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Using data from Vietnamese-origin older immigrants/refugees in the Houston, Texas area, we assessed their overall health, chronic conditions, disability, depressive symptoms, and cognitive impairment, and examined the association between their chronic conditions and disability by comorbidity clusters. The mean age of the sample was 76 years old. The majority were married in fair/poor health with several chronic conditions and disabilities and lived with families in low-income households. Hypertension and arthritis were the most common health conditions, but cognitive impairment had the most significant impact on their disability. They experienced similar health conditions to other older Americans but had higher rates of depressive symptoms and cognitive impairment possibly due to cultural factors that may have delayed mental health treatment. Culturally and linguistically tailored services created by policymakers, healthcare professionals, and local social service agencies are recommended for the well-being of immigrants/refugees who migrated to the U.S. for a better life.

Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In VIII: clinical approaches, authors address the following themes: Evaluation, diagnosis and management I-toward a working diagnosis, Evaluation, diagnosis and management II-process steps, Interweaving integrative medicine and family medicine, Halfway-the art of clinical judgment, Seamless integration in family medicine-team-based care, Technology-uncovering stories from noise and Caring for patients with multiple long-term conditions. May readers recognise in these essays the uniqueness of a family medicine approach to care.

Objectives: This study investigated the mediating role of maladaptive cognitive emotion regulation strategies in the relationship between alexithymia and self-perceived aging among older adults. Methods: We surveyed 478 Chinese community-dwelling older adults from November 2022 to May 2023. The Toronto Alexithymia Scale (TAS-20), Cognitive Emotion Regulation Questionnaire (CERQ), and Brief Aging Perceptions Questionnaire (B-APQ) were used. Correlation analyses, multiple linear regression analysis, and structural equation modeling were performed. Results: The average age of participants was 71.52 ± 7.80 years, and the number of chronic diseases was distributed as follows: 270 (56.49%) had 2 disease conditions, 156 (32.64%) had 3 disease conditions, and 52 (10.88%) had 4 disease conditions or more. Scores for alexithymia 57.83 ± 10.19; maladaptive cognitive emotion regulation strategies 49.63 ± 10.65; and self-perceived aging 58.74 ± 10.23. Alexithymia and maladaptive cognitive emotion regulation strategies were positively correlated with negative self-perceived aging (r=0.665 and r=0.673, respectively), explaining 51.8% of the variance in self-perceived aging. Structural equation modeling results showed that alexithymia had a direct effect (of 0.368) on self-perceived aging, accounting for 44.1% of the total effect. Maladaptive cognitive emotion regulation strategies partially mediated the relationship, with a mediation effect of 0.386, accounting for 51.8% of the total effect. Conclusion: These findings suggest that addressing maladaptive cognitive emotion regulation strategies can help reduce negative self-perceived aging in elderly individuals with multiple chronic conditions, particularly among those with alexithymia. [ABSTRACT FROM AUTHOR]

Background: Integrating behavioral health services in primary care is challenging; a toolkit approach to practice implementation can help. A recent comparative effectiveness randomized clinical trial examined the impact of a toolkit for improving integration on outcomes for patients with multiple chronic conditions. Some aspects of behavioral health integration improved; patient-reported outcomes did not. This report evaluates the implementation strategy (Toolkit) using Proctor's (2011) implementation outcomes model. Methods: Using data from the 20 practices randomized to the active (toolkit strategy) arm (education, redesign workbooks, online learning community, remote coaching), we identified 23 measures from practice member surveys, coach interviews, reports, and field logs to assess Toolkit acceptability, appropriateness, feasibility, and fidelity. A practice survey score was high (met expectations) if its average was ≥ 4 on a scale 1-5; all other data were coded dichotomously, with high = 1. Results: Regarding acceptability, 74% (14) of practices had high scores for willingness of providers and staff to use the Toolkit and 68% (13) for quality improvement teams liking the Toolkit. For appropriateness, 95% (19) of practices had high scores for the structured process being a good match and 63% (12) for the Toolkit being a good match. Feasibility, measured by Toolkit prerequisites, was scored lower by site members at project end (e.g., provider leader available as champion: 53% of practices) compared to remote coaches observing practice teams (74%). For "do-ability," coaches rated feasibility lower for practices (e.g., completion of workbook activities: 32%) than the practice teams (68%). Fidelity was low as assessed across seven measures, with 50% to 78% of practices having high scores across the seven measures. Conclusions: Existing data from large trials can be used to describe implementation outcomes. The Toolkit was not implemented with fidelity in at least one quarter of the sites, despite being acceptable and appropriate, possibly due to low feasibility in the form of unmet prerequisites and Toolkit complexity. Variability in fidelity reflects the importance of implementation strategies that fit each organization, suggesting that further study on contextual factors and use of the Toolkit, as well as the relationship of Toolkit use and study outcomes, is needed. Trial registration: ClinicalTrials.gov NCT02868983; date of registration: 08/15/2016. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives Methods Results Conclusion Trial Registration This qualitative study aimed to explore the experience and perception of the mouth, oral health, functioning and the social environment amongst adults with disabilities and complex health conditions.Purposive sampling using the maximum variation strategy was performed to select participants with a wide range of experiences in terms of demographics, disability and health conditions. Consent was sought, and semi‐structured interviews were conducted, recorded and transcribed verbatim. Within the interpretivist tradition, a phenomenological approach was used to describe the lived, contextualised experience of people in relation to their mouths, as described by participants. Thematic analysis was undertaken.Eighteen participants with disabilities and complex health conditions were interviewed. Twelve individuals had an intellectual disability. Three main themes were identified: perception of the mouth and oral health; symptomatic perceptions and responses to oral health problems; and inter‐relationships between the mouth, oral health and the socio‐medical environment. The mouth had a central place in the lives of the participants, but its importance was only recognised when oral health problems interfered with daily life, function, social relationships, family life or autonomy. Certain social determinants of health were identified: social exclusion, financial insecurity, lack of autonomy, nutrition and negotiation of services. Oral problems were perceived as an additional burden to those with disabilities or complex health conditions.This study provided insight into the daily lives of adults with disabilities and complex health conditions. It helps to fill the gaps in the existing literature regarding the perceptions of the mouth and oral health, connecting oral function, general health and social environment for this population.This study was registered into ClinicalTrials.gov (NCT04815434) [ABSTRACT FROM AUTHOR]

Background Aim Study Design Results Conclusion Relevance to Clinical Practice Children with medical complexity (CMC) are at increased risk of admission in intensive care. Despite improvements in mortality rates, there remains a burden of morbidity, long‐term health care needs and hospital readmissions. Beyond clinical factors, socio‐demographic determinants could impact utilization of acute services.To identify risk factors that can differentiate CMC who are admitted to the paediatric intensive care unit (PICU).A 6‐year longitudinal retrospective cohort study evaluated clinical, socio‐demographic and health care utilization.A total of 248 CMC were included, with a median age of 13 years (9.75–17.00). Intensive care admission rate was 47.2%. The risk of PICU admission was higher for children undergoing surgical interventions (HR = 1.58, 95% CI 1.34–1.86, p < .001) and those using medical devices (HR = 1.81, 95% CI 1.54–2.13, p < .001). Mother's higher educational level was a protective factor (HR = 0.66, 95% CI 0.55–0.79, p < .001). Multivariable analysis revealed significant associations between risk of admission and the presence of malignancy, comorbidities, home medical devices, surgical procedures and higher health care utilization. Children's age and higher maternal educational level acted as protective factors.Socio‐demographic factors should be considered in the provision of care to CMC. Individualized assessments to guide supportive interventions adapted to socio‐economic factors may prevent PICU admissions.This study highlights the importance of integrating individualized assessments of socio‐demographic risk factors, such as maternal educational level, into the clinical practice of paediatric nurses. Moreover, targeted interventions, including educational resources and community support programmes, may optimize care. [ABSTRACT FROM AUTHOR]

Objectives Multimorbidity, known as multiple chronic conditions (MCC), is the coexistence of two or more chronic health conditions (CHC). The near-retirement-age population with MCC is more likely to experience discontinued labor force participation (LFP). Our objective was to evaluate the impact of MCC on LFP among adults aged 50–64 and to explore heterogeneous effects between self-employed and non-self-employed workers. Methods We constructed our sample using the Health and Retirement Study (HRS) from 1996 to 2018. We adopted an individual fixed-effect (F.E.) model and propensity score matching (PSM) to measure the impact of MCC on the probability of being employed and changes in annual work hours. Results 50.5% of respondents have MCC. Individuals with MCC exhibit a predicted probability of being employed that is 9.3 percentage points (p  < .01, 95% confidence interval [95% CI]: −0.109, −0.078) lower than those without MCC. Compared with non-CHC, MCC significantly reduced annual working hours by 6.1% (p  < .01, 95% CI: −0.091, −0.036) in the F.E. model and by 4.9% (p  < .01, 95% CI: −0.064, −0.033) in PSM estimation. The effect is more pronounced for the self-employed with MCC, who have 13.0% (p  < .05, 95% CI: −0.233, −0.026) fewer annual work hours than non-CHC based on the FE model and 13.4% (p  < .01, 95% CI: −0.197, −0.070) in PSM estimation. Discussion MCC significantly reduces LFP compared with non-MCC. MCC has a heterogeneous impact across occupational types. It is important to support the near-retirement-age working population with multimorbidity through effective clinical interventions and workplace wellness policies to help manage health conditions and remain active in the labor market. [ABSTRACT FROM AUTHOR]

ObjectivesMethodsResultsConclusionsClinical ImplicationsThis study was conducted to determine the relationships between activities of daily living (ADL), depression, and quality of life. Specifically, the study aimed to evaluate the potential mediating role of depression in the relationship between activities of daily living and quality of life in a sample of Iranian older adults.This cross-sectional study recruited 118 older adult adults with multiple chronic conditions in Iran from December 2022 to September 2023. Data were collected using a demographic and health information questionnaire, the Katz Index, the Lawton scale, Old-World Health Organization Quality of Life, and the Geriatric Depression Scale. Path analysis was used to test the hypothesis.Participants’ average age was 70.15 ± 6.91 years. BADL (B = 0.2, p = .02), and depression (B = −0.25, p = .004) were significantly related to the quality of life. The standardized indirect effect of BADL on quality of life was 0.08 (p = .006).According to the results of this study, functional status can directly and also, indirectly affect the quality of life of older adults with multiple chronic conditions through depression.Health care providers are advised to carefully assess older adults’ mental health and functional status and consider their relationships to quality of life. [ABSTRACT FROM AUTHOR]

Background: Patients with multiple chronic conditions often have many care plans, polypharmacy, and unrelieved symptoms that contribute to high emergency department and hospital use. High-quality primary care delivered in practices that employ nurse practitioners can help prevent the need for such acute care services. However, such practices located in primary care health professional shortage areas face challenges caring for these patients because of higher workloads and fewer resources. Objective: We examined differences in hospitalization and emergency department use among patients with multiple chronic conditions who receive care from practices that employ nurse practitioners in health professional shortage areas compared to practices that employ nurse practitioners in non-health professional shortage areas. Methods: We performed an analysis of Medicare claims, merged with Health Resources and Services Administration data on health professional shortage area status in five states. Our sample included 394,424 community-dwelling Medicare beneficiaries aged ≥65 years, with at least two of 15 common chronic conditions who received care in 779 practices that employ nurse practitioners. We used logistic regression to assess the relationship between health professional shortage area status and emergency department visits or hospitalizations. Results: We found a higher likelihood of emergency department visits among patients in health professional shortage areas compared to those in non-health professional shortage areas and no difference in the likelihood of hospitalization. Discussion: Emergency department use differences exist among older adults with multiple chronic conditions receiving care in practices that employ nurse practitioners in health professional shortage areas, compared to those in non-health professional shortage areas. To address this disparity, the health professional shortage area program should invest in recruiting and retaining nurse practitioners to health professional shortage areas to ease workforce shortages. [ABSTRACT FROM AUTHOR]

Abstract Background Integrating behavioral health services in primary care is challenging; a toolkit approach to practice implementation can help. A recent comparative effectiveness randomized clinical trial examined the impact of a toolkit for improving integration on outcomes for patients with multiple chronic conditions. Some aspects of behavioral health integration improved; patient-reported outcomes did not. This report evaluates the implementation strategy (Toolkit) using Proctor’s (2011) implementation outcomes model. Methods Using data from the 20 practices randomized to the active (toolkit strategy) arm (education, redesign workbooks, online learning community, remote coaching), we identified 23 measures from practice member surveys, coach interviews, reports, and field logs to assess Toolkit acceptability, appropriateness, feasibility, and fidelity. A practice survey score was high (met expectations) if its average was ≥ 4 on a scale 1-5; all other data were coded dichotomously, with high = 1. Results Regarding acceptability, 74% (14) of practices had high scores for willingness of providers and staff to use the Toolkit and 68% (13) for quality improvement teams liking the Toolkit. For appropriateness, 95% (19) of practices had high scores for the structured process being a good match and 63% (12) for the Toolkit being a good match. Feasibility, measured by Toolkit prerequisites, was scored lower by site members at project end (e.g., provider leader available as champion: 53% of practices) compared to remote coaches observing practice teams (74%). For “do-ability,” coaches rated feasibility lower for practices (e.g., completion of workbook activities: 32%) than the practice teams (68%). Fidelity was low as assessed across seven measures, with 50% to 78% of practices having high scores across the seven measures. Conclusions Existing data from large trials can be used to describe implementation outcomes. The Toolkit was not implemented with fidelity in at least one quarter of the sites, despite being acceptable and appropriate, possibly due to low feasibility in the form of unmet prerequisites and Toolkit complexity. Variability in fidelity reflects the importance of implementation strategies that fit each organization, suggesting that further study on contextual factors and use of the Toolkit, as well as the relationship of Toolkit use and study outcomes, is needed. Trial registration ClinicalTrials.gov NCT02868983; date of registration: 08/15/2016.

Background With the acceleration of China's aging population, the prevalence of chronic diseases and comorbidity patterns pose significant challenges to global health. There is a close relationship between the prevalence of chronic diseases and individuals' self-related health (SRH) status. However, there is limited research on the prevalence of chronic diseases and comorbidity patterns among middle-aged and elderly populations in rural areas of Xinjiang, China, and their impact on SRH status. Objective To understand the prevalence of chronic diseases and comorbidity patterns among middle-aged and elderly populations in rural areas of Xinjiang and to explore the impact of chronic diseases and comorbidity patterns on SRH status, providing effective reference for improving the health level of this population. Methods The data for this study were derived from the survey database of the National Social Science Foundation project (17BRK030) from 2016 to 2019. A questionnaire survey was conducted on the demographic characteristics, chronic disease status, and self-rated health status of male and female heads of households. Ordered logistics regression analysis was used to screen the influencing factors of SRH status. SOM network training analysis and partial least squares method were employed to evaluate the interrelationships among 14 chronic diseases and the degree of their impact on SRH status. Results A total of 3 400 middle-aged and elderly individuals were surveyed. Residents' SRH status varied significantly by geographical distribution, gender, age, education level, occupation, marital status, illness or disability, and chronic disease status (P

Hypertension, type 2 diabetes mellitus (T2DM), and dyslipidemia are collectively referred to as the "three highs", which often coexist in the same individual. It significantly increases the risk of hospitalization, death, and relevant burdens for affected people. It is necessary to jointly control the risk and standardize the treatment of hypertension, T2DM and dyslipidemia. Primary healthcare institutions have become the main battlefield for the prevention and treatment of chronic diseases. Existing clinical evidence provides important insights into the prevention, treatment, and management of the "three highs", although norms, consensus, and guidelines for the co-management of the "three highs" in primary healthcare institutions at domestic and foreign are current not available. Four academic organizations led by Beijing Hypertension Association organized primary healthcare workers and invited experts and scholars from medical fields of cardiovascular diseases, endocrine, pharmacy, and public health services to participate in the consensus. Through widely soliciting clinical practice needs of primary healthcare workers, integrating and evaluating the evidence related to the prevention and treatment of the "three highs" in primary healthcare institutions, the consensus for primary healthcare in the prevention and treatment of the "three highs" including 21 opinions was developed after multiple rounds of discussions, revisions, and voting. The recommended opinions of this consensus aim to improve the awareness and ability of primary healthcare workers in the prevention and treatment of the "three highs", provide scientific strategic support, implement management with primary healthcare characteristics, and lay a solid foundation for comorbidity co-management.

Background In the face of the serious challenges posed by the high prevalence of chronic diseases among the elderly and the coexistence of multiple chronic diseases, the health problems of community-dwelling elderly people' with multimorbidity require urgent attention. The comorbidity management model is being explored and practiced. Disease experience, as self-reported health information from patients, is expected to become a key component of the patient-centered community multimorbidity management model. Objective This study aimed to gain a deeper understanding of the real disease experience of community-dwelling elderly people with multimorbidity and provide a basis for personalized health management and supportive strategies of the group. Methods This study used purposive sampling and maximum difference sampling to select eligible interviewees from four communities under the jurisdiction of a community health service center in Zhengzhou City from August to September in 2022. Based on the principle of information saturation, 20 subjects were ultimately included. Based on the research objective, literature review, and expert consultation results, the preliminary interview outline was formulated, and the final interview outline was determined after interviewing 2 patients. Semi-structured interviews were conducted with the study participants, guided by the phenomenological research methodology. Golaizzi analysis was used to analyse the data. Results Four themes and eleven sub-themes had been extracted from this study, including mainly long-standing symptomatic distress (physical dysfunction, fatigue, sleep disorders, and pain), negative psychological experiences (feelings of helplessness and worry about future life, reduced sense of social value and self-identity, and loneliness with altered social activities), positive mindset of coexisting harmoniously with multimorbidity (being grateful for being satisfied, and positively adapting), and aspirations in times of adversity (hoping for improvement in functioning, and seeking multi-directional social support) . Conclusion Physical dysfunction, sleep disturbances, fatigue, and pain are the most concerning health disturbances for community-dwelling elderly people with multimorbidity. The symptom management and multiple social support of the multimorbidity need to be strengthened. In the future, it is expected that multidimensional data would be used for dynamic health assessment to explore the common and individual patterns of multimorbidity, and to achieve precise management and intervention of elderly multimorbidity in the community.

Deprescribing is the intentional dose reduction or discontinuation of a medication. The development of deprescribing interventions should take into consideration important organizational, interprofessional, and patient-specific barriers that can be further complicated by the presence of multiple prescribers involved in a patient's care. Patients who receive care from an increasing number of prescribers may experience disruptions in the timely transfer of relevant healthcare information, increasing the risk of exposure to drug-drug interactions and other medication-related problems. Furthermore, the fragmentation of healthcare information across health systems can contribute to the refilling of discontinued medications, reducing the effectiveness of deprescribing interventions. Thus, deprescribing interventions must carefully consider the unique characteristics of patients and their prescribers to ensure interventions are successfully implemented. In this special article, an international working group of physicians, pharmacists, nurses, epidemiologists, and researchers from the United States Deprescribing Research Network (USDeN) developed a socioecological model to understand how multiple prescribers may influence the implementation of a deprescribing intervention at the individual, interpersonal, organizational, and societal level. This manuscript also includes a description of the concept of multiple prescribers and outlines a research agenda for future investigations to consider. The information contained in this manuscript should be used as a framework for future deprescribing interventions to carefully consider how multiple prescribers can influence the successful implementation of the service and ensure the intervention is as effective as possible.

Patients with multimorbidity often require the concomitant use of multiple medications, presenting general practitioners (GPs) with the dilemma of assessing the benefits and risks due to complex and potential interactions between diseases and medications. This article takes one case of a multimorbid patient at a community health service center to illustrate and elucidate the process by which GP employs a medication decision-making framework for multimorbidity (MDMF). Furthermore, by examining the multi-stage goals set by Ariadne principle in the process of multimorbidity management, this article analyzes the key points and considerations for GPs in the assessment, communication, and making treatment plans, thereby offering reference to improve the quality of medication decision-making for patients with multimorbidity in the community.

Multimorbidity refers to an individual suffering from two or more chronic diseases simultaneously. Patients with multimorbidity refers often require the concurrent use of multiple medications, posing a challenge to community general practitioners in making scientific medication decisions. This paper analyzes the reasons and influencing factors that lead to the dilemmas in medication decision-making for patients with multimorbidity in the community. It also proposes a dynamic and comprehensive decision-making framework known as the Medication Decision-making for Multimorbidity Framework (MDMF). The framework consists of five stages in the process of community general practitioners treating patients with multimorbidity, which include "Health problems review""Comprehensive medication assessment""Shared decision-making""Medication therapy recording", and "Follow-up arrangement". The MDMF facilitates the development of individualized medication therapy for patients with multimorbidity by community general practitioners, but it also places certain demands on their capabilities. Therefore, it is recommended to provide training for community general practitioners centered on the MDMF, offer decision-making support, and implement reasonable incentives and supervision measures. This is expected to promote primary care institutions to provide patient-centered medication therapy, enhance its safety and efficacy, and alleviate the treatment burden on patients.

Background With the population aging, the number of patients with chronic diseases and disability is increasing, which brings a heavy burden on the medical system. While it is well established that comorbidity and disability are closely interconnected, there is a noticeable scarcity of studies addressing the relationship between different patterns of comorbidity and disability. Objective To explore the common comorbidity patterns and their associations with disability among the older adults in China taking Sichuan as an example. Methods A total of 501 older adults, aged 60 and above, were selected using quota sampling in Sichuan from August to Novermber 2022. Detailed data on chronic diseases, disability, and general demographics were collected. Comorbidity patterns among the older adults were identified using a two-step clustering method that combined self-organizing maps and K-Means. The association between patterns of comorbidity and disability was explored using a logistic regression model, employing the National Disability Assessment Scale for the Long-term Care issued by the National Healthcare Security Administration of China in 2021. Results In this survey, The prevalence of comorbidity 62.3% (312/501) and the prevalence of disability was 74.3% (372/501). We identified six comorbidity patterns: Arthritis/Rheumatism and Hypertension diseases, Cardiovascular and Metabolic diseases, Kidney and Arthritis/Rheumatism diseases, Cancer and Arthritis/Rheumatism diseases, Asthma, Hypertension, and Gastrointestinal diseases, Emotional/Mental and Memory-related diseases. The results of binomial logistic regression showed that the risk of disability was 6.3 times higher when people suffering from two or more chronic diseases at the same time (OR=6.3, 95%CI=3.9-10.3, P