“There’s always something else”: Patient perspectives on improving the implementation of obesity guidelines in general practice

ObjectivesThe prevalence of obesity in Australia is rising. National guidelines for the management of overweight and obesity exist but our previous work demonstrates poor implementation of key elements in general practice. The aim of this study was to describe patient perspectives on the implementation of obesity guidelines in general practice.MethodsQualitative study of 40 people living with obesity (PwO) who were recruited through general practices in Melbourne, Australia. PwO had a recorded BMI in the overweight range or above (>25), had attended a consultation in the last 6 months and had a diagnosis of at least one of the following: diabetes, kidney disease, hyperlipidemia, hypertension, or cardiovascular disease. Semi-structured telephone interviews were conducted with patients. Interviews were audio-recorded, transcribed verbatim and analysed thematically.ResultsWhile a strong general practitioner (GP)-patient relationship enabled conversation to occur about weight management there was uncertainty as to whether patients or GPs should broach the topic of weight. Patients described complacency regarding their weight and often being unprepared to take up GP advice. Other health issues were felt to take precedence, and patients described inconsistent provision of information and resources to assist them in tackling their weight problems.ConclusionsIt is imperative to take into account patient perspectives on obesity management in general practice in order to improve health outcomes. This study provides valuable insights into how PwO can be better managed. Interventions should also include strategies to help patients maintain motivation in making lifestyle changes to support healthy weight loss.     

Concordance of patients’ beliefs about chronic obstructive pulmonary disease,their comorbidities,and their medications

ObjectiveTo test the association of chronic obstructive pulmonary disease (COPD) illness and medication beliefs with those specific to hypertension or diabetes in patients with COPD and coexisting chronic conditions.MethodsA cross-sectional analysis of data collected from a sample of 282 adults with COPD and comorbid hypertension or diabetes recruited from primary care practices in New York, NY, and Chicago, IL. Beliefs about COPD, hypertension, and diabetes were measured using the Brief Illness Perception Questionnaire. Higher scores indicate a more adaptive view of the illness. Beliefs about medications were measured using the 10-item Beliefs about Medicines Questionnaire; higher scores on the two subscales indicate increased concerns and necessity, respectively.ResultsIn adjusted analyses, scores for COPD and hypertension as well as COPD and diabetes illness beliefs, medication necessity, and medication concern were significantly associated.ConclusionPatients with COPD and comorbid hypertension or diabetes have consistent beliefs about their diseases and the medications used to treat them.Practice implications: The consistency of beliefs across conditions may help in the development of a more holistic approach to disease management in patients with COPD who have comorbid illnesses and contribute to a better understanding of the Common-Sense Model of Illness Representation.     

Pharmakokinetik und Pharmakodynamik von Theophyllin bei multimorbiden geriatrischen Patienten

Summary The pharmacokinetics of theophylline (200 mg i.v.) were determined in 20 geriatric patients with multiple diseases. Serum concentrations were fitted to an open 2-compartment model. Percent changes in venous pCO₂ and pO₂ were used as parameters of the pharmacodynamic action. Total clearance was decreased and elimination half-life of theophylline was found to be prolonged in the elderly patients compared with data of a study with young healthy volunteers. The stronger the pharmacodynamic action of theophylline (percent change of venous pCO₂ after 30 min), the faster was its elimination and the lower were measured concentrations after 2, 6, and 12 h.

     

Health burden in chronic disease: multimorbidity is associated with self-rated health more than medical comorbidity alone

Objectives

To investigate the association between multimorbidity—a construct comprising several health domains (medical comorbidity, musculoskeletal, physical and social functional status, mental health, and geriatric problems)—and overall self-rated health (SRH), an important chronic disease health outcome. We investigate whether medical comorbidity effects are mediated through other health domains and whether these domains have independent effects on SRH.

Study Design and Setting

Medicare recipients (n = 958) completed a questionnaire 3 years post primary total hip replacement surgery. Self-reported sociodemographic characteristics, SRH, and health domain statuses were ascertained. Probit regressions and path analyses were used to evaluate the independent effects of the health domains on SRH and the interrelationships between domains and to quantify direct and mediated effects.

Results

All domains were independently associated with SRH. Medical comorbidity explained 11.7% of the variance in SRH, and all other health domains explained 27.3%. The impact of medical comorbidity was largely direct (only 21.5% mediated through other domains). Medical comorbidity minimally explained the variance in other domain scores.

Conclusion

SRH has multiple determinants. This finding suggests that an exclusive focus on any one domain in health research may limit the researchers' ability to understand health outcomes for which SRH is predictive.     

Multimorbidity Patterns and 6-Year Risk of Institutionalization in Older Persons: The Role of Social Formal and Informal Care

ObjectivesThe aim was to evaluate patterns of multimorbidity that increase the risk of institutionalization in older persons, also exploring the potential buffering effect of formal and informal care.DesignProspective cohort study.Setting and ParticipantsThe population-based Swedish National study on Aging and Care in Kungsholmen, Stockholm, Sweden.MeasuresIn total, 2571 community-dwelling older adults were grouped at baseline according to their underlying multimorbidity patterns, using a fuzzy c-means cluster algorithm, and followed up for 6 years to test the association between multimorbidity patterns and institutionalization.ResultsSix patterns of multimorbidity were identified: psychiatric diseases; cardiovascular diseases, anemia, and dementia; metabolic and sleep disorders; sensory impairments and cancer; musculoskeletal, respiratory, and gastrointestinal diseases; and an unspecific pattern including diseases of which none were overrepresented. In total, 110 (4.3%) participants were institutionalized during the follow-up, ranging from 1.7% in the metabolic and sleep disorders pattern to 8.4% in the cardiovascular diseases, anemia, and dementia pattern. Compared with the unspecific pattern, only the cardiovascular diseases, anemia, dementia pattern was significantly associated with institutionalization [relative risk ratio (RRR) = 2.23; 95% confidence interval (CI) 1.07‒4.65)], after adjusting for demographic characteristics and disability status at baseline. In stratified analyses, those not receiving formal care in the psychiatric diseases pattern (RRR 3.34; 95% CI 1.20‒9.32) and those not receiving formal or informal care in the ‘cardiovascular diseases, anemia, dementia’ pattern (RRR 2.99; 95% CI 1.20‒7.46; RRR 2.79; 95% CI 1.16‒6.71, respectively) had increased risks of institutionalization.Conclusions and ImplicationsOlder persons suffering from specific multimorbidity patterns have a higher risk of institutionalization, especially if they lack formal or informal care. Interventions aimed at preventing the clustering of diseases could reduce the associated burden on residential long-term care. Formal and informal care provision may be effective strategies in reducing the risk of institutionalization.