Question

review RNAO BPG identify a topic surrounding chronic illness that is not addressed

Answer 1

Abstract

Objectives Nursing home (NH) residents experience a high burden of chronic disease. Chronic disease management (CDM) can be a challenge, as the context of care provision and the way care is provided impact care delivery. This scoping review aimed to identify types of chronic diseases studied in intervention studies in NHs, influential contextual factors addressed by interventions and future CDM research considerations.

Data sources We searched four databases: CINAHL, EMBASE, PubMed and Scopus, in March 2018.

Data extraction and synthesis Extracted information included the type of chronic disease, the type and number of CCM model components used in the intervention, the method of delivery of the intervention, and outcomes.

Results On completion of the review of 11 917 citations, 13 studies were included. Most interventions targeted residents living with dementia. There was significant heterogeneity noted among designs, outcomes, and type and complexity of intervention components. There was little evaluation of the sustainability of interventions, including feasibility.

Conclusions Research was heavily focused on management of dementia. The most commonly included CCM components were multidisciplinary care, evidence-based care, coordinated care and clinical information systems. Future research should include subjective and objective outcomes, which are meaningful for NH residents, for common chronic diseases.

INTRODUCTION

Chronic diseases are conditions lasting at least 1 year in duration and, when poorly managed, they can negatively impact the lives of older adults.1 The impact of chronic disease is staggering: 63%–67% of deaths in Canada and the USA are caused by cancer, diabetes mellitus, cardiovascular diseases and chronic respiratory diseases.2–4 Dementia, another chronic disease, has become very relevant in caring for ageing populations as it is often responsible for older adults moving to nursing homes (NH).5 NHs are especially impacted by chronic disease, as individuals often need care for several chronic diseases and symptoms, leading to complex care needs and clinical uncertainty and/or difficulty in addressing those needs.6–8

Chronic disease management (CDM) refers to the ongoing care and support provided to individuals living with a chronic disease. To improve care delivery generally, the context in which care is provided and the way care is provided need to be considered. Wagner and colleagues9–11 developed a model (ie, chronic care model ‘CCM’) of external factors to support high-quality CDM including multidisciplinary teams to provide patient care, inclusion of patient self-management techniques, provision of coordinated care, delivery system redesign (to promote improved access to resources), use of clinical information systems (to improve evaluation and communication) and using an evidence-based approach to provide care (see online supplementary appendix A).10 Consequently, studies evaluating interventions for CDM should account for contextual factors to maximise uptake in bedside applications.

Supplemental material
[bmjopen-2019-032316supp001.pdf]
A systematic review examining how CDM programme incorporated the CCM10 in interventions for patients in primary healthcare settings showed improved survival and disease control.11 Additionally, primary studies12–14 found that incorporating components of the CCM10 (ie, patient self-management and delivery system redesign) within their interventions improved outcomes for primary care clients living with chronic disease. It would be reasonable to assume that CDM interventions aimed at improving care for residents living in NHs would also be strengthened from incorporating components of the CCM.10

Given the rising demand for NH capacity and quality care delivery, we sought to identify (1) which chronic diseases have been the subject of intervention studies in NHs, (2) what CCM10 components are addressed in CDM interventions for NH residents and (3) what gaps may future research consider to improve CDM in NHs.