This report describes how stakeholder groups informed a web-based care planning tool’s development for addressing root causes of poor health. Stakeholders included community members (n = 6), researchers (n = 6), community care providers (n = 9), and patients (n = 17). Feedback was solicited through focus groups, semi-structured interviews, and user experience observations and then qualitatively analyzed to identify themes. Each group contributed a unique perspective. Researchers wanted evidence-based content; community members and providers focused on making goals manageable; patients wanted care team support and simple action-oriented language. Our findings highlight the benefits of stakeholder input. Blending perspectives from multiple groups results in a more robust intervention design.

Management of chronic diseases, such as heart failure, is a major public health problem. A standard approach to managing chronic diseases by medical community is to have a committee of experts develop guidelines that all physicians should follow. Due to their complexity, these guidelines are difficult to implement and are adopted slowly by the medical community at large. We have developed a physician advisory system that codes the entire set of clinical practice guidelines for managing heart failure using answer set programming. In this paper, we show how abductive reasoning can be deployed to find missing symptoms and conditions that the patient must exhibit in order for a treatment prescribed by a physician to work effectively. Thus, if a physician does not make an appropriate recommendation or makes a non-adherent recommendation, our system will advise the physician about symptoms and conditions that must be in effect for that recommendation to apply. It is under consideration for acceptance in TPLP.

Management of chronic diseases such as chronic heart failure (CHF) is a major problem in health care. A standard approach followed by the medical community is to have a committee of experts develop guidelines that all physicians should follow. These guidelines typically consist of a series of complex rules that make recommendations based on a patient's information. Due to their complexity, often the guidelines are ignored or not complied with at all. It is not even clear whether it is humanly possible to follow these guidelines due to their length and complexity. For instance, for CHF, the guidelines run nearly eighty pages. In this paper we describe a physician-advisory system for CHF management that codes the entire set of clinical practice guidelines for CHF using answer set programming (ASP). Our approach is based on developing reasoning templates, that we call knowledge patterns, and using them to systemically code the clinical guidelines for CHF as ASP rules. Use of the knowledge patterns greatly facilitates the development of our system. Given a patient's medical information, our system generates a recommendation for treatment just as a human physician would, using the guidelines. Our system works even in the presence of incomplete information.

Objectives: An overview was produced of approaches currently used to evaluate chronic disease management in selected European countries. The study aims to describe the methods and metrics used in Europe as a first to help advance the methodological basis for their assessment.

Methods: A common template for collection of evaluation methods and performance measures was sent to key informants in twelve European countries; responses were summarized in tables based on template evaluation categories. Extracted data were descriptively analyzed.

Results: Approaches to the evaluation of chronic disease management vary widely in objectives, designs, metrics, observation period, and data collection methods. Half of the reported studies used noncontrolled designs. The majority measure clinical process measures, patient behavior and satisfaction, cost and utilization; several also used a range of structural indicators. Effects are usually observed over 1 or 3 years on patient populations with a single, commonly prevalent, chronic disease.

Conclusions: There is wide variation within and between European countries on approaches to evaluating chronic disease management in their objectives, designs, indicators, target audiences, and actors involved. This study is the first extensive, international overview of the area reported in the literature.

Musculoskeletal symptoms are frequent in primary care, and back pain and osteoarthritis are the commonest causes of disability in the developed world. Effective primary care could make a real difference to population levels of pain and disability. Traditional approaches, which see musculoskeletal pain only as a guide to underlying pathology, underestimate the need to assess and manage pain and disability in their own right. This paper presents the rationale for new models of diagnosis and care. These include: placing symptoms and their impact on daily life at the centre of primary care management of common musculoskeletal syndromes; a focus on the person with co-morbidity rather than on neatly parcelled distinctive single musculoskeletal diagnoses; promotion of positive messages such as the safety of activity and the efficacy of simple treatments; inclusion of the psychological and social context in management of musculoskeletal conditions; supporting patients to live and participate in daily life despite their pain or disability; supporting and training health care professionals other than doctors to provide a ‘gatekeeping’ role for these conditions; evaluation of changes in the organisation of care for patients with musculoskeletal problems. Evidence for the effectiveness of such new models is uneven. The paper reviews other research directions, such as qualitative research into patient perceptions and priorities, and the idea that non-specific treatment effects (eg, acupuncture) are often bigger than specific effects and could be harnessed to improve clinical care. Natural history studies remain important for understanding causation: prevalence is already near lifetime maximum by young adulthood for example and we do not know why. Musculoskeletal medicine is the Cinderella of primary care and primary care research. Knowledge, training and enthusiasm lags behind other priority areas for primary care clinicians. Yet the potential benefits, which primary care could achieve, are enormous.

Background: Hemodialysis is a palliative treatment for patients with established renal failure (ERF), and volume overload is a common problem for hemodialysis patients with low urinary output. Volume overload is thought to be mostly attributable to interdialytic fluid intake by the patient and is associated with an increased symptom burden and the development of serious medical complications. Repeated episodes of volume overload may adversely affect staff–patient relationships and the perception of care in this patient population. The aim of this case series study was to evaluate the effect and experience of a psychological intervention on interdialytic weight gain in a small group of patients.

Methods: Five patients were treated. The intervention involved using techniques derived from both cognitive behavior therapy and motivational interviewing. The main outcome measures were interdialytic weight gain and patient perception of the intervention.

Results: Three of the five patients reduced both mean interdialytic weight gain and the frequency with which they gained in excess of 3% of their dry weight during the intervention phase. The intervention was found to be acceptable to patients.

Significance of results: The intervention was effective in helping three of the five patients to reduce both the frequency and the severity of volume overload, and two of these patients maintained this for at least 6 months post intervention. The intervention used actively engaged the patients and appeared to be experienced positively. The methods used to mobilize patient resources and optimize staff–patient relationships as vehicles of change are discussed. Both may have implications for treatment concordance and the perception of care delivered.