Sample Research Paper on Evidence Review

Evidence Review

Empirical studies indicate that, one of the greatest challenges
facing the current global healthcare system in the 21st century is
the relatively increased burden of the chronic illnesses. As discovered by the
World Health Organization (WHO), in order to promote the patient empowerment,
chronic conditions often require a complex response from coordinated inputs by
a wide range of healthcare professionals, access to valid monitoring systems
and essential medicines over an extended period of time. However, as these
chronic conditions continue to prolong, creation of a contradictory and range
of diverse needs is often experienced. Multi-morbidity per se is a facet of patient complexity that deters the delivery of
effective medication (‘Brien et al, 2014). For example, depression condition in
patients with chronic conditions such as hypertension and chronic obstructive
pulmonary disease. Such malfunctions often confront patients and health care
professionals with a broad spectrum of needs in order to manage (Anonymous,
2012). Further, factors such as episodic, acute health care models and
ill-equipped healthcare systems, often pose most of these chronic conditions to
go untreated until more acute complications arise.  

and Co-morbidity

In order to determine the prevalence occurrence of multi-morbidity
and co-morbidity on the chronic respiratory disease, the World Health
Organization carried out a disease code and drug searches within computerised
database in Australia.  The research
employed a univariate (Person X2) statistics and multivariate
(logistic regression models) with the best fit measured by the Hosmer-Le Cessie
test.  The socio-economic status, age and
gender were considered in all the variations.  The disease code and drug searchers revealed
that out of total number of screening, 20% had a chronic respiratory condition
and 90% had a morbid condition (Kelly et al, 2011).  The chronic obstructive pulmonary disease was
the most commonly detected respiratory disease in the study at about 54% of the
total sample. Unfortunately, two thirds of the individuals who were
experiencing the chronic obstructive pulmonary condition and hypertension were
also subjected to depression and hypertension. 
The univariate analysis identified that aged female patients who lived
in relatively low economic status areas had significantly higher rates of chronic
obstructive pulmonary condition and hypertension as compared to their male
counterparts.  The study also found that
50% of the female patients aged 45 years and above had more than two chronic
conditions. The study used relatively large primary-care database that is a
regarded as a representation of the wider global population. As recommended, it
shares the limitations of other demographic studies particularly on data
reliance and quality recording.

All these results indicate that multi-morbidity condition of
chronic obstructive pulmonary condition, hypertension and depression is a prevalent
condition across the globe in all aged female in poor socio-economic conditions.
 Despite the constant improvements in
health care sector since 1900s, the multi-morbidity problem of the chronic
conditions continues to remain, with recent estimates looming to be rising
(Committee on Living well et al, 2011). As the strong relationship of
multi-morbidity condition of chronic obstructive pulmonary condition,
hypertension and depression with age across all the genders is well recognized,
it is important to note that these multi-morbid condition often results into a
co-morbid conditions. Critical analysis indicates that most of the clinicians
treating the multi-morbid patients also had a high prevalence of both physical
and mental health disorders (Kelly et al, 2011).

As noted in many circumstances, Individuals with multi-morbid
conditions often exhibit poor functioning status, health outcomes and
relatively low quality of life. Across all nations, improvement and
coordination of care for patients with multi-morbid disorders is often a key
challenge. This is due to the medical specialities and facilities that are
often required by these patients (Khan et al, 2007).  As compared to the co-morbid conditions which
entails a closely related condition thus may require a specialist, multi-morbid
often requires a generalised standards in order to manage. The microeconomics studies
also reveal that these chronic conditions often pose salient econometric
challenges to the nations that are involved in treatment and management. Therefore,
relevant policy routes should be formulated in order to provide the best
interventions on how to cube these global challenges (Wissam et al, 2008).

Nursing Interventions

Critical evidence suggests that in most circumstances medical beneficiaries
with multi-morbid conditions often receive suboptimal care. In various
conditions, the services are often fragmented, uncoordinated and inefficient
thus leading to poor medical outcomes (Acton, 2012).  Over a long period of time, putative remedies
such as disease management programmes and diseases specific guidelines have
proved to be ineffective.  A decade of
research and demonstration from well established clinical bodies have well
established “care coordination” approach that will improve the beneficiary
outcome and reduce the expenses that are often incurred in the healthcare
sector (Blum, 2011). These successful coordination management approaches can be
grouped into three broad classes; transitional care, self-management and care
coordination interventions.

The Transitional Care Intervention

The well tested model was designed has been recommended by
Lamprecht et al, (2011) to cater for the patients who were mainly hospitalized
multi morbid conditions and were assigned highly trained practice nurses
(APNs). In their model, the specialist recommended the APNs nurses to
constantly meet the patients in health facilities and make regular visits to
their homes even after the discharge. This process was necessary to provide the
patients with relevant education on the various medications and self care
approach. In a typical example, the intervention was employed in patients
suffering from the depression condition in patients with chronic conditions
such as hypertension and chronic obstructive pulmonary disease that lasted for
a period of 12 weeks (Lubkin & Larsenm, 2011). The process was revaluated
as recommended intent-to-treat approach was employed. To the discovery, the
number of rehospitalisation per patient was reduced to dramatically as compared
to the control group. The other successful transitional care model ever to be
used was the Colman 2006 model (Nici & ZuWallack, 2011). The Colman model
targeted purely multi-morbid patients were vulnerable to exhibiting a co-morbid
condition. The model proved to promote cross-site communication, encouraged
patients to take more active roles in managing their health and encouraged
continued care and guidance to the patients by the medical professionals.
Medical records reveal that transitional care intervention reduces the cost of
hospitalization by approximately 65%, thus proving to be one of the most
relevant and effective models of dealing with the multi-morbid condition on

Self Management and care Intervention

Educating patients on the best methods on how to manage themselves
has also proven to be one of the effective approaches to manage the
multi-morbid chronic conditions. Lynch et al (2014) in their study developed
one of the effective self-management models to intervene in these conditions.
The model mainly focuses on four basic factors which include; patient’s goal
identification, self management skills improvement, building the self efficacy
sense and finally, assessing the mastery of the aforementioned skills. Powers,
Oddone, Olsen  & Bosworth, (2009) in their study, offered a community based self management
programme to patients suffering from the depression condition with chronic
conditions such as hypertension and chronic obstructive pulmonary disease who
were  40 years and above. In a six weeks
group session, the medical specialist provided the patients with relevant
instructions, cognitive symptom management and use of medication among other
relevant topics. The approach was re-evaluated with intent to treat approach.  Compared to control exercises, the educated
subjects demonstrated incredible improvements in the cognitive symptom
management, communication and other positive health practices. The treated
subjects generated 31% fewer individuals who visited hospitals and 43% lower
costs thus reducing the average health expenditure (Thomas, 2011).

Care coordination basically incorporates deliberately organizing
patient care issues and sharing of valid information among all the stakeholders
who are concerned with the safer care of the patient in order to achieve a
better and more effective care. This approach prefers that the patient
individual preferences and needs are delivered to the home caregivers, nurses
and specialists at the right time. It is also important that the delivered
information is used to give safe and effective health care to the subjects.
Nurses have relatively well established relationship with the local healthcare
systems and the physicians (Chizobam et al, 2009).


Multi-morbid and co-morbid as discussed mainly refers to a medical
condition for the majority of patients with varied chronic ailments. It is
associated with varied adverse outcomes such as reduced functioning status,
increased healthcare services and even death. 
In order to improve the primary care, the varied studies together with
the recommended interventions reflect some of the specific approaches and
therapies that emphasize the varied ways to capture co-morbidity and
multi-morbidity conditions. It is important to note that more rigorous examination
on the various heterogeneity related to the conditions are necessary in order
to provide valid therapy (ACCCN, 2011).  
Further current research in line with the already produced results can
be considered very useful in order to provide modest changes on the topic.  These researches will expose a combination of
potentially valid factors that will address the knowledge gaps and modify the
various risks and benefits of the therapies recommended.


(2011). ACCCN’s Critical Care Nursing. Australia: Elsevier.

A. (Ed.) (2012). Joint Diseases: advances in Research & Treatment. Georgia:


(2012). Patient- Centered Care for Older Adults with Multiple Chronic

A stepwise Approach from the American Geriatrics society. Journal
of American Geriatrics Society. Special Compilation

J. (2011). Improving Quality, Lowering costs: The role of Health Care Delivery

U.S. Department of Health and Human Services.

C., Vollenweider, D. & Puhan, M. (2012). Informing Evidence- Based

for Patients with Comorbidity: Availability of Necessary
Information in Clinical Trials for Chronic Diseases. Journal of American Medical Association.

DOI: 10.1371/journal.pone.0041601

Chizobam, A.,
Bazarghan, M., Hindman, D., Bell. D., Rodriguez, M and Baker, R. (2009).

Comorbid Chronic Illnesses and the Diagnosis and
Treatment of Depression in Safety Net Primary Care Settings. Journal of
American Board of Family Medicine.22 (2) 123-135

on Living Well with Chronic Disease: Public Action to Reduce Disability and

Improve Functioning and Quality of Life, Board on Population
Health and Public Health Practice & Institute of Medicine. (2011). Living
well with Chronic Illnesses. USA: National Academies Press.

J. & Reddy, M. (2012). Evidence Based Geriatric Medicine. Massachusetts:


S., Smith, M., Telieur, C. & O’Dowd, T. (2011). Chronic Respiratory disease

multimorbidity: Prevalence and impact in a general practice
setting. 105 (2) 236-242.


L., Fox, C., Olawaiye, A., Servoss, T. & McLean-Plunkett, E. (2007).
Facilitating Quality

Improvement in Physician management of Comorbid Chronic Disease in
an Urban Minority Practice. Journal of national Medical Association. 99 (4):

Lamprecht, B., McBurnie, M., Volmer, W.,
Gudmundsson, G., Welte, T., Nizankoswa-

Mogilnicka, E., et al. 
(2011). CPD in Never Smokers from the population-Based Burden of Obstructive
Lung disease study. 139 (4). Chest. 2011;139(4):752-763.


E., Liebman, R., Ventrelle, J., Avery, E. & Richardson, D. (2014). A self-

intervention for African Americans with Comorbid diabetes and
Hypertension: A Pilot randomized controlled trial.


I. & Larsenm P. (2011). Chronic illnesses: Impact & Intervention. 8th

Massachusetts: Wiley.

L. & ZuWallack, R. (2011). Chronic Obstructive Pulmonary Disease:
Comorbidities &

Systemic Consequences. New York: Springer.

R., Wyke, S., Guthrie, B., Watt, G. & Mercer, S. (2014). The “everyday
work” of living

with multimorbidity in socioeconomically deprived areas of Scotland. Journal of Comorbidity. 4 (1).

Donohue, W. & Cummings, N. (2011). Evidence- Based Adjunctive Treatments.

Massachusetts: Academies Press.

Pagoto, S. Psychological Co-Morbidities of Physical Illnesses. New York:

Powers, B., Oddone, E.,
Olsen, M. & Bosworth, H. (2009). The Effect of a hypertension self

intervention on diabetes and cholesterol control.  American Journal of Medicine. 122 (7):
639-46. doi: 10.1016/j.amjmed.2008.12.022.

V. (2012).  Research Insights: What Works
in Care Coordination? Activities to Reduce

Spending in Medicare Fee for service. Academy Health. Retrieved
August 6, from

Wissam, C.,
Thomashow, B., Minai, O., Criner, G. & Make, B. (2008). Comorbidities in

Obstructive Pulmonary
Disease. 5 (4): 549-555.

The post Sample Research Paper on Evidence Review appeared first on Best Essay Services.

We offer homework writing services with you in mind. Our homework help service is made to meet your demands, whatever the challenge. Every paper is written from scratch by experts in your field. You can order essays, discussion, article critique, coursework, projects, case study, term papers, research papers, reaction paper, movie review, research proposal, capstone project, speech/presentation, book report/review, annotated bibliography, and more.

Your Writing Help Service in a Nutshell