<p>Extreme Consumers of Health Care: Patterns of Care Utilization in Patients with Multiple Chronic Conditions Admitted to a Novel Integrated Clinic</p>

Background: The association between objectively measured nonadherence and health care utilization in multimorbid older people is unclear. Objective: To measure medication adherence across multiple chronic conditions, identify adherence patterns, and estimate the association between adherence and self-reported health care utilization. Methods: This is a retrospective cohort study of multimorbid participants aged ≥70 years in the Irish LongituDinal Study on Ageing (TILDA). Eligible participants had linked pharmacy claims data and completed TILDA wave 2 (2 years after wave 1). The RxRisk-V tool was used to identify multimorbidity. Average adherence (AA) across RxRisk-V conditions was estimated using the CMA7 function (AdhereR). Group-based trajectory models (GBTMs) identified adherence patterns in the 12 months following wave 1. Negative binomial regression was used to estimate the association between adherence and the rate of subsequent self-reported general practitioner [GP] visits, emergency department (ED) visits, outpatient visits, and hospitalizations in the 12 months following adherence measurement (reported at wave 2). Adjusted Incident Rate Ratios (aIRR) and 95% CIs are presented. Results: Higher AA (CMA7) was associated with a small significant decrease in GP visit rate (aIRR = 0.70; CI = 0.53-0.94) and outpatient visit rate (aIRR = 0.44; CI = 0.23-0.81). GBTM identified 6 adherence groups (n = 1050). Compared with high adherers, group 1 (rapid decline, modest increase) membership (aIRR = 1.72; CI = 1.09-2.73) and group 4 (high adherence, delayed decline) membership (aIRR = 1.92; CI = 1.19-3.05) significantly increased ED visit rate. Conclusion and Relevance: Suboptimal medication adherence in multimorbid older adults is associated with increased health care utilization. Identification of suboptimal adherence groups for medication management interventions may help decrease the health system burden and health care costs.

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A proposal for managed care payment options for patients with chronic conditions

Australian Health Review ◽

10.1071/ah960027 ◽

1996 ◽

Vol 19 (1) ◽

pp. 27 ◽

Cited By ~ 1

Author(s):

Terri Jackson

Keyword(s):

Health Care ◽

Managed Care ◽

Ambulatory Care ◽

Patient Group ◽

Chronic Conditions ◽

Patient Autonomy ◽

Payment System ◽

Patterns Of Care ◽

Episode Of Care ◽

Health Care Efficiency

This paper proposes an episode of care payment system for patients with chronicillnesses, extending earlier published work on this model of ambulatory care (Duckett& Jackson 1993). The payment system relies on annual voluntary enrolment andsome marginal broadening of Medicare coverage in exchange for patients? willingnessto participate in an ambulatory managed care arrangement. In the context ofAustralian health ministers? enthusiasm for managed care, the proposal embodiesan intermediate policy approach which supports greater health care efficiency whileminimising the prospect for reductions in patient autonomy or serious distortionsin patterns of care. The policy is not designed to be applied population-wide, butto address the issues involved with a resource-intensive patient group, those requiringongoing management of chronic conditions.

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“In Our Corner”: A Qualitative Descriptive Study of Patient Engagement in a Community-Based Care Coordination Program

Clinical Nursing Research ◽

10.1177/1054773816685746 ◽

2016 ◽

Vol 27 (3) ◽

pp. 258-277 ◽

Cited By ~ 3

Author(s):

Justine S. Sefcik ◽

Darina Petrovsky ◽

Megan Streur ◽

Mark Toles ◽

Melissa O’Connor ◽

...

Keyword(s):

Older Adults ◽

Health Care ◽

Care Coordination ◽

Patient Engagement ◽

Care Delivery ◽

Care Utilization ◽

Multiple Chronic Conditions ◽

Analytical Technique ◽

Increased Risk ◽

Qualitative Descriptive

The purpose of this study was to explore participants’ experience in the Health Quality Partners (HQP) Care Coordination Program that contributed to their continued engagement. Older adults with multiple chronic conditions often have limited engagement in health care services and face fragmented health care delivery. This can lead to increased risk for disability, mortality, poor quality of life, and increased health care utilization. A qualitative descriptive design with two focus groups was conducted with a total of 20 older adults enrolled in HQP’s Care Coordination Program. Conventional content analysis was the analytical technique. The overarching theme resulting from the analysis was “in our corner,” with subthemes “opportunities to learn and socialize” and “dedicated nurses,” suggesting that these are the primary contributing factors to engagement in HQP’s Care Coordination Program. Study findings suggest that nurses play an integral role in patient engagement among older adults enrolled in a care coordination program.

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A Web-Based eHealth Intervention to Improve the Quality of Life of Older Adults With Multiple Chronic Conditions: Protocol for a Randomized Controlled Trial

JMIR Research Protocols ◽

10.2196/25175 ◽

2021 ◽

Vol 10 (2) ◽

pp. e25175

Author(s):

David H Gustafson Sr ◽

Marie-Louise Mares ◽

Darcie C Johnston ◽

Jane E Mahoney ◽

Randall T Brown ◽

...

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Primary Care ◽

Health Care ◽

Chronic Conditions ◽

Health Care Use ◽

Multiple Chronic Conditions ◽

Secondary Outcomes ◽

Ehealth Intervention

Background Multiple chronic conditions (MCCs) are common among older adults and expensive to manage. Two-thirds of Medicare beneficiaries have multiple conditions (eg, diabetes and osteoarthritis) and account for more than 90% of Medicare spending. Patients with MCCs also experience lower quality of life and worse medical and psychiatric outcomes than patients without MCCs. In primary care settings, where MCCs are generally treated, care often focuses on laboratory results and medication management, and not quality of life, due in part to time constraints. eHealth systems, which have been shown to improve multiple outcomes, may be able to fill the gap, supplementing primary care and improving these patients’ lives. Objective This study aims to assess the effects of ElderTree (ET), an eHealth intervention for older adults with MCCs, on quality of life and related measures. Methods In this unblinded study, 346 adults aged 65 years and older with at least 3 of 5 targeted high-risk chronic conditions (hypertension, hyperlipidemia, diabetes, osteoarthritis, and BMI ≥30 kg/m2) were recruited from primary care clinics and randomized in a ratio of 1:1 to one of 2 conditions: usual care (UC) plus laptop computer, internet service, and ET or a control consisting of UC plus laptop and internet but no ET. Patients with ET have access for 12 months and will be followed up for an additional 6 months, for a total of 18 months. The primary outcomes of this study are the differences between the 2 groups with regard to measures of quality of life, psychological well-being, and loneliness. The secondary outcomes are between-group differences in laboratory scores, falls, symptom distress, medication adherence, and crisis and long-term health care use. We will also examine the mediators and moderators of the effects of ET. At baseline and months 6, 12, and 18, patients complete written surveys comprising validated scales selected for good psychometric properties with similar populations; laboratory data are collected from eHealth records; health care use and chronic conditions are collected from health records and patient surveys; and ET use data are collected continuously in system logs. We will use general linear models and linear mixed models to evaluate primary and secondary outcomes over time, with treatment condition as a between-subjects factor. Separate analyses will be conducted for outcomes that are noncontinuous or not correlated with other outcomes. Results Recruitment was conducted from January 2018 to December 2019, and 346 participants were recruited. The intervention period will end in June 2021. Conclusions With self-management and motivational strategies, health tracking, educational tools, and peer community and support, ET may help improve outcomes for patients coping with ongoing, complex MCCs. In addition, it may relieve some stress on the primary care system, with potential cost implications. Trial Registration ClinicalTrials.gov NCT03387735; https://www.clinicaltrials.gov/ct2/show/NCT03387735. International Registered Report Identifier (IRRID) DERR1-10.2196/25175

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