“Multimorbidity Plus”: a secondary analysis exploring GP work in areas of high socioeconomic deprivation

BackgroundThere is a GP workforce crisis, particularly in areas of high socioeconomic deprivation where multimorbidity, and social complexity, is higher. How this impacts GP work, and how they manage workload has not been fully explored.AimTo explore GP work in areas of high socioeconomic deprivation, and the strategies GPs employ using Corbin and Strauss’s ‘Managing Chronic Illness’ model as an analytical lens.MethodSecondary analysis of in-depth interviews, with GPs working in areas of high socio-economic deprivation (n=10).ResultsAll three types of work defined by Corbin and Strauss (everyday, illness, biographical) were described, and one additional type: emotional (work managing GPs’ own emotions). The context of socioeconomic deprivation influenced GP work, increased multimorbidity PLUS social complexity (“Multimorbidity plus”). Healthcare systems, and self-management strategies, did not meet patients’ needs; meeting the resulting gap created extra hidden everyday work, often unrecognised (source of frustration). GPs also described taking on “illness work” for patients who were either overwhelmed, or unable to do it. Some GPs described biographical work asserting their professional role against demands from patients, and other professionals. Work aligning with personal values was important in sustaining motivation; strong teams and outside professional appeared to build resilience.ConclusionGPs working in areas of high socioeconomic deprivation experience different types of work; much unrecognised and not resourced. Current strategies to reduce burnout could be more effective if the complexity of different types of work was addressed, personal values supported, practice teams and outside professional interests were supported.

Balance Beams and Suicide-Risk Screening

This chapter examines how the mental illness model of suicide has led us to place more faith than may be warranted in concepts such as suicide “warning signs” and suicide-risk screening tools. These concepts are notoriously unreliable indicators of emerging suicidal behaviors because they do not sufficiently reflect the inherently dynamic and ever-changing nature of suicide risk. Any given warning sign for suicide will be wrong much, much more often than it will be right. Even when multiple warning signs are experienced or expressed by an individual, this problem persists. One factor limiting the accuracy of suicide-risk screening is that thoughts about death and suicide fluctuate over time. Thus, we should move away from assuming that we must know who will and who will not attempt suicide to prevent these behaviors from occurring.

Exploring the Biopsychosocial Pathways Shared by Obstructive Sleep Apnea (OSA) and Central Serous Chorioretinopathy (CSC): A Literature Overview

This study addressed the following question: “Is it possible to highlight the link between obstructive sleep apnea (OSA) and central serous chorioretinopathy (CSC) through common biopsychosocial pathogenetic pathways?”. The study was conducted through electronic searches of the PubMed, Web of Science, and Scopus databases. All relevant selected human research studies published from January 2003 to December 2020 were included. The scientific literature search was performed through repeated use of the words “OSA” and/or “acute/chronic CSC” paired with “biomedical/biopsychosocial illness model”, “psychopathology”, “stress”, “personality characteristics”, “functional diseases”, “comorbidity”, and “quality of life” in different combinations. Our literature search identified 213 reports, of which 54 articles were ultimately reviewed in this paper. Taken together, the results indicate that there is a cross-link between OSA and CSC that can be classified among biopsychological disorders in which various major biological variables integrate with psychological-functional and sociological variables; many of these variables appear in both diseases. This concept can have important implications for improving patients’ quality of life, thus providing the necessary strategies to cope with challenging life events even through nonpharmacological approaches.

Is our health system ready for the future?

This chapter looks at how the National Health Service (NHS) and the UK health system as a whole are understood now, and some of the issues that must be addressed. It also explores how to envisage a future that, after the first wave of the COVID-19 pandemic, looks very different to what might have been predicted six months ago. The NHS is a source of deep pride to British citizens because of its founding principles—universal access to healthcare for all, free at the point of use. However, things have changed since the NHS was founded in 1948. Ageing populations present with more and more complex chronic health conditions, but the health and care services have not kept pace and continue to use a single-illness model. This does not work well for patients and is expensive for the payer.

Using a Physician Survey to Estimate the Economic Burden of Fibromyalgia in China

Background: Fibromyalgia (FM) is a chronic pain disorder with a global prevalence estimated to be between 2 and 3%. In addition to the chronic pain incurred by patients, FM is commonly associated with comorbidities and complications such as depression, anxiety, and sleep disturbances. This study estimates the economic burden of patients with FM in China using a physician survey. Methods: A burden of illness model was constructed using a micro-costing approach to estimate the direct cost associated with FM patients in China. FM-related comorbidities of anxiety, depression, and sleep disturbance were included in the model. Treatment utilization and costs for FM and FM-related comorbidities were included as well as FM-related healthcare resource utilization (physician visits, hospitalizations, blood tests, and radiologic tests). FM treatments included nonsteroidal anti-inflammatory drugs, pregabalin, duloxetine, amitriptyline, tramadol, Chinese medicine, physiotherapy, and acupuncture. The model leveraged the results of a physician survey, which targeted 6 rheumatologists and pain experts each with 5-10 FM patients per month in China. All costs are presented in Renminbi (¥) using spot exchange rates as of May 1, 2020.Results: From the physician survey, the prevalence rate of FM in China was estimated to be 2.8% with 75.8% as female. The economic model estimated the annual per patient direct medical cost of FM to be ¥17,377. Within these costs, FM-medication and treatment costs (¥11,216), healthcare resource utilization (¥4,297), and costs for medications treating FM-related comorbidities (¥1,863) were the highest contributors. Healthcare resource utilization costs were driven by physician visits (¥2,787) followed by radiographic tests (¥808), blood tests (¥508), and hospitalizations (¥194). Conclusion: The prevalence and gender distribution of FM patients in China is similar to those of other countries. The economic model estimates patients with fibromyalgia in China to incur significant economic costs.

Rapid assessment of avoidable blindness-based healthcare costs of diabetic retinopathy in Hungary and its projection for the year 2045

Background/aimsThe purpose of this study was to estimate the total healthcare cost associated with diabetic retinopathy (DR) in the population aged 18 years and older in Hungary, and its projection for the year 2045.MethodsA cost model was developed based on the standardised rapid assessment of avoidable blindness with the diabetic retinopathy module (RAAB+DRM) methodology and recently reported prevalent-based cost of illness model. Projection for 2045 was made based on the estimation for increasing diabetes mellitus (DM) prevalence of the International Diabetes Federation. Costs were analysed from the perspective of the healthcare system and the patients. Our DR cost model was constructed according to the Scottish DR grading scale and based on the DR severity stadium.ResultsThe total DR-associated healthcare cost was US$145.8 million in 2016 and will increase to US$169.0 million by 2045. The two major cost drivers were intravitreal antivascular endothelial growth factor injections and vitrectomies in this study (US$126.4 million in 2016 and US$146.5 million in 2045); they amounted to 86.7% of the total treatment cost of DR. The DR-related cost per patient was US$180.5 in Hungary.ConclusionsThe cost per patient for treating DR was lower in Hungary than in other countries. Due to the increasing socioeconomic burden of proliferative DR and diabetes-related blindness, it would be important to invest in DR screening, prevention and early treatment. Our new RAAB-based cost of DR model may facilitate comparisons of DR treatment costs across countries.

Measuring Family Members’ Experiences of Integrating Chronic Illness Into Family Life: Preliminary Validity and Reliability of the Family Integration Experience Scale:Chronic Illness (FIES:CI)

Measures of family members’ experiences of integrating chronic conditions (CC) or chronic illnesses (CI) into family life are needed to optimize family care. This article reports development and psychometric testing of the Family Integration Experience Scale: Chronic Illness (FIES:CI), a measure of family member perceptions of integrating CC or CI into evolving family life. Family Systems Nursing (FSN), the Reintegration Within Families in the Context of Chronic Illness Model, and measurement theory guided the study. Participants were those ( N = 328) managing a CC or CI. Concurrent validity ( r = +.629; p < .001) and discriminant validity, F(1, 155) = 7.09; p < .05, were demonstrated. Exploratory factor analysis revealed a two-dimensional model explaining 63.8% variance. Scale internal reliability was α = .70 and .785, and factor reliabilities were α = .798 (Factor 1) and α = .847 (Factor 2). Test–retest item and subscale correlations, while accounting for intra-family correlation, were acceptable. The FIES:CI contributes a valuable new measure of family integration in the context of CC or CI with preliminary validity and reliability as tested in these samples.

Food Attribution and Economic Cost Estimates for Meat- and Poultry-Related Illnesses

ABSTRACT The economic burden of foodborne illness has been estimated to be as high as US$90 billion annually. For policy purposes, it is often important to understand not only the overall cost of illness but also the costs associated with individual products or groups of products. In this study, I estimate the cost of foodborne illnesses from 29 pathogens associated with nongame meat and poultry products that are regulated by the U.S. Department of Agriculture. To complete this, I merge results from a food attribution model with results from an illness model and an economic burden of illness model. The food attribution model uses outbreak and expert elicitation data to attribute foods to pathogens. The illness model is a replication of the 2011 study published by the Centers for Disease Control and Prevention. The economic cost model is an updated version of previously published studies that include costs for medical care, lost productivity, loss of life, and pain and suffering. The primary attribution model, based largely on Interagency Food Safety Analytics Collaboration assumptions, estimates that meat and poultry products are vectors for 30.9% of all foodborne illnesses. This translates into 2.9 million annual illnesses, yielding economic costs of up to $20.3 billion. The costliest food-pathogen pairs include Campylobacter spp. in poultry ($6.9 billion), Salmonella spp. in chicken and pork ($2.8 and $1.9 billion, respectively), and Toxoplasma gondii in pork ($1.9 billion). Results based on alternative attribution and economic model assumptions are also presented, generating meat and poultry attribution estimates ranging from 27.1 to 36.7% and economic costs of $8.1 to $22.5 billion. HIGHLIGHTS