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Drew KJ, Homer C, Radley D, Jones S, Freeman C, Bakhai C, Ells L. Normalisation and equity of referral to the NHS Low Calorie Diet programme pilot; a qualitative evaluation of the experiences of health care staff. BMC Public Health 2024; 24:152. [PMID: 38200463 PMCID: PMC10782747 DOI: 10.1186/s12889-023-17526-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Health and wellbeing can be profoundly impacted by both obesity and type 2 diabetes, while the normalisation and equity of care for people living with these non-communicable diseases remain as challenges for local health systems. The National Health Service Low Calorie Diet programme in England, aims to support people to achieve type 2 diabetes remission, while also reducing health inequalities. We have explored the experiences of health care staff who have made a referral to the LCD programme, while identifying effective and equitable delivery of programme referrals, and their normalisation into routine care. METHODS Nineteen individual semi-structured interviews were completed health care staff in the first year of the Low Calorie Diet programme. Interviewees were purposively sampled from the ten localities who undertook the Low Calorie Diet programme pilot. Each interview explored a number of topics of interest including communication and training, referrals, equity, and demands on primary care, before being subjected to a thematic analysis. RESULTS From the data, five core themes were identified: Covid-19 and the demands on primary care, the expertise and knowledge of referrers, patient identification and the referral process, barriers to referrals and who gets referred to the NHS LCD programme. Our findings demonstrate the variation in the real world settings of a national diabetes programme. It highlights the challenge of COVID-19 for health care staff, whereby the increased workload of referrals occurred at a time when capacity was curtailed. We have also identified several barriers to referral and have shown that referrals had not yet been normalised into routine care at the point of data collection. We also raise issues of equity in the referral process, as not all eligible people are informed about the programme. CONCLUSIONS Referral generation had not yet been consistently normalised into routine care, yet our findings suggest that the LCD programme runs the risk of normalising an inequitable referral process. Inequalities remain a significant challenge, and the adoption of an equitable referral process, normalised at a service delivery level, has the capacity to contribute to the improvement of health inequalities.
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Affiliation(s)
- Kevin J Drew
- Obesity Institute, School of Health, Leeds Beckett University, City Campus, Leeds, LS6 3QW, UK.
| | - Catherine Homer
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Olympic Legacy Park, 2 Old Hall Road, Sheffield, S9 3TU, UK
| | - Duncan Radley
- Obesity Institute, School of Sport, Leeds Beckett University, Headingley Campus, Leeds, LS6 3QW, UK
| | - Susan Jones
- School of Health and Life Sciences, Teesside University, Middlesbrough, Tees Valley, TS1 3BX, UK
| | - Charlotte Freeman
- Public Health Calderdale Metropolitan Borough Council, Halifax, HX1 1TS, UK
| | - Chirag Bakhai
- Larkside Practice, Churchfield Medical Centre, 322 Crawley Green Road, Luton, Bedfordshire, LU2 9SB, UK
| | - Louisa Ells
- Obesity Institute, School of Health, Leeds Beckett University, City Campus, Leeds, LS6 3QW, UK
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Abd Jamil J, Myers EF, Swee WCS. Defining the Practice of Dietitians in Malaysia Using the Nutrition Care Process in Patients with Type 2 Diabetes Mellitus. Dietetics 2022; 1:203-215. [DOI: 10.3390/dietetics1030018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
(1) Background: The quality of dietetic care is crucial to improve patient outcomes. The aim of this study was to measure the current practices regarding the provision of nutrition care in type 2 diabetes mellitus (T2DM) among dietitians in Malaysia. (2) Methods: A 49-item online survey was distributed via Malaysian Dietitians’ Association and Ministry of Health Malaysia social media platforms. Self-reported dietetic practices in the management of T2DM were evaluated against practice guidelines. (3) Results: A total of 173 dietitians completed the survey, with a response rate of 62%. Three-quarters of dietitians in the public sector consulted patients within two to three weeks or more than four weeks versus less than two weeks (86.3%) among private dietitians (p-value < 0.001). More than 95% of private dietitians spent 31–60 min or more than 60 min on new cases versus 71% among public dietitians (p-value < 0.001). Group counseling was only practiced among public dietitians (36.0%). Different practice settings led to the current findings. A limited use of behavioral counseling theories and strategies was observed among dietitians from both sectors. Limited adherence to nutrition-related recommendations (62.8%) and lack of readiness for diet/lifestyle changes (45.5%) were the key challenges faced by dietitians when managing T2DM. (4) Conclusions: The survey indicates that there is a need for the development of comprehensive training to increase the utilization of behavioral counselling. Practice setting is an element to consider when designing training.
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Piya MK, Fletcher T, Myint KP, Zarora R, Yu D, Simmons D. The impact of nursing staff education on diabetes inpatient glucose management: a pilot cluster randomised controlled trial. BMC Endocr Disord 2022; 22:61. [PMID: 35272649 PMCID: PMC8911103 DOI: 10.1186/s12902-022-00975-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 03/01/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND An increasing number of patients in hospital have diabetes, with most of them cared for by non-specialist staff. The effect of diabetes education for staff on patient outcomes, as well as the most effective method of staff education is unclear. Therefore, the aim of this study was to compare diabetes outcomes in medical wards where nursing staff were offered one face-to-face (F2F) session followed by access to online education (online), F2F education only, or standard care (control). METHODS We conducted a pilot cluster randomised controlled trial involving 16-weeks baseline/rollout followed by a 28-week post-intervention period across three medical wards (clusters) in a Sydney Teaching Hospital. The online ward provided an online competency-based diabetes education program and 1-h F2F teaching from a diabetes nurse educator (DNE), the F2F ward provided four separate 1-h teaching sessions by a DNE, with no additional sessions in the control ward. The primary outcome was length of stay (LOS); secondary outcomes included good diabetes days (GDD), hypoglycaemia and medication errors. Poisson and binary logistic regression were used to compare clusters. RESULTS Staff attendance/completion of ≥ 2 topics was greater with online than F2F education [39/48 (81%) vs 10/33 (30%); p < 0.001]. Among the 827/881 patients, there was no difference in LOS change between online [Median(IQR) 5(2-8) to 4(2-7) days], F2F [7(4-14) to 5(3-13) days] or control wards [5(3-9) to 5(3-7) days]. GDD improved only in the online ward 4.7(2.7-7.0) to 6.0(2.3-7.0) days; p = 0.038. Total patients with hypoglycaemia and appropriately treated hypoglycaemia increased in the online ward. CONCLUSIONS The inclusion of online education increased diabetes training uptake among nursing staff. GDD and appropriate hypoglycaemia management increased in the online education wards. TRIAL REGISTRATION Prospectively registered on the Australia New Zealand Clinical Trials Registry (ANZCTR) on 24/05/2017: ACTRN12617000762358 .
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Affiliation(s)
- Milan K Piya
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia.
- Macarthur Diabetes Endocrinology and Metabolism Service, Camden and Campbelltown Hospitals, Campbelltown, NSW, Australia.
| | - Therese Fletcher
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Macarthur Diabetes Endocrinology and Metabolism Service, Camden and Campbelltown Hospitals, Campbelltown, NSW, Australia
| | - Kyaw P Myint
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Reetu Zarora
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Dahai Yu
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK
| | - David Simmons
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Macarthur Diabetes Endocrinology and Metabolism Service, Camden and Campbelltown Hospitals, Campbelltown, NSW, Australia
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Murfet G, Ostaszkiewicz J, Rasmussen B. Diabetes Capabilities for the Healthcare Workforce Identified via a 3-Staged Modified Delphi Technique. IJERPH 2022; 19:1012. [PMID: 35055832 PMCID: PMC8775604 DOI: 10.3390/ijerph19021012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/14/2022] [Accepted: 01/15/2022] [Indexed: 11/29/2022]
Abstract
Consumers access health professionals with varying levels of diabetes-specific knowledge and training, often resulting in conflicting advice. Conflicting health messages lead to consumer disengagement. The study aimed to identify capabilities required by health professionals to deliver diabetes education and care to develop a national consensus capability-based framework to guide their training. A 3-staged modified Delphi technique was used to gain agreement from a purposefully recruited panel of Australian diabetes experts from various disciplines and work settings. The Delphi technique consisted of (Stage I) a semi-structured consultation group and pre-Delphi pilot, (Stage II) a 2-phased online Delphi survey, and (Stage III) a semi-structured focus group and appraisal by health professional regulatory and training organisations. Descriptive statistics and central tendency measures calculated determined quantitative data characteristics and consensus. Content analysis using emergent coding was used for qualitative content. Eighty-four diabetes experts were recruited from nursing and midwifery (n = 60 [71%]), allied health (n = 17 [20%]), and pharmacy (n = 7 [9%]) disciplines. Participant responses identified 7 health professional practice levels requiring differences in diabetes training, 9 capability areas to support care, and 2 to 16 statements attained consensus for each capability-259 in total. Additionally, workforce solutions were identified to expand capacity for diabetes care. The rigorous consultation process led to the design and validation of a Capability Framework for Diabetes Care that addresses workforce enablers identified by the Australian National Diabetes Strategy. It recognises diversity, creating shared understandings of diabetes across health professional disciplines. The findings will inform diabetes policy, practice, education, and research.
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Affiliation(s)
- Giuliana Murfet
- School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
- Diabetes Centre, Tasmanian Health Service, Burnie, TAS 7250, Australia
- School of Public Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW 2007, Australia
| | - Joan Ostaszkiewicz
- National Aging Research Institute, Royal Melbourne Hospital, Parkville, VIC 3050, Australia
| | - Bodil Rasmussen
- School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
- Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, 1 Geringhap Street, Geelong, VIC 3220, Australia
- Western Health Partnership, 176 Furlong Road, St Albans, VIC 3021, Australia
- Department of Public Health, University of Copenhagen, Nørregade 10, DK-1017 Copenhagen, Denmark
- Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, DK-5230 Odense, Denmark
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Garsia K, MacMillan F, Dune T, Simmons D. The role of the pharmacist in contraception and pre-pregnancy management for women with diabetes: a study of patient and pharmacist perspectives. Journal of Pharmaceutical Health Services Research 2021. [DOI: 10.1093/jphsr/rmab019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Objectives
Women with diabetes are at increased risk of adverse pregnancy outcomes compared to women with gestational diabetes (GDM) or no diabetes. Pregnancy outcomes are improved by specialist pre-pregnancy care. We aimed to explore pharmacists’ and women with diabetes’ perceptions of the roles and barriers to pharmacist participation in a diabetes contraception and pre-pregnancy program in South-Western Sydney (SWS).
Methods
The Diabetes Contraception and Pre-pregnancy Program (DCAPP) aims to reduce adverse pregnancy outcomes among women with diabetes. This includes awareness raising among, and through, pharmacists. Surveys to explore pharmacists’ roles in contraception and pre-pregnancy management (CPPM) were completed by SWS pharmacists and women with diabetes from diabetes clinics aged 18–50 years. Survey themes were then discussed in interviews and focus groups with pharmacists across Australia. Thematic analysis of transcripts was undertaken.
Key findings
Pharmacists were seen to have a role in diabetes health promotion, information distribution and referral to pre-pregnancy clinics. Pharmacists and women recognised the need for increased knowledge and educational materials about CPPM and effective awareness and coordination of CPPM services. Some pharmacists recognised deficits in their knowledge regarding diabetes in pregnancy, including CPPM and differences to GDM. Barriers to pharmacists’ involvement in CPPM included difficulty identifying applicable women and reluctance to initiate pregnancy planning and contraception conversations, often due to language and cultural barriers.
Conclusions
Pharmacists and women with diabetes see an important role for pharmacists in CPPM. Co-designed diabetes training for pharmacists and increased communication about DCAPP were seen important for ongoing implementation.
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Affiliation(s)
- Kathryn Garsia
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Freya MacMillan
- School of Health Sciences & Diabetes Obesity and Metabolism Translation Unit, Western Sydney University, Campbelltown, NSW, Australia
- Diabetes Obesity and Metabolism Translational Research Unit, Western Sydney University, Campbelltown, NSW, Australia
| | - Tinashe Dune
- School of Health Sciences & Diabetes Obesity and Metabolism Translation Unit, Western Sydney University, Campbelltown, NSW, Australia
- Diabetes Obesity and Metabolism Translational Research Unit, Western Sydney University, Campbelltown, NSW, Australia
| | - David Simmons
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Diabetes Obesity and Metabolism Translational Research Unit, Western Sydney University, Campbelltown, NSW, Australia
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Zarora R, Jani R, MacMillan F, Pham A, Dench A, Simmons D. Challenges to Introducing Integrated Diabetes Care to an Inner-Regional Area in South Western Sydney, Australia. Int J Integr Care 2020; 20:6. [PMID: 32405283 DOI: 10.5334/ijic.4692] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction Diabetes care often requires collaboration between general practitioners, allied health professionals, nurses, and/or medical specialists. This study aimed to describe the establishment of an integrated diabetes prevention and care approach in an area with limited access to primary and secondary care, and the challenges faced in its initial development. Description A qualitative research approach to identify challenges was taken. Data included meeting minutes, observational data and reports involving local clinical and non-clinical stakeholders from June 2016- December 2018 and were thematically analysed. Discussion Key challenges were low patient attendance in general practice, healthcare professional time, low participation at health promotion activities/peer support groups and diabetes education reflecting a low priority among people with and at risk of diabetes. Coordination between services remained a challenge. Conclusion This study highlights the need to integrate new diabetes services with existing health activities in the community and the importance of allowing flexibility and regular contact with local healthcare professional and community to encourage their involvement. Regular meetings with the funders, internal and external stakeholders are key for sustainability and to adapt programmes to the local situation. Further work is needed to identify and implement strategies to overcome these challenges.
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Abstract
This paper presents a service evaluation on the role of Community Diabetes Nurse Specialists (CDNS), which was undertaken as a response to various changes. Quantitative and qualitative data were captured over 6 months. It was found that GPs refer patients to CDNSs four times more frequently than other health professionals. The clinical care of CDNSs mainly relates to diabetes education, insulin, assessment and self-management. Telehealth is used twice as frequently as face-to-face communications. The CDNSs do not refer patients onto other health professionals, but have multiple communications with other health professionals and agencies. They manage very complex clinical and social situations, using high-level clinical decision making and balancing person-centred care and patient safety. Structured patient education is being delivered. CDNSs mentor other staff and students, although their own formal professional development is very limited. To conclude, CDNSs are the end point for patient care in the community, managing complex patient situations, while adopting a person-centred approach.
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Affiliation(s)
- Joan McDowell
- Honorary Senior Research Fellow, University of Glasgow
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Abstract
AIMS Diabetes educators (DEs) play a major role in diabetes education and management. The aims of this scoping review were to compile the currently identified core competencies for DEs and, to review the currently used criteria to assess DEs' core competencies. METHODS A scoping review was conducted using the methodology of the Joanna Briggs Institute. Five databases (Ovid, CINAHL, Scopus, Web of Science and PubMed) were searched. Keywords as well as inclusion and exclusion criteria were identified as search strategies and study selection for this review. RESULTS A total of (n = 22) publications comprising sixteen peer-reviewed studies and six professional-organisations (grey literature) were selected for review, as they listed the core competencies of DEs. The most common core competencies were related to knowledge and skills in diabetes self-management education, knowledge of pathophysiology and epidemiology, teaching skills, clinical skills and cultural competency. Evidently, an appropriate tool for assessing DEs' competencies is currently unavailable. CONCLUSIONS Given the importance of diabetes education in the care of people living with diabetes, it is imperative that DEs possess competencies in diabetes education and management. The review also identified the need to develop a globally applicable core competency assessment tool for DEs.
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Affiliation(s)
- Talal Alharbi
- School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia; University Diabetes Centre, King Saud University, Saudi Arabia.
| | - Nikos Thomacos
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - Gayle McLelland
- School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
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Abstract
Insulin is one of the top ten high-alert medications worldwide. Approximately 30% of people with diabetes in the UK use injectable therapies, most commonly insulin, to manage their condition. With an increasing number of people with diabetes being managed within the community, district nurses play an important role in the safe and effective use of insulin. This study surveyed a convenience sample of 164 district nurses working within one Health and Social Care Trust in Northern Ireland to ascertain their knowledge and practice regarding insulin. Study response rate was 38% (n=63). It was found that district nurses' knowledge and practice relating to insulin therapy was lacking as indicated by a total mean score of 53.1%. Total knowledge scores were slightly higher (58%) than total practice scores (46%). Nevertheless, 79.4% of district nurses felt secure and 6.3% felt very secure in managing diabetes. Deficits in district nurses' knowledge and practice were identified in areas relating to insulin action, dosage, storage, injection site technique and rotation, hypoglycaemic/hyperglycaemic management, pharmacological action and prescription format. These deficits highlight the need for workplacebased learning and development programmes, incorporating real time, point of care interventions, to enhance and maintain district nurses' insulin knowledge and practice.
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Affiliation(s)
- Alison Robb
- District Nurse, Western Health and Social Care Trust
| | - Bernie Reid
- Lecturer in Nursing, School of Nursing, Ulster University
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