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Advancing the chronic care road map: a contemporary overview.

https://arctichealth.org/en/permalink/ahliterature143105
Source
Healthc Q. 2010;13(3):72-9
Publication Type
Article
Date
2010
Author
Sara Ahmed
Amede Gogovor
Mylene Kosseim
Lise Poissant
Richard Riopelle
Maureen Simmonds
Marilyn Krelenbaum
Terrence Montague
Author Affiliation
McGill University, Montreal, Quebec. sara.ahmed@mcgill.ca
Source
Healthc Q. 2010;13(3):72-9
Date
2010
Language
English
Publication Type
Article
Keywords
Canada
Chronic Disease - prevention & control - therapy
Community Health Services - organization & administration
Disease Management
Humans
Models, organizational
Program Evaluation
Abstract
In an effort to assess and advance the community-based model of chronic care, we reviewed a contemporary spectrum of Canadian chronic disease management and prevention (CDMP) programs with a participatory audience of administrators, academics, professional and non-professional providers and patients. While many questions remain unanswered, several common characteristics of CDMP success were apparent. These included community-based partnerships with aligned goals; inter-professional and non-professional care, including patient self-management; measured and shared information on practices and outcomes; and visible leadership. Principal improvement opportunities identified were the enhanced engagement of all stakeholders; further efficacy evidence for team care; facile information systems, with clear rationales for data selection, access, communication and security; and increased education of, and resource support for, patients and caregivers. Two immediate actions were suggested. One was a broad and continuing communication plan highlighting CDMP issues and opportunities. The other was a standardized survey of team structures, interventions, measurements and communications in ongoing CDMP programs, with a causal analysis of their relation to outcomes. In the longer term, the key needs requiring action were more inter-professional education of health human resources and more practical information systems available to all stakeholders. Things can be better.
PubMed ID
20523157 View in PubMed
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Comparison of persistence rates with angiotensin-converting enzyme inhibitors used in secondary and primary prevention of cardiovascular disease.

https://arctichealth.org/en/permalink/ahliterature161164
Source
Value Health. 2007 Sep-Oct;10(5):431-41
Publication Type
Article
Author
Amédé Gogovor
Alice Dragomir
Michelle Savoie
Sylvie Perreault
Author Affiliation
University of Montreal, Montreal, QC, Canada.
Source
Value Health. 2007 Sep-Oct;10(5):431-41
Language
English
Publication Type
Article
Keywords
Angiotensin-Converting Enzyme Inhibitors - therapeutic use
Antihypertensive Agents - therapeutic use
Cardiovascular Diseases - drug therapy - prevention & control
Cohort Studies
Female
Humans
Hypertension - drug therapy
Kaplan-Meier Estimate
Male
Middle Aged
Patient compliance
Quebec
Abstract
On average, 50% of patients are noncompliant with drugs for chronic health problems, despite their proven efficacy. It is therefore essential to have real-world data to devise suitable methods for improving persistence with these therapies. To measure and compare persistence rates with the angiotensin-converting enzyme inhibitors (ACEIs) in primary and secondary prevention and their determinants.
Two cohorts were reconstructed from the Régie de l'assurance maladie du Québec's databases. The subjects had to be newly treated with ACEIs between January 1, 1998 and December 31, 2000. The primary prevention cohort consisted of 4596 hypertensive patients and the secondary prevention cohort of 1620 patients. The cumulative persistence rates were determined by the Kaplan-Meier method. The determinants of nonpersistence were evaluated with a Cox regression model.
The 1-year persistence rates for the nonexclusive use of antihypertensive agents by initial prescribed agent: enalapril, fosinopril, lisinopril, quinapril, and ramipril were 66%, 64%, 69%, 65%, and 72% in the secondary prevention cohort, and of 66%, 72%, 71%, 72%, and 75% in the primary prevention cohort. The adjusted 1.5-year nonpersistence rates in primary prevention were higher for quinapril and enalapril than for ramipril. In secondary prevention all of the ACEIs were equivalent in nonpersistence rate. In secondary prevention cohort, having dyslipidemia, respiratory disease, >or=4 different classes of drugs/month increase the rate of persistence. Among, the primary prevention cohort, the fact of having diabetes, dyslipidemia, respiratory disease, using >or=4 different classes of drugs/month or prior hospitalization increased significantly the rate of persistence. For both cohorts, the fact of having high number of oral doses/day or elevated health-care resource utilization decreased significantly the rate of persistence.
The 1.5-year persistence rate was low compared with the threshold of 80% generally accepted. The high-risk patients were less likely to discontinue their treatment. These results can be of help in devising methods for improving the effectiveness of these drugs in routine practice.
PubMed ID
17888108 View in PubMed
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Contemporary disease management in Quebec.

https://arctichealth.org/en/permalink/ahliterature158386
Source
Healthc Q. 2008;11(1):30-7
Publication Type
Article
Date
2008
Author
Amédé Gogovor
Michelle Savoie
Yola Moride
Marilyn Krelenbaum
Terrence Montague
Author Affiliation
Health Management Research Group, Université de Montréal, Quebec. amede.gogovor@umontreal.ca
Source
Healthc Q. 2008;11(1):30-7
Date
2008
Language
English
Publication Type
Article
Keywords
Disease Management
Health Services Research
Humans
Interinstitutional Relations
Patient care team
Patient-Centered Care
Program Evaluation
Quality Assurance, Health Care - methods
Quebec
Abstract
Health or disease management (DM) has emerged as a promising solution to improve the quality of healthcare and patient outcomes in a cost-efficient way. This solution is particularly relevant in the care of our increasing, and aging, patient populations with multiple chronic diseases. This article reviews the recent history and current status of DM in the province of Quebec and summarizes its evolving perspectives and future prospects. Most DM projects in Quebec have developed from a public-private partnership, and they have addressed several disease states. The results of completed programs confirmed the presence of care gaps--the differences between best and usual care in several disease states. They also identified process changes leading to improved practices and enhanced professional satisfaction among stakeholders. Priorities identified for further research include increased knowledge of the underlying causes of care gaps and greater concentration on the measurement of clinical, humanistic and fiscal outcomes and their causal links to DM structures and processes. Although still embryonic in Quebec and Canada, the available evidence suggests that DM partnerships are practical and functional vehicles to expedite knowledge creation and transfer in the care of whole populations of patients. Future projects offer the promise of updated knowledge and continuously improved care and outcomes.
PubMed ID
18326378 View in PubMed
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Time for chronic disease care and management.

https://arctichealth.org/en/permalink/ahliterature160862
Source
Can J Cardiol. 2007 Oct;23(12):971-5
Publication Type
Article
Date
Oct-2007
Author
Terrence J Montague
Amédé Gogovor
Marilyn Krelenbaum
Author Affiliation
Health Management Research Group, Faculty of Medicine, University of Montreal, Montreal, Outremont, Quebec, Canada. terrence.montague@umontreal.ca
Source
Can J Cardiol. 2007 Oct;23(12):971-5
Date
Oct-2007
Language
English
Publication Type
Article
Keywords
Canada
Chronic Disease - economics - therapy
Community Networks
Delivery of Health Care - organization & administration
Disease Management
Health Personnel - organization & administration
Humans
Patient care team
Quality of Health Care - economics - standards
Abstract
To manage the future costs and quality of care, a health strategy must move beyond the individual, acute care model and address the care of older people with chronic, and often multiple, diseases. This strategy must address the issue of care gaps, ie, the differences between best care and usual care. It should also embrace broad partnerships in which providers may be a cross-disciplinary team of nurses, physicians and pharmacists; the patient partners may include all patients in the community with a disease or group of diseases; and the system managers should work with all to seek improved long-term care and share the governance of interventions and resources. This partnership is activated by repeated and widely communicated measurements of actual practices and outcomes, facilitating rapid knowledge gain and translation, including unmasking the invisible wait list of unmeasured care gaps. It drives continuous improvement in practices and outcomes. The time is right for such care models. There is increasing evidence of their clinical and financial benefits. There is a clear and immediate opportunity to evaluate them as part of a health strategy for effective chronic care in our aging society. Things can be better.
Notes
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Cites: Pharos Alpha Omega Alpha Honor Med Soc. 2006 Summer;69(3):116939168
PubMed ID
17932573 View in PubMed
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