Differences in primary care support offered to patients with documented lack of physical activity. Regarding patients with diabetes, hypertension and depression

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JACOBSSON Iwona, DOCK Johannes

 

Introduction

The importance of physical activity for both prevention and management of non-communicable diseases is well established. Less is known, to what degree health-care providers identify patients with lack of physical activity and how many of these are offered support. There are also differences between patients with diabetes, hypertension and depression and whether they are asked about their level of physical activity.

 

Purpose/Methods

In the Swedish County Council of Västernorrland a system for documentation of lifestyle habits is part of the Computerized Medical Record System. Patients with appointments connected with a diagnosis of depression, diabetes or hypertension at one of the counties’ 32 primary health-care centers were studied.

 

Results

In 2016, of the county’s 209,940 inhabitants aged 13 or older, 12,425 had been seen for depression, 15,112 for diabetes and 40,641 for hypertension. Proportions of patients whose level of physical activity was registered were 24%, 43% and 32%, respectively. 73% (depression), 76% (diabetes) and 70% (hypertension) had inadequate levels of physical activity and of these 48%, 49% and 46% were offered support. At individual Health care centers, the proportions of patients with recorded activity levels varied between 2% and 77%, proportions of inactive patients who were offered support vary between 0% and 100%.

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Results

In 2016, of the county’s 209,940 inhabitants aged 13 or older, 12,425 had been seen for depression, 15,112 for diabetes and 40,641 for hypertension. Proportions of patients whose level of physical activity was registered were 24%, 43% and 32%, respectively. 73% (depression), 76% (diabetes) and 70% (hypertension) had inadequate levels of physical activity and of these 48%, 49% and 46% were offered support. At individual Health care centers, the proportions of patients with recorded activity levels varied between 2% and 77%, proportions of inactive patients who were offered support vary between 0% and 100%.

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Conclusions

Patients with diabetes had their activity levels recorded to a larger extent than those with hypertension or depression. It is of importance to present the variations in support from primary health care centers between different diagnoses, as patients with diabetes receive the most support whilst those who suffer from depression get the least amount of help.

 

Contact: JACOBSSON Iwon

Swedish County Council of Västernorrland
iwona.jacobsson@rvn.se

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The relationship between unmet healthcare needs and quality of life in Korean elderly: EQ-5D assessment

 

KIM Kue Sook, SONG Se Yong, DONG Yoo Jeong , LEE Ji Hong, LEE Yu Jeong, RYU Heui Geun, KIM Rock Kwon, MOON Seung Kwon

 

Introduction

The use of medical services is essential to maintaining a healthy life for the elderly and improving the quality of life, but unmet medical treatment occurs for various reasons. Unmet medical care has recently in geriatric studies received attention as a significant factor influencing the quality of life in later years. The purpose of this study is to analyze the relationship between the Korean National Nutrition Survey data and the quality of life through EQ-5D.

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Purpose/Methods

In this study, 3,880 of 4,509 elderly patients aged 65 years or more who participated in the National Health and Nutrition Survey data during the 6th period (2013-2015) were included from the analysis of unmet healthcare needs. In the study, composite sampled data were used and analyzed by Rao-Scott chi-square test using weighted questionnaire and test stratification (strata).

 

Results

It was statistically significant that the elderly who were involved were more than 75 years old (p<0.001), female (p=0.010), having less than middle-school education (p<0.001), without spouse (p<0.001), and lower income (p<0.001). In addition, EQ-5D according to the healthcare needs analysis showed that elderly people with health care respectively satisfied (p<0.001) the quality of life (Mobility, Self-care, Usual activity, Pain / discomfort, Anxiety / depression).

 

Conclusions

As a result of this study, it was found that the condition to manage health and the satisfaction of medical service is an opportunity to assess and affects the quality of life. Even if the elder do not visit the hospital, they should be able to recognize that they are being managed continuously. In order to do this, the researcher proposes to revitalize community care by national policy.

 

Contact: KIM Kue Sook 

Seoul Metropolitan Dongbu Hospital / Korea Institute for Health  
Information and Policy. 
mdkimks16@gmail.com

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Comparison of the effects between Physician Reputation and Medical Equipment on the willingness to seek Medical Care - A Study of patients with Urinary Calculi in Taiwan

 

CHANG Chih-Ming, YEN Chia-Chi

 

Introduction

Under Taiwanese National Health Insurance, medical expenses are no longer the main factor to consider for medical treatment. Relevant studies indicated that “distance”, “physician reputation”, “medical equipment”, “service attitude” and “hospital environment” can all affect the people’s willingness to seek medical care in different regions. This study explored the effects that “physician reputation” and “medical equipment” have on the willingness of patients with urinary calculi to seek medical care.

 

Purpose/Methods

Telephone interviews were conducted with patients with urinary calculi who did not have a follow-up visit for over six months. The patients were randomly assigned to be informed of the newly enlisted physician from the medical center or the newly purchasing holmium-YAG laser. The numbers of follow-up visits for the next three months were tracked, and the Pearson chi-square test was used to analyze whether there is a significant difference between these two return-visit rates.

 

Results

84 telephone interviews were conducted. Among them, 8 of 42 patients were informed about the newly enlisted physician from medical center with a return-visit rate of 19.04%. 1 of 42 patients was informed about the newly purchasing holmium-YAG laser with a return-visit rate of 2.38%. The Pearson chi-square value was .015<.05, indicating there is a significant difference between these two return visit rates.

 

Conclusions

The study result showed that patients informed of the newly enlisted physician have a significantly higher return-visit rate compared to those informed of the newly purchasing laser equipment. This indicates that “physician reputation” has stronger impact than “medical equipment on urinary calculi patients. However, the lack of the patient’s understanding or the interviewer’s description for the holmium-YAG laser may be a confounding variable for this study.

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Contact: CHANG Chih Ming 

Kaohsiung Municipal Min-Sheng Hospital 
psy7034@gmail.com

 

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Integrated system for TB control: Communication, empowerment and integration as key points of the strategy 

 

CASONI Carmen, BONVICINI Francesca, GRECI Marina, FORNACIARI Rossano, PERILLI Cinzia, SEVERI Carla, GEMMI Maria Cristina, BIGLIARDI Mariella, LAROSA Elisabetta, BISACCIA Eufemia, MONICI Lucia, CHIARENZA Antonio

 

Introduction

Tuberculosis (TB) is still a major public health problem with high social impact and requires a coordinated management of case index, contacts and community. In some cases (elderly subjects, homeless etc.), an integrated social-assistance system is required. It is important to ensure adherence to therapy, and follow-up and to carry out screening of contacts, to avoid the onset of drug resistance and to stop the transmission in the community.

 

Purpose/Methods

The local health unit of Reggio Emilia implemented an integrated system of hospital-territory care, multidisciplinary and inter-departmental. Nurses dedicated to TB treatment had the objectives to actively monitor patients’ adherence to follow-up, to communicate the importance of completing treatment (health education and patient empowerment) effectively and to act as a link between medical staff and patients. TB cases were followed-up in dedicated outpatient clinics, located throughout the province to improve accessibility, until the end of treatment with direct delivery of drugs.

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Results

From 2004 to 2016, 89% of the 455 cases of pulmonary TB successfully completed treatment (WHO’s objective ≥ 85%). Contacts were quickly identified and proposed for treatment of latent TB infection if positive. In 2014-2016, 1121 contacts at risk were identified; the 93% completed the entire diagnostic-therapeutic pathway (objective ≥ 85%). The 87% of positive contacts successfully completed treatment for latent tuberculosis infection (objective ≥ 75%).

 

Conclusions

Tangible results can be achieved through coordinated activities and specifically trained professionals for TB control. The promotion of clinical-organizational models that improve continuity of care and the definition of multidisciplinary diagnostic-therapeutic pathways ensure the optimization of disease surveillance.

 

Contact: BONVICINI Francesc

Local health Unit of Reggio Emilia  
francibonvi@libero.it

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Evaluating estimated dietary salt intake using spot urine samples for low salt lifestyle; for the “Sukoshio®” movement

 

OZAWA Nobuyuki, NEGISHI Kyota, YOKOYAMA Sachiko, KONISHI Tsuyako

 

Introduction
The Japanese Health and Welfare Co-Operative recommends a ‘salt intake reducing movement of 6g. or less a day’ with a registered trademark of “Sukoshio®”. But changing eating habits for many years is not easy. It is one of the important activities of health promotion to aim for salt intake reduction by a collaboration of medical experts and people. Estimation of daily salt intake using spot urine samples can be an objective indicator of the reduced salt movement.

 

Purpose/Methods

From June of 2017 to January 2018, the estimated salt intake measurements were calculated by urine test (Tanaka method) at municipal health examination. After that, volunteers were recruited, and learning about salt intake reduction was conducted as an intensive intervention. Two weeks later, remeasurement of salt intake and a dietary questionnaire were carried out. Three hundred twenty-five community members (103 men, 222 women) related to the Tokyo Kensei Hospital and the Nezu Clinic were enrolled in this study.

 

Results

The mean age of participants was 74.7. The average amount of estimated salt intake was 8.6g. There was a strong correlation between BMI and daily salt intake. The mean age of volunteers was 66.6. The amount of salt intake after the intervention unchanged or decreased for 21 volunteers. The total score of the dietary questionnaire significantly reduced from 12.4 to 9.9. However, estimated dietary salt intake using spot urine samples showed no significant decrease before and after the intervention.

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Conclusions

Although estimation of salt intake is often based on subjective evaluation of meal content, objective assessment became possible by adopting estimated daily saline intake using occasional urinalysis. Obese tend to be overeating with the result of an increased salt intake. For expanding the “Sukoshio®” movement, it is necessary to conduct awareness-raising activities on balanced eating methods and quantities. Subjective assessment of dietary habits does not always improve an actual salt reduction, and it is essential to instruct diet programmes based on objective indicators.

 

Contact: SAITOH Fumihiro

Oizumi Health Cooperative Hospital, Tokyo 
fumisaitoh@gmail.com

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Development of senior-specific, citizen-oriented healthcare service system in South Korea based on the Canadian 48/6 Model of Care

 

Yoon-Sook Kim, Jongmin Lee, Jinyoung Shin, Kyeong Eun Uhm, Kyoung Jin Kim, Seol-Heui Han, Jaekyung Choi

 

Introduction

The current medical delivery system in Korea in the age of ageing faces the risks of increasing the number of medical and caring refugees, thereby requiring a comprehensive breakthrough. This study attempts to develop a senior citizen-oriented healthcare service system in which daily care, professional care, and rehabilitation are organically organized between medical institutions and local communities, thereby meeting the daily life needs of the elderly and induce well-being, wellness, and well-dying.

 

Purpose/Methods

For the development of senior-specific, citizen-oriented healthcare service, the research conducted three steps:  1) systematic review; 2) literature review, bench marking, and focus group interviews; and 3) confirmation with experts.

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Results

This senior-specific, citizen-oriented healthcare service system is an integrated medical treatment system for elderly patients that enables patient-specific treatment planning and respective mediation. The system screens and evaluates 10 items that organically influence the health of the elderly, not only at the time of admission but also during hospitalization and discharge. This system enables a systematic link between medical institutions and community resources, as it aims for the continuous management of issues that have occurred to patients even after discharge (i.e. back in the community). Furthermore, the system establishes a multidisciplinary treatment plan that considers patients and their families so that diseases that are common to the elderly are diagnosed and treated in a timely manner.

 

Conclusions

In the medical delivery system in Korea, it is difficult to establish a senior-specific, citizen-oriented healthcare service system by the efforts of one hospital. Government-led systems need to be extended. Subsequently, patients, families, and caregivers, as well as providers of care, can organically organize daily care, professional care, and rehabilitation according to their roles to improve the quality of life, health, and safety as well as meet the needs of the elderly.

 

Contact: KIM YOON-SOOK

KONKUK University Medical Center, Seoul 
20080352@kuh.ac.kr

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The effect of Mindfulness-Based intervention on reduction of chronic pain for patients

 

CHEN Mei-Wen, WANG Chiao-Chu, HUANG Shu-Hua

 

Introduction

The prevalence of chronic pain in adults is obvious, yet little is known of its predictable factors. Thus, this review investigated the effect of Mindfulness Based Stress Reduction (MBSR) of self-management on chronic pain by paper reviews.

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Purpose/Methods

We searched the literature electronic databases Cochrane Library and Ovid, the PubMeb from inception to 27 November 2018 for relevance of systematic review and meta-analysis studies. We used keywords such as Mindfulness Based Stress Reduction (MBSR) and chronic pain. 

 

Results 

The Meta-analysis suggested that MBSR interventions may be associated with pain intensity (standardized mean difference=-0.89; 95% CI=1.63 to -0.15; P = 0.02) and headache frequency (standardized mean difference=-0.67; 95% CI=-1.24 to -0.10; P=0.02) (Gu, Hou et al. 2018). Besides, Anheyer, Haller et al. (2017) showed no significant differences on low back pain of MBSR. Furthermore, Bawa, Mercer et al. (2015) suggested that no significant evidence of MBSR was found for chronic pain.

 

Conclusions

The inconsistent results indicated that the effect of mindfulness may rely on duration of the intervention, meaning no favorable long-term effect were found with short-term training. Further studies can investigate how the effect of medicine with MBSR on reduction of chronic pain in patients work best. The article concluded by discussing the implications of the study for MBSR may reduce pain headache and maybe an option of treatment for patients in the future. 

 

Contact: Mei-Wen Chen 

Department of Tumor Center, Changhua Christian Hospital, Changhua, Taiwan 
135442@cch.org.tw

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Using Computerized Health Counseling System for diabetes prevention program in a health promoting hospital in Korea

 

CHU Jieun, NAH Eun-Hee, CHO Seon, CHAI Jong-Yil

 

Introduction

People who use drugs (PWUD) have higher rates of emergency room visits and hospital admissions, and may encounter stigma, perceive receiving substandard care, and leave hospital before discharge. This is especially concerning for PWUD with complex health needs, including those with or at risk for HIV. Few studies have examined illicit drug use in acute settings despite unman-aged withdrawal being a predictor of leaving hospital early.

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Purpose/Methods

We conducted semi-structured interviews with adults living with HIV and/or HCV who self-identified as PWUD, and with health care providers (HCP) on in-patient hospital units in two large Canadian cities to understand what leads to on-premise use. PWUD were asked to describe their drug use during hospital stays, staff interactions and experiences leaving before discharge. HCP were asked to describe their attitudes and experiences providing care to PWUD and related hospital policies. Interviews were audio-recorded, transcribed and analyzed inductively.

 

Results

The system is combined with a survey and input at the same time and allows assessment outcomes to be immediately printed and used for consultation. In this system, we can obtain integrated result paper by entering the results of surveyed diet, drinking, and physical activities habits. The integrated outcome sheet pro-vides an assessment of the level of lifestyle, as well as an appropriate intake of nutrients, and may include the opinion of a consultant. Through this process, we were able to offer personalized counseling effectively. Both the consultants and participants were highly satisfied with using CHCS.

 

Conclusions

Using a computer-based system for lifestyle intervention program, we were able to provide efficient personalized 1:1 counseling services. The use of appropriate computer systems and the balance of human resources are essential in the health promoting hospital (HPH). We will continue to use this system in patient care and counseling. 

 

Contact: CHU Jieun 

Korea Association of Health Promotion, Seoul 
je_wow@naver.com​

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Project on identifying key figures for measuring workplace health promotion?

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GROSS Nicole, ÜBELACKER Anna 

 

Introduction

Workplace health promotion is advocated to progress the health and well-being of employees. Within a Master thesis of the program in Advanced Nursing Practice at the University of Paracelsus Medizinische Privatuniversität Salzburg there is a project in cooperation with the Voestalpine Steel Division. Health promotion and determination of key figures is one of the main topics of the master thesis. As health is an asset, which is difficult to measure, the purpose of this project is to identify key figures. Health promotion experts will be interviewed to determine key figures and will then be compared with results from a literature research. The evaluation and presentation of the results are treated confidentially, transparent and scientifically neutral. The aim of the expert survey is to identify the most important key figures for health measuring.

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Methods/Intervention

The research design of this project will be qualitative. First step will be an expert survey at the HPH conference in Warsaw by explorative guided interviews. On the basis of this survey, a partly structured guided interview will be created. In conclusion, managers from Voestalpine Steel Division will be interviewed. Results will be compared with the literary research and documented. The master’s thesis will also look at current ways to evaluate health promotion. In the end of the project there will be key figures and ideas shown with which health promotion could be measured.

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Results

The project is just about to start, so there are no results yet. But to exhaust the health potential of the employees it is important to consider working circumstances and conditions.

 

Conclusions

Identifying key figures to measure health and how to preserve health sustainable is one of the major topics of this project. 

 

Contact: GROSS Nicole 

Master student at Advanced Nursing Practice University of 
Paracelsus Medizinische Privatuniversität Salzburg 
nicole.gross@alumni.pmu.ac.at