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Tu Q, Hyun K, Hafiz N, Knight A, Hespe C, Chow CK, Briffa T, Gallagher R, Reid CM, Hare DL, Zwar N, Woodward M, Jan S, Atkins ER, Laba TL, Halcomb E, Usherwood T, Billot L, Redfern J. Age-Related Variation in the Provision of Primary Care Services and Medication Prescriptions for Patients with Cardiovascular Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10761. [PMID: 36078474 PMCID: PMC9518583 DOI: 10.3390/ijerph191710761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/20/2022] [Accepted: 08/24/2022] [Indexed: 06/15/2023]
Abstract
As population aging progresses, demands of patients with cardiovascular diseases (CVD) on the primary care services is inevitably increased. However, the utilisation of primary care services across varying age groups is unknown. The study aims to explore age-related variations in provision of chronic disease management plans, mental health care, guideline-indicated cardiovascular medications and influenza vaccination among patients with CVD over differing ages presenting to primary care. Data for patients with CVD were extracted from 50 Australian general practices. Logistic regression, accounting for covariates and clustering effects by practices, was used for statistical analysis. Of the 14,602 patients with CVD (mean age, 72.5 years), patients aged 65-74, 75-84 and ≥85 years were significantly more likely to have a GP management plan prepared (adjusted odds ratio (aOR): 1.6, 1.88 and 1.55, respectively, p < 0.05), have a formal team care arrangement (aOR: 1.49, 1.8, 1.65, respectively, p < 0.05) and have a review of either (aOR: 1.63, 2.09, 1.93, respectively, p < 0.05) than those < 65 years. Patients aged ≥ 65 years were more likely to be prescribed blood-pressure-lowering medications and to be vaccinated for influenza. However, the adjusted odds of being prescribed lipid-lowering and antiplatelet medications and receiving mental health care were significantly lowest among patients ≥ 85 years. There are age-related variations in provision of primary care services and pharmacological therapy. GPs are targeting care plans to older people who are more likely to have long-term conditions and complex needs.
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Affiliation(s)
- Qiang Tu
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney 2050, Australia
| | - Karice Hyun
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney 2050, Australia
- Department of Cardiology, Concord Hospital, Sydney 2139, Australia
| | - Nashid Hafiz
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney 2050, Australia
| | - Andrew Knight
- The Primary and Integrated Care Unit, South Western Sydney Local Health District, Sydney 2170, Australia
- School of Population Health, University of New South Wales, Sydney 2052, Australia
| | - Charlotte Hespe
- School of Medicine, The University of Notre Dame, Sydney 2010, Australia
| | - Clara K. Chow
- Research Education Network, Western Sydney Local Health District, Sydney 2151, Australia
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead 2154, Australia
| | - Tom Briffa
- School of Population and Global Health, The University of Western Australia, Perth 6009, Australia
| | - Robyn Gallagher
- Faculty of Medicine and Health, Sydney Nursing School, University of Sydney, Sydney 2006, Australia
| | - Christopher M. Reid
- School of Population Health, Curtin University, Perth 6102, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - David L. Hare
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne 3010, Australia
- Department of Cardiology, Austin Health, Heidelberg 3084, Australia
| | - Nicholas Zwar
- School of Population Health, University of New South Wales, Sydney 2052, Australia
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast 4226, Australia
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales, Sydney 2046, Australia
- The George Institute for Global Health, School of Public Health, Imperial College London, London NW9 7PA, UK
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney 2046, Australia
| | - Emily R. Atkins
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead 2154, Australia
- The George Institute for Global Health, University of New South Wales, Sydney 2046, Australia
| | - Tracey-Lea Laba
- Pharmacy Program, Clinical and Health Sciences Unit, University of South Australia, Adelaide 5001, Australia
| | - Elizabeth Halcomb
- School of Nursing, University of Wollongong, Wollongong 2522, Australia
| | - Tim Usherwood
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead 2154, Australia
- The George Institute for Global Health, University of New South Wales, Sydney 2046, Australia
| | - Laurent Billot
- The George Institute for Global Health, University of New South Wales, Sydney 2046, Australia
| | - Julie Redfern
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney 2050, Australia
- The George Institute for Global Health, University of New South Wales, Sydney 2046, Australia
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Epidemiology and resource use in Spanish type 2 diabetes patients without previous cardiorenal disease: CaReMe Spain study summary. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2021.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Sicras-Mainar A, Sicras-Navarro A, Palacios B, Sequera M, Blanco J, Hormigo A, Manito N, Alcázar-Arroyo R, Botana-Lopez MA. Epidemiology and resource use in Spanish type 2 diabetes patients without previous cardiorenal disease: CaReMe Spain study summary. ENDOCRINOL DIAB NUTR 2022; 69:509-519. [PMID: 36084988 DOI: 10.1016/j.endien.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/10/2021] [Indexed: 06/15/2023]
Abstract
AIMS To determine the first manifestation of cardiovascular or kidney disease (CVKD) and associated resource use in type 2 diabetes mellitus (T2DM) patients during seven years of follow-up. METHODS Observational-retrospective secondary data study using medical records of patients aged ≥18 years with T2DM and without prior CVKD between 2013 and 2019. The index date was 01/01/2013 (fixed date). The manifestation of CVKD was defined by the first diagnosis of heart-failure (HF), chronic-kidney disease (CKD), myocardial-infarction (MI), stroke or peripheral-artery disease (PAD). The main variables were baseline characteristics, manifestation of CVKD, mortality, resource use and costs. Descriptive analyses and Cox model were applied to the data. RESULTS 26,542 patients were selected (mean age: 66.6 years, women: 47.8%, mean duration of T2DM: 17.1 years). 18.7% (N=4974) developed a first CVKD manifestation during the seven years [distribution: HF (22.4%), CKD (36.6%), MI (14.5%), stroke (15.3%) and PAD (11.3%)]. Overall mortality was 8.3% (N=2214). The mortality risk of the group that developed HF or CKD as the first manifestation compared to the CVKD-free cohort was higher [HR: 2.5 (95% CI: 1.8-3.4) and 1.8 (95% CI: 1.4-2.3)], respectively. The cumulative costs per patient of HF (€50,942.80) and CKD (€48,979.20) were higher than MI (€47,343.20) and stroke (€47,070.30) and similar to PAD (€51,240.00) vs. €13,098.90 in patients who did not develop CVKD, p<0.001. CONCLUSIONS In T2DM patients, HF and CKD were the first most common manifestations and had higher mortality and re-hospitalisation rates. HF and CKD were associated with the highest resource use and costs for the Spanish National-Health-System.
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Affiliation(s)
| | | | | | | | | | - Antonio Hormigo
- Dirección Médica, Centro de Salud de San Andrés-Torca, Málaga, Spain
| | - Nicolas Manito
- Bellvitge Hospital, Hospitalet de Llobregat, Barcelona, Spain
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Hafiz N, Hyun K, Knight A, Hespe C, Chow CK, Briffa T, Gallagher R, Reid CM, Hare DL, Zwar N, Woodward M, Jan S, Atkins ER, Laba TL, Halcomb E, Usherwood T, Redfern J. Gender Comparison of Receipt of Government-Funded Health Services and Medication Prescriptions for the Management of Patients With Cardiovascular Disease in Primary Care. Heart Lung Circ 2021; 30:1516-1524. [PMID: 33933363 DOI: 10.1016/j.hlc.2021.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/11/2021] [Accepted: 04/08/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) and risk factors remains a major burden in terms of disease, disability, and death in the Australian population and mental health is considered as an important risk factor affecting cardiovascular disease. A multidisciplinary collaborative approach in primary care is required to ensure an optimal outcome for managing cardiovascular patients with mental health issues. Medicare introduced numerous primary care health services and medications that are subsidised by the Australian government in order to provide a more structured approach to reduce and manage CVD. However, the utilisation of these services nor gender comparison for CVD management in primary care has been explored. Therefore, the aim is to compare the provision of subsidised chronic disease management plans (CDMPs), mental health care and prescription of guideline-indicated medications to men and women with CVD in primary care practices for secondary prevention. METHODS De-identified data for all active patients with CVD were extracted from 50 Australian primary care practices. Outcomes included the frequency of receipt of CDMPs, mental health care and prescription of evidence-based medications. Analyses adjusted for demography and clinical characteristics, stratified by gender, were performed using logistic regression and accounted for clustering effects by practices. RESULTS Data for 14,601 patients with CVD (39.4% women) were collected. The odds of receiving the CDMPs was significantly greater amongst women than men (preparation of general practice management plan [GPMP]: (46% vs 43%; adjusted OR [95% CI]: 1.22 [1.12, 1.34]). Women were more likely to have diagnosed with mental health issues (32% vs 20%, p<0.0001), however, the adjusted odds of men and women receiving any government-subsidised mental health care were similar. Women were less often prescribed blood pressure, lipid-lowering and antiplatelet medications. After adjustment, only an antiplatelet medication or agent was less likely to be prescribed to women than men (44% vs 51%; adjusted OR [95% CI]: 0.84 [0.76, 0.94]). CONCLUSION Women were more likely to receive CDMPs but less likely to receive antiplatelet medications than men, no gender difference was observed in the receipt of mental health care. However, the receipt of the CDMPs and the mental health treatment consultations were suboptimal and better use of these existing services could improve ongoing CVD management.
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Affiliation(s)
- Nashid Hafiz
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia. https://twitter.com/HafizNashid
| | - Karice Hyun
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Andrew Knight
- Primary and Integrated Care Unit, South Western Sydney Local Health District, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Charlotte Hespe
- The University of Notre Dame, School of Medicine, Sydney, NSW, Australia
| | - Clara K Chow
- Western Sydney Local Health District, Sydney, NSW, Australia; Westmead Applied Research Centre, The University of Sydney, Sydney, NSW, Australia
| | - Tom Briffa
- School of Population and Global Health, Faculty of Health and Medical Sciences, The University of Western Australia, Sydney, NSW, Australia
| | - Robyn Gallagher
- Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Christopher M Reid
- School of Public Health, Curtin University, Perth, WA, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - David L Hare
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic, Australia; Austin Health, Melbourne, Vic, Australia
| | - Nicholas Zwar
- Faculty of Health Sciences & Medicine, Bond University, Brisbane, Qld, Australia
| | - Mark Woodward
- University of New South Wales, Sydney, NSW, Australia; The George Institute for Global Health, Sydney, NSW, Australia
| | - Stephen Jan
- The George Institute for Global Health, Sydney, NSW, Australia
| | - Emily R Atkins
- The George Institute for Global Health, Sydney, NSW, Australia
| | - Tracey-Lea Laba
- University of Technology Sydney Centre for Health Economics Research and Evaluation, Sydney, NSW, Australia
| | - Elizabeth Halcomb
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia
| | - Timothy Usherwood
- The George Institute for Global Health, Sydney, NSW, Australia; The University of Sydney, Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Julie Redfern
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; The George Institute for Global Health, Sydney, NSW, Australia.
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McGill B, O Hara BJ, Grunseit AC, Bauman A, Lawler L, Phongsavan P. Sociodemographic and health risk profile associated with participation in a private health insurance weight loss maintenance and chronic disease management program. AUST HEALTH REV 2020; 44:642-649. [PMID: 31991092 DOI: 10.1071/ah19046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 10/09/2019] [Indexed: 11/23/2022]
Abstract
Objective Identifying who participates in chronic disease management programs yields insights into program reach and appeal. This study investigated sustained participation in a remotely delivered weight loss maintenance program offered to Australian private health insurance members. Methods All participants completing an initial 18-week weight loss program were eligible for a maintenance phase. A pre-post test design was used and sociodemographic and anthropometric characteristics of those who did and did not opt in to the maintenance phase were compared using binary logistic regression. Results Maintenance phase participants lost more weight during the initial weight loss program (-2.2kg (P<0.001); body mass index -0.8kg/m2 (P<0.001)) than those who did not opt in. Participants who were obese (v. overweight) upon completion of the initial weight loss program were less likely to opt in to the maintenance phase (adjusted odds ratio (aOR) 1.76, 95% confidence interval (CI) 1.35-2.30, P<0.001) and participants aged ≥55 years were more likely to opt in (aOR 0.59, 95% CI 0.44-0.80, P<0.001) than those aged <55 years. Conclusions Understanding why health insurance members opt in to maintenance programs can assist the development of strategies to improve program reach. Younger participants and those who remain obese following a weight loss program may be targeted by private health insurers and service providers to increase weight loss maintenance program participation. What is known about the topic? Australian private health insurers offer chronic disease management programs to support members to manage obesity-related chronic disease. An 18-week weight loss and lifestyle modification program was extended to assist participants maintain weight loss and health benefits resulting from the initial program. This weight loss maintenance phase is novel in the private health insurance setting and is thought to be important to sustained health improvement. Although program reach is important to benefit those most in need, little is known about who sustains the use (or does not) of such programs. What does this paper add? This study provides an insight to the characteristics of participants more likely to opt in to a weight loss maintenance program. It highlights the sociodemographic and anthropometric characteristics associated with maintenance program uptake, identifying the subgroups less likely to opt in. These study findings are novel because they report on participation in a chronic disease management program with a focus on maintenance of weight loss. What are the implications for practitioners? These results will benefit private health insurers and service providers implementing maintenance programs for weight loss, providing an awareness of which participant groups to target to increase maintenance and reach. In addition, they offer avenues for future exploration, such as the generalisability and sustainability of chronic disease management programs. Although those not opting in are a difficult-to-access group, a qualitative study of reasons for not opting in to such a program would provide further information for program design, recruitment and retention.
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Affiliation(s)
- Bronwyn McGill
- The University of Sydney, Sydney School of Public Health, Prevention Research Collaboration, Charles Perkins Centre, NSW 2006, Australia. ; ; ; ; and The Australian Prevention Partnership Centre, 235 Jones Street, Ultimo, NSW 2007, Australia; and Corresponding author.
| | - Blythe J O Hara
- The University of Sydney, Sydney School of Public Health, Prevention Research Collaboration, Charles Perkins Centre, NSW 2006, Australia. ; ; ;
| | - Anne C Grunseit
- The University of Sydney, Sydney School of Public Health, Prevention Research Collaboration, Charles Perkins Centre, NSW 2006, Australia. ; ; ; ; and The Australian Prevention Partnership Centre, 235 Jones Street, Ultimo, NSW 2007, Australia
| | - Adrian Bauman
- The University of Sydney, Sydney School of Public Health, Prevention Research Collaboration, Charles Perkins Centre, NSW 2006, Australia. ; ; ; ; and The Australian Prevention Partnership Centre, 235 Jones Street, Ultimo, NSW 2007, Australia
| | - Luke Lawler
- Prima Health Solutions, PO Box 7468, Warringah Mall, NSW 2100, Australia.
| | - Philayrath Phongsavan
- The University of Sydney, Sydney School of Public Health, Prevention Research Collaboration, Charles Perkins Centre, NSW 2006, Australia. ; ; ;
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Tang L, Li K, Wu CJJ. Thirty-day readmission, length of stay and self-management behaviour among patients with acute coronary syndrome and type 2 diabetes mellitus: A scoping review. J Clin Nurs 2019; 29:320-329. [PMID: 31698508 DOI: 10.1111/jocn.15087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 09/16/2019] [Accepted: 10/20/2019] [Indexed: 01/22/2023]
Abstract
AIMS AND OBJECTIVES To summarise the current evidence on comorbid type 2 diabetes mellitus (T2DM) related to 30-day readmission and hospital length of stay (LOS) among patients with acute coronary syndrome (ACS) and evidence on the effectiveness of self-management programmes for patients with both conditions. BACKGROUND Acute coronary syndrome and T2DM remain two major diseases leading to serious consequences. Thirty-day readmission and LOS were considered indicators of the quality of care, with the understanding that the potential significant effects of these outcomes could be varied. DESIGN This scoping review followed the methodology described by Arksey and O'Malley. METHODS Five databases including PubMed, Embase, Cochrane Library, Web of Science and CINAHL were searched, and a total of 20 articles involving 913,807 patients were included. Results were reported in accordance with PRISMA-ScR guidelines. RESULTS The results indicated that patients with both ACS and T2DM have prolonged LOS and increased 30-day readmission rates. The findings supported that improvements in patient self-management behaviour for optimal health outcomes were partially successful by effective self-management programmes; however, few articles on intervention programmes specifically designed for patients with two conditions were found. CONCLUSION Prolonged LOS and increased 30-day readmission rates are found among patients with ACS and T2DM. Based on few pilot studies building on each other, the effectiveness of self-management programmes in promoting self-care behaviour, self-efficacy and knowledge for patients with ACS and T2DM cannot be concluded. RELEVANCE TO CLINICAL PRACTICE Findings from this review provide valuable information on and a better understanding of readmissions and LOS among patients with ACS and T2DM for healthcare providers. Future developments and implementations of effective self-management programmes should target patients with dual diagnoses to improve health behaviour and reduce readmission and LOS.
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Affiliation(s)
- Liya Tang
- School of Nursing, Jilin University, Changchun, China
| | - Kun Li
- School of Nursing, Jilin University, Changchun, China
| | - Chiung-Jung Jo Wu
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast (USC), Sippy Downs, QLD, Australia.,Royal Brisbane and Women's Hospital (RBWH), Brisbane, QLD, Australia.,Mater Medical Research Institute-University of Queensland (MMRI-UQ), Brisbane, QLD, Australia
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Hamar GB, Coberley C, Pope JE, Cottrill A, Verrall S, Larkin S, Rula EY. Effect of post-hospital discharge telephonic intervention on hospital readmissions in a privately insured population in Australia. AUST HEALTH REV 2019; 42:241-247. [PMID: 28390471 DOI: 10.1071/ah16059] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 02/02/2017] [Indexed: 11/23/2022]
Abstract
Objective The aim of the present study was to evaluate the effect of telephone support after hospital discharge to reduce early hospital readmission among members of the disease management program My Health Guardian (MHG) offered by the Hospitals Contribution Fund of Australia (HCF). Methods A quasi-experimental retrospective design compared 28-day readmissions of patients with chronic disease between two groups: (1) a treatment group, consisting of MHG program members who participated in a hospital discharge (HODI) call; and (2) a comparison group of non-participating MHG members. Study groups were matched for age, gender, length of stay, index admission diagnoses and prior MHG program exposure. Adjusted incidence rate ratios (IRR) and odds ratios (OR) were estimated using zero-inflated negative binomial and logistic regression models respectively. Results The treatment group exhibited a 29% lower incidence of 28-day readmissions than the comparison group (adjusted IRR 0.71; 95% confidence interval (CI) 0.59-0.86). The odds of treatment group members being readmitted at least once within 28 days of discharge were 25% lower than the odds for comparison members (adjusted OR 0.75; 95% CI 0.63-0.89). Reduction in readmission incidence was estimated to avoid A$713730 in cost. Conclusions The HODI program post-discharge telephonic support to patients recently discharged from a hospital effectively reduced the incidence and odds of hospital 28-day readmission in a diseased population. What is known about the topic? High readmission rates are a recognised problem in Australia and contribute to the over 600000 potentially preventable hospitalisations per year. What does this paper add? The present study is the first study of a scalable intervention delivered to an Australian population with a wide variety of conditions for the purpose of reducing readmissions. The intervention reduced 28-day readmission incidence by 29%. What are the implications for practitioners? The significant and sizable effect of the intervention support the delivery of telephonic support after hospital discharge as a scalable approach to reduce readmissions.
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Affiliation(s)
- G Brent Hamar
- Healthways Inc., 701 Cool Springs Boulevard, Franklin, TN 37067, USA
| | | | - James E Pope
- Healthways Inc., 701 Cool Springs Boulevard, Franklin, TN 37067, USA
| | - Andrew Cottrill
- Hospitals Contribution Fund of Australia (HCF), Level 6, 403 George Street, Sydney, NSW 2000, Australia.
| | - Scott Verrall
- Hospitals Contribution Fund of Australia (HCF), Level 6, 403 George Street, Sydney, NSW 2000, Australia.
| | - Shaun Larkin
- Hospitals Contribution Fund of Australia (HCF), Level 6, 403 George Street, Sydney, NSW 2000, Australia.
| | - Elizabeth Y Rula
- Tivity Health, 701 Cool Springs Boulevard, Franklin, TN 37067, USA. Email
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Yarnell CJ, Shadowitz S, Redelmeier DA. Hospital Readmissions Following Physician Call System Change: A Comparison of Concentrated and Distributed Schedules. Am J Med 2016; 129:706-714.e2. [PMID: 26976386 DOI: 10.1016/j.amjmed.2016.02.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 02/16/2016] [Accepted: 02/17/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Physician call schedules are a critical element for medical practice and hospital efficiency. We compared readmission rates prior to and after a change in physician call system at Sunnybrook Health Sciences Centre. METHODS We studied patients discharged over a decade (2004 through 2013) and identified whether or not each patient was readmitted within the subsequent 28 days. We excluded patients discharged for a surgical, obstetrical, or psychiatric diagnosis. We used time-to-event analysis and time-series analysis to compare rates of readmission prior to and after the physician call system change (January 1, 2009). RESULTS A total of 89,697 patients were discharged, of whom 10,001 (11%) were subsequently readmitted and 4280 died. The risk of readmission was increased by about 26% following physician call system change (9.7% vs 12.2%, P <.001). Time-series analysis confirmed a 26% increase in the readmission rate after call system change (95% confidence interval, 22%-31%; P <.001). The increase in readmission rate after call system change persisted across patients with diverse ages, estimated readmission risks, and medical diagnoses. The net effect was equal to 7240 additional patient days in the hospital following call system change. A modest increase was observed at a nearby acute care hospital that did not change physician call system, and no increase in risk of death was observed with increased hospital readmissions. CONCLUSION We suggest that changes in physician call systems sometimes increase subsequent hospital readmission rates. Further reductions in readmissions may instead require additional resources or ingenuity.
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Affiliation(s)
- Christopher J Yarnell
- Department of Medicine, University of Toronto, Ont., Canada; Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ont., Canada
| | - Steven Shadowitz
- Department of Medicine, University of Toronto, Ont., Canada; Division of General Internal Medicine, University of Toronto, Ont., Canada
| | - Donald A Redelmeier
- Department of Medicine, University of Toronto, Ont., Canada; Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ont., Canada; Division of General Internal Medicine, University of Toronto, Ont., Canada; Institute of Clinical Evaluative Sciences (ICES) in Ontario, Toronto, Canada; Institute for Health Policy Management and Evaluation, Toronto, Ont., Canada.
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Goderis G, Van Casteren V, Declercq E, Bossuyt N, Van Den Broeke C, Vanthomme K, Moreels S, Nobels F, Mathieu C, Buntinx F. Care trajectories are associated with quality improvement in the treatment of patients with uncontrolled type 2 diabetes: A registry based cohort study. Prim Care Diabetes 2015; 9:354-361. [PMID: 25709079 DOI: 10.1016/j.pcd.2015.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 01/07/2015] [Accepted: 01/19/2015] [Indexed: 11/29/2022]
Abstract
AIMS To analyse whether care trajectories (CT) were associated with increased prevalence of parenteral hypoglycemic treatment (PHT=insulin or GLP-1 analogues), statin therapy or RAAS-inhibition. Introduced in 2009 in Belgium, CTs target patients with type 2 diabetes mellitus (T2DM), in need for or with PHT. METHODS Retrospective study based on a registry with 97 general practitioners. The evolution in treatment since 2006 was compared between patients with vs. without a CT, using longitudinal logistic regression. RESULTS Comparing patients with (N=271) vs. without a CT (N=4424), we noted significant differences (p<0.05) in diabetes duration (10.1 vs. 7.3 years), HbA1c (7.5 vs. 6.9%), LDL-C (85 vs. 98mg/dl), microvascular complications (26 vs. 16%). Moreover, in 2006, parenteral treatment (OR 52.1), statins (OR 4.1) and RAAS-inhibition (OR 9.6) were significantly more prevalent (p<0.001). Between 2006 and 2011, the prevalence rose in both groups regarding all three treatments, but rose significantly faster (p<0.05) after 2009 in the CT-group. CONCLUSIONS Patients enrolled in a CT differ from other patients even before the start of this initiative with more intense hypoglycemic and cardiovascular treatment. Yet, they presented higher HbA1c-levels and more complications. Enrolment in a CT is associated with additional treatment intensification.
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Affiliation(s)
- Geert Goderis
- Department of General Practice, Katholieke Universiteit Leuven, Leuven, Belgium.
| | - Viviane Van Casteren
- Unit Health Services Research, Scientific Institute of Public Health, Brussels, Belgium
| | - Etienne Declercq
- Faculty of Public Health, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Nathalie Bossuyt
- Unit Health Services Research, Scientific Institute of Public Health, Brussels, Belgium
| | | | - Katrien Vanthomme
- Unit Health Services Research, Scientific Institute of Public Health, Brussels, Belgium
| | - Sarah Moreels
- Unit Health Services Research, Scientific Institute of Public Health, Brussels, Belgium
| | | | | | - Frank Buntinx
- Department of General Practice, Katholieke Universiteit Leuven, Leuven, Belgium; Department of General Practice, Maastricht University, Maastricht, The Netherlands
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Gauntlett-Gilbert J, Rodham K, Jordan A, Brook P. Emergency Department Staff Attitudes Toward People Presenting in Chronic Pain: A Qualitative Study. PAIN MEDICINE 2015; 16:2065-74. [PMID: 26177229 DOI: 10.1111/pme.12844] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Patients who experience their nonmalignant chronic pain as intolerable sometimes present at Emergency Departments (EDs). However, as emergency medical services are set up to provide rapid treatment for acute injury or illness; there is potential for misunderstanding and disappointment. Literature on the topic of ED staff attitudes toward chronic pain patients is minimal, USA-based and methodologically unsatisfying. We carried out an in-depth, qualitative study identifying the attitudes and narratives of ED staff around people in chronic pain. DESIGN Focus groups with ED staff; qualitative analysis of the group transcripts. SETTING Regional trauma centre in the UK. SUBJECTS Three focus groups, 20 ED clinicians, mean ED experience 8.1 years. RESULTS The clinical challenge of treating patients in the ED stemmed from a mismatch between patients' needs and what the setting can deliver. Participants reported frustration with the system and with chronic pain patients' perceived inconsistencies and requirements. However, they also highlighted good practice and acknowledged their frustration around not being able to help this group. CONCLUSIONS ED staff found people presenting at ED with chronic pain to be a challenging and frustrating population to treat. Staff was constrained by the fast-paced nature of their jobs as well as the need to prioritise emergency cases, and so were unable to spend the time needed by chronic pain patients. This was seen as being bad for staff, and for the patient experience. Staff suggested that care could be improved by appropriate information, signposting and with time invested in communication with the patient.
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Affiliation(s)
- Jeremy Gauntlett-Gilbert
- Bath Centre for Pain Services, Royal National Hospital for Rheumatic Diseases, Bath, Avon, BA1 1RL, United Kingdom.,Department of Psychology, University of Bath, Bath, North East Somerset, BA2 7AY, United Kingdom
| | - Karen Rodham
- School of Psychology, Sport and Exercise, Staffordshire University, Staffordshire, ST4 2DE, United Kingdom
| | - Abbie Jordan
- Department of Psychology, University of Bath, Bath, North East Somerset, BA2 7AY, United Kingdom
| | - Peter Brook
- Bath Centre for Pain Services, Royal National Hospital for Rheumatic Diseases, Bath, Avon, BA1 1RL, United Kingdom
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Van Casteren VFA, Bossuyt NHE, Moreels SJS, Goderis G, Vanthomme K, Wens J, De Clercq EW. Does the Belgian diabetes type 2 care trajectory improve quality of care for diabetes patients? Arch Public Health 2015; 73:31. [PMID: 26171143 PMCID: PMC4499949 DOI: 10.1186/s13690-015-0080-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/05/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The Belgian care trajectory (CT) for diabetes mellitus type 2 (T2DM), implemented in September 2009, aims at providing integrated, evidence-based, multidisciplinary patient- centred care, based on the chronic care model. The research project ACHIL (Ambulatory Care Health Information Laboratory) studied the adherence of CT patients, in the early phases of CT programme implementation, with CT obligations, their uptake of incentives for self-management, whether the CT programme was targeting the appropriate group of patients, how care processes for these patients evolved over time and whether CT start led to better quality in the processes and outcomes of care. METHODS This observational study took place in the period 2006-2011 and covered T2DM patients who started a CT between 01/09/2009 and 31/12/2011. Four data sources were used: outcome data, from electronic patient records (EPRs) on all CT patients, provided by general practitioners (GPs); reimbursement process data on all CT patients and clinically comparable patients; and data from a sample of CT patients and clinically comparable patients from an EPR-based regional GP network and a paper-based national GP network, respectively. Through multilevel analysis of cross-sectional and longitudinal data, the effect of CT inclusion on processes and outcome was estimated, controlling for potential confounders. RESULTS By the end of 2011, data on 18,250 CT patients had been collected. Approximately 50 % of these CT patients had received reimbursement for a glucometer and nearly 60 % had had at least one encounter with a diabetes educator. The CT programme recruited T2DM patients who had been difficult to control in the past. In the years prior to CT start, there had been a gradual improvement in the follow up of these patients. Moreover, compared to non-CT patients, the proportion of CT patients adhering to the recommended frequency for monitoring of parameters, such as HbA1c, increased significantly around CT start. Some data sources, albeit not all, suggested there had been an improvement in certain outcomes, such as HbA1c, after CT inclusion. CONCLUSIONS According to this study, CT enrolment is associated with better quality of care processes compared to non-CT patients. This improvement was found in several of the data sources used in this study. However, results on outcome parameters remain inconclusive.
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Affiliation(s)
- Viviane F. A. Van Casteren
- />Scientific Institute of Public Health, Operational Direction Public Health and Surveillance, J. Wytsmanstreet 14, 1050 Brussels, Belgium
| | - Nathalie H. E. Bossuyt
- />Scientific Institute of Public Health, Operational Direction Public Health and Surveillance, J. Wytsmanstreet 14, 1050 Brussels, Belgium
| | - Sarah J. S. Moreels
- />Scientific Institute of Public Health, Operational Direction Public Health and Surveillance, J. Wytsmanstreet 14, 1050 Brussels, Belgium
| | - Geert Goderis
- />Katholieke Universiteit Leuven - Academisch Centrum voor Huisartsgeneeskunde, Kapucijnevoer 33 Blok J Bus 7001, 3000 Leuven, Belgium
- />UZ Leuven - MIR (Management Informatie Rapportering, Herestraat 49, 3000 Leuven, Belgium
| | - Katrien Vanthomme
- />Vrije Universiteit Brussel, Demografie, Pleinlaan 2, 1050 Brussel, Belgium
| | - Johan Wens
- />Universiteit Antwerpen, Academisch Centrum voor Huisartsgeneeskunde, Campus 3 Eiken, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Etienne W De Clercq
- />Université Catholique de Louvain, Institut de Recherche Santé et Société, Clos Chapelle aux Champs 30, 1200 Brussels, Belgium
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Saxena N, You AX, Zhu Z, Sun Y, George PP, Teow KL, Chong PN, Sim J, Wong JEL, Ong B, Foo HJ, Soh EF, Tham L, Heng BH, Choo P. Singapore's regional health systems-a data-driven perspective on frequent admitters and cross utilization of healthcare services in three systems. Int J Health Plann Manage 2015; 32:36-49. [DOI: 10.1002/hpm.2300] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Nakul Saxena
- Health Services and Outcomes Research; National Healthcare Group; Singapore
- National Healthcare Group; Singapore
| | - Alex Xiaobin You
- Health Services and Outcomes Research; National Healthcare Group; Singapore
- National Healthcare Group; Singapore
| | - Zhecheng Zhu
- Health Services and Outcomes Research; National Healthcare Group; Singapore
- National Healthcare Group; Singapore
| | - Yan Sun
- Health Services and Outcomes Research; National Healthcare Group; Singapore
- National Healthcare Group; Singapore
| | - Pradeep Paul George
- Health Services and Outcomes Research; National Healthcare Group; Singapore
- National Healthcare Group; Singapore
| | - Kiok Liang Teow
- Health Services and Outcomes Research; National Healthcare Group; Singapore
- National Healthcare Group; Singapore
| | | | - Joe Sim
- National University Health System; Singapore
| | | | | | | | | | | | - Bee Hoon Heng
- Health Services and Outcomes Research; National Healthcare Group; Singapore
- National Healthcare Group; Singapore
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Hamar GB, Rula EY, Coberley C, Pope JE, Larkin S. Long-term impact of a chronic disease management program on hospital utilization and cost in an Australian population with heart disease or diabetes. BMC Health Serv Res 2015; 15:174. [PMID: 25895499 PMCID: PMC4422132 DOI: 10.1186/s12913-015-0834-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 04/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the longitudinal value of a chronic disease management program, My Health Guardian (MHG), in reducing hospital utilization and costs over 4 years. METHODS The MHG program provides individualized support via telephonic nurse outreach and online tools for self-management, behavior change and well-being. In follow up to an initial 18-month analysis of MHG, the current study evaluated program impact over 4 years. A matched-cohort analysis retrospectively compared MHG participants with heart disease or diabetes (treatment, N = 4,948) to non-participants (comparison, N = 28,520) on utilization rates (hospital admission, readmission, total bed days) and hospital claims cost savings. Outcomes were evaluated using regression analyses, controlling for remaining demographic, disease, and pre-program admissions or cost differences between the study groups. RESULTS Over the 4 year period, program participation resulted in significant reductions in hospital admissions (-11.4%, P < 0.0001), readmissions (-36.7%, P < 0.0001), and bed days (-17.2%, P < 0.0001). The effect size increased over time for admissions and bed days. The relative odds of any admission and readmission over the 4 years were 27% and 45% lower, respectively, in the treatment group. Cumulative program savings from reduced hospital claims was $3,549 over 4-years; savings values for each program year were significant and increased with time (P = 0.003 to P < 0.0001). Savings calculations did not adjust for pooled costs (and savings) in Australia's risk equalization system for private insurers. CONCLUSIONS Results confirm and extend prior program outcomes and support the longitudinal value of the MHG program in reducing hospital utilization and costs for individuals with heart disease or diabetes and demonstrate the increasing program effect with continued participation over time.
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Affiliation(s)
- G Brent Hamar
- Healthways Inc, 701 Cool Springs Blvd, Franklin, TN, 37067, USA.
| | - Elizabeth Y Rula
- Healthways Inc, 701 Cool Springs Blvd, Franklin, TN, 37067, USA.
| | - Carter Coberley
- Healthways Inc, 701 Cool Springs Blvd, Franklin, TN, 37067, USA.
| | - James E Pope
- Healthways Inc, 701 Cool Springs Blvd, Franklin, TN, 37067, USA.
| | - Shaun Larkin
- HCF, Level 6, 403 George Street, Sydney, NSW, 2000, Australia.
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Conway R, Byrne D, O'Riordan D, Silke B. Emergency readmissions are substantially determined by acute illness severity and chronic debilitating illness: a single centre cohort study. Eur J Intern Med 2015; 26:12-7. [PMID: 25582075 DOI: 10.1016/j.ejim.2014.12.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 12/12/2014] [Accepted: 12/26/2014] [Indexed: 11/13/2022]
Abstract
BACKGROUND The factors influencing hospital readmissions are debated. We assessed whether readmissions could be predicted using routinely collected hospital data. METHODS All emergency admissions to a single institution over 12years (2002-2013) were included. The predictor variables, of acute illness severity, Manchester Triage Category, chronic disabling disease and Charlson co-morbidity scores, were studied univariably and entered into a multivariable logistic regression model to predict the bivariate of any readmission or none. A zero truncated Poisson regression model assessed the predictors against the readmission count and incidence rate ratios were calculated. Factors reflecting the clinical load on the emergency department were examined. RESULTS 66,933 admissions were recorded in 36,271 patients. The readmission rates at 1, 3, 6 and 9years were 29.5%, 38.9%, 42.9% and 44.1%. Early readmissions represented 14.1%. In the multivariable model, an admission in the previous 6months was the strongest predictor of readmission, OR of 5.02 (95% CI: 4.86, 5.18). Acute illness severity - OR of 2.68 (95% CI: 2.33, 3.09) for group VI vs group I, and chronic disabling score - OR of 2.08 (95% CI: 1.87, 2.32) for a score of 4+ vs 0 were significant predictors of readmission in the multivariable model. Both of these predictors demonstrated a linear relationship. Illness severity was the strongest predictor of an early readmission within 4weeks. CONCLUSION Readmissions increase as a function of time; illness severity, chronic disabling disease score and a recent admission are the strongest predictors of readmission.
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Affiliation(s)
- Richard Conway
- Department of Internal Medicine, St. James's Hospital, Dublin 8, Ireland
| | - Declan Byrne
- Department of Internal Medicine, St. James's Hospital, Dublin 8, Ireland
| | - Deirdre O'Riordan
- Department of Internal Medicine, St. James's Hospital, Dublin 8, Ireland
| | - Bernard Silke
- Department of Internal Medicine, St. James's Hospital, Dublin 8, Ireland.
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Jaglal SB, Guilcher SJT, Hawker G, Lou W, Salbach NM, Manno M, Zwarenstein M. Impact of a chronic disease self-management program on health care utilization in rural communities: a retrospective cohort study using linked administrative data. BMC Health Serv Res 2014; 14:198. [PMID: 24885135 PMCID: PMC4036726 DOI: 10.1186/1472-6963-14-198] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 04/14/2014] [Indexed: 11/22/2022] Open
Abstract
Background Internationally, chronic disease self-management programs (CDSMPs) have been widely promoted with the assumption that confident, knowledgeable patients practicing self-management behavior will experience improved health and utilize fewer healthcare resources. However, there is a paucity of published data supporting this claim and the majority of the evidence is based on self-report. Methods We used a retrospective cohort study using linked administrative health data. Data from 104 tele-CDSMP participants from 13 rural and remote communities in the province of Ontario, Canada were linked to administrative databases containing emergency department (ED) and physician visits and hospitalizations. Patterns of health care utilization prior to and after participation in the tele-CDSMP were compared. Poisson Generalized Estimating Equations regression was used to examine the impact of the tele-CDSMP on health care utilization after adjusting for covariates. Results There were no differences in patterns of health care utilization before and after participating in the tele-CDSMP. Among participants ≤ 66 years, however, there was a 34% increase in physician visits in the 12 months following the program (OR = 1.34, 95% CI 1.11-1.61) and a trend for decreased ED visits in those >66 years (OR = 0.59, 95% CI 0.33-1.06). Conclusions This is the first study to examine health care use following participation in the CDSMP in a Canadian population and to use administrative data to measure health care utilization. Similar to other studies that used self-report measures to evaluate health care use we found no differences in health care utilization before and after participation in the CDSMP. Future research needs to confirm our findings and examine the impact of the CDSMP on health care utilization in different age groups to help to determine whether these interventions are more effective with select population groups.
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Affiliation(s)
- Susan B Jaglal
- Women's College Research Institute, Toronto, Ontario, Canada.
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Nseir W, Haj S, Beshara B, Mograbi J, Cohen O. Seeking out high risk population: the prevalence characteristics and outcome of diabetic patients of arab ethnicity hospitalized in internal medical and acute coronary units in Israel. Int J Endocrinol 2013; 2013:371608. [PMID: 23861680 PMCID: PMC3703333 DOI: 10.1155/2013/371608] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 05/25/2013] [Accepted: 05/26/2013] [Indexed: 11/17/2022] Open
Abstract
Aims. To seek high risk population for diabetes and to improve their health care by investigating the characteristics and outcome of hospitalization in hospitals with predominant Arab patients in Northern Israel. Methods. Retrospective analysis of the prevalence of diabetes and the outcome of diabetic in comparison to nondiabetic patients hospitalized in the internal medicine and intensive cardiac units in two major hospitals with one-year postdischarge data between 1.1.2009 and 31.12.2009. Results. Thirty-nine percent of the patients were diagnosed with diabetes. The preponderance of women in the diabetes group was noted. Diabetic patients had an increase in the duration of hospitalization (P = 0.0008), with one hospital having a high readmission rate for the diabetic patients. The average glycemia during hospitalization exceeded the recommended threshold of 180 mg% without major changes in the therapeutic regimens in comparison to preadmission regimens. Conclusions. Arab populations, women in particular, in westernizing societies are at high risk for diabetes which exemplifies as high rate of patients with diabetes among hospitalized patients. Areas for intervention during hospitalization and at predischarge have been identified to improve health outcomes and prevent readmissions.
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Affiliation(s)
| | - Shehadeh Haj
- The Medical Department, Nazareth Hospital, EMMS, Nazareth, Israel
| | - Basma Beshara
- The Medical Department, Nazareth Hospital, EMMS, Nazareth, Israel
| | | | - Ohad Cohen
- Sackler School of Medicine, Tel Aviv University, Israel
- *Ohad Cohen:
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