Transdisciplinary Challenges for Health Service Research and Evaluation in General Practice: The Case of Chronic Disease Management

1997 ◽  
Vol 3 (3) ◽  
pp. 32 ◽  
Author(s):  
Carmel Martin ◽  
Chris Peterson
Keyword(s):  
Health Care ◽  
General Practice ◽  
Chronic Disease ◽  
Chronic Illness ◽  
Wide Spectrum ◽  
Clinical Care ◽  
Practice Research ◽  
Service Research ◽  
Multidisciplinary Teams ◽  
Objective Evidence

Changing expectations of general practice are driven by diverse forces including an increased demand for chronic care. General practice care of chronic disease and illness straddles a wide spectrum of disciplines. However, political, health care, and research structures maintain discrete discipline orientated research. 'Objective' evidence, from quantitative paradigms, about disease, treatment and services predominate over 'subjective' evidence based upon understandings, for example, about how people live with chronic illness. Transdisciplinary approaches are desirable to provide synthesis of evidence across these paradigms to inform and evaluate the complexity of generalism in clinical care. However, transdisciplinarity is only feasible if it both respects disciplinary traditions, yet challenges underlying assumptions about knowledge creation. Inductive processes and open rather than closed systems provide mechanisms for this process. Transdisciplinarity needs to operate at levels of abstraction where there is commonality, typically at the level of the research question and the resultant formulation of theory and knowledge to inform policy or practice. Multidisciplinary teams and transdisciplinary trained researchers with meta-theoretical frameworks that facilitate these conceptual and practicable linkages are discussed. Major challenges to transdisciplinary approaches remain, not only because of their newness, but because of different theoretical traditions, and with the current structures of disciplines, evaluation and research funding and training. We need reflexive integrated general practice research in response to the ever-changing and multi-dimensional nature of health care. Despite fluidity and evolution, research processes that are mainly driven by expediency, may not best serve the needs of those with chronic illness or general practice.

The role of self-help groups in chronic illness management: A qualitative study

2003 ◽  
Vol 9 (3) ◽  
pp. 68 ◽  
Author(s):  
Kay Coppa ◽  
Frances M Boyle
Keyword(s):  
Health Care ◽  
Chronic Illness ◽  
Health Care Professionals ◽  
Clinical Care ◽  
National Policy ◽  
Illness Management ◽  
Group Leaders ◽  
Self Help ◽  
South Wales ◽  
Self Help Groups

Self-help groups offer a unique form of support based on mutual understanding and the experiential knowledge of members. They constitute a potentially valuable resource for assisting people to manage chronic illness and its impacts. We conducted in-depth interviews with 15 members and the leaders of five chronic illness-related self-help groups in Newcastle, New South Wales. The focus was on small, voluntary groups with little or no external funding; agencies that are often overlooked in terms of their contribution to the health care system. Those interviewed readily identified benefits relating to quality of life, illness management, and interactions with health care professionals. Increased emotional and social support, access to an expanded information base, a better understanding of their illness, and a greater sense of confidence and control in relation to it seemed to enhance the capacity of members to engage in active self-management of their conditions. Along with such benefits, group leaders also highlighted some of the challenges faced by volunteers who run these agencies. Self-help groups are effective structures that can serve as an adjunct to clinical care and provide tangible benefits to their members. Further investigation and better recognition of these groups is warranted given their potential to assist those with chronic illness and to contribute to national policy objectives for chronic disease management such as those identified in the Sharing Health Care Initiative.

Small-scale rural pilot programs in chronic illness management - what next?

2003 ◽  
Vol 9 (3) ◽  
pp. 114
Author(s):  
PW Harve y ◽  
PD Mill s ◽  
G Misa n ◽  
K Warre n
Keyword(s):  
Health Care ◽  
Chronic Disease ◽  
Chronic Illness ◽  
Self Management ◽  
Small Scale ◽  
Illness Management ◽  
Care Services ◽  
Primary Health ◽  
Pilot Programs ◽  
Chronic Illness Management

In recent years, rural SA has been the recipient of significant funding to support a range of new primary health care initiatives. Much of this funding, additional to normal recurrent budgets in our health system, has facilitated effective change and development through demonstration and research projects across the state. The resultant work involves programs such as: ? coordinated care trials (COAG) ? more allied health services (MAHS) ? Commonwealth regional health service initiatives (CRHS) ? quality use of medicines (QUM) ? community packages for aged care services ? Indigenous chronic disease self-management pilot programs (CDSM) ? chronic disease self-management (CDSM) programs - Sharing Health Care SA ? chronic disease self-management (CDSM) programs in Indigenous communities. In addition to the resources listed above, funding was also provided by the Commonwealth to establish the South Australian Centre for Rural and Remote Health (SACRRH) and develop the University Department of Rural Health in Whyalla. While this new funding has led to substantial developmental work in chronic illness management in particular, one needs to ask whether the time might not be right now for these hitherto small-scale change initiatives to be transformed into ongoing mainstream programs, informed and guided by research outcomes to date. Is it time to move beyond tentative chronic illness programs and into mainstream reform? We have shown that there is much to be gained, both for patients and for the system, from improved coordination of primary care services and initiatives such as self-management programs for patients with chronic conditions. Better management leads to improved patient health outcomes and can reduce demand for unplanned hospital and emergency services. Many admissions to rural hospitals requiring expensive services, in terms of infrastructure and staffing, could be either prevented, or patients could be managed more effectively in the community as part of a wider primary health care program.

The Promotion and Implementation of Exercise is Medicine® in Kinesiology

2020 ◽  
Vol 9 (4) ◽  
pp. 319-323 ◽  
Author(s):  
Carena Winters
Keyword(s):  
Physical Activity ◽  
Health Care ◽  
Chronic Disease ◽  
Health Care Professionals ◽  
Clinical Care ◽  
Evidence Based ◽  
Physical Activity Assessment ◽  
Activity Assessment ◽  
Exercise Referral

Evidence supporting exercise as a medicine in the prevention and management of chronic disease is indisputable. Created in 2007, Exercise is Medicine® (EIM) aims to make physical activity assessment and promotion a standard in clinical care, connecting health care professionals with qualified exercise professionals to provide evidence-based physical activity resources and programs to everyone of all abilities. Opportunities exist for exercise professionals in several areas within EIM, including exercise referral and prescription, EIM on Campus, and physical activity and EIM education. Connections between EIM and kinesiology and the need for exercise professionals to contribute to the EIM evidence are discussed.

scholarly journals Promoting chronic disease management in persons with complex social needs: A qualitative descriptive study

2019 ◽  
Vol 16 ◽  
pp. 147997311983202 ◽  
Author(s):  
Donna Goodridge ◽  
Thilina Bandara ◽  
Darcy Marciniuk ◽  
Shelly Hutchinson ◽  
Lois Crossman ◽  
...  
Keyword(s):  
Health Care ◽  
Chronic Disease ◽  
Chronic Illness ◽  
Disease Management ◽  
Disease Management Program ◽  
Chronic Disease Management ◽  
Descriptive Study ◽  
Management Program ◽  
Complex Patients ◽  
Qualitative Descriptive

While there are both ethical and practical imperatives to address health inequity issues related to chronic disease management for persons with social complexity, existing programs often do not appropriately address the needs of these individuals. This leads to low levels of participation in programs, suboptimal chronic disease management, and higher health-care utilization. The aims of this project were to describe the challenges related to availability, accessibility, and acceptability faced by socially complex patients with Chronic Obstructive Pulmonary Disease (COPD) who were eligible, but declined enrollment in a traditional Chronic Disease Management Program (CDMP). Using a qualitative descriptive study approach informed by a health equity lens, interviews with participants, managers, and a focus group with providers were used to gather data addressing the above aims. Qualitative data were analyzed using Braun and Clarke’s theoretical thematic analysis approach. The ability of participants to manage chronic disease was profoundly influenced by contextual and personal factors, such as poverty, disability, personal attitudes and beliefs (including shame, mistrust, and hopelessness), and barriers inherent in the organization of the health-care system. The existing chronic disease management program did not adequately address the most critical needs of socially complex patients. Challenges with accessibility and acceptability of chronic disease management and health services played important roles in the ways these socially complex participants managed their chronic illness. The individualistic approach to self-management of chronic illness inherent in conventional CDMP can be poorly aligned with the needs, capacity, and circumstances of many socially complex patients. Innovative models of care that promote incremental and guided approaches to enhancing health and improving self-efficacy need further development and evaluation.

Thinking outside the system: the integrated care experience in Queensland, Australia

2019 ◽  
Vol 25 (4) ◽  
pp. 303 ◽  
Author(s):  
Linda Mundy ◽  
Kaye Hewson
Keyword(s):  
Health Care ◽  
Chronic Disease ◽  
Integrated Care ◽  
Complex Disease ◽  
Wide Spectrum ◽  
Ageing Population ◽  
Patient Journey ◽  
Developmental Issues ◽  
Care Experience ◽  
Seed Funding

Health policy-makers are faced with a demand for health care that exceeds supply, driven in part by an ageing population and an increased prevalence of chronic disease. An integrated ‘people-centred’ model of care across primary, secondary and tertiary health care can strengthen the health system by streamlining services to improve the patient journey and outcomes. Integrated care offers an opportunity to reduce admissions and re-admissions to hospitals, reduce presentations to emergency departments and improve the capacity of outpatient clinics while delivering better outcomes to patients. Queensland’s $35 million Integrated Care Innovation Fund (ICIF) has provided seed funding to 24 projects covering a wide spectrum of chronic disease management and complex disease. Programs such as the ICIF offer an opportunity to provide a new approach to caring for vulnerable populations such as the frail and elderly; children with behavioural and developmental issues; children in out-of-home care; rural and remote populations; and people with mental health issues, whose care runs the risk of ‘falling through the cracks’ with conventional healthcare approaches.

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