Publications

Objectives. To strengthen existing evidence on the role of neighborhoods in chronic disease onset in later life, we investigated associations between multiple neighborhood features and 2-year onset of 6 common conditions using a national sample of older adults.Methods. Neighborhood features for adults aged 55 years or older in the 2002 Health and Retirement Study were measured by use of previously validated scales reflecting the built, social, and economic environment. Two-level random-intercept logistic models predicting ...

OBJECTIVES: To evaluate the effectiveness of patient-led teaching compared with doctor-led teaching, regarding the impact of chronic disease (rheumatoid arthritis [RA]). METHODS: A set of learning objectives regarding the impact of RA on patient and family was designed. Students (n = 42) attached to the academy for their musculoskeletal diseases module were randomized to teaching either by a doctor or a patient. Outcome was assessed using a knowledge test, feedback forms and qualitative written interview. RESULTS ...

BACKGROUND:: Large administrative datasets such as Medicare and Medicaid claims have much potential utility in clinical and comparative effectiveness (CE) studies. Among their advantages are the inclusion of clinically heterogeneous populations, without exclusions typical in clinical trials; the ability to study extremely large study populations with power to examine differential outcomes across individual drugs, treatment effect modification, and the risk of uncommon outcomes. However, claims data by themselves are subject to many limitations, notably, in ...

A Complex Chronic Disease (CCD) is a condition involving multiple morbidities that requires the attention of multiple health care providers or facilities and possibly community (home)-based care. A patient with CCD presents to the health care system with unique needs, disabilities, or functional limitations. The literature on how to best support self-management efforts in those with CCD is lacking. With this paper, the authors present the case of an individual with diabetes and end-stage ...

Wagner's modern construct for chronic care recognizes the primacy of 'productive interactions' among the patient, their personal community and the care provider team. No longer the only locus of care, the health system should operate within the context of and have access to the people and resources of the larger community involved in the patient's care. Shared medical visits in the care of patients with diabetes serve as a model for collaborative care ...

This paper discusses the challenges that those living with complex chronic disease present to the Canadian health-care system. The literature suggests home care and the management of complex chronic disease can together ease many of the present and future pressures facing the health-care system in dealing with this new health-care phenomenon. A review of current literature and dialogue with key informants reveals that the current level of investment and the present policy environment are not ...

OBJECTIVES: To find the social and economic characteristics, and to identify the problems and health needs, of chronic patients confined to the home (CPHs). DESIGN: A descriptive cross-sectional study. SETTING: Otxarkoaga Health Centre (Bilbao). PARTICIPANTS: 121 CPHs of the 134 identified. These included patients with sub-acute, chronic or terminal illness, with physical and/or psychological disability, and/or with lack of social or family support, which prevented their attending the Health Centre. MEASUREMENTS AND RESULTS ...

OBJECTIVES: To describe the management of the geriatric hospital home assessment team to support at primary care in the need of health of geriatric patients. DESIGN: Prospective observational study. SETTING: 5-North health district from Madrid. PARTICIPANTS AND METHODS: All patients evaluated at home and the coordination activities between primary care and hospital geriatric service, developed by the geriatric assessment team between january 1997 at december 1999. Inquiry to primary care physicians about the usefulness of ...

Patients who are seen by internists seldom have a single, well-defined nosological entity. More often they are elderly patients with marginal pluripathology who have associated chronic or terminal illness with their attendant social problems. Nowadays, the majority of patients with the most prevalent diseases fit this profile. Sometimes, in large hospitals, the Department of Internal Medicine has little opportunity to manage specific or defined entities without the 'competition' of other subspecialist colleagues. Until a consensus ...

AIM: To determine the influence of the cognitive state on the presence of different frailty factors in the elderly. METHODS: Study of an outpatient elderly population with chronic diseases (resident at home or institutionalised), the presence of different frailty risk factors and their relation to cognitive state (measured using the mini-mental state examination-MEC). RESULTS: Study of 147 elderly people with an average age of 71.4 years and a similar proportion of men (74; 50 ...