Thesis (M.A.)--Northern Kentucky University, 2006. / Made available through ProQuest. Publication number: AAT 1437734. ProQuest document ID: 1203575521. Includes bibliographical references (p. 37-38)

Thesis (M.A.)--Northern Kentucky University, 2006. / Made available through ProQuest. Publication number: AAT 1438042. ProQuest document ID: 1203575911. Includes bibliographical references (p. 41-43)

Thesis (M.S.)--Springfield College, 2005. / Includes bibliographical references. Also available online (PDF file) by a subscription to the set or by purchasing the individual file.

Thesis (M.S.)--Springfield College, 2005. / Includes bibliographical references.

The purpose of this study proposal is to examine the peer relationships of adolescents with chronic conditions, particularly as a result of spending less time at school and socializing with peers, and more time at home or in the healthcare system. Participants will be 50 adolescents with chronic conditions, 50 healthy adolescents attending regular schools, and 50 homeschooled adolescents. They will complete a variety of questionnaires relating to activity restriction, best friendship quality, number of friends, peer-group attachment, relationships with selected adults, and parent-child relationships. Information about the chronic condition and school attendance will also be collected. It is predicted that despite experiencing a high quality best friendship, adolescents with chronic conditions will have fewer friends and worse peer-group attachment. There is also expected to be an inverse relationship between both activity restriction and absenteeism and peer-group attachment and number of friends. This study proposal has several implications for healthcare practitioners, school administrators, and parents: particularly, that more should be done to integrate adolescents with chronic conditions into schools and social activities.

Asthma, gout and hypothyroidism are common chronic medical disorders encountered in general practice. Optimal disease management according to standard guidelines are fundamental to disease control. This study aimed to objectively and subjectively assess the quality of care provided in a private general practice to patients with asthma, gout and hypothyroidism by means of a practice audit and questionnaire based survey. These tools proved to be an effective measure for the quality of care provided and identified areas needing improvement. Patient’s understanding of the disease process plays an important role in both patient satisfaction ratings and success of disease control. The medical audit identified and highlighted specific areas of care that can be improved. Evidence from the practice audit showed that control for asthma based on the PEFR readings, gout based on the serum uric acid reading and hypothyroidism based on a blood TSH reading, was found at 56.7%, 43.3%, and 66.7 % respectively. In addition acute attacks of asthma and gout occurred in 22.7% and 32.8% respectively. This does not represent good control. Definition of disease control for each condition is placed in the text. The survey revealed overall patient understanding for the disease processes of asthma, gout and hypothyroidism to be 69.6%, 73.3% and 66.8% respectively. The patient survey satisfaction rating for asthma, gout and hypothyroidism was 93.1%, 93.9% and 89.2% respectively. Patient suggestions for improvement included three dominant themes: better assessment of disease control, education about their chronic disease and implementation of a clearer referral process. The study concludes that disease control can be achieved if patients are educated about their chronic disease and regularly followed up to assess disease control based on standard management guidelines. Patients' disease education was a major contributing factor for satisfaction rating bias. The study confirms that in spite of high satisfaction ratings, patients are not optimally managed with substandard disease control. It would be expected that as disease education improves, the quality of care will improve, but satisfaction ratings will decrease.

Background: Respiratory disease has been one of the top three causes of deaths in Macau in the past decade. As one of the chronic respiratory diseases, chronic obstructive pulmonary disease (COPD) is incurable, but is preventable and treatable. COPD patients suffer from recurrent and progressive respiratory symptoms, and this impacts the health and well-being of patients. Self-management education programmes (SMEP) provide teaching and learning guidance for understanding COPD, emotional support and behaviour change needed to carry out disease-specific care in chronic patients. Evidence has demonstrated that SMEP can mediate a change in health-related behaviours, improve symptom control and the quality of life of COPD patients, with an associated reduction in health care utilization. However, SMEP has never been conducted in Macau, and experiences of providing any form of chronic care for COPD patients in this place is lacking. Aims: This study aimed to explore the effects of a specifically designed self-management education programme on Stage II to IV COPD patients in Macau. Design: The study was conducted as an exploratory randomized controlled trial in a mixed methods approach. Both illness perception and self-efficacy beliefs were adopted to formulate the theoretical framework. In the quantitative strand, the assessment of primary outcomes included illness perception, self-efficacy and inhaler technique. The secondary outcomes included pulmonary function, healthcare utilization and health-related quality of life. In the qualitative strand, focus groups were conducted to explore the subjective perception and experiences of self-management of COPD patients. Fifty one eligible COPD patients were recruited and allocated to experimental (26 patients) and control group (25 patients) by block randomization. A SMEP for COPD patients was developed and validated according to Medical Research Council (MRC) framework. Results: Quantitative results indicated that the primary outcomes (illness perception, self-efficacy and inhaler technique) improved in the experimental group after the SMEP. In relating to the secondary outcomes, days of hospitalization were reduced and symptom dimension of disease-specific health related quality of life (St. George Respiratory Questionnaire) improved. Qualitative findings identified the emergence of a core theme ‘Essentiality’ and five sub-themes ‘Helplessness’, ‘Mutual involvement’, ‘Support’, ‘Control’ and ‘Beneficial’, indicating perception and experiences of participants for self-management. These findings indicate a potential relationship of illness perception and self-efficacy in guiding COPD patients to adapt to health-related behaviour. Discussion and Conclusion: This study has obtained evidence for supporting the proposed theoretical framework and expected experimental effect through employing the MRC guidelines. The study also confirms the estimates of recruitment for a definitive RCT, demonstrated readiness and positive impact in Macau COPD patients to receive self-management intervention, and SMEP as an acceptable and preferable mode of chronic care for COPD for the healthcare system of Macau.

Orientador: Irma de Godoy / Resumo: Várias doenças pulmonares são associadas ou apresentam na sua evolução a hipoxemia crônica. A mais comum é a doença pulmonar obstrutiva crônica (DPOC), que é caracterizada pela obstrução ao fluxo aéreo devido a bronquite crônica e/ou enfisema. O tratamento para esta condição é a administração de oxigênio. A oxigenoterapia domiciliar prolongada (ODP) melhora a expectativa de vida, reduz a policitemia, aumenta o peso do corpo, melhora a atividade cardíaca e a função neuropsicológica e aumenta a capacidade para realização de exercícios e atividades da vida diária. Os objetivos desta pesquisa foram levantar as características dos pacientes cadastrados no Serviço de Oxigenoterapia, avaliar as condições de fornecimento e uso do oxigênio e orientá-los quanto ao manuseio dos materiais e equipamentos para o tratamento com oxigênio. Foi realizado estudo retrospectivo e prospectivo no período de janeiro de 1997 a janeiro de 1999, que avaliou o total de 70 pacientes. Foram analisados dados da avaliação clínica e nutricional, de exames laboratoriais e de função pulmonar, questionário geral e de qualidade de vida e visita domiciliar. Os resultados mostraram que maior prevalência era do sexo masculino (59%), idade de 61 ? 12 anos, com mínimo de 20 e o máximo de 89 anos, sendo que a maioria dos pacientes (58%) tinha idade acima dos 61 anos. A avaliação nutricional apontou peso médio do corpo de 63,6 ? 19,3 Kg, o IMC foi de 24,7 ? 7,2 kg/m e a pocentagem do peso ideal era de 103,1 ? 42,1%. O diagnóstico de DPOC ocorreu em 70% dos pacientes estudados. O resultado de gasometria arterial mostrou valores de PaO2 de 46,12 ? 9,10 mmHg, PaCO2 de 44,68 ? 8,75 mmHg e SaO2 de 79,30 ? 11,91%. O resultado da prova de função pulmonar mostrou que a maioria dos pacientes apresentava distúrbios ventilatórios restritivos ou obstrutivos... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Several pulmonary diseases are associated or in it's evolution is presented chronic hypoxemia. The most common is the chronic obstructive pulmonary disease (COPD): witch is characterized by the obstruction of the airflow due to a chronic bronchitis or na emphysema. The long term domiciliary oxygen therapy (LTOT) improves the life expectation, reduces the polycythemia and the neuropsychological and also increases the patient's faculty for exercises and daily activities. This research has as main objectives to study the registered patient's on Oxygen Therapy Services, evaluate the oxygen supplyng and using condictions and orientates these patients for the correct use of the materials and oxygen equipment used in treatment. A retrospective and prospective study was made in the period of January of 1997 to January of 1999; witch evaluated the total of 70 patients. Clinical and nutritional data were analysed and the patient's laboratory exams and pulmonary function, domiciliary visits survey and life conditions were as well analysed. The results shown a prevalence of male gender (59%) ages of 61 ? 12 years with the minimum average of 20 and the maximum average of 89 years, that the greatest part of the patients (58%) had their ages above 61 years. The nutritional evaluations shown a medium weigh average of 63,6 ? 19,3 Kg, the body mass index (BMI) was 24,7 ? 7,2Kg/m2 and the percentile of the patients with the ideal body weigh was 103,1 ? 42,1%. The COPD diagnoses occurred in 70% of the evaluated patients. The arterial gasometry results shown PaO2 levels of 46,12 ? 9,10 mmHg, PaCO2 levels of the 44,68 ? 8,75 mmHg and SaO2 levels of 79,30 ? 11,91%. The results of the pulmonary function testing shown that the greatest part of the studies patients has presented restrictives or obstructives ventilatory disturbs. The patient's characteristics results shown... (Complete abstract click electronic address below) / Mestre

Background: Health systems internationally face a common set of challenges: ageing populations, increasing numbers of patients suffering from multiple long-term conditions (multimorbidity) and severe pressure on health and care budgets. ‘Integrated care’ is pitched as the solution to current health system challenges. But, in the literature, what integrated care actually involves is complex and contested. Aims: 1. What does ‘integrated care’ currently look like in practice in the NHS? 2. What is the effectiveness of current models of ‘integrated care’? 3. To what extent are there differential effects of ‘integrated care’ for different types of multimorbidity? Methods: The thesis utilises routinely collected data, systematic review and meta-analysis, combined with quasi-experimental methods (difference-in-differences, and subgroup analysis, difference-in-difference-in-differences). Results: The current implementation of the concept of integrated care is predominantly carried out through multidisciplinary team (MDT) case management of ‘at risk’ (usually of secondary-care admissions) patients in primary care. This approach, however, has not proven capable of meeting health outcome and utilisation/cost aims. Patient satisfaction, though, is consistently improved by the approach. There might also be positive spill-over effects of increased team-working through MDTs for the wider practice population. There does not appear to be a multimorbidity subgroup which benefits significantly more than others in terms of secondary-care utilisation or cost. However, patients at the end of life and/or those with only primary-care sensitive conditions might benefit slightly more than others. Conclusions: Integrated care, in its current manifestation, is not a silver bullet that will enable health systems to simultaneously accomplish better health outcomes for those with long-term conditions and multimorbidity while increasing their satisfaction with services and reducing costs. The current financial climate might mean that other means of achieving prioritised aims are required in the short-term, with comprehensive primary care and population health strategies employed to better prevent/compress the negative effects of lifestyle-associated conditions in the longer-term.

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