Defining and measuring quality of diabetes care

Short-term impact of co-payment level increase on the use of medication and patient-reported outcomes in Finnish patients with type 2 diabetes

A new reimbursement scheme for non-insulin medications used for treatment of hyperglycemia in type 2 diabetes (T2D) was implemented in Finland on January 1, 2017. The aim of the study was to evaluate the impact of this co-payment increase (i.e. + 35 percentage points) on patient-reported satisfaction for diabetes care, diabetes medication use, and financial difficulties. Baseline data were collected in 114 pharmacies, where patients with T2D were asked to fill in a questionnaire in November 2016. Follow-ups were conducted at 6 and 12 months. In total, 955 participants with T2D attended the baseline examination. During the follow-up, satisfaction with diabetes care decreased significantly (p < 0.001). Use of insulin increased (OR 1.16, 95 % CI 1.06-1.27) whereas use of metformin and DPP-4 inhibitors decreased (metformin: OR 0.80, 95 % CI 0.70‒0.90; DPP-4 inhibitors: OR 0.82, 95 % CI 0.73‒0.93). Financial difficulties with the purchase of diabetes medications were reported more often both at 6 (OR 2.44, 95 % CI 1.96-3.03) and at 12 months (OR 2.70, 95 % CI 2.18-3.35) than at baseline. These negative short-term effects require future studies. If persistent, the long-term effects of lower treatment satisfaction and increased financial difficulties may imply impaired metabolic control and increased diabetes complication risk and health care costs. Patient perspective should be taken into account in future policy making.

Patient satisfaction and medication adherence assessment amongst patients at the diabetes medication therapy adherence clinic

AIMS

To determine the satisfaction and current adherence status of patients with diabetes mellitus at the diabetes Medication Therapy Adherence Clinic and the relationship between patient satisfaction and adherence.

METHODS

This cross-sectional descriptive study was carried out at three government hospitals in the state of Johor, Malaysia. Patient's satisfaction was measured using the Patient Satisfaction with Pharmaceutical Care Questionnaire; medication adherence was measured using the eight-item Morisky Medication Adherence Scale.

RESULTS

Of n=165 patients, 87.0% of patients were satisfied with DMTAC service (score 60-100) with mean scores of 76.8. On the basis of MMAS, 29.1% had a medium rate and 26.1% had a high rate of adherence. Females are 3.02 times more satisfied with the pharmaceutical service compared to males (OR 3.03, 95% CI 1.12-8.24, p<0.05) and non-Malays are less satisfied with pharmaceutical care provided during DMTAC compared to Malays (OR 0.32, 95% CI 0.12-0.85, p<0.05). Older patients age group ≥60 years were 3.29 times more likely to adhere to their medications (OR 3.29, 95% CI 1.10-9.86, p<0.05). Females were the most adherent compared to males (OR 2.33, 95%CI 1.10-4.93, p<0.05) and patients with secondary level of education were 2.72 times more adherent to their medications compared to those in primary school and no formal education (OR 2.72, 95%CI 1.13-6.55, p<0.05). There is a significant (p<0.01), positive fair correlation (r=0.377) between satisfaction and adherence.

CONCLUSION

Patients were highly satisfied with DMTAC service, while their adherence levels were low. There is an association between patient satisfaction and adherence.

Quality of Diabetic Care among Patients in a Tertiary Care Hospital in Bangalore, South India: A Cross-sectional Study

BACKGROUND

Despite high prevalence of diabetes, translation of practice recommendations to care is still deficient in Asian and developed countries. The objective of this study is to assess the quality of care provided to diabetic patients and extent of knowledge transfer by the provider to these patients as a measure of the quality of service.

MATERIALS AND METHODS

A cross sectional study was done among 190 diabetic patients over a period of 6 months. All type II diabetic patients, 30 years and above, who were diagnosed at least 1 year back without any other co-morbidity satisfied the inclusion criteria. They were interviewed based on an audit checklist formulated by National Diabetes Quality Improvement Alliance.

RESULTS

The results revealed that blood pressure is the only parameter which is regularly monitored in majority (93%) of the diabetics. Hb1AC, LDL cholesterol and eye check up were less common and done only in 40%, 52.6% and 56.8% of diabetics respectively. Only 33(17.37%) had at least 5 of the 7 essential parameters monitored at least once in the last year. The knowledge questionnaire showed that more than 70% of the diabetic patients know that their condition requires lifelong management, diet modifications and exercises. There was no difference in the knowledge scores between the people who had no essential tests done and those diabetics who got 5 essential tests done. Gender, education, occupation and duration of diabetes were associated with knowledge score.

CONCLUSION

There is a need to formulate the local standards of care and clinical practice guidelines for the management of diabetes that are easily affordable and available to the health care providers and applicable to our country at the national level. Continuing audit of patients with diabetes is a feasible and a very useful method of promoting and helping to achieve the management goals of a good quality care.

Clinical experience with insulin glargine in type 1 diabetes

The Diabetes Control and Complications Trial (DCCT) demonstrated the importance of optimal glycemic control achieved through intensive insulin therapy in reducing the microvascular complications associated with type 1 diabetes. However, the DCCT, which was conducted prior to the availability of insulin analogs, also reported a significant increase in severe hypoglycemia with intensive versus conventional therapy. Insulin analogs were developed to aid patients in achieving better diabetes control by providing insulins with optimized pharmacokinetic and pharmacodynamic characteristics. Insulin glargine was the first long-acting insulin analog with a 24-h duration of action, offering once-daily injection, and has now been in clinical use for over 10 years. The authors performed a systematic search of EMBASE, MEDLINE, and Web of Science (Science Citation Index) to determine the efficacy of insulin glargine in type 1 diabetes in basal-bolus insulin regimens. Randomized controlled trials have demonstrated that glycemic control with insulin glargine is at least comparable to that with neutral protamine Hagedorn (NPH) insulin in adults and in children and adolescents, and with continuous subcutaneous insulin infusion in adults. However, these same trials show a significantly lower risk for hypoglycemia with insulin glargine compared with NPH insulin in adults.

Patient-reported outcomes following treatment with the human GLP-1 analogue liraglutide or glimepiride in monotherapy: results from a randomized controlled trial in patients with type 2 diabetes

AIM

As weight gain and hypoglycaemia associated with glimepiride therapy can negatively impact weight perceptions, psychological well-being and overall quality of life in type 2 diabetes, we investigated whether liraglutide treatment could improve these factors.

METHODS

Seven hundred and thirty-two patients with type 2 diabetes completed a 77-item questionnaire during a randomized, 52-week, double-blind study with liraglutide 1.2 mg (n = 245) or 1.8 mg (n = 242) compared with glimepiride 8 mg (n = 245).

RESULTS

Mean (SE) decreases in glycated haemoglobin levels were greater with liraglutide 1.2 mg [-0.84 (0.08)%] and 1.8 mg [-1.14 (0.08)%] than glimepiride [-0.51 (0.08)%; p = 0.0014 and p < 0.0001, respectively]. Patients gained weight on glimepiride [mean (SE), 1.12 (0.27) kg] but lost weight on liraglutide [1.2 mg: -2.05 (0.28) kg; 1.8 mg: -2.45 (0.28) kg; both p < 0.0001]. Patient weight assessment was more favourable with liraglutide 1.8 mg [mean (SE) score: 40.0 (2.0)] than glimepiride [48.7 (2.0); p = 0.002], and liraglutide 1.8 mg patients were 52% less likely to feel overweight [odds ratio (OR) 0.48; 95% confidence interval (CI): 0.331-0.696]. Mean (SE) weight concerns were less with liraglutide [1.2 mg: 30.0 (1.2); 1.8 mg: 32.8 (1.2)] than glimepiride [38.8 (1.2); p < 0.0001 and p < 0.001, respectively], with liraglutide groups 45% less likely to report weight concern (OR 0.55, 95% CI: 0.41-0.73). Mean (SE) mental and emotional health and general perceived health improved more with liraglutide 1.8 mg [476.1 (2.8) and 444.2 (3.2), respectively] than glimepiride [466.3 (2.8) and 434.5 (3.2), respectively; p = 0.012 and p = 0.033, respectively].

CONCLUSIONS

Improved glycaemic control and decreased weight with liraglutide 1.8 mg vs. glimepiride can improve psychological and emotional well-being and health perceptions by reducing anxiety and worry associated with weight gain.

Treatment satisfaction of diabetic patients: what are the contributing factors?

BACKGROUND

Treatment satisfaction is an important factor of quality of care, especially in treating chronic diseases such as diabetes mellitus. Identifying factors that independently influence treatment satisfaction may help in improving clinical outcomes.

OBJECTIVE

To find the relationship between treatment satisfaction of diabetic patients and socio-demographic, clinical, adherence, treatment and health perception factors.

METHODS

Patients were interviewed by telephone about their socio-demographic parameters, health status, clinical data and treatment factors. The Diabetes Treatment Satisfaction Questionnaire (DTSQ) was used to measure satisfaction and adherence. This is a cross-sectional study, as part of a larger study of chronic patients in Israel. Subjects were randomly selected diabetes patients. The main outcome measures were DTSQ levels. A multivariate linear regression model was constructed to identify factors independently associated with patients' satisfaction.

RESULTS

In all, 630 patients were included in the study. Multivariate analysis indicated that demographic parameters (e.g. female gender, P = 0.036), treatment factors (e.g. type of medication, P < 0.001), adherence factors (e.g. difficulty attending follow-up or taking medications, P < 0.001) and clinical factors (e.g. diabetes complications, P < 0.01) were independently associated with lower treatment satisfaction.

CONCLUSIONS

Treatment satisfaction is lower among diabetic patients who have a lower educational level, who are insulin treated or have a diabetic complication and is related to difficulties in taking medications and coming to follow-up visits. Addressing the specific needs of these patients might be effective in improving their satisfaction, thus having a positive influence on other clinical outcomes.

Addressing the burden of diabetes in the 21st century: better care and primary prevention

By the end of the 20th century, the worldwide diabetes pandemic had affected an estimated 151 million persons. Strategies to mitigate both the human and economic burden are urgently needed. Efficacious treatments are currently available but the quality of diabetes care being delivered is suboptimal in both developed and developing countries. Some progress to improve quality has been made thought national strategies. These efforts need two elements: "translation" research that will establish the methods needed to assure that clinical research findings are delivered effectively in every day practice settings; and development and implementation of quality improvement measures that will reliably track progress. New interventions that prevent diabetes among those at high risk also now hold much promise and need to be implemented.

Functional health status of persons with diabetes in a nurse-managed clinic

PURPOSE

The purpose of this psychometric analysis was to (1) describe the functional health status of medically underserved persons with diabetes participating in an exercise program; (2) examine the relationships between functional health status scores and physiologic measures for blood pressure, heart rate, and blood glucose levels; and (3) examine the reliability and validity of the Medical Outcomes Study SF-36 survey.

METHODS

Data were collected from 31 men and women receiving diabetes disease management in a community-based nurse-managed clinic. The SF-36 survey was used to measure functional health status. Blood pressure, heart rate, and blood glucose also were measured (pretest/posttest).

RESULTS

The SF-36 survey had good internal consistency in the total sample. Blood pressure and blood glucose levels decreased significantly and heart rate increased significantly from pretest to posttest. Functional health status was negatively associated with physiological parameters.

CONCLUSIONS

Further research is needed on the use of the SF-36 survey in medically underserved persons with diabetes because this instrument lacked construct validity as a measure of functional health status in this population.