HTx team. Additionally, we explored potential meso-level moderators of this relationship (time spent on patient visits, number of visits, multidisciplinarity, CIM competencies, and CIM preparedness of the healthcare team). A secondary analysis was conducted using the international cross-sectional BRIGHT study, which included 1397 HTx recipients and 100 HTx clinicians from 36 HTx centers across 11 countries. Level of CIM was measured using the Patient Assessment of Chronic Illness Care (PACIC – patients’ report) and the CIMI BRIGHT (clinicians’ reports). Patients’ trust in the HTx team was measured using an adapted Wake Forest Trust scale. Multiple logistic regression was used to test the hypothesis. 1397 patients (mean age 53.6 13.2 years; 72.7% male; 85.9% white; average time post HTx 3.4 1.4 years) and 100 HTx clinicians (mean age 46.2 10.2 years; 87% female; 85% nurses; mean time worked in HTx center 10.0 7.5 years) were included. Even after controlling for patient’s age, gender, race, education, employment, years post HTx, health literacy, language congruency, and comorbidities, level of CIM as assessed by both patients and clinicians was significantly associated with trust in the HTx team (odds ratio (OR)=1.85, p<.001; OR=1.35, p=.012, respectively). Patients from centers with higher levels of CIM were more likely to trust their HTx team. Lastly, only ‘ time spent on patient visits ’ significantly moderated the relationship between level of CIM (PACIC and CIMI) and trust (OR=1.61, p=.037; OR=1.56, p=.048, respectively), wherein the impact of time in fostering trust towards the HTx team was greater when level of CIM was high. In conclusion, level of CIM (assessed from patients’ and clinicians’ perspectives) was positively associated with trust. Our findings also suggest that allotting more time for patients during follow-up visits is a relevant factor to consider to further optimize the HTx care ecosystem.
Abstract only Introduction: Social support is critical in follow-up of patients after heart transplant (HTx) and positively influences well-being and clinical outcomes. Hypothesis: The purpose of ...this secondary analysis was to 1) explore received social support variation in HTx-recipients at country and center level (emotional and practical) and 2) to assess patient-, micro-, meso- and macro-level correlates. Methods: We examined data from the multi-level cross-sectional BRIGHT study, conducted in 36 HTx-centers in 11 countries. We used an 11-item instrument to measure received social support related to medication adherence with emotional and practical sub-scales. The Conceptual Model of Social Networks and Health guided selection of patient-, micro-, meso- and macro-level factors. Descriptive statistics for multi-level variables and bivariate analysis for emotional and practical dimensions of social support were conducted. Sequential multiple ordinal mixed logistic regression analysis was used to test multi-level models. Results: A total of 1379 adult HTx-recipients were included in this study. We identified variability at country and center level for both, emotional (country: 8.2%; center: 5.3%) and practical (country: 2.1%; center: 3.4%) dimensions of received social support. Independent correlates of emotional support at the micro level were patient-perceived level of chronic illness management and trust in the HTx-team, and at the patient level were female gender, living alone and depressive symptoms. Independent correlates of practical support were patients’ (micro) and clinicians (meso) perceived level of chronic illness management, and at the patient level were age, male gender and living alone. Conclusions: Social support in HTx-recipients varies by country, center and was associated with multi-level correlates. Qualitative and longitudinal studies are needed to understand influencing factors of social support for intervention development, improvement of social support and clinical outcomes.
Innovation in care processes based on chronic illness management (CIM) has shown to improve outcomes in chronically ill. We hypothesized that higher level of CIM in post-heart transplant (HTx) ...follow-up care is associated with better patient survival.The BRIGHT study, a multi-center, cross sectional study included a convenience sample of 36 HTx centers in 11 countries and 4 continents. Patients were selected by stratified random sampling. CIM was assessed both by clinicians’ report (N=82, mean age47.6±10.2 y., 85% f.) (55 item CIMI BRIGHT instrument) and patients’ report (N=1026, mean age54.0±13.2 y., 27% f., mean years post-HTx; 3.4±1.4)(11 item PACIC scale). CIM data were aggregated at center level. Three groups were built(1) positive deviantsboth patients’ and clinicians’ median CIM scores above median CIM score of 36 centers;(2) negative deviantsboth median CIM scores below median of all centers; (3) mixed groupincongruence in median CIM scores between patients and clinicians. Centerʼs mean patient survival at 1, 3, 5, 10 and 15 years was reported by the HTx center director using a structured questionnaire. We used mixed regression analysis, contrasting positive to negative deviants in a confounder-adjusted analysis.We found major variability in CIM scores (PACIC mean 39±10.5; CIMI BRIGHT mean 165±17.1, range136-197) and mean survival rates (1 year84%±5.3 ; 5 year 73%±15.8) among HTx centers. Thirty-two percent of centers were positive deviants, 32% negative deviants and 36% belonged to the mixed group. Figure 1 shows centerʼs mean patient survival at 1, 3, 5, 10 and 15 years for the 3 groups. As hypothesized, mortality was lower in positive vs. negative deviants especially at 1 year post-HTx (p<0.008).The association between higher levels of CIM and lower mortality in HTx patients highlights a potential pathway for improving outcomes after HTx by investing in innovative systems of care based on principles of CIM.
Background Little is known of the extent to which nursing-care tasks are left undone as an international phenomenon. Aim The aim of this study is to describe the prevalence and patterns of nursing ...care left undone across European hospitals and explore its associations with nurse-related organisational factors. Methods Data were collected from 33 659 nurses in 488 hospitals across 12 European countries for a large multicountry cross-sectional study. Results Across European hospitals, the most frequent nursing care activities left undone included ‘Comfort/talk with patients’ (53%), ‘Developing or updating nursing care plans/care pathways’ (42%) and ‘Educating patients and families’ (41%). In hospitals with more favourable work environments (B=−2.19; p<0.0001), lower patient to nurse ratios (B=0.09; p<0.0001), and lower proportions of nurses carrying out non-nursing tasks frequently (B=2.18; p<0.0001), fewer nurses reported leaving nursing care undone. Conclusions Nursing care left undone was prevalent across all European countries and was associated with nurse-related organisational factors. We discovered similar patterns of nursing care left undone across a cross-section of European hospitals, suggesting that nurses develop informal task hierarchies to facilitate important patient-care decisions. Further research on the impact of nursing care left undone for patient outcomes and nurse well-being is required.
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