Changing healthcare: stakeholder perceptions of the burden of chronic disease and the value of teams, measurements and communication.

Canadian healthcare is changing. Over the course of the past decade, the Health Care in Canada Survey (HCIC) has annually measured the reactions of the public and professional stakeholders to many of these change forces. In HCIC 2008, for the first time, the public's perception of their health status and all stakeholders' views of the burden and effective management of chronic diseases were sought. Overall, Canadians perceive themselves as healthy, with 84% of adults reporting good-to-excellent health. However, good health decreased with age as the occurrence of chronic illness rose, from 12% in the age group 18-24 to 65% for the population =65 years. More than 70% of all stakeholders were strongly or somewhat supportive of the implementation of coordinated care, or disease management programs, to improve the care of patients with chronic illnesses. Concordant support was also expressed for key disease management components, including coordinated interventions to improve home, community and self-care; increased wellness promotion; and increased use of clinical measurements and feedback to all stakeholders. However, there were also important areas of non-concordance. For example, the public and doctors consistently expressed less support than other stakeholders for the value of team care, including the use of non-physician professionals to provide patient care; increased patient involvement in decision-making; and the use of electronic health records to facilitate communication. The actual participation in disease management programs averaged 34% for professionals and 25% for the public. We conclude that chronic diseases are common, age-related and burdensome in Canada. Disease management or coordinated intervention often delivered by teams is also relatively common, despite its less-than-universal acceptance by all stakeholders. Further insights are needed, particularly into the variable perceptions of the value and efficacy of team-delivered healthcare and its important components.

The relationship between eating self-efficacy and eating disorder symptoms in a non-clinical sample.

Most research on eating self-efficacy has focused on its relationship with eating behaviors and weight-loss in clinical populations. The purpose of this study was to investigate the relationship between eating self-efficacy and the behavioral and psychological characteristics associated with eating disorders in a non-clinical sample of adults. A total of 219 men and women aged 18 and older completed questionnaires measuring eating disorder symptoms and eating self-efficacy. The results indicated that low confidence in the ability to control eating while experiencing negative emotions was associated with greater weight preoccupation and bulimic thought and behaviors. In addition, low confidence in ability to control eating when an abundance of food is available was inversely related to feelings of ineffectiveness or general negative self-evaluation. Ultimately, the findings suggest that low eating self-efficacy may also be associated with eating problems within populations not seeking treatment for either eating disorders or weight-loss. The implications of the findings are discussed.