CLINICAL TRIAL

Patient Priorities Care for Multiple Chronic Conditions

Waitlist Available · 65+ · All Sexes · West Haven, CT

This study is evaluating whether a patient-centered approach to care can improve outcomes for older veterans with multiple chronic conditions.

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About the trial for Multiple Chronic Conditions

Eligible Conditions
Multiple Chronic Conditions · Disease · Shared Decision Making

Treatment Groups

This trial involves 2 different treatments. Patient Priorities Care is the primary treatment being studied. Participants will all receive the same treatment. Some patients will receive a placebo treatment. The treatments being tested are not being studied for commercial purposes.

Main TreatmentA portion of participants receive this new treatment to see if it outperforms the control.
Patient Priorities Care
BEHAVIORAL
Control TreatmentAnother portion of participants receive the standard treatment to act as a baseline.
Usual Care
OTHER

About The Treatment

Treatment
First Studied
Drug Approval Stage
How many patients have taken this drug
Patient Priorities Care
2016
N/A
~420

Eligibility

This trial is for patients born any sex aged 65 and older. There are 2 eligibility criteria to participate in this trial as listed below.

Inclusion & Exclusion Checklist
Mark “yes” if the following statements are true for you:
I have had two encounters with people in the past twelve months. show original
She has 3 active health problems which are listed on her active problem list, and she is taking 10 medications. show original
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Odds of Eligibility
Unknown<50%
Be sure to apply to 2-3 other trials, as you have a low likelihood of qualifying for this one.Apply To This Trial
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Approximate Timelines

Please note that timelines for treatment and screening will vary by patient
Screening: ~3 weeks
Treatment: varies
Reporting: 6 month follow-up
Screening: ~3 weeks
Treatment: Varies
Reporting: 6 month follow-up
This trial has approximate timelines as follows: 3 weeks for initial screening, variable treatment timelines, and reporting: 6 month follow-up.
View detailed reporting requirements
Trial Expert
Connect with the researchersHop on a 15 minute call & ask questions about:
- What options you have available- The pros & cons of this trial
- Whether you're likely to qualify- What the enrollment process looks like

Measurement Requirements

This trial is evaluating whether Patient Priorities Care will improve 2 primary outcomes and 4 secondary outcomes in patients with Multiple Chronic Conditions. Measurement will happen over the course of 6 month follow-up.

Patient-clinician conversation analysis for changes in care that are aligned with identified priorities
6 MONTH FOLLOW-UP
The investigators will collect audio recordings of 2 patient encounters from each study arm for a random subset of 10 providers (5 per site, for a total of 40 recordings). Using discourse analytic techniques validated in past studies, the investigators will code transcripts to determine whether: (a) patient values and outcome goals were identified, (b) care preferences were discussed, and (c) care recommendations were aligned with priorities (i.e., discussion explicitly aligning care recommendations with priorities, care recommendations were congruent with priorities, or care was not aligned with priorities).
6 MONTH FOLLOW-UP
Patients' goal setting
6 MONTH FOLLOW-UP
Will measure patients' perceptions of whether health care decisions were collaborative and focused on their goals using the Older Patient Assessment of Chronic Illness Care (OPACIC) score (11 items; range, 1-5; Cronbach = 0.87; higher scores indicate better perceived chronic disease care).
6 MONTH FOLLOW-UP
shared decision making
6 MONTH FOLLOW-UP
Measured using the CollaboRATE scale (3 items; possible range 0-100; Cronbach = 0.89; higher score indicates greater perceived shared decision-making and goal ascertainment).
6 MONTH FOLLOW-UP
Ambulatory care utilization
6 MONTH FOLLOW-UP
Medications added or stopped and diagnostic tests, referrals, and procedures ordered or avoided. Measured using a structured chart review tool using our validated process to guide uniform abstraction and classification to a) document specific changes in treatment (i.e., medications, referrals, diagnostics, self-care, services and supports), b) attribute changes to alignment with priorities, and c) identify documentation of any avoided care.
6 MONTH FOLLOW-UP
Home and Community Services Use
6 MONTH FOLLOW-UP
Home and community based services includes care that supports independence and the ability to stay in one's own home. They are defined by the VA Geriatrics and Extended Care Data Analysis Center (GEC-DAC) as VA Long Term Services and Supports: adult day health care, home based primary care, homemaker and home health aide, hospice care, palliative care, respite care, skilled home health care, home telehealth, and home care services. GEC-DAC has created a composite measure, which is associated with delays in nursing home and institutional long-term care placement.
6 MONTH FOLLOW-UP
Patient Reported Treatment Burden
6 MONTH FOLLOW-UP
Measured by the validated Treatment Burden Questionnaire, treatment burden measures perceptions of burdensomeness of overall care and treatment burden (e.g., medication taking, self-monitoring, visits to the provider, tests, tasks to access and coordinate care) imposed by healthcare as assessed with 15 items; possible range, 0-150; Cronbach = 0.90; higher scores indicate greater perceived burden.
6 MONTH FOLLOW-UP

Patient Q & A Section

Please Note: These questions and answers are submitted by anonymous patients, and have not been verified by our internal team.

Can multiple chronic conditions be cured?

Recent findings suggest that MCCs can be treated with pharmacotherapy. Because MCCs cannot be cured, it is important that patients with these conditions do not try to cure MCCs by using non-pharmacologic intervention techniques. Copyright © 2006 John Wiley & Sons Ltd.

Anonymous Patient Answer

What is multiple chronic conditions?

Multiple chronic conditions are common and a growing problem. Effective prevention and treatment is needed not only to prevent disabling chronic conditions themselves, but also to reverse the progression of illness into functional impairment.

Anonymous Patient Answer

What are common treatments for multiple chronic conditions?

Common treatment options include lifestyle interventions, counseling for diet and/or exercise, multifactorial treatment, and medication. These strategies are designed to target multiple chronic conditions simultaneously.

Anonymous Patient Answer

What are the signs of multiple chronic conditions?

Individuals with several chronic conditions may have signs that overlap with their respective chronic conditions and with each other. The signs and symptoms will vary by the combination of conditions and will likely change over time.

Anonymous Patient Answer

How many people get multiple chronic conditions a year in the United States?

Between 1.1 and 1.6 million are diagnosed with MCZ's a year in the United States. For women, MCZ's a year are found to be more common (1.4%) than for men (1.2%) and are more likely to be attributed to psychological symptoms (49.3%) rather than an identifiable mental disorder (40.2%).

Anonymous Patient Answer

What causes multiple chronic conditions?

The strongest determinants of multiple chronic conditions are lifestyle factors, such as smoking, physical inactivity, unhealthy diet, and alcohol consumption. Moreover, a large amount of evidence is now showing that the causal link between lifestyle factors and most of the world's diseases lie outside a person's control. The evidence-based approach requires the development of tailored strategies that may include lifestyle and behaviour interventions, as well as health policy interventions.

Anonymous Patient Answer

Has patient priorities care proven to be more effective than a placebo?

Findings from a recent study of these studies suggest that patients' reported priority care priorities are at least as effective as placebo treatment for insomnia, and have benefits related to quality of life and self-rated health but without a change in objective sleep parameters. While some of the findings were based on small and nonrandomized studies, meta-analyses are more robust and allow for better exploration of treatment effects by combining many independent studies.

Anonymous Patient Answer

How serious can multiple chronic conditions be?

Although the MCC's are associated with high levels of functional impairment and high levels of burden, these patients have low levels of subjective health-related quality of life. The MCC's can result from multiple chronic conditions, or from a single chronic condition. It seems that, in the last quarter of the last decade, there is increasing interest in the MCC's. The aim of this article was to identify the most common chronic conditions for a patient's functional decline and the associated MCC's.

Anonymous Patient Answer

What is patient priorities care?

Patient priorities of care are often different according to the primary care provider (PCP). It is important to evaluate the patient's priorities and to incorporate this into the patients' care plans to help improve care.

Anonymous Patient Answer

What does patient priorities care usually treat?

In a recent study, findings indicate two major trends: (a) the need for more patient-centred care, and (b) the need to engage patients more fully in clinical decision making. In the future there are hopes to integrate these for the benefit of all stakeholders.

Anonymous Patient Answer

Have there been other clinical trials involving patient priorities care?

Using priorities care as a framework in this pilot study may lead to clinicians engaging in active and high-quality communication and interaction with patients, which is often associated with reduced health care costs, improved patient satisfaction, and improved quality of care for patients with chronic conditions.

Anonymous Patient Answer

Who should consider clinical trials for multiple chronic conditions?

Given the high prevalence of comorbidities, MCC, multiple chronic non-cardiovascular diseases, and multiple chronic cardiovascular diseases are often seen as a whole. Patients who may benefit from new medications are often considered to take into account the complexity of their condition, instead of just the main diagnosis.

Anonymous Patient Answer
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