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Jønsson ABR, Brodersen JB, Reventlow S, Svanholm C, Møller A, Kousgaard MB. General practitioners' experiences of providing somatic care for patients with severe mental illness: a qualitative study. BMC PRIMARY CARE 2024; 25:96. [PMID: 38519880 PMCID: PMC10958876 DOI: 10.1186/s12875-024-02338-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 03/11/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Patients dealing with severe mental illnesses (SMI) often face suboptimal clinical outcomes and higher mortality rates due to a range of factors, including undetected physical health conditions. The provision of care for individuals with SMI is frequently disjointed, as they engage with diverse healthcare providers. Despite this fragmentation, primary care, particularly general practitioners (GPs), assumes a pivotal role in the care of SMI patients. Our study aimed to delve into the first-hand experiences of GPs in delivering somatic care to SMI patients, concentrating on the challenges they encounter and the strategies they employ to navigate these difficulties. METHODS We conducted in-depth interviews with fifteen GPs, utilizing a semi-structured interview guide, supplemented by ethnographic observations during clinical consultations in general practice. Through inductive coding, interview transcripts and observational field notes were systematically analysed using interpretative phenomenological analysis (IPA). The findings were then deliberated upon within the author group. RESULTS GPs revealed that managing the chronic somatic care of SMI patients posed significant challenges. These challenges encompassed the multifaceted needs of patients, their behavior tied to symptoms, a lack of care continuity, and overarching time constraints. To tackle these challenges, the GPs had devised various strategies. However, all participants underscored the critical importance of having adequate time to properly prepare for, conduct, and follow up on consultations. CONCLUSION The GPs' interactions with SMI patients brought numerous challenges, although treating these patients were concurrently acknowledged as vital and fulfilling. The findings suggest that increased allocated time in general practice consultations for patients with SMI is important to support the somatic treatment requirements of this patient group.
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Affiliation(s)
- Alexandra Brandt Ryborg Jønsson
- Center for General Practice, University of Copenhagen, Copenhagen, Denmark.
- Department of People and Technology, Roskilde University, Roskilde, Denmark.
- Department of Community Health, The Arctic University of Norway, Tromsø, Norway.
| | - John Brandt Brodersen
- Center for General Practice, University of Copenhagen, Copenhagen, Denmark
- Department of Community Health, The Arctic University of Norway, Tromsø, Norway
- Research Unit for General Practice, Region Zealand, Denmark
| | - Susanne Reventlow
- Center for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Christina Svanholm
- Center for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Anne Møller
- Center for General Practice, University of Copenhagen, Copenhagen, Denmark
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Tranberg K, Due TD, Rozing M, Jønsson ABR, Kousgaard MB, Møller A. Challenges in reaching patients with severe mental illness for trials in general practice-a convergent mixed methods study based on the SOFIA pilot trial. Pilot Feasibility Stud 2023; 9:182. [PMID: 37908003 PMCID: PMC10617218 DOI: 10.1186/s40814-023-01395-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/11/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Patients with severe mental illness (SMI) die prematurely due to undetected and inadequate treatment of somatic illnesses. The SOFIA pilot study was initiated to mend this gap in health inequity. However, reaching patients with SMI for intervention research has previously proven difficult. This study aimed to investigate the recruitment of patients with SMI for the SOFIA pilot study in 2021. METHODS We used a mixed-method convergent design. The qualitative material comprised 20 interviews with general practitioners (GPs) and staff, during patient recruitment. The quantitative data consisted of process data on baseline characteristics, GPs reported reasons for excluding a patient, reported reasons for patients declining participation, and registered data from a Danish population of patients with SMI. We used thematic analysis in the qualitative analysis and descriptive statistics for the quantitative analysis. Pillar integration was used for integrating the material. RESULTS Our findings show that selection bias occurred in the pilot study. We describe four main themes based on the integrated analysis that highlights selection issues: (1) poor data quality and inconsistency in defining severity definitions troubled identification and verification, (2) protecting the patient and maintaining practice efficiency, (3) being familiar with the patient was important for a successful recruitment, and (4) in hindsight, the GPs questioned whether the target population was reached. CONCLUSIONS In the light of theories of professions and street-level bureaucracy, we find that the main drivers of the patient selection bias occurring in the SOFIA pilot study were that 1) GPs and staff mended eligibility criteria to protect certain patients and/or to minimize workload and maintain efficiency in the practice 2) the data from the GP record systems and the digital assessment tool to assist recruitment was not optimal. Interventions targeting this patient group should carefully consider the recruitment strategy with a particular focus on professionals' discretionary practices and information technology pitfalls. TRIAL REGISTRATION The pilot trial protocol was registered on the 5th of November 2020. The registration number is NCT04618250 .
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Affiliation(s)
- Katrine Tranberg
- The Section of General Practice and the Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Tina Drud Due
- The Section of General Practice and the Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- The Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Maarten Rozing
- The Section of General Practice and the Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Psychiatric Center Copenhagen, Copenhagen, Denmark
| | - Alexandra Brandt Ryborg Jønsson
- The Section of General Practice and the Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- The Research Unit for General Practice, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Department of People and Technology, Roskilde University, Roskilde, Denmark
| | - Marius Brostrøm Kousgaard
- The Section of General Practice and the Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anne Møller
- The Section of General Practice and the Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Tranberg K, Jønsson A, Due T, Siersma V, Brodersen JB, Bissenbakker K, Martiny F, Davidsen A, Kjellberg PK, Doherty K, Mercer SW, Nielsen MH, Reventlow S, Møller A, Rozing M. The SOFIA pilot study: assessing feasibility and fidelity of coordinated care to reduce excess mortality and increase quality of life in patients with severe mental illness in a general practice setting; a cluster-randomised pilot trial. BMC PRIMARY CARE 2023; 24:188. [PMID: 37715123 PMCID: PMC10504748 DOI: 10.1186/s12875-023-02141-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 08/25/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVE To evaluate the feasibility and fidelity of implementing and assessing the SOFIA coordinated care program aimed at lowering mortality and increasing quality of life in patients with severe mental illness by improving somatic health care in general practice. DESIGN A cluster-randomised, non-blinded controlled pilot trial. SETTING General Practice in Denmark. INTERVENTION The SOFIA coordinated care program comprised extended structured consultations carried out by the GP, group-based training of GPs and staff, and a handbook with information on signposting patients to relevant municipal, health, and social initiatives. PATIENTS Persons aged 18 years or older with a diagnosis of psychotic, bipolar, or severe depressive disorder. MAIN OUTCOME MEASURES We collected quantitative data on the delivery, recruitment and retention rates of practices and patients, and response rates of questionnaires MMQ and EQ-5D-5 L. RESULTS From November 2020 to March 2021, nine practices were enrolled and assigned in a 2:1 ratio to the intervention group (n = 6) or control group (n = 3). Intervention group practices included 64 patients and Control practices included 23. The extended consultations were delivered with a high level of fidelity in the general practices; however, thresholds for collecting outcome measures, and recruitment of practices and patients were not reached. CONCLUSION Our findings suggest that delivering the coordinated care program in a fully powered trial in primary care is likely feasible. However, the recruitment methodology requires improvement to ensure sufficient recruitment and minimize selective inclusion. TRIAL REGISTRATION The date of pilot trial protocol registration was 05/11/2020, and the registration number is NCT04618250.
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Affiliation(s)
- Katrine Tranberg
- Department of Public Health, The Section of General Practice and the Research Unit for General Practice, University of Copenhagen, Copenhagen, Denmark.
| | - Alexandra Jønsson
- Department of Public Health, The Section of General Practice and the Research Unit for General Practice, University of Copenhagen, Copenhagen, Denmark
- Department of People and Technology, Roskilde University, Roskilde, Denmark
- Department of Community Medicine, Faculty of Health Sciences, The Research Unit for General Practice, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tina Due
- Department of Public Health, The Section of General Practice and the Research Unit for General Practice, University of Copenhagen, Copenhagen, Denmark
- The Mental health services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Volkert Siersma
- Department of Public Health, The Section of General Practice and the Research Unit for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - John Brandt Brodersen
- Department of Public Health, The Section of General Practice and the Research Unit for General Practice, University of Copenhagen, Copenhagen, Denmark
- Department of Community Medicine, Faculty of Health Sciences, The Research Unit for General Practice, UiT The Arctic University of Norway, Tromsø, Norway
- The Primary Health Care Research Unit, Region Zealand, Zealand, Denmark
| | - Kristine Bissenbakker
- Department of Public Health, The Section of General Practice and the Research Unit for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Frederik Martiny
- Department of Public Health, The Section of General Practice and the Research Unit for General Practice, University of Copenhagen, Copenhagen, Denmark
- Department of Social Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Annette Davidsen
- Department of Public Health, The Section of General Practice and the Research Unit for General Practice, University of Copenhagen, Copenhagen, Denmark
| | | | - Kevin Doherty
- Copenhagen Center for Health Technology (CACHET), Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Stewart W Mercer
- Old Medical School, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Maria Haahr Nielsen
- Department of Public Health, The Section of General Practice and the Research Unit for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Reventlow
- Department of Public Health, The Section of General Practice and the Research Unit for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Anne Møller
- Department of Public Health, The Section of General Practice and the Research Unit for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Maarten Rozing
- Department of Public Health, The Section of General Practice and the Research Unit for General Practice, University of Copenhagen, Copenhagen, Denmark
- Psychiatric Center Copenhagen, Copenhagen, Denmark
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Rozing MP, Jønsson A, Køster-Rasmussen R, Due TD, Brodersen J, Bissenbakker KH, Siersma V, Mercer SW, Guassora AD, Kjellberg J, Kjellberg PK, Nielsen MH, Christensen I, Bardram JE, Martiny F, Møller A, Reventlow S. The SOFIA pilot trial: a cluster-randomized trial of coordinated, co-produced care to reduce mortality and improve quality of life in people with severe mental illness in the general practice setting. Pilot Feasibility Stud 2021; 7:168. [PMID: 34479646 PMCID: PMC8413362 DOI: 10.1186/s40814-021-00906-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 08/20/2021] [Indexed: 11/25/2022] Open
Abstract
Background People with severe mental illness (SMI) have an increased risk of premature mortality, predominantly due to somatic health conditions. Evidence indicates that primary and tertiary prevention and improved treatment of somatic conditions in patients with SMI could reduce this excess mortality. This paper reports a protocol designed to evaluate the feasibility of a coordinated co-produced care program (SOFIA model, a Danish acronym for Severe Mental Illness and Physical Health in General Practice) in the general practice setting to reduce mortality and improve quality of life in patients with severe mental illness. Methods The SOFIA pilot trial is designed as a cluster randomized controlled trial targeting general practices in two regions in Denmark. We aim to include 12 practices, each of which is instructed to recruit up to 15 community-dwelling patients aged 18 and older with SMI. Practices will be randomized by a computer in a ratio of 2:1 to deliver a coordinated care program or usual care during a 6-month study period. A randomized algorithm is used to perform randomization. The coordinated care program includes educational training of general practitioners and their clinical staff educational training of general practitioners and their clinical staff, which covers clinical and diagnostic management and focus on patient-centered care of this patient group, after which general practitioners will provide a prolonged consultation focusing on individual needs and preferences of the patient with SMI and a follow-up plan if indicated. The outcomes will be parameters of the feasibility of the intervention and trial methods and will be assessed quantitatively and qualitatively. Assessments of the outcome parameters will be administered at baseline, throughout, and at end of the study period. Discussion If necessary the intervention will be revised based on results from this study. If delivery of the intervention, either in its current form or after revision, is considered feasible, a future, definitive trial to determine the effectiveness of the intervention in reducing mortality and improving quality of life in patients with SMI can take place. Successful implementation of the intervention would imply preliminary promise for addressing health inequities in patients with SMI. Trial registration The trial was registered in Clinical Trials as of November 5, 2020, with registration number NCT04618250. Protocol version: January 22, 2021; original version
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Affiliation(s)
- M P Rozing
- The Section of General Practice and the Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark. .,Psychiatric Centre Copenhagen, Outpatient clinic for geriatric psychiatry, Copenhagen, Denmark.
| | - A Jønsson
- The Section of General Practice and the Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - R Køster-Rasmussen
- The Section of General Practice and the Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - T D Due
- The Section of General Practice and the Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - J Brodersen
- The Section of General Practice and the Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,The Primary Health Care Research Unit, Region Zealand, Denmark
| | - K H Bissenbakker
- The Section of General Practice and the Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - V Siersma
- The Section of General Practice and the Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - S W Mercer
- Old Medical School, University of Edinburgh, Edinburgh, UK
| | - A D Guassora
- The Section of General Practice and the Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - J Kjellberg
- VIVE - The Danish Center for Social Science Research, Copenhagen, Denmark
| | - P K Kjellberg
- VIVE - The Danish Center for Social Science Research, Copenhagen, Denmark
| | - M H Nielsen
- The Section of General Practice and the Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - I Christensen
- The Section of General Practice and the Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,VIVE - The Danish Center for Social Science Research, Copenhagen, Denmark
| | - J E Bardram
- Copenhagen Center for Health Technology (CACHET), Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - F Martiny
- The Section of General Practice and the Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - A Møller
- The Section of General Practice and the Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - S Reventlow
- The Section of General Practice and the Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Niskanen L, Partonen T, Auvinen A, Haukka J. Trends and predictors in all-cause and cause-specific mortality in diabetic and reference populations during 21 years of follow-up. J Epidemiol Community Health 2020; 74:950-956. [PMID: 32620580 DOI: 10.1136/jech-2019-213602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/17/2020] [Accepted: 06/20/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Patients with diabetes mellitus (DM) have a markedly higher overall mortality from coronary heart disease (CHD), as well as many other causes of death like cancer. Since diabetes is a multisystem disease, this fact together with the increased lifespan among individuals with diabetes may also lead to the emergence of other diabetes-related complications and ultimately to diversification of the causes of death. METHODS The study population of this observational historic cohort study consisted of subjects with DM, who had purchased for at least one insulin prescription and/or one oral antidiabetic between January 1, 1997 and December 31, 2010 (N=199 354), and a reference population matched by age, sex and hospital district (N=199 354). Follow-up was continued until December 31, 2017. All-cause and cause-specific mortality (cancer, CHD and stroke) was analysed with Poisson and Cox's regression. Associations between baseline medications and mortality were analysed using LASSO (Least Absolute Shrinkage and Selection Operator) models. RESULTS The mortality rates were significantly elevated among the patients with DM. However, the relative risk of all-cause mortality between the DM and reference populations tended to converge during the follow-up. The lowering trend was most apparent in CHD mortality. The difference between DM and reference populations in stroke mortality vanished with a later entrance to the follow-up period. There were a few differences between DM and no-DM groups with respect to how baseline medications were associated with mortality. CONCLUSIONS The gap between the mortality of patients with diabetes compared to subjects who are non-diabetic diminished markedly during the 21-year period. This was driven primarily by the reduced CHD mortality.
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Affiliation(s)
- Leo Niskanen
- Central Hospital Stomach Centre, Helsinki University, Helsinki, Finland
| | - Timo Partonen
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Anssi Auvinen
- Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Jari Haukka
- Public Health, University of Helsinki, Helsinki, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Factors influencing harmonized health data collection, sharing and linkage in Denmark and Switzerland: A systematic review. PLoS One 2019; 14:e0226015. [PMID: 31830124 PMCID: PMC6907832 DOI: 10.1371/journal.pone.0226015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 11/18/2019] [Indexed: 02/06/2023] Open
Abstract
Introduction The digitalization of medicine has led to a considerable growth of heterogeneous health datasets, which could improve healthcare research if integrated into the clinical life cycle. This process requires, amongst other things, the harmonization of these datasets, which is a prerequisite to improve their quality, re-usability and interoperability. However, there is a wide range of factors that either hinder or favor the harmonized collection, sharing and linkage of health data. Objective This systematic review aims to identify barriers and facilitators to health data harmonization—including data sharing and linkage—by a comparative analysis of studies from Denmark and Switzerland. Methods Publications from PubMed, Web of Science, EMBASE and CINAHL involving cross-institutional or cross-border collection, sharing or linkage of health data from Denmark or Switzerland were searched to identify the reported barriers and facilitators to data harmonization. Results Of the 345 projects included, 240 were single-country and 105 were multinational studies. Regarding national projects, a Swiss study reported on average more barriers and facilitators than a Danish study. Barriers and facilitators of a technical nature were most frequently reported. Conclusion This systematic review gathered evidence from Denmark and Switzerland on barriers and facilitators concerning data harmonization, sharing and linkage. Barriers and facilitators were strictly interrelated with the national context where projects were carried out. Structural changes, such as legislation implemented at the national level, were mirrored in the projects. This underlines the impact of national strategies in the field of health data. Our findings also suggest that more openness and clarity in the reporting of both barriers and facilitators to data harmonization constitute a key element to promote the successful management of new projects using health data and the implementation of proper policies in this field. Our study findings are thus meaningful beyond these two countries.
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Arreskov AB, Olsen MÅ, Pouplier SS, Siersma V, Andersen CL, Friis S, de Fine Olivarius N. The impact of cancer on diabetes outcomes. BMC Endocr Disord 2019; 19:60. [PMID: 31185995 PMCID: PMC6560822 DOI: 10.1186/s12902-019-0377-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 04/30/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Survival from many cancer types is steadily increasing, and as a result, a growing number of cancer patients will live with other chronic diseases, of which diabetes is one of the most prevalent. This study aims to describe the impact of cancer on health outcomes in patients with type 2 diabetes and to compare the effectiveness of a multifactorial intervention in diabetes patients with and without cancer. METHODS The randomized controlled trial Diabetes Care in General Practice (DCGP) included 1381 patients newly diagnosed with type 2 diabetes. Patients were randomized to either six years of structured personal diabetes care or routine care. In a post hoc analysis, we followed patients for 19 years in Danish national registries for the occurrence of diabetes-related outcomes. We used Cox regression models to estimate hazard ratios for outcomes. RESULTS At diagnosis 48 patients had cancer, and 243 patients were diagnosed with cancer during follow up. Patients with diabetes and cancer had excess all-cause mortality (HR 3.33; 95%CI 2.72-4.06), as well as an increased incidence of myocardial infarction (HR 1.76; 95%CI 1.29-2.39) and any diabetes-related outcome (HR 1.36; 95%CI 1.07-1.71). The intervention reduced the risk of both these endpoints in patients without cancer. Furthermore, there was no statistically significant difference in the effectiveness of the intervention among patients with and without cancer. CONCLUSIONS Diabetes patients with cancer had an increased risk of myocardial infarction and any diabetes-related outcome. The observed positive effect of structured personal diabetes care on clinical outcomes did not differ between patients with and without cancer. Attention to and prevention of diabetes complications in patients with both type 2 diabetes and cancer is warranted. TRIAL REGISTRATION ClinicalTrials.gov NCT01074762 (February 24, 2010).
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Affiliation(s)
- Anne Beiter Arreskov
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, DK-1014 Copenhagen K, Denmark
| | - Maria Å. Olsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, DK-1014 Copenhagen K, Denmark
| | - Sandra Sinius Pouplier
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, DK-1014 Copenhagen K, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, DK-1014 Copenhagen K, Denmark
| | - Christen L. Andersen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, DK-1014 Copenhagen K, Denmark
| | - Søren Friis
- Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | - Niels de Fine Olivarius
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, DK-1014 Copenhagen K, Denmark
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Siersma V, Køster-Rasmussen R, Bruun C, Olivarius NDF, Brunes A. Visual impairment and mortality in patients with type 2 diabetes. BMJ Open Diabetes Res Care 2019; 7:e000638. [PMID: 31749968 PMCID: PMC6827812 DOI: 10.1136/bmjdrc-2018-000638] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 09/12/2019] [Accepted: 09/18/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To evaluate whether visual acuity impairment was an independent predictor of mortality in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS This is a 19-year follow-up of a cohort of 1241 patients newly diagnosed with type 2 diabetes and aged 40 years or over. Visual acuity was assessed by practicing ophthalmologists both at diabetes diagnosis and after 6 years. The logarithmic value of the visual acuity (logMAR) was the exposure. Multivariable Cox regression models were adjusted for multiple potential confounders including cardiovascular disease, and censored for potential mediators, that is, fractures/trauma. Primary outcomes were from national registers: all-cause mortality and diabetes-related mortality. RESULTS Visual impairment at diabetes diagnosis was robustly associated with subsequent 6-year all-cause mortality. Per 1 unit reduced logMAR acuity the incidence rate of all-cause mortality increased with 51% (adjusted HR: 1.51; 95% CI 1.12 to 2.03) and of fractures/trauma with 59% (HR: 1.59; 95% CI 1.18 to 2.15), but visual acuity was not associated with diabetes-related mortality. After censoring for fractures/trauma, visual acuity was still an independent risk factor for all-cause mortality (HR: 1.68; 95% CI 1.23 to 2.30). In contrast, visual acuity 6 years after diabetes diagnosis was not associated with the subsequent 13 years' incidence of any of the outcomes, as an apparent association with all-cause mortality and diabetes-related mortality was explained by confounding from comorbidity. CONCLUSIONS Visual acuity measured by ophthalmologists in patients newly diagnosed with type 2 diabetes was an independent predictor of mortality in the short term.
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Affiliation(s)
- Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Køster-Rasmussen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Christine Bruun
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Niels de Fine Olivarius
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Audun Brunes
- Section for Trauma, Catastrophes and Forced Migration–Adults and Elderly, Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
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Rokkjær N, Sølund S. Nine deaths among 29 patients with severe mental illness identified with high mortality using SSEPP. Nord J Psychiatry 2018; 72:543-548. [PMID: 30261795 DOI: 10.1080/08039488.2018.1489893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE It is an established consensus that patients suffering from Severe Mental Illness (SMI) often have somatic comorbidities and a shortened life expectancy. In this study, we examine to what extent previously unknown comorbidities can be revealed if patients suffering from SMI are examined by a specialist in general medicine using the new clinical tool of Systematic Somatic Examinations of Psychiatric Patients (SSEPP). METHODS SSEPP is a detailed, in-depth questioning and clinical evaluation performed by a specialist in General medicine. A total of 112 patients were recruited from asylums for patients suffering from chronic and severe psychiatric disorders in the Copenhagen area. Diagnosis within SMI led to 106 patients included. 6 patients had no SMI diagnosis and were excluded. Four years later, deaths in the cohort were registered. RESULTS Ninety percent of examined patients were found to have previously unknown indications for medical treatment. Nine deaths occurred among the examined patients during follow-up. All deaths happened among the 29 patients identified with high expected risk of ischemic manifestation (31%, p < .0001). CONCLUSIONS In this study, SSEPP is shown to be capable of: Identifying previously unknown and/or undertreated somatic comorbidity in patients with SMI. Identifying the patients with the highest risk of ischemic manifestation with a score of 9 deaths/29 patients. This is statistically significant (p < .0001). This study suggests that patients with SMI in every psychiatric ward be systematically examined for somatic comorbidity by GPs especially trained with tools like SSEPP.
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Affiliation(s)
- Niels Rokkjær
- a Region Hovedstadens Psykiatri , Psychiatric Department Hvidovre , Copenhagen , Denmark
| | - Søren Sølund
- a Region Hovedstadens Psykiatri , Psychiatric Department Hvidovre , Copenhagen , Denmark
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Pouplier S, Olsen MÅ, Willadsen TG, Sandholdt H, Siersma V, Andersen CL, Olivarius NDF. The development of multimorbidity during 16 years after diagnosis of type 2 diabetes. JOURNAL OF COMORBIDITY 2018; 8:2235042X18801658. [PMID: 30363325 PMCID: PMC6169975 DOI: 10.1177/2235042x18801658] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 08/14/2018] [Indexed: 12/21/2022]
Abstract
Objective: The aims of this study were to (1) quantify the development and composition
of multimorbidity (MM) during 16 years following the diagnosis of type 2
diabetes and (2) evaluate whether the effectiveness of structured personal
diabetes care differed between patients with and without MM. Research design and methods: One thousand three hundred eighty-one patients with newly diagnosed type 2
diabetes were randomized to receive either structured personal diabetes care
or routine diabetes care. Patients were followed up for 19 years in Danish
nationwide registries for the occurrence of outcomes. We analyzed the
prevalence and degree of MM based on 10 well-defined disease groups. The
effect of structured personal care in diabetes patients with and without MM
was analyzed with Cox regression models. Results: The proportion of patients with MM increased from 31.6% at diabetes diagnosis
to 80.4% after 16 years. The proportion of cardiovascular and
gastrointestinal diseases in surviving patients decreased, while, for
example, musculoskeletal, eye, and neurological diseases increased. The
effect of the intervention was not different between type 2 diabetes
patients with or without coexisting chronic disease. Conclusions: In general, the proportion of patients with MM increased after diabetes
diagnosis, but the composition of chronic disease changed during the 16
years. We found cardiovascular and musculoskeletal disease to be the most
prevalent disease groups during all 16 years of follow-up. The post hoc
analysis of the intervention showed that its effectiveness was not different
among patients who developed MM compared to those who continued to have
diabetes alone.
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Affiliation(s)
- Sandra Pouplier
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Maria Åhlander Olsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tora Grauers Willadsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Håkon Sandholdt
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Christen Lykkegaard Andersen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Niels de Fine Olivarius
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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11
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Keinänen J, Mantere O, Markkula N, Partti K, Perälä J, Saarni SI, Härkänen T, Suvisaari J. Mortality in people with psychotic disorders in Finland: A population-based 13-year follow-up study. Schizophr Res 2018; 192:113-118. [PMID: 28499768 DOI: 10.1016/j.schres.2017.04.048] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 04/21/2017] [Accepted: 04/30/2017] [Indexed: 01/31/2023]
Abstract
OBJECTIVES We conducted a population based study aiming at finding predictors of mortality in psychotic disorders and evaluating the extent to which sociodemographic, lifestyle and health-related factors explain the excess mortality. METHODS In a nationally representative sample of Finns aged 30-70years (n=5642), psychotic disorders were diagnosed using structured interviews and medical records in 2000-2001. Information on mortality and causes of death was obtained of those who died by the end of year 2013. Cox proportional hazards models were used to investigate the mortality risk. RESULTS No people with affective psychoses (n=36) died during the follow-up, thus the analysis was restricted to non-affective psychotic disorders (NAP) (n=106). Adjusting for age and sex, NAP was statistically significantly associated with all-cause mortality (hazard ratio (HR) 2.99, 95% CI 2.03-4.41) and natural-cause mortality (HR 2.81, 95% CI 1.85-4.28). After adjusting for sociodemographic factors, health status, inflammation and smoking, the HR dropped to 2.11 (95% CI 1.10-4.05) for all-cause and to 1.98 (95% CI 0.94-4.16) for natural-cause mortality. Within the NAP group, antipsychotic use at baseline was associated with reduced HR for natural-cause mortality (HR 0.25, 95% CI 0.07-0.96), and smoking with increased HR (HR 3.54, 95% CI 1.07-11.69). CONCLUSIONS The elevated mortality risk in people with NAP is only partly explained by socioeconomic factors, lifestyle, cardio-metabolic comorbidities and inflammation. Smoking cessation should be prioritized in treatment of psychotic disorders. More research is needed on the quality of treatment of somatic diseases in people with psychotic disorders.
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Affiliation(s)
- Jaakko Keinänen
- National Institute for Health and Welfare, Department of Public Health Solutions, Mental Health Unit, P.O. Box 30, FIN-00271 Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 590, FIN-00029, HUS, Helsinki, Finland.
| | - Outi Mantere
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 590, FIN-00029, HUS, Helsinki, Finland; Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montréal, QC H3A 1A1, Canada; Bipolar Disorders Clinic, Douglas Mental Health University Institute, 6875 LaSalle Boulevard, Montréal, QC H4H 1R3, Canada.
| | - Niina Markkula
- National Institute for Health and Welfare, Department of Public Health Solutions, Mental Health Unit, P.O. Box 30, FIN-00271 Helsinki, Finland; Universidad del Desarrollo, Av. Plaza 680, San Carlos de Apoquindo, Las Condes, Santiago, Chile.
| | - Krista Partti
- National Institute for Health and Welfare, Department of Public Health Solutions, Mental Health Unit, P.O. Box 30, FIN-00271 Helsinki, Finland; University of Helsinki, Doctoral Program in Clinical Research, P.O. Box 700, FIN-00029 HUS, Finland.
| | - Jonna Perälä
- National Institute for Health and Welfare, Department of Public Health Solutions, Mental Health Unit, P.O. Box 30, FIN-00271 Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 590, FIN-00029, HUS, Helsinki, Finland.
| | - Samuli I Saarni
- National Institute for Health and Welfare, Department of Public Health Solutions, Mental Health Unit, P.O. Box 30, FIN-00271 Helsinki, Finland; Turku University Hospital and the University of Turku, P.O. Box 52, FIN-20521, Turku, Finland.
| | - Tommi Härkänen
- National Institute for Health and Welfare, Department of Public Health Solutions, Health Monitoring Unit, P.O. Box 30, FIN-00271, Helsinki, Finland.
| | - Jaana Suvisaari
- National Institute for Health and Welfare, Department of Public Health Solutions, Mental Health Unit, P.O. Box 30, FIN-00271 Helsinki, Finland.
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12
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Rodríguez-Rodríguez I, Rodríguez JV, Zamora-Izquierdo MÁ. Variables to Be Monitored via Biomedical Sensors for Complete Type 1 Diabetes Mellitus Management: An Extension of the "On-Board" Concept. J Diabetes Res 2018; 2018:4826984. [PMID: 30363935 PMCID: PMC6186351 DOI: 10.1155/2018/4826984] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/16/2018] [Accepted: 08/09/2018] [Indexed: 11/27/2022] Open
Abstract
Type 1 diabetes mellitus (DM1) is a growing disease, and a deep understanding of the patient is required to prescribe the most appropriate treatment, adjusted to the patient's habits and characteristics. Before now, knowledge regarding each patient has been incomplete, discontinuous, and partial. However, the recent development of continuous glucose monitoring (CGM) and new biomedical sensors/gadgets, based on automatic continuous monitoring, offers a new perspective on DM1 management, since these innovative devices allow the collection of 24-hour biomedical data in addition to blood glucose levels. With this, it is possible to deeply characterize a diabetic person, offering a better understanding of his or her illness evolution, and, going further, develop new strategies to manage DM1. This new and global monitoring makes it possible to extend the "on-board" concept to other features. This well-known approach to the processing of variable "insulin" describes some inertias and aggregated/remaining effects. In this work, such analysis is carried out along with a thorough study of the significant variables to be taken into account/monitored-and how to arrange them-for a deep characterization of diabetic patients. Lastly, we present a case study evaluating the experience of the continuous and comprehensive monitoring of a diabetic patient, concluding that the huge potential of this new perspective could provide an acute insight into the patient's status and extract the maximum amount of knowledge, thus improving the DM1 management system in order to be fully functional.
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13
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Jorgensen A, Siersma V, Davidsen AS, Weimann A, Henriksen T, Poulsen HE, Olivarius NDF. Markers of DNA/RNA damage from oxidation as predictors of a registry-based diagnosis of psychiatric illness in type 2 diabetic patients. Psychiatry Res 2018; 259:370-376. [PMID: 29120845 DOI: 10.1016/j.psychres.2017.11.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 10/30/2017] [Accepted: 11/04/2017] [Indexed: 12/18/2022]
Abstract
Oxidative stress is a potential biological mediator of the higher rates of psychiatric illness (PI) observed after the onset of type 2 diabetes (T2DM). We investigated validated urinary markers of systemic DNA/RNA damage from oxidation (8-oxodG/8-oxoGuo respectively) as predictors of incident PI in a cohort of 1381 newly diagnosed T2DM patients, who were followed prospectively for a total of 19 years after diagnosis. Psychiatric diagnoses were from Danish national registries. Patients were examined at the time of diagnosis and at a 6-year follow-up. At baseline, 8-oxodG was slightly lower in PI vs. non-PI patients, while at 6-year follow-up, 8-oxoGuo was significantly higher in PI patients. Using Cox proportional hazard models, we found that higher levels of 8-oxodG at 6-year follow-up significantly predicted lower incidence of PI after the adjustment for confounders. In a subgroup analysis, this association was most predominant in minor PIs (unipolar depression and anxiety) compared to major PIs such as schizophrenia and bipolar disorder. These observations indicate that higher levels of systemic oxidative stress are not associated with a higher risk of PI after T2DM onset. Only PI patients treated in hospital care were included in the registries, and the conclusion thus only applies to these individuals.
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Affiliation(s)
- Anders Jorgensen
- Psychiatric Center Copenhagen (Rigshospitalet), Mental Health Services of the Capital Region, Copenhagen, Denmark.
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Denmark
| | - Annette S Davidsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Denmark
| | - Allan Weimann
- Laboratory of Clinical Pharmacology, Copenhagen University Hospital Rigshospitalet, Denmark; Department of Clinical Pharmacology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark
| | - Trine Henriksen
- Laboratory of Clinical Pharmacology, Copenhagen University Hospital Rigshospitalet, Denmark; Department of Clinical Pharmacology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark
| | - Henrik E Poulsen
- Laboratory of Clinical Pharmacology, Copenhagen University Hospital Rigshospitalet, Denmark; Department of Clinical Pharmacology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark
| | - Niels de Fine Olivarius
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Denmark
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14
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Heltberg A, Siersma V, Andersen JS, Ellervik C, Brønnum-Hansen H, Kragstrup J, de Fine Olivarius N. Socio-demographic determinants and effect of structured personal diabetes care: a 19-year follow-up of the randomized controlled study diabetes Care in General Practice (DCGP). BMC Endocr Disord 2017; 17:75. [PMID: 29216868 PMCID: PMC5721594 DOI: 10.1186/s12902-017-0227-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 11/29/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We investigated how four aspects of socio-demography influence the effectiveness of an intervention with structured personal diabetes care on long-term outcomes. METHODS The Diabetes Care in General Practice (DCGP) study is a cluster-randomized trial involving a population-based sample of 1381 patients with newly diagnosed type 2-diabetes mellitus. We investigated how education, employment, cohabitation status and residence influenced the effectiveness of 6 years of intervention with structured personal diabetes care, resembling present day recommendations. Outcomes were incidence of any diabetes-related endpoint and death during 19 years after diagnosis, and cardiovascular risk factors, behaviour, attitudes and process-of-care variables 6 years after diagnosis. RESULTS Structured personal care reduced the risk of any diabetes-related endpoint and the effect of the intervention was modified by geographical area (interaction p = 0.034) with HR of 0.71 (95%CI: 0.60-0.85) and of 1.07 (95%CI: 0.77-1.48), for patients in urban and rural areas, respectively. Otherwise, there was no effect modification of education, employment and civil status on the intervention for the final endpoints. There were no noticeable socio-demographic differences in the effect of the intervention on cardiovascular risk factors, behaviour, attitudes, and process-of-care. CONCLUSION Structured personal care reduced the aggregate outcome of any diabetes-related endpoint and independent of socio-demographic factors similar effect on cardiovascular risk factors, behaviour, attitudes and process of care, but the intervention did not change the existing inequity in mortality and morbidity. Residence modified the uptake of the intervention with patients living in urban areas having more to gain of the intervention than rural patients, further investigations is warranted. TRIAL REGISTRATION ClinicalTrials.gov registration no. NCT01074762 (February 24, 2010).
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Affiliation(s)
- Andreas Heltberg
- Section of General Practice, Institute of Public Health, Faculty of Health Sciences, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, Denmark
- The Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Production, Research, and Innovation, Sorø, Region Zealand Denmark
| | - Volkert Siersma
- The Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - John Sahl Andersen
- Section of General Practice, Institute of Public Health, Faculty of Health Sciences, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, Denmark
| | - Christina Ellervik
- Department of Production, Research, and Innovation, Sorø, Region Zealand Denmark
- Department of Laboratory Medicine, Boston Children’s Hospital Study, Boston, MA USA
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Jakob Kragstrup
- Section of General Practice, Institute of Public Health, Faculty of Health Sciences, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, Denmark
| | - Niels de Fine Olivarius
- The Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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15
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Lahiri SW. Personalizing Type 2 Diabetes Management: Use of a Patient-Centered Approach to Individualizing A1C Goals and Pharmacological Regimens. Clin Diabetes 2017; 35:321-328. [PMID: 29263575 PMCID: PMC5734170 DOI: 10.2337/cd17-0083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
IN BRIEF Caring for people with type 2 diabetes requires a patient-centered approach to treatment targets and medication regimens. Focusing on patients' individual characteristics, needs, and treatment responses can improve compliance and clinical outcomes. Medication selection can be guided by the mechanisms of action, advantages, disadvantages, and costs of available options; patients' behavioral and psychological variables, personal preferences, and socioeconomic status also should be taken into account. This article provides an overview of patient-centered and individualized diabetes management, offers pharmacological recommendations for specific clinical scenarios, and describes a complicated case illustrating the patient-centered approach in clinical practice.
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Affiliation(s)
- Sharon W Lahiri
- Division of Endocrinology, Diabetes, Bone and Mineral Disorders, Henry Ford Hospital, Detroit, MI
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16
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Gal G, Munitz H, Levav I. Health Care and Mortality among Persons with Severe Mental Illness. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:259-267. [PMID: 27573257 PMCID: PMC5407547 DOI: 10.1177/0706743716666997] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Reports show disparities in the health care of persons with severe mental illness (SMI), including in countries with universal health insurance. However, the moderating effect on disparities of specific mental health legislation is yet to be studied. The study aimed to investigate equality of health care for people with SMI in a country with a national health insurance and a comprehensive rehabilitation law for persons with mental disabilities. METHOD A case-control epidemiological study compared health services (laboratory tests, visits to specialists, and medications) provided to users with and without a history of schizophrenia and bipolar disorder ( N = 52,131) and with regard to a subgroup of users with diabetes ( n = 16,280). In addition, we examined the mortality rates of the study population. RESULTS While service users with schizophrenia were somewhat less likely to meet the same indexes of care as controls, those with bipolar disorder did not differ from their counterparts. Yet, mortality risk among service users with schizophrenia and bipolar disorder was 2.4 and 1.7 times higher, respectively. Rates of services to persons with SMI and comorbid diabetes did not differ from their counterparts. CONCLUSIONS In Israel, a country with a national health insurance and a rehabilitation law for persons with mental disabilities, service users with bipolar disorder receive equitable levels of general health care. For users with schizophrenia, the disparities exist in some of the health care measures but to a smaller extent than in other countries with universal health insurance. In contrast, mortality rates are elevated in persons with SMI.
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Affiliation(s)
- Gilad Gal
- School of Behavioral Sciences, Tel Aviv-Yaffo Academic College, Tel Aviv, Israel
| | | | - Itzhak Levav
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, Haifa University, Haifa, Israel
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17
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Broholm-Jørgensen M, Guassora AD, Reventlow S, Dalton SO, Tjørnhøj-Thomsen T. Balancing trust and power: a qualitative study of GPs perceptions and strategies for retaining patients in preventive health checks. Scand J Prim Health Care 2017; 35:89-97. [PMID: 28277053 PMCID: PMC5361424 DOI: 10.1080/02813432.2017.1288811] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Little is known about how strategies of retaining patients are acted out by general practitioners (GPs) in the clinical encounter. With this study, we apply Grimens' (2009) analytical connection between trust and power to explore how trust and power appear in preventive health checks from the GPs' perspectives, and in what way trust and power affect and/or challenge strategies towards retaining patients without formal education. DESIGN Data in this study were obtained through semi-structured interviews with GPs participating in an intervention project, as well as observations of clinical encounters. RESULTS From the empirical data, we identified three dimensions of respect: respect for the patient's autonomy, respect for professional authority and respect as a mutual exchange. A balance of respect influenced trust in the relationship between GP and patients and the transfer of power in the encounter. The GPs articulated that a balance was needed in preventive health checks in order to establish trust and thus retain the patient in the clinic. One way this balance of respect was carried out was with the use of humour. CONCLUSIONS To retain patients without formal education in the clinical encounter, the GPs balanced trust and power executed through three dimensions of respect. In this study, retaining patients was equivalent to maintaining a trusting relationship. A strategic use of the three dimensions of respect was applied to balance trust and power and thus build or maintain a trusting relationship with patients. KEY POINTS Little is known about how strategies for retaining patients are acted out by GPs in preventive health checks. • Retaining patients requires a balance of trust and power, which is executed through three dimensions of respect by the GPs. • Challenges of recruiting and retaining patients in public health initiatives might be associated with the balance of respect.
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Affiliation(s)
- Marie Broholm-Jørgensen
- National Institute of Public Health, Research Programme on Health and Social Conditions, University of Southern Denmark, Copenhagen, Denmark
- CONTACT Marie Broholm-Jørgensen National Institute of Public Health, Research Programme on Health and Social Conditions, University of Southern Denmark, Copenhagen, Øster Farimagsgade 5A, 2., 1353 Copenhagen, Denmark
| | - Ann Dorrit Guassora
- The Research Unit and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Reventlow
- The Research Unit and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Tine Tjørnhøj-Thomsen
- National Institute of Public Health, Research Programme on Health and Social Conditions, University of Southern Denmark, Copenhagen, Denmark
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