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Cooper ZW, O'Shields J, Ali MK, Chwastiak L, Johnson LCM. Effects of Integrated Care Approaches to Address Co-occurring Depression and Diabetes: A Systematic Review and Meta-analysis. Diabetes Care 2024; 47:2291-2304. [PMID: 39602589 DOI: 10.2337/dc24-1334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Accepted: 09/12/2024] [Indexed: 11/29/2024]
Abstract
BACKGROUND Depressive symptoms frequently co-occur with diabetes and, when unaddressed, can function to worsen diabetes control and increase the risk of diabetes-related morbidity. Integrated care (IC) approaches aim to improve outcomes among people with diabetes and depression, but there are no current meta-analyses examining their effects. PURPOSE In our study we summarize the effects of IC approaches to address depression and diabetes and examine moderating effects of IC approaches (e.g., behavioral intervention used; type of IC approach). DATA SOURCES A systematic search was conducted of PubMed, PsycInfo, CINAHL, and ProQuest. STUDY SELECTION Two reviewers triaged abstracts and full-text articles to identify relevant articles. Randomized controlled trials with enrollment of participants with diabetes and depressive symptoms and with provision of sufficient data on depression scores and hemoglobin A1c were included. DATA EXTRACTION Two reviewers extracted demographic information, depression scores, diabetes outcomes, intervention details, and the risk of bias for each study. DATA SYNTHESIS From 517 abstracts, 75 full-text reports were reviewed and 31 studies with 8,843 participants were analyzed. Among 26 studies with reporting of HbA1c, IC approaches were associated with a significant between-group difference regarding the percent decrease of HbA1c (d = -0.36, 95% CI -0.52 to -0.21). Studies that included a combination of behavioral interventions (behavioral activation with cognitive behavioral therapy) showed greater reductions in HbA1c. Among 23 studies with reporting of depressive symptoms, the pooled effect of IC approaches lowered depressive scores by 0.72 points (95% CI -1.15 to -0.28). LIMITATIONS The inclusion of a wide range of IC approaches increased study heterogeneity. A random effects model and sensitivity analyses mitigated this limitation. CONCLUSIONS IC approaches are associated with improved glycemia and depressive symptoms in comparison with treatment as usual.
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Affiliation(s)
- Zach W Cooper
- University of Georgia School of Social Work, Athens, GA
| | - Jay O'Shields
- University of Georgia School of Social Work, Athens, GA
| | - Mohammed K Ali
- Department of Family and Preventative Medicine, School of Medicine, Emory University, Atlanta, GA
- Emory Global Diabetes Research Center, Robert W. Woodruff Health Sciences Center, Atlanta, GA
| | - Lydia Chwastiak
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Leslie C M Johnson
- Department of Family and Preventative Medicine, School of Medicine, Emory University, Atlanta, GA
- Emory Global Diabetes Research Center, Robert W. Woodruff Health Sciences Center, Atlanta, GA
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King T, Shafran R, Hargreaves DS, Muschialli L, Linton D, Bennett S. Mental health clinical pathways for children and young people with long-term health conditions: A systematic review. J Eval Clin Pract 2024; 30:894-908. [PMID: 38963879 DOI: 10.1111/jep.14018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 03/14/2024] [Indexed: 07/06/2024]
Abstract
RATIONALE Clinical pathways (CPWs) are structured care plans that set out essential steps in the care of patients with a specific clinical problem. Amidst calls for the prioritisation of integrated mental and physical health care for young people, multidisciplinary CPWs have been proposed as a step towards closer integration. There is very limited evidence around CPWs for young people with mental and physical health needs, necessitating a review of the literature. AIMS AND OBJECTIVES The aim of this review is to understand how clinical pathways have been used to deliver mental health support to children and young people with long-term physical health conditions and their effectiveness across a range of outcomes. METHODS The databases MEDLINE, CENTRAL, PsycINFO and CINAHL were searched from inception to 6 September 2023. Keywords linked to children and young people, mental health, long-term physical health conditions and CPWs were used. Studies using either quantitative or qualitative research designs were included. All studies must have evaluated a CPW to provide mental health support to children and young people (up to 25 years old) with long-term health physical conditions. Both mental and physical health outcomes were considered. Pathways were grouped by integration 'model' as described in the wider literature. RESULTS The initial search returned 4082 studies after deduplication. A total of eight studies detailing six distinct care pathways (232 participants [170 children and young people; 50 caregivers; 12 healthcare professionals]) met eligibility criteria and were included in the analysis. Four pathways were conducted within an 'integrated model'; two were a combination of 'integrated' and 'colocated'; and none within a 'co-ordinated model'. Only pathways within an integrated model reported quantitative health outcomes, with improvements across a range of mental health measures. One negative physical health outcome was reported from an integrated diabetes pathway, but this should be interpreted with caution. CONCLUSION This review identified a range of CPW designs but most fell under an integrated model. The results suggest that calls for integrated mental health pathways in this population may be appropriate; however, conclusions are limited by a paucity of evidence.
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Affiliation(s)
- Thomas King
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Dougal S Hargreaves
- Houston Reader in Paediatrics and Population Health, Mohn Centre for Children's Health and Wellbeing, School of Public Health, Imperial College London, London, UK
| | | | - Daniela Linton
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Sophie Bennett
- UCL Great Ormond Street Institute of Child Health, London, UK
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Ciardullo S, Morieri ML, Daniele G, Fiorentino TV, Mezza T, Tricò D, Consoli A, Del Prato S, Giorgino F, Piro S, Solini A, Avogaro A. GLP1-GIP receptor co-agonists: a promising evolution in the treatment of type 2 diabetes. Acta Diabetol 2024; 61:941-950. [PMID: 38831203 PMCID: PMC11329401 DOI: 10.1007/s00592-024-02300-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/04/2024] [Indexed: 06/05/2024]
Abstract
Type 2 diabetes represents a growing challenge for global public health. Its prevalence is increasing worldwide, and, like obesity, it affects progressively younger populations compared to the past, with potentially greater impact on chronic complications. Dual glucagon like peptide 1 (GLP1) and glucose-dependent insulinotropic peptide (GIP) receptor agonists are among the new pharmacological strategies recently developed to address this challenge. Tirzepatide, characterized by its ability to selectively bind and activate receptors for the intestinal hormones GIP and GLP-1, has been tested in numerous clinical studies and is already currently authorized in several countries for the treatment of type 2 diabetes and obesity. In this context, the aim of the present document is to summarize, in the form of a narrative literature review, the currently available data on the main mechanisms of action of GIP/GLP-1 co-agonists and the clinical effects of tirzepatide evaluated in various clinical trials.
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Affiliation(s)
- Stefano Ciardullo
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Milan, Italy.
- Department of Medicine and Rehabilitation, Policlinico di Monza, Via Modigliani 10, 20900, Monza, Italy.
| | | | - Giuseppe Daniele
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- CISUP, Center for Instrument Sharing, University of Pisa, 56124, Pisa, Italy
| | - Teresa Vanessa Fiorentino
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, 88100, Catanzaro, Italy
| | - Teresa Mezza
- Department of Medicine and Translational Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
- Digestive Disease Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Domenico Tricò
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Agostino Consoli
- Department of Medicine and Aging Sciences, Center for Advanced Studies and Technology (CAST, Ex CeSIMet) G. d'Annunzio University Chieti-Pescara, Chieti, Italy
- Endocrinology and Metabolism Unit, Pescara Health Service, Pescara, Italy
| | | | - Francesco Giorgino
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, 70124, Bari, Italy
| | - Salvatore Piro
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Anna Solini
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Angelo Avogaro
- Unit of Metabolic Disease, University Hospital of Padua, Padua, Italy
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Valentijn PP, Tymchenko L, Gruisen W, Bruls B, Abdalla Pereira F, Arends RY. Effectiveness of Integrated Care for Diabetes Mellitus Type 2, Cardiovascular and Chronic Respiratory Diseases: A Systematic Review and Meta-Analysis. Int J Integr Care 2024; 24:16. [PMID: 39184531 PMCID: PMC11342834 DOI: 10.5334/ijic.7744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 08/01/2024] [Indexed: 08/27/2024] Open
Abstract
Introduction In this paper, we use the Rainbow Model of Integrated Care (RMIC) framework to evaluate the effectiveness of integrated care in terms of enhancing the outcomes of chronic conditions such as diabetes mellitus type 2 (DMT2), cardiovascular diseases (CVD), chronic respiratory diseases (CRD), or their combinations. Methods The data extracted from randomized controlled trials (RCT) of integrated care interventions for DMT2, CVD, and CRD (follow-up ≥ 3 months) in 11 databases were analysed using random-effects meta-analysis. Results A total of 54 eligible studies covering 12,976 participants, with a mean follow-up of 54 weeks, were included. In moderate-quality evidence, integrated care interventions reduced mortality for CVD, adverse events for CVD and DMT2, and improved quality of life for CVD and DMT2, physical and mental functioning, self-management, and blood pressure control. Conclusion Integrated care can reduce all-cause mortality, adverse events, and improve quality of life, physical and mental functioning, self-management and blood pressure control in chronic disease patients. However, available evidence for some outcomes (e.g., all-cause hospital admissions) remains uncertain.
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Affiliation(s)
- Pim P. Valentijn
- Essenburgh Research & Consultancy, Essenburgh Group, Harderwijk, the Netherlands
- Research Group Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands
| | - Liza Tymchenko
- Essenburgh Research & Consultancy, Essenburgh Group, Harderwijk, the Netherlands
| | - Wiro Gruisen
- Healthcare Division, CZ Health Insurance, Tilburg, the Netherlands
| | - Bem Bruls
- Health Centre Hoensbroek North, Hoensbroek, the Netherlands
- General Practitioners Eastern South Limburg, Heerlen, the Netherlands
| | | | - Rosa Y. Arends
- Essenburgh Research & Consultancy, Essenburgh Group, Harderwijk, the Netherlands
- University of Applied Sciences Utrecht, Utrecht, the Netherlands
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Yoon YJ. Depressive symptom trajectory of older adults with diabetes: exploring the role of physical activities using latent growth modeling. Aging Ment Health 2024; 28:1041-1049. [PMID: 38353514 DOI: 10.1080/13607863.2024.2313722] [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: 11/02/2023] [Accepted: 01/25/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVES The literature highlights the role of physical activities in reducing depression, primarily in clinical samples and international longitudinal studies on older adults with diabetes. Based on Andersen's Behavioral Model, this study aims to describe the trajectory of depressive symptoms in this population and examine whether physical activities are associated with this trajectory. METHODS This study used a longitudinal survey design, utilizing three waves of data from the Health and Retirement Study. The respondents were adults aged 50 or older (N = 4,278) with diabetes. After conducting descriptive analyses, latent growth modeling was performed including unconditional and conditional models. RESULTS The overall trajectory of depressive symptoms in adults with diabetes decreased over a 4-year period. Physical activities were significantly associated with the variance in the intercept of the trajectory (p < .05), but not associated with the variance in the slope (p > .05). Additionally, this study identified factors significantly associated with the variance in the intercept (e.g. age, gender, race, marriage, education, income, self-reported health) or the slope (e.g. race, marriage, education, self-reported health) of the depressive symptom trajectory (p < .05). CONCLUSION The findings underscore the importance of implementing targeted interventions to encourage and promote physical activities among older adults with diabetes, recognizing the potential benefits for managing their mental health.
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Affiliation(s)
- Young Ji Yoon
- Department of Social Work, Colorado State University Pueblo, Pueblo, USA
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Lammila-Escalera E, Greenfield G, Pan Z, Nicholls D, Majeed A, Hayhoe B. Interventions to improve medication adherence in adults with mental-physical multimorbidity in primary care: a systematic review. Br J Gen Pract 2024; 74:e442-e448. [PMID: 38429109 PMCID: PMC11181560 DOI: 10.3399/bjgp.2023.0406] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 02/26/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Medication non-adherence is a notable contributor to healthcare inefficiency, resulting in poor medication management, impaired patient outcomes, and ineffective symptom control. AIM To summarise interventions targeting medication adherence for adults with mental-physical multimorbidity in primary healthcare settings. DESIGN AND SETTING A systematic review of the literature - published in any language and with any country of origin - was conducted. METHOD MEDLINE, EMBASE, PsycInfo, Web of Science, Cochrane Library, and the Cumulated Index to Nursing and Allied Health Literature - more commonly known as CINAHL - were searched for relevant studies. Data were extracted and synthesised using narrative synthesis. The Effective Practice and Organisation of Care (EPOC) taxonomy was used to classify intervention types. Risk of bias was assessed using the National Heart, Lung, and Blood Institute's quality assessment tool for controlled intervention studies. RESULTS Eleven studies, representing 2279 patients, were included. All interventions examined were classified into one EPOC domain, namely 'delivery arrangements'. All included studies examined patients who had a physical condition and depression. Seven studies examining interventions focused on coordination of care and management of care processes reported statistically significant improvements in medication adherence that were attributed to the intervention. Four studies considering the use of information and communication technology observed no changes in medication adherence. CONCLUSION Interventions that coordinate and manage healthcare processes may help improve patients' adherence to medication regimes in those with mental-physical multimorbidity. However, it is still necessary to better understand how digital health technology can support patients in following their medication regimes. As the growing challenges of treating multimorbidity are faced, everyone involved in health services - from providers to policymakers - must be receptive to a more integrated approach to healthcare delivery.
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Affiliation(s)
| | | | - Ziyang Pan
- Department of Primary Care and Public Health
| | | | | | - Benedict Hayhoe
- Department of Primary Care and Public Health, Imperial College London, London
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Laursen SH, Giese IE, Udsen FW, Hejlesen OK, Barington PF, Ohrt M, Vestergaard P, Hangaard S. A telemonitoring intervention design for patients with poorly controlled type 2 diabetes: protocol for a feasibility study. Pilot Feasibility Stud 2024; 10:83. [PMID: 38778345 PMCID: PMC11110324 DOI: 10.1186/s40814-024-01509-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Maintaining optimal glycemic control in type 2 diabetes (T2D) is difficult. Telemedicine has the potential to support people with poorly regulated T2D in the achievement of glycemic control, especially if the telemedicine solution includes a telemonitoring component. However, the ideal telemonitoring design for people with T2D remains unclear. Therefore, the aim of this feasibility study is to evaluate the feasibility of two telemonitoring designs for people with non-insulin-dependent T2D with a goal of identifying the optimal telemonitoring intervention for a planned future large-scale randomized controlled trial. METHOD This 3-month randomized feasibility study will be conducted in four municipalities in North Denmark starting in January 2024. There will be 15 participants from each municipality. Two different telemonitoring intervention designs will be tested. One intervention will include self-monitoring of blood glucose (SMBG) combined with sleep and mental health monitoring. The second intervention will include an identical setup but with the addition of blood pressure and activity monitoring. Two municipalities will be allocated to one intervention design, whereas the other two municipalities will be allocated to the second intervention design. Qualitative interviews with participants and clinicians will be conducted to gain insight into their experiences with and acceptance of the intervention designs and trial procedures (e.g., blood sampling and questionnaires). In addition, sources of differences in direct intervention costs between the two alternative interventions will be investigated. DISCUSSION Telemonitoring has the potential to support people with diabetes in achieving glycemic control, but the existing evidence is inconsistent, and thus, the optimal design of interventions remains unclear. The results of this feasibility study are expected to produce relevant information about telemonitoring designs for people with T2D and help guide the design of future studies. A well-tested telemonitoring design is essential to ensure the quality of telemedicine initiatives, with goals of user acceptance and improved patient outcomes. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT06134934 . Registered November 1, 2023. The feasibility trial has been approved (N-20230026) by the North Denmark Region Committee on Health Research Ethics (June 5, 2023).
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Affiliation(s)
- Sisse H Laursen
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark.
- Department of Health Science and Technology, Aalborg University, Gistrup, Denmark.
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark.
| | | | - Flemming W Udsen
- Department of Health Science and Technology, Aalborg University, Gistrup, Denmark
| | - Ole K Hejlesen
- Department of Health Science and Technology, Aalborg University, Gistrup, Denmark
| | - Pernille F Barington
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
| | - Morten Ohrt
- Nord-KAP, The Quality Unit for General Practice in the North Denmark Region, Aalborg, Denmark
| | - Peter Vestergaard
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Stine Hangaard
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
- Department of Health Science and Technology, Aalborg University, Gistrup, Denmark
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Jäger M, Zangger G, Bricca A, Dideriksen M, Smith SM, Midtgaard J, Taylor RS, Skou ST. Mapping interventional components and behavior change techniques used to promote self-management in people with multimorbidity: a scoping review. Health Psychol Rev 2024; 18:165-188. [PMID: 36811829 PMCID: PMC7615688 DOI: 10.1080/17437199.2023.2182813] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/15/2023] [Indexed: 02/24/2023]
Abstract
Ageing populations and improved survival, have contributed to a rise in the number of people living with multimorbidity, raising issues related to polypharmacy, treatment burden, competing priorities and poor coordination of care. Self-management programs are increasingly included as an essential component of interventions to improve outcomes in this population. However, an overview of how interventions supporting self-management in patients with multimorbidity is missing. This scoping review focused on mapping the literature on patient-centered interventions for people living with multimorbidity. We searched several databases, clinical registries, and grey literature for RCTs published between 1990-2019 describing interventions that supported self-management in people with multimorbidity. We included 72 studies that were found to be very heterogeneous when it comes to the population, delivery modes and modalities, intervention elements and facilitators. The results pointed to an extensive use of cognitive behavioral therapy as a basis for interventions, as well as behavior change theories and disease management frameworks. The most coded behavior change techniques stemmed from the categories Social Support, Feedback and monitoring and Goals and Planning. To allow for implementation of effective interventions in clinical practice, improved reporting of intervention mechanisms in RCTs is warranted.
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Affiliation(s)
- Madalina Jäger
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Danish Centre for Motivation and Behaviour Science, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Graziella Zangger
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Alessio Bricca
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Mette Dideriksen
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Susan M. Smith
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Julie Midtgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Centre for Applied Research in Mental Health Care (CARMEN), Mental Health Centre Glostrup, Mental Health Services in the Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark
| | - Rod S. Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, Scotland
| | - Søren T. Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
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El-Tantawy NL, AlZhrany AK, ALZahrani HS, ALZahrani RS, Al Zahrani WK, ALGhamdi AS, Abouhussien RM, Alzahrani HA, Shanawaz MA. The Significance of Disease Knowledge as a Risk Factor for Depression and Anxiety in Diabetic Patients. J Lifestyle Med 2024; 14:38-45. [PMID: 38665322 PMCID: PMC11039438 DOI: 10.15280/jlm.2024.14.1.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/28/2024] [Accepted: 02/22/2024] [Indexed: 04/28/2024] Open
Abstract
Background Diabetes mellitus is a chronic disease that can lead to depression and anxiety disorders if it is not controlled and managed properly. This study aimed to estimate the prevalence of depression and anxiety disorders among diabetic patients and to determine whether patient knowledge is a risk factor. Methods The study included 220 patients with diabetes who attended the Diabetic Care Center. Socio-demographic data on the patients was collected. The Hospital Anxiety and Depression Scale questionnaire was used to assess patients' depression and anxiety levels. The Diabetes Knowledge Test 2 was used to assess the patients' knowledge of diabetes. Results From 220 patients with diabetes, anxiety was detected in 78.2%. From the recordings of these patients with diabetes, it was observed that 32.7%, 29.5%, and 15.9% suffered from mild, moderate, and severe anxiety, respectively. Depression was diagnosed in 170 patients (77.2%), with the majority sowing a moderate degree (32.3%) of depression. Furthermore, 29.5% and 15.5% patients had recorded mild and severe degrees of depression, respectively. Patients' understanding of diabetes was inadequate in this study, with the majority of patients (70.5%) having a low level of overall diabetes knowledge. In terms of general knowledge of diabetes, 64.1% patients had a low knowledge level, whereas 74.5% patients had a low knowledge level related to insulin therapy. Conclusion The patients' diabetes knowledge is significantly correlated with their anxiety and depression symptoms. Patients with diabetes should be regularly screened for anxiety and depression symptoms. Our findings indicate that the educational diabetes program could be a useful intervention for reducing depression and anxiety.
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Affiliation(s)
- Nora Labeeb El-Tantawy
- Department of Public Health, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha, Saudi Arabia
| | - Amirah Kodran AlZhrany
- Department of Public Health, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha, Saudi Arabia
| | - Hibah Saeed ALZahrani
- Department of Public Health, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha, Saudi Arabia
| | - Rimas Saeed ALZahrani
- Department of Public Health, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha, Saudi Arabia
| | - Waad Khader Al Zahrani
- Department of Public Health, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha, Saudi Arabia
| | | | - Rabab Morsy Abouhussien
- Department of Public Health, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha, Saudi Arabia
| | - Hind Ali Alzahrani
- Department of Basic Sciences, Faculty of Applied of Medical Sciences, Al-Baha University, Al-Baha, Saudi Arabia
| | - Mohammed Adel Shanawaz
- Department of Public Health, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha, Saudi Arabia
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Littenberg B, Clifton J, Crocker AM, Baldwin LM, Bonnell LN, Breshears RE, Callas P, Chakravarti P, Clark/Keefe K, Cohen DJ, deGruy FV, Eidt-Pearson L, Elder W, Fox C, Frisbie S, Hekman K, Hitt J, Jewiss J, Kaelber DC, Kelley KS, Kessler R, O'Rourke-Lavoie JB, Leibowitz GS, Macchi CR, Martin MP, McGovern M, Mollis B, Mullin D, Nagykaldi Z, Natkin LW, Pace W, Pinckney RG, Pomeroy D, Reynolds P, Rose GL, Scholle SH, Sieber WJ, Soucie J, Stancin T, Stange KC, Stephens KA, Teng K, Waddell EN, van Eeghen C. A Cluster Randomized Trial of Primary Care Practice Redesign to Integrate Behavioral Health for Those Who Need It Most: Patients With Multiple Chronic Conditions. Ann Fam Med 2023; 21:483-495. [PMID: 38012036 PMCID: PMC10681692 DOI: 10.1370/afm.3027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/05/2023] [Accepted: 05/31/2023] [Indexed: 11/29/2023] Open
Abstract
PURPOSE Patient outcomes can improve when primary care and behavioral health providers use a collaborative system of care, but integrating these services is difficult. We tested the effectiveness of a practice intervention for improving patient outcomes by enhancing integrated behavioral health (IBH) activities. METHODS We conducted a pragmatic, cluster randomized controlled trial. The intervention combined practice redesign, quality improvement coaching, provider and staff education, and collaborative learning. At baseline and 2 years, staff at 42 primary care practices completed the Practice Integration Profile (PIP) as a measure of IBH. Adult patients with multiple chronic medical and behavioral conditions completed the Patient-Reported Outcomes Measurement Information System (PROMIS-29) survey. Primary outcomes were the change in 8 PROMIS-29 domain scores. Secondary outcomes included change in level of integration. RESULTS Intervention assignment had no effect on change in outcomes reported by 2,426 patients who completed both baseline and 2-year surveys. Practices assigned to the intervention improved PIP workflow scores but not PIP total scores. Baseline PIP total score was significantly associated with patient-reported function, independent of intervention. Active practices that completed intervention workbooks (n = 13) improved patient-reported outcomes and practice integration (P ≤ .05) compared with other active practices (n = 7). CONCLUSION Intervention assignment had no effect on change in patient outcomes; however, we did observe improved patient outcomes among practices that entered the study with greater IBH. We also observed more improvement of integration and patient outcomes among active practices that completed the intervention compared to active practices that did not. Additional research is needed to understand how implementation efforts to enhance IBH can best reach patients.
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Affiliation(s)
- Benjamin Littenberg
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.);
| | - Jessica Clifton
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
- Parhelia Wellness, Santa Rosa, California (J.C.)
| | - Abigail M Crocker
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | - Laura-Mae Baldwin
- University of Washington, Seattle, Washington (L-M.B., B.M., K.A.S.)
| | - Levi N Bonnell
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | | | - Peter Callas
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | | | - Kelly Clark/Keefe
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | - Deborah J Cohen
- Oregon Health & Science University, Portland, Oregon (D.J.C., E.N.W.)
| | - Frank V deGruy
- University of Colorado School of Medicine, Aurora, Colorado (F.V.D., R.K.)
| | | | | | - Chester Fox
- University at Buffalo, Buffalo, New York (C.F.)
| | - Sylvie Frisbie
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | - Katie Hekman
- University of California San Diego, San Diego, California (K.H., W.J.S.)
| | - Juvena Hitt
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | - Jennifer Jewiss
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | - David C Kaelber
- The MetroHealth System, Cleveland, Ohio (D.C.K., T.S., K.T.)
- Case Western Reserve University, Cleveland, Ohio (D.C.K., K.C.S.)
| | - Kairn Stetler Kelley
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | - Rodger Kessler
- University of Colorado School of Medicine, Aurora, Colorado (F.V.D., R.K.)
| | - Jennifer B O'Rourke-Lavoie
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | | | - C R Macchi
- Arizona State University, Tempe, Arizona (C.R.M., M.P.M.)
| | | | - Mark McGovern
- Stanford University School of Medicine, Stanford, California (M.M.)
| | - Brenda Mollis
- University of Washington, Seattle, Washington (L-M.B., B.M., K.A.S.)
| | - Daniel Mullin
- UMass Chan Medical School, Worcester, Massachusetts (L.E-P., D.M.)
| | - Zsolt Nagykaldi
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma (Z.N.)
| | - Lisa W Natkin
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | | | - Richard G Pinckney
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | - Douglas Pomeroy
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | - Paula Reynolds
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | - Gail L Rose
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | | | - William J Sieber
- University of California San Diego, San Diego, California (K.H., W.J.S.)
| | - Jeni Soucie
- National Committee for Quality Assurance, Washington, DC (S.H.S., J.S.)
| | - Terry Stancin
- The MetroHealth System, Cleveland, Ohio (D.C.K., T.S., K.T.)
| | - Kurt C Stange
- Case Western Reserve University, Cleveland, Ohio (D.C.K., K.C.S.)
| | - Kari A Stephens
- University of Washington, Seattle, Washington (L-M.B., B.M., K.A.S.)
| | - Kathryn Teng
- The MetroHealth System, Cleveland, Ohio (D.C.K., T.S., K.T.)
| | | | - Constance van Eeghen
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
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11
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Konnyu KJ, Yogasingam S, Lépine J, Sullivan K, Alabousi M, Edwards A, Hillmer M, Karunananthan S, Lavis JN, Linklater S, Manns BJ, Moher D, Mortazhejri S, Nazarali S, Paprica PA, Ramsay T, Ryan PM, Sargious P, Shojania KG, Straus SE, Tonelli M, Tricco A, Vachon B, Yu CH, Zahradnik M, Trikalinos TA, Grimshaw JM, Ivers N. Quality improvement strategies for diabetes care: Effects on outcomes for adults living with diabetes. Cochrane Database Syst Rev 2023; 5:CD014513. [PMID: 37254718 PMCID: PMC10233616 DOI: 10.1002/14651858.cd014513] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND There is a large body of evidence evaluating quality improvement (QI) programmes to improve care for adults living with diabetes. These programmes are often comprised of multiple QI strategies, which may be implemented in various combinations. Decision-makers planning to implement or evaluate a new QI programme, or both, need reliable evidence on the relative effectiveness of different QI strategies (individually and in combination) for different patient populations. OBJECTIVES To update existing systematic reviews of diabetes QI programmes and apply novel meta-analytical techniques to estimate the effectiveness of QI strategies (individually and in combination) on diabetes quality of care. SEARCH METHODS We searched databases (CENTRAL, MEDLINE, Embase and CINAHL) and trials registers (ClinicalTrials.gov and WHO ICTRP) to 4 June 2019. We conducted a top-up search to 23 September 2021; we screened these search results and 42 studies meeting our eligibility criteria are available in the awaiting classification section. SELECTION CRITERIA We included randomised trials that assessed a QI programme to improve care in outpatient settings for people living with diabetes. QI programmes needed to evaluate at least one system- or provider-targeted QI strategy alone or in combination with a patient-targeted strategy. - System-targeted: case management (CM); team changes (TC); electronic patient registry (EPR); facilitated relay of clinical information (FR); continuous quality improvement (CQI). - Provider-targeted: audit and feedback (AF); clinician education (CE); clinician reminders (CR); financial incentives (FI). - Patient-targeted: patient education (PE); promotion of self-management (PSM); patient reminders (PR). Patient-targeted QI strategies needed to occur with a minimum of one provider or system-targeted strategy. DATA COLLECTION AND ANALYSIS We dual-screened search results and abstracted data on study design, study population and QI strategies. We assessed the impact of the programmes on 13 measures of diabetes care, including: glycaemic control (e.g. mean glycated haemoglobin (HbA1c)); cardiovascular risk factor management (e.g. mean systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), proportion of people living with diabetes that quit smoking or receiving cardiovascular medications); and screening/prevention of microvascular complications (e.g. proportion of patients receiving retinopathy or foot screening); and harms (e.g. proportion of patients experiencing adverse hypoglycaemia or hyperglycaemia). We modelled the association of each QI strategy with outcomes using a series of hierarchical multivariable meta-regression models in a Bayesian framework. The previous version of this review identified that different strategies were more or less effective depending on baseline levels of outcomes. To explore this further, we extended the main additive model for continuous outcomes (HbA1c, SBP and LDL-C) to include an interaction term between each strategy and average baseline risk for each study (baseline thresholds were based on a data-driven approach; we used the median of all baseline values reported in the trials). Based on model diagnostics, the baseline interaction models for HbA1c, SBP and LDL-C performed better than the main model and are therefore presented as the primary analyses for these outcomes. Based on the model results, we qualitatively ordered each QI strategy within three tiers (Top, Middle, Bottom) based on its magnitude of effect relative to the other QI strategies, where 'Top' indicates that the QI strategy was likely one of the most effective strategies for that specific outcome. Secondary analyses explored the sensitivity of results to choices in model specification and priors. Additional information about the methods and results of the review are available as Appendices in an online repository. This review will be maintained as a living systematic review; we will update our syntheses as more data become available. MAIN RESULTS We identified 553 trials (428 patient-randomised and 125 cluster-randomised trials), including a total of 412,161 participants. Of the included studies, 66% involved people living with type 2 diabetes only. Participants were 50% female and the median age of participants was 58.4 years. The mean duration of follow-up was 12.5 months. HbA1c was the commonest reported outcome; screening outcomes and outcomes related to cardiovascular medications, smoking and harms were reported infrequently. The most frequently evaluated QI strategies across all study arms were PE, PSM and CM, while the least frequently evaluated QI strategies included AF, FI and CQI. Our confidence in the evidence is limited due to a lack of information on how studies were conducted. Four QI strategies (CM, TC, PE, PSM) were consistently identified as 'Top' across the majority of outcomes. All QI strategies were ranked as 'Top' for at least one key outcome. The majority of effects of individual QI strategies were modest, but when used in combination could result in meaningful population-level improvements across the majority of outcomes. The median number of QI strategies in multicomponent QI programmes was three. Combinations of the three most effective QI strategies were estimated to lead to the below effects: - PR + PSM + CE: decrease in HbA1c by 0.41% (credibility interval (CrI) -0.61 to -0.22) when baseline HbA1c < 8.3%; - CM + PE + EPR: decrease in HbA1c by 0.62% (CrI -0.84 to -0.39) when baseline HbA1c > 8.3%; - PE + TC + PSM: reduction in SBP by 2.14 mmHg (CrI -3.80 to -0.52) when baseline SBP < 136 mmHg; - CM + TC + PSM: reduction in SBP by 4.39 mmHg (CrI -6.20 to -2.56) when baseline SBP > 136 mmHg; - TC + PE + CM: LDL-C lowering of 5.73 mg/dL (CrI -7.93 to -3.61) when baseline LDL < 107 mg/dL; - TC + CM + CR: LDL-C lowering by 5.52 mg/dL (CrI -9.24 to -1.89) when baseline LDL > 107 mg/dL. Assuming a baseline screening rate of 50%, the three most effective QI strategies were estimated to lead to an absolute improvement of 33% in retinopathy screening (PE + PR + TC) and 38% absolute increase in foot screening (PE + TC + Other). AUTHORS' CONCLUSIONS There is a significant body of evidence about QI programmes to improve the management of diabetes. Multicomponent QI programmes for diabetes care (comprised of effective QI strategies) may achieve meaningful population-level improvements across the majority of outcomes. For health system decision-makers, the evidence summarised in this review can be used to identify strategies to include in QI programmes. For researchers, this synthesis identifies higher-priority QI strategies to examine in further research regarding how to optimise their evaluation and effects. We will maintain this as a living systematic review.
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Affiliation(s)
- Kristin J Konnyu
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Sharlini Yogasingam
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Johanie Lépine
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Katrina Sullivan
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Alun Edwards
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Michael Hillmer
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Sathya Karunananthan
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada
| | - John N Lavis
- McMaster Health Forum, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Stefanie Linklater
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Braden J Manns
- Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Canada
| | - David Moher
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Sameh Mortazhejri
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Samir Nazarali
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Canada
| | - P Alison Paprica
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Timothy Ramsay
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Peter Sargious
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Kaveh G Shojania
- University of Toronto Centre for Patient Safety, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Sharon E Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital and University of Toronto, Toronto, Canada
| | - Marcello Tonelli
- Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Canada
| | - Andrea Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital and University of Toronto, Toronto, Canada
- Epidemiology Division and Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Queen's University, Kingston, Canada
| | - Brigitte Vachon
- School of Rehabilitation, Occupational Therapy Program, University of Montreal, Montreal, Canada
| | - Catherine Hy Yu
- Department of Medicine, St. Michael's Hospital, Toronto, Canada
| | - Michael Zahradnik
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Thomas A Trikalinos
- Departments of Health Services, Policy, and Practice and Biostatistics, Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Noah Ivers
- Department of Family and Community Medicine, Women's College Hospital, Toronto, Canada
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12
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Sifunda S, Mbewu AD, Mabaso M, Manyaapelo T, Sewpaul R, Morgan JW, Harriman NW, Williams DR, Reddy SP. Prevalence and Psychosocial Correlates of Diabetes Mellitus in South Africa: Results from the South African National Health and Nutrition Examination Survey (SANHANES-1). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5798. [PMID: 37239526 PMCID: PMC10218408 DOI: 10.3390/ijerph20105798] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023]
Abstract
In South Africa, there are a limited number of population estimates of the prevalence of diabetes and its association with psychosocial factors. This study investigates the prevalence of diabetes and its psychosocial correlates in both the general South African population and the Black South African subpopulation using data from the SANHANES-1. Diabetes was defined as a hemoglobin A1c (HbA1c) ≥6.5% or currently on diabetes treatment. Multivariate ordinary least squares and logistic regression models were used to determine factors associated with HbA1c and diabetes, respectively. The prevalence of diabetes was significantly higher among participants who identified as Indian, followed by White and Coloured people, and lowest among Black South Africans. General population models indicated that being Indian, older aged, having a family history of diabetes, and being overweight and obese were associated with HbA1c and diabetes, and crowding was inversely associated with HbA1c and diabetes. HbA1c was inversely associated with being White, having higher education, and residing in areas with higher levels of neighborhood crime and alcohol use. Diabetes was positively associated with psychological distress. The study highlights the importance of addressing the risk factors of psychological distress, as well as traditional risk factors and social determinants of diabetes, in the prevention and control of diabetes at individual and population levels.
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Affiliation(s)
- Sibusiso Sifunda
- Public Health, Societies and Belonging, Human Sciences Research Council, Pretoria 0001, South Africa; (S.S.); (M.M.)
| | - Anthony David Mbewu
- School of Medicine, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa;
| | - Musawenkosi Mabaso
- Public Health, Societies and Belonging, Human Sciences Research Council, Pretoria 0001, South Africa; (S.S.); (M.M.)
| | - Thabang Manyaapelo
- Social Science Core, Africa Health Research Institute, Somkhele 3925, South Africa
| | - Ronel Sewpaul
- Public Health, Societies and Belonging, Human Sciences Research Council, Cape Town 8000, South Africa;
| | - Justin Winston Morgan
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (J.W.M.); (N.W.H.); (D.R.W.)
| | - Nigel Walsh Harriman
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (J.W.M.); (N.W.H.); (D.R.W.)
| | - David R. Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (J.W.M.); (N.W.H.); (D.R.W.)
- Department of African and African American Studies, Harvard University, Cambridge, MA 02138, USA
| | - Sasiragha Priscilla Reddy
- Faculty of Health Sciences, Nelson Mandela University, Port Elizabeth 6031, South Africa;
- The Centre for Critical Research on Race and Identity, University of KwaZulu-Natal, Durban 4041, South Africa
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13
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Hangaard S, Laursen SH, Andersen JD, Kronborg T, Vestergaard P, Hejlesen O, Udsen FW. The Effectiveness of Telemedicine Solutions for the Management of Type 2 Diabetes: A Systematic Review, Meta-Analysis, and Meta-Regression. J Diabetes Sci Technol 2023; 17:794-825. [PMID: 34957864 PMCID: PMC10210100 DOI: 10.1177/19322968211064633] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous systematic reviews have aimed to clarify the effect of telemedicine on diabetes. However, such reviews often have a narrow focus, which calls for a more comprehensive systematic review within the field. Hence, the objective of the present systematic review, meta-analysis, and meta-regression is to evaluate the effectiveness of telemedicine solutions versus any comparator without the use of telemedicine on diabetes-related outcomes among adult patients with type 2 diabetes (T2D). METHODS This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We considered telemedicine randomized controlled trials (RCT) including adults (≥18 years) diagnosed with T2D. Change in glycated hemoglobin (HbA1c, %) was the primary outcome. PubMed, EMBASE, and the Cochrane Library Central Register of Controlled Trials (CENTRAL) were searched on October 14, 2020. An overall treatment effect was estimated using a meta-analysis performed on the pool of included studies based on the mean difference (MD). The revised Cochrane risk-of-bias tool was applied and the certainty of evidence was graded using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. RESULTS The final sample of papers included a total of 246, of which 168 had sufficient information to calculate the effect of HbA1c%. The results favored telemedicine, with an MD of -0.415% (95% confidence interval [CI] = -0.482% to -0.348%). The heterogeneity was great (I2 = 93.05%). A monitoring component gave rise to the higher effects of telemedicine. CONCLUSIONS In conclusion, telemedicine may serve as a valuable supplement to usual care for patients with T2D. The inclusion of a telemonitoring component seems to increase the effect of telemedicine.
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Affiliation(s)
- Stine Hangaard
- Department of Health Science and
Technology, Aalborg University, Aalborg, Denmark
- Steno Diabetes Center North Denmark,
Aalborg, Denmark
| | - Sisse H. Laursen
- Department of Health Science and
Technology, Aalborg University, Aalborg, Denmark
- Department of Nursing, University
College of Northern Denmark, Aalborg, Denmark
| | - Jonas D. Andersen
- Department of Health Science and
Technology, Aalborg University, Aalborg, Denmark
| | - Thomas Kronborg
- Department of Health Science and
Technology, Aalborg University, Aalborg, Denmark
- Steno Diabetes Center North Denmark,
Aalborg, Denmark
| | - Peter Vestergaard
- Steno Diabetes Center North Denmark,
Aalborg, Denmark
- Department of Endocrinology, Aalborg
University Hospital, Aalborg, Denmark
- Department of Clinical Medicine,
Aalborg University, Aalborg, Denmark
| | - Ole Hejlesen
- Department of Health Science and
Technology, Aalborg University, Aalborg, Denmark
| | - Flemming W. Udsen
- Department of Health Science and
Technology, Aalborg University, Aalborg, Denmark
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14
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Alenazi F, Peddle M, Bressington D, Mahzari M, Gray R. Adherence therapy for adults with type 2 diabetes: a feasibility study of a randomized controlled trial. Pilot Feasibility Stud 2023; 9:71. [PMID: 37106431 PMCID: PMC10134646 DOI: 10.1186/s40814-023-01294-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Adherence Therapy is a candidate intervention to promote consistent medication taking in people with type 2 diabetes. The aim of this study was to establish the feasibility of conducting a randomized controlled trial of adherence therapy in people with type 2 diabetes who were non-adherent with medication. METHODS The design is an open-label, single-center, randomized controlled feasibility trial. Participants were randomly allocated to receive either eight sessions of telephone-delivered adherence therapy or treatment as usual. Recruitment occurred during the COVID-19 pandemic. Outcome measures-adherence, beliefs about medication, and average blood glucose (sugar) levels (HbA1c)-were administered at baseline and after 8 weeks (TAU group) or at the completion of the treatment (AT group). Feasibility outcomes included the number of people approached to participate in the trial and the numbers that consented, completed study measures, finished treatment with adherence therapy, and dropped out of the trial. Fieldwork for this trial was conducted in the National Guard Hospital, a tertiary care provider, in the Kingdom of Saudi Arabia. RESULTS Seventy-eight people were screened, of which 47 met eligibility criteria and were invited to take part in the trial. Thirty-four people were excluded for various reasons. The remaining thirteen who consented to participate were enrolled in the trial and were randomized (AT, n = 7) (TAU, n = 6). Five (71%) of the seven participants in the adherence therapy arm completed treatment. Baseline measures were completed by all participants. Week 8 (post-treatment) measures were completed by eight (62%) participants. Dropout may have been linked to a poor understanding of what was involved in taking part in the trial. CONCLUSIONS It may be feasible to conduct a full RCT of adherence therapy, but careful consideration should be given to developing effective recruitment strategies, consent procedures, rigorous field testing, and clear support materials. TRIAL REGISTRATION The trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12619000827134, on the 7th of June 2019.
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Affiliation(s)
- Fatimah Alenazi
- School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, 3086, Australia.
- Department of Public Health, College of Public Health and Health Informatics, Qassim University, AlBukayriyah, Kingdom of Saudi Arabia.
| | - Monica Peddle
- School of Nursing and Midwifery, Deakin University, Melbourne, Australia
| | - Daniel Bressington
- Faculty of Nursing, Chiang Mai University, 110/406 Inthawaroros Road, Sri Phum District, Chiang Mai, 50200, Thailand
- Faculty of Health, Charles Darwin University, Ellengowan Drive, Darwin, Northern Territory, 0810, Australia
| | - Moeber Mahzari
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
- Department of Medicine, Division of Endocrinology, Ministry of National Guard, Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Richard Gray
- School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, 3086, Australia
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15
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Geerlings AD, Janssen Daalen JM, Ypinga JHL, Bloem BR, Meinders MJ, Munneke M, Darweesh SKL. Case management interventions in chronic disease reduce anxiety and depressive symptoms: A systematic review and meta-analysis. PLoS One 2023; 18:e0282590. [PMID: 37058492 PMCID: PMC10104285 DOI: 10.1371/journal.pone.0282590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 02/18/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND There is no systematic insight into the effect of case management on common complications of chronic diseases, including depressive symptoms and symptoms of anxiety. This is a significant knowledge gap, given that people with a chronic disease such as Parkinson Disease or Alzheimer's Disease have identified care coordination as one of their highest priorities. Furthermore, it remains unclear whether the putative beneficial effects of case management would vary by crucial patient characteristics, such as their age, gender, or disease characteristics. Such insights would shift from "one size fits all" healthcare resource allocation to personalized medicine. OBJECTIVE We systematically examined the effectiveness of case management interventions on two common complications associated PD and other chronic health conditions: Depressive symptoms and symptoms of anxiety. METHODS We identified studies published until November 2022 from PubMed and Embase databases using predefined inclusion criteria. For each study, data were extracted independently by two researchers. First, descriptive and qualitative analyses of all included studies were performed, followed by random-effects meta-analyses to assess the impact of case management interventions on anxiety and depressive symptoms. Second, meta-regression was performed to analyze potential modifying effects of demographic characteristics, disease characteristics and case management components. RESULTS 23 randomized controlled trials and four non-randomized studies reported data on the effect of case management on symptoms of anxiety (8 studies) or depressive symptoms (26 studies). Across meta-analyses, we observed a statistically significant effect of case management on reducing symptoms of anxiety (Standardized Mean Difference [SMD] = - 0.47; 95% confidence interval [CI]: -0.69, -0.32) and depressive symptoms (SMD = - 0.48; CI: -0.71, -0.25). We found large heterogeneity in effect estimates across studies, but this was not explained by patient population or intervention characteristics. CONCLUSIONS Among people with chronic health conditions, case management has beneficial effects on symptoms of depressive symptoms and symptoms of anxiety. Currently, research on case management interventions are rare. Future studies should assess the utility of case management for potentially preventative and common complications, focusing on the optimal content, frequency, and intensity of case management.
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Affiliation(s)
- Angelika D. Geerlings
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jules M. Janssen Daalen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan H. L. Ypinga
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bastiaan R. Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marjan J. Meinders
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marten Munneke
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sirwan K. L. Darweesh
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, Nijmegen, The Netherlands
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16
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Page-Reeves J, Murray-Krezan C, Burge MR, Mishra SI, Regino L, Bleecker M, Perez D, McGrew HC, Bearer EL, Erhardt E. A patient-centered comparative effectiveness research study of culturally appropriate options for diabetes self-management. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.01.31.23285236. [PMID: 36778329 PMCID: PMC9915824 DOI: 10.1101/2023.01.31.23285236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This project compared the effectiveness of two evidence-based models of culturally competent diabetes health promotion: The Diabetes Self-Management Support Empowerment Model (DSMS), and The Chronic Care Model (CCM). Our primary outcome was improvement in patient capacity for diabetes self-management as measured by the Diabetes Knowledge Questionnaire (DKQ) and the Patient Activation Measure (PAM). Our secondary outcome was patient success at diabetes self-management as measured by improvement in A1c, depression sores using the PHQ-9, and Body Mass Index (BMI). We also gathered data on the cultural competence of the program using the Consumer Assessment of Healthcare Providers and Systems Cultural Competence Set (CAHPS-CC). We compared patient outcomes in two existing sites in Albuquerque, New Mexico that serve a large population of Latino diabetes patients from low-income households. Participants were enrolled as dyads-a patient participant (n=226) and a social support participant (n=226). Outcomes over time and by program were analyzed using longitudinal linear mixed modeling, adjusted for patient participant demographic characteristics and other potential confounding covariates. Secondary outcomes were also adjusted for potential confounders. Interactions with both time and program helped to assess outcomes. This study did not find a difference between the two sites with respect to the primary outcome measures and only one of the three secondary outcomes showed differential results. The main difference between programs was that depression decreased more for CCM than for DSMS. An exploratory, subgroup analysis revealed that at CCM, patient participants with a very high A1c (>10) demonstrated a clinically meaningful decrease. However, given the higher cultural competence rating for the CCM, statistically significant improvement in depression, and the importance of social support to the patients, results suggest that a culturally and contextually situated diabetes self-management and education program design may deliver benefit for patients, especially for patients with higher A1c levels.
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Affiliation(s)
- Janet Page-Reeves
- Department of Family & Community Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
- Office for Community Health, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Cristina Murray-Krezan
- Department of Medicine, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Shiraz I. Mishra
- Department of Family & Community Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Lidia Regino
- Office for Community Health, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Molly Bleecker
- Office for Community Health, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Daniel Perez
- Office for Community Health, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | | | - Elaine L. Bearer
- Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Erik Erhardt
- Department of Mathematics and Statistics, University of New Mexico, Albuquerque, New Mexico, USA
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17
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Lee DY, Cho YH, Kim M, Jeong CW, Cha JM, Won GH, Noh JS, Son SJ, Park RW. Association between impaired glucose metabolism and long-term prognosis at the time of diagnosis of depression: Impaired glucose metabolism as a promising biomarker proposed through a machine-learning approach. Eur Psychiatry 2023; 66:e21. [PMID: 36734114 PMCID: PMC9970146 DOI: 10.1192/j.eurpsy.2023.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Predicting the course of depression is necessary for personalized treatment. Impaired glucose metabolism (IGM) was introduced as a promising depression biomarker, but no consensus was made. This study aimed to predict IGM at the time of depression diagnosis and examine the relationship between long-term prognosis and predicted results. METHODS Clinical data were extracted from four electronic health records in South Korea. The study population included patients with depression, and the outcome was IGM within 1 year. One database was used to develop the model using three algorithms. External validation was performed using the best algorithm across the three databases. The area under the curve (AUC) was calculated to determine the model's performance. Kaplan-Meier and Cox survival analyses of the risk of hospitalization for depression as the long-term outcome were performed. A meta-analysis of the long-term outcome was performed across the four databases. RESULTS A prediction model was developed using the data of 3,668 people, with an AUC of 0.781 with least absolute shrinkage and selection operator (LASSO) logistic regression. In the external validation, the AUCs were 0.643, 0.610, and 0.515. Through the predicted results, survival analysis and meta-analysis were performed; the hazard ratios of risk of hospitalization for depression in patients predicted to have IGM was 1.20 (95% confidence interval [CI] 1.02-1.41, p = 0.027) at a 3-year follow-up. CONCLUSIONS We developed prediction models for IGM occurrence within a year. The predicted results were related to the long-term prognosis of depression, presenting as a promising IGM biomarker related to the prognosis of depression.
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Affiliation(s)
- Dong Yun Lee
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
| | - Yong Hyuk Cho
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Korea.,Department of Medical Sciences, Graduate School of Ajou University, Suwon, South Korea
| | | | - Chang-Won Jeong
- Medical Convergence Research Center, Wonkwang University, Iksan, Korea
| | - Jae Myung Cha
- Department of Gastroenterology, Gang Dong Kyung Hee University Hospital, Seoul, Korea
| | - Geun Hui Won
- Department of Psychiatry, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jai Sung Noh
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Korea
| | - Sang Joon Son
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Korea
| | - Rae Woong Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
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18
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Abrahamian H, Kautzky-Willer A, Rießland-Seifert A, Lebherz-Eichinger D, Fasching P, Ebenbichler C, Kautzky A, Toplak H. [Mental disorders and diabetes mellitus (Update 2023)]. Wien Klin Wochenschr 2023; 135:225-236. [PMID: 37101044 PMCID: PMC10133031 DOI: 10.1007/s00508-022-02117-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 04/28/2023]
Abstract
Psychiatric disorders and psychological problems are common in patients with diabetes mellitus. There is a twofold increase in depression which is associated with suboptimal glycemic control and increased morbidity and mortality. Other psychiatric disorders with a higher incidence of diabetes are cognitive impairment, dementia, disturbed eating behavior, anxiety disorders, schizophrenia, bipolar disorders and borderline personality disorder. The coincidence of mental disorders and diabetes has unfavorable influences on metabolic control and micro- and macroangiopathic complications. Improvement of therapeutic outcome is a challenge in the modern health care system. The intentions behind this position paper are to rise awareness of this special set of problems, to intensify cooperation between involved health care providers and to reduce incidence of diabetes mellitus as well as morbidity and mortality from diabetes in this patient group.
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Affiliation(s)
| | - Alexandra Kautzky-Willer
- Gender Medicine Unit, Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich.
| | - Angelika Rießland-Seifert
- 1. Psychiatrische Abteilung mit Zentrum für Psychotherapie und Psychosomatik, Klinik Penzing, Wien, Österreich
| | | | - Peter Fasching
- Medizinische Abteilung für Endokrinologie, Rheumatologie und Akutgeriatrie, Klinik Ottakring, Wien, Österreich
| | - Christoph Ebenbichler
- Universitätsklinik für Innere Medizin I, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Alexander Kautzky
- Klinische Abteilung für Sozialpsychiatrie, Medizinische Universitätsklinik für Psychiatrie und Psychotherapie, Wien, Österreich
| | - Hermann Toplak
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für , Innere Medizin, Medizinische Universität Graz, Graz, Österreich
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19
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eHealth to Improve Psychological Functioning and Self-Management of People With Chronic Kidney Disease: A Randomized Controlled Trial. Psychosom Med 2023; 85:203-215. [PMID: 36662615 PMCID: PMC9924966 DOI: 10.1097/psy.0000000000001163] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Psychological distress is common among patients with chronic kidney disease and can interfere with disease self-management. We assessed the effectiveness of the personalized E-GOAL electronic health care pathway with screening and cognitive-behavioral therapy including self-management support, aimed to treat psychological distress and facilitate self-management among people with chronic kidney disease not on dialysis ( N = 121). METHODS Primary outcome of the open two-arm parallel randomized controlled trial in four Dutch hospitals was psychological distress at posttest directly after the intervention and at 3-month follow-up. Secondary outcomes were physical and mental health-related quality of life, self-efficacy, chronic disease self-management, and personalized outcomes, that is, perceived progress compared with the previous time point on functioning (e.g., mood or social functioning) and self-management (e.g., dietary or medication adherence) outcomes that were prioritized by each individual. RESULTS Linear mixed-effects analyses showed no significant time-by-group interaction effects for psychological distress, health-related quality of life, self-efficacy, and chronic condition self-management, whereas analyses of covariance showed significantly more perceived progress in the intervention group at posttest on personally prioritized areas of functioning ( b = 0.46, 95% confidence interval = 0.07-0.85) and self-management ( b = 0.55, 95% confidence interval = 0.16-0.95), with Cohen d values of 0.46 and 0.54 (medium effects), respectively. Effects on personalized outcomes were maintained at follow-up. CONCLUSIONS Compared with regular care only, the electronic health intervention did not reduce psychological distress, whereas personalized outcomes did improve significantly after intervention. Future studies could consider personalized outcomes that reflect individually relevant areas and treatment goals, matching person-tailored treatments. TRIAL REGISTRATION Registered at the Netherlands Trial Register with study number NTR7555 ( https://trialsearch.who.int/Trial2.aspx?TrialID=NTR7555 ).
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20
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Pourhabibi N, Mohebbi B, Sadeghi R, Shakibazadeh E, Sanjari M, Tol A, Yaseri M. Factors associated with treatment adherence to treatment among in patients with type 2 diabetes in Iran: A cross-sectional study. Front Public Health 2022; 10:976888. [PMID: 36407991 PMCID: PMC9667890 DOI: 10.3389/fpubh.2022.976888] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/04/2022] [Indexed: 01/25/2023] Open
Abstract
Introduction Diabetes is a chronic metabolic disorder that affects millions of people worldwide. Adherence to treatment is a key determinant to proper management. This study aimed to assess the factors associated treatment adherence in patients with type 2 diabetes. Materials and methods We conducted this cross-sectional study on 704 patients with type 2 diabetes referred to three diabetes clinics in Kerman, Iran. We used treatment adherence questionnaire and functional communicative critical health literacy (FCCHL) to collect data and descriptive statistics, as well as Pearson correlation coefficient and multivariate regression analysis to analyze data. Significance level was <0.05. Results The study results showed that health literacy, HbA1c, and income were main predictors of diabetes treatment adherence. The patients' adherence increased as their health literacy increased. The patients' HbA1c decreases as their adherence increased. We found a 2.54-point increase in the treatment adherence score for those with sufficient income and a 0.76-point increase in the treatment adherence score for those with relatively sufficient income compared with those with insufficient income. Conclusion We found several factors affecting diabetes treatment adherence. Planning theory-based interventions can be helpful to improve the determinants.
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Affiliation(s)
- Nasrin Pourhabibi
- School of Public Health Tehran, University of Medical Sciences, Tehran, Iran
| | - Bahram Mohebbi
- Cardiovascular Intervention Research Center, Cardio-Oncology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Roya Sadeghi
- Department of Health Promotion and Education, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Shakibazadeh
- Department of Health Promotion and Education, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojgan Sanjari
- Department of Internal Medicine, School of Medicine Endocrinology and Metabolism Research Center Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Azar Tol
- Department of Health Education and Health Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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21
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Kappelin C, Carlsson AC, Wachtler C. Specific content for collaborative care: a systematic review of collaborative care interventions for patients with multimorbidity involving depression and/or anxiety in primary care. Fam Pract 2022; 39:725-734. [PMID: 34546354 PMCID: PMC9295603 DOI: 10.1093/fampra/cmab079] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In primary care (PC) many patients suffer from multimorbidity involving depression and/or anxiety. Collaborative care (CC) has shown promising results for patients with depression, anxiety, and multimorbidity involving depression. However, specific content in CC for patients with multimorbidity involving depression and/or anxiety is unknown. OBJECTIVE (i) To examine the effect of CC interventions in patients with multimorbidity involving depression and/or anxiety compared with usual care; (ii) to identify specific content of CC. METHODS We conducted a systematic literature review of randomized controlled trial studies evaluating CC models for adults with multimorbidity involving depression and/or anxiety in PC settings. PubMed, CINAHL, Web of Science, and PsycInfo were searched in December 2019. We conducted a qualitative synthesis using an existing framework and developed a new framework to map the content for each studied intervention. RESULTS We identified 1,447 studies. Twelve publications were included. Eleven had medium-to-high quality of CC for patients with multimorbidity involving depression. Specific content of CC in these studies is: A stepped care model, involving medication and psychotherapy delivered by a nurse or psychologist Care Manager (CM) focusing on problem-solving techniques; follow-up including monitoring of symptoms and function, and relapse prevention strategies; scheduled CM supervision. CONCLUSIONS Specific content for CC for patients with multimorbidity involving depression is identified from current research. Research gaps were found regarding CC for patients with multimorbidity and anxiety, depression and anxiety, and depression and/or anxiety and more than 2 diseases.
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Affiliation(s)
- Caroline Kappelin
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institute, Huddinge, Sweden
| | - Axel C Carlsson
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institute, Huddinge, Sweden.,Academic Primary Healthcare Centre, Stockholm, Sweden
| | - Caroline Wachtler
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institute, Huddinge, Sweden
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22
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Rosenfeld LC, Wang P, Holland J, Ruble M, Parsons T, Huang H. Care Management of Comorbid Medical and Psychiatric Illness: A Conceptual Framework for Improving Equity of Care. Popul Health Manag 2022; 25:148-156. [PMID: 35442788 PMCID: PMC9058884 DOI: 10.1089/pop.2021.0366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Psychiatric and medical comorbidities are common among adults in the United States. Due to the complex interplay between medical and psychiatric illness, comorbidities result in substantial disparities in morbidity, mortality, and health care costs. There is, thus, both an ethical and fiscal imperative to develop care management programs to address the needs of individuals with comorbid conditions. Although there is substantial evidence supporting the use of care management for improving health outcomes for patients with chronic diseases, the majority of interventions described in the literature are condition-specific. Given the prevalence of comorbidities, the authors of this article reviewed the literature and drew on their clinical expertise to guide the development of future multimorbidity care management programs. Their review yielded one study of multimorbidity care management and two studies of multimorbidity collaborative care. The authors supplemented their findings by describing three key pillars of effective care management, as well as specific interventions to offer patients based on their psychiatric diagnoses and illness severity. The authors proposed short-, medium-, and long-term indicators to measure and track the impact of care management programs on disparities in care. Future studies are needed to identify which elements of existing multimorbidity collaborative care models are active ingredients, as well as which of the suggested supplemental interventions offer the greatest value.
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Affiliation(s)
- Lisa C Rosenfeld
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Philip Wang
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | - Hsiang Huang
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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23
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Impact of integrated behavioral health services on adherence to long-acting injectable antipsychotics. JOURNAL OF INTEGRATED CARE 2022. [DOI: 10.1108/jica-08-2021-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeIntegrated health care occurs when specialty and general care providers work together to address both the physical and mental health needs of their patients. The Substance Abuse and Mental Health Services Administration model of integration is broken into six levels of coordinated, co-located and integrated care. Our institution offers both co-located and integrated care among eight clinic sites. The care team is typically composed of the primary care provider, nurse and medical assistant, but other professionals may be introduced based on the patient’s medical and psychiatric conditions. The purpose of this prospective, quality improvement study was to compare the rates of adherence to long-acting injectable antipsychotics (LAIAs) between both types of integrated primary care settings at our institution. The comparison of the two settings sought to determine which environment provides improved outcomes for patients with serious psychiatric illnesses. Additionally, we aimed to assess the quality of medication-related monitoring and care team composition between care settings, and the ability of pharmacists to deliver interprofessional care team training and education on LAI use in clinical practice.Design/methodology/approachSubjects were identified and included in the study if they had received primary care services from our institution within the previous 12 months. Patient demographic and laboratory variables were collected at baseline and when clinically indicated. The rates of adherence between care settings were assessed at intervals that align with the medication’s administration schedule (e.g. every four weeks). Medication-related monitoring parameters were collected at baseline and when clinically indicated. The interprofessional care team completed Likert scale surveys to evaluate the pharmacist’s LAIA education and training.FindingsThere was not a statistically significant difference detected between integrated primary care settings on the rates of adherence to LAIAs. Additionally, there was not a statistically significant difference between rates of adherence to medication-related monitoring parameters or the effect of the patient treatment team composition. There was a statistically significant difference between pre- and post-session survey scores following interprofessional education and training provided by a pharmacist.Originality/valueBecause overall rates of adherence were low, both primary care settings were found to be equivalent. Our study may have been underpowered to detect a difference in the primary endpoint because of the small sample size. However, our study demonstrates that interprofessional education and training may lend itself to changes in practice, which is evident by the clinically significant relative increase in adherence. The Henry J. Austin Health Center network will be implementing a standard operating procedure regarding LAIA management within the primary care setting. Further studies are needed to assess a larger number of patients between both types of primary care settings, as well as the impact of the clinical psychiatric pharmacist as a member of the treatment team.
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24
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Sridhar GR. Can the management of depression in type 2 diabetes be democratized? World J Diabetes 2022; 13:203-212. [PMID: 35432759 PMCID: PMC8984566 DOI: 10.4239/wjd.v13.i3.203] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/07/2022] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
Both type 2 diabetes and depression are common and are projected to increase. There is increasing evidence for a bidirectional relationship between the two. Diabetes is a risk factor for depression; contrariwise, individuals with depression are at greater risk of developing diabetes. They are a burden for both the individual and the society. Co-existent depression worsens diabetic control because of obesity, insulin resistance and the adverse metabolic effects of anti-diabetes medicines. In addition, compliance to lifestyle measures required for diabetes is also compromised such as following a specific diet, taking proper medications on time, getting metabolic parameters assessed and maintaining a sleep cycle. Depression occurs in many grades; mild depression is more common in diabetes than frank or full-blown depression leading to suicide. Unfortunately, there are not enough trained and accessible mental health professionals such as psychologists or psychiatrists to deal with the increasing burden of depression in diabetes. Therefore, alternate models for management of mild to moderate depression are required. There is evidence that a team-approach by employing health care assistants can lower the risk of cardiac risk factors. INtegrating DEPrEssioN and Diabetes treatmENT study was carried out to determine whether the team-approach using non-health care professionals could be effective in managing mild to moderate depression and to study its effects on metabolic parameters among subjects with type 2 diabetes mellitus. The international study, carried out in four independent centers in India assessed the impact of a trained but not qualified non-psychiatrist in coordinating and forming a fulcrum between the patient, the family and the consultant endocrinologist/diabetologist. The interventions were fine-tuned to be culturally appropriate by qualitative interviews before they began. It was shown that the outcomes of both depression and diabetes could be improved by the employment of a clinical care coordinator. It is possible to scale up the studies to wider geographical areas and health-care organizations.
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Affiliation(s)
- Gumpeny R Sridhar
- Department of Endocrinology, Endocrine & Diabet Ctr, Visakhapatnam 530002, India
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25
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Tardif I, Guénette L, Zongo A, Demers É, Lunghi C. Depression and the risk of hospitalization in type 2 diabetes patients: A nested case-control study accounting for non-persistence to antidiabetic treatment. DIABETES & METABOLISM 2022; 48:101334. [PMID: 35231612 DOI: 10.1016/j.diabet.2022.101334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/29/2022] [Accepted: 02/12/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Depression is one of the most common comorbidities of type 2 diabetes. The relationship between these two diseases seems to be bidirectional. Both conditions separately lead to significant morbidity and mortality, including hospitalization. Moreover, depression is associated with non-persistence with antidiabetic drugs. OBJECTIVES To measure the effect of depression on morbidity and particularly on all-cause, diabetes-related, cardiovascular-related and major cardiovascular events-related hospitalization, adjusting for non-persistence to antidiabetic drugs and other confounders. METHODS We performed a nested case-control study within a cohort of type 2 diabetic individuals initiating antidiabetic drugs. Using the health administrative data of the province of Quebec, Canada, we identified all-cause, diabetes-related, cardiovascular-related and major cardiovascular hospitalizations during a maximum follow-up of eight years after the initiation of antidiabetic drug treatment. A density sampling method matched all cases with up to 10 controls by age, sex, and the Elixhauser comorbidity index. The effect of depression on hospitalization was estimated using conditional logistic regressions adjusting for non-persistence to antidiabetic drug treatment and other variables. RESULTS We identified 41,550 all-cause hospitalized cases, of which 34,437 were related to cardiovascular (CV) diseases, 29,584 to diabetes, and 13,867 to major CV events. Depression was diagnosed in 2.51% of all-cause hospitalizations and 1.16% of matched controls. 69.11% of cases and 72.59% of controls were on metformin monotherapy. The majority (71.62% vs 75.02%, respectively) stayed on metformin monotherapy without adding or switching drugs during follow-up. Non-persistence was at similar rates (about 30%) in both groups. In the multivariable analyses, depression was associated with an increased risk for all-cause hospitalizations, with odds ratios (ORs) ranging from 2.21 (95% CI: 2.07-2.37) to 1.32 (95% CI: 1.22-1.44) according to the model adjustment (from the univariate to the fully adhjusted). CONCLUSION Depression increased the risk of all-cause hospitalizations among patients treated for diabetes, even after accounting for non-persistence and other potentially confounding factors. These results stress the impact of depression on diabetic patients' use of health care resources.
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Affiliation(s)
- Isabelle Tardif
- Faculty of Medicine, 1050 avenue de la Médecine, Université Laval, Quebec City, QC, Canada
| | - Line Guénette
- Faculty of Pharmacy, 1050 avenue de la Médecine, Université Laval, Quebec City, QC, Canada; Axe Santé des Populations et Pratiques Optimales en Santé (SP-POS), Centre de recherche du CHU de Quebec-Université Laval, 1050 chemin Ste-Foy, Quebec City, QC, Canada
| | - Arsène Zongo
- Faculty of Pharmacy, 1050 avenue de la Médecine, Université Laval, Quebec City, QC, Canada; Axe Santé des Populations et Pratiques Optimales en Santé (SP-POS), Centre de recherche du CHU de Quebec-Université Laval, 1050 chemin Ste-Foy, Quebec City, QC, Canada
| | - Éric Demers
- Axe Santé des Populations et Pratiques Optimales en Santé (SP-POS), Centre de recherche du CHU de Quebec-Université Laval, 1050 chemin Ste-Foy, Quebec City, QC, Canada
| | - Carlotta Lunghi
- Axe Santé des Populations et Pratiques Optimales en Santé (SP-POS), Centre de recherche du CHU de Quebec-Université Laval, 1050 chemin Ste-Foy, Quebec City, QC, Canada; Department of Health Sciences, Université du Québec à Rimouski, 1595 boulevard Alphonse-Desjardins, Lévis, QC, Canada.
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26
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Validation of a Virtual Assistant for Improving Medication Adherence in Patients with Comorbid Type 2 Diabetes Mellitus and Depressive Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212056. [PMID: 34831811 PMCID: PMC8620667 DOI: 10.3390/ijerph182212056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/08/2021] [Accepted: 11/13/2021] [Indexed: 12/30/2022]
Abstract
Virtual assistants are programs that interact with users through text or voice messages simulating a human-based conversation. The development of healthcare virtual assistants that use messaging platforms is rapidly increasing. Still, there is a lack of validation of these assistants. In particular, this work aimed to validate the effectiveness of a healthcare virtual assistant, integrated within messaging platforms, with the aim of improving medication adherence in patients with comorbid type 2 diabetes mellitus and depressive disorder. For this purpose, a nine-month pilot study was designed and subsequently conducted. The virtual assistant reminds patients about their medication and provides healthcare professionals with the ability to monitor their patients. We analyzed the medication possession ratio (MPR), measured the level of glycosylated hemoglobin (HbA1c), and obtained the patient health questionnaire (PHQ-9) score in the patients before and after the study. We also conducted interviews with all participants. A total of thirteen patients and five nurses used and evaluated the proposed virtual assistant using the messaging platform Signal. Results showed that on average, the medication adherence improved. In the final interview, 69% of the patients agreed with the idea of continuing to use the virtual assistant after the study.
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Tominaga Y, Morisky DE, Mochizuki M. A cross-sectional study clarifying profiles of patients with diabetes who discontinued pharmacotherapy: reasons and consequences. BMC Endocr Disord 2021; 21:117. [PMID: 34120602 PMCID: PMC8201823 DOI: 10.1186/s12902-021-00778-7] [Citation(s) in RCA: 3] [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: 12/03/2020] [Accepted: 05/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although diabetes is one of the fastest increasing diseases in prevalence worldwide and demands significant medical resources, more than half of all patients with diabetes do not achieve the expected target level of blood glucose. As a potential cause of poor glycemic control, insufficient adherence to medication has long been discussed and variably studied. However, dropout from treatment as another plausible cause has not been fully examined. The aim of this study was to clarify profiles of patients with diabetes who discontinued pharmacotherapy (Discont group) by extracting reasons of their decisions and by comparing with those who continued (Cont group) in terms of the related factors to glycemic control. METHODS A cross-sectional, internet-based survey was conducted among Japanese with diabetes registered in a database. A self-administered questionnaire consisting of the 8-item version of the Morisky Medication Adherence Scale (MMAS-8), glycosylated haemoglobin (HbA1c) level, and demographic and disease characteristics was completed by all participants. Reasons for medication discontinuation and resumption were also received retrospectively from participants in the Discont group. To examine the risk of uncontrolled HbA1c, logistic regression analysis was conducted in each group. RESULTS In the Discont group (148 cases), older age at resumption of pharmacotherapy and current smoking habit increased the probability of uncontrolled HbA1c, whereas in the Cont group (146 cases), a familial history of diabetes and better medication adherence in MMAS-8 scores decreased the probability of uncontrolled HbA1c. A relationship between medication adherence and HbA1c level was seen in the Cont but not in the Discont group. About 70 % of those in the Discont group made their decision to terminate diabetes treatment without consulting physicians and half of them perceived their situations inappropriately. CONCLUSIONS Those who discontinued pharmacotherapy were less adherent to medication than those who did not discontinue. Risk factors for glycemic control also differed between those who discontinued and those who did not. More than one-third of participants with diabetes who discontinued pharmacotherapy had inappropriate perceptions of their disease, which medical professionals should be aware of for better interventions.
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Affiliation(s)
- Yoshiko Tominaga
- Social Pharmacy, Faculty of Pharmaceutical Sciences, Niigata University of Pharmacy and Applied Life Science, Niigata, Japan.
- Division of Hospital Pharmacy Science, Faculty of Pharmacy, Keio University, Tokyo, Japan.
| | - Donald E Morisky
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California, United States of America
| | - Mayumi Mochizuki
- Division of Hospital Pharmacy Science, Faculty of Pharmacy, Keio University, Tokyo, Japan
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28
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van der Feltz‐Cornelis C, Allen SF, Holt RIG, Roberts R, Nouwen A, Sartorius N. Treatment for comorbid depressive disorder or subthreshold depression in diabetes mellitus: Systematic review and meta-analysis. Brain Behav 2021; 11:e01981. [PMID: 33274609 PMCID: PMC7882189 DOI: 10.1002/brb3.1981] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/02/2020] [Accepted: 11/16/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To provide an estimate of the effect of interventions on comorbid depressive disorder (MDD) or subthreshold depression in type 1 and type 2 diabetes. METHODS Systematic review and meta-analysis. We searched PubMed, PsycINFO, Embase, and the Cochrane Library for randomized controlled trials evaluating the outcome of depression treatments in diabetes and comorbid MDD or subthreshold symptoms published before August 2019 compared to care as usual (CAU), placebo, waiting list (WL), or active comparator treatment as in a comparative effectiveness trial (CET). Primary outcomes were depressive symptom severity and glycemic control. Cohen's d is reported. RESULTS Forty-three randomized controlled trials (RCTs) were selected, and 32 RCTs comprising 3,543 patients were included in the meta-analysis. Our meta-analysis showed that, compared to CAU, placebo or WL, all interventions showed a significant effect on combined outcome 0,485 (95% CI 0.360; 0.609). All interventions showed a significant effect on depression. Pharmacological treatment, group therapy, psychotherapy, and collaborative care had a significant effect on glycemic control. High baseline depression score was associated with a greater reduction in HbA1 c and depressive outcome. High baseline HbA1 c was associated with a greater reduction in HbA1 c. CONCLUSION All treatments are effective for comorbid depression in type 1 diabetes and type 2 diabetes. Over the last decade, new interventions with large effect sizes have been introduced, such as group-based therapy, online treatment, and exercise. Although all interventions were effective for depression, not all treatments were effective for glycemic control. Effective interventions in comorbid depressive disorder may not be as effective in comorbid subthreshold depression. Baseline depression and HbA1 c scores modify the treatment effect. Based on the findings, we provide guidance for treatment depending on patient profile and desired outcome, and discuss possible avenues for further research.
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Affiliation(s)
| | - Sarah F. Allen
- Department of Health SciencesHull York Medical SchoolUniversity of YorkYorkUK
| | - Richard I. G. Holt
- Human Development and HealthFaculty of MedicineUniversity of SouthamptonSouthamptonUK
| | - Richard Roberts
- Department of Family Medicine & Community HealthUniversity of WisconsinMadisonWIUSA
| | - Arie Nouwen
- Department of PsychologyMiddlesex UniversityLondonUK
| | - Norman Sartorius
- Association for the Improvement of Mental Health ProgrammesGenevaSwitzerland
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29
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Bashir T, Morrissey H, Ball P. Systematic Review of Psychological and Educational Interventions Used to Improving Adherence in Diabetes and Depression Patients. ARCHIVES OF PHARMACY PRACTICE 2021. [DOI: 10.51847/q8elnfrbh6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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30
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Ouk M, Wu CY, Colby-Milley J, Fang J, Zhou L, Shah BR, Herrmann N, Lanctôt KL, Linkewich E, Law M, Swartz RH, Kapral MK, Black SE, MacIntosh BJ, Edwards JD, Swardfager W. Depression and Diabetes Mellitus Multimorbidity Is Associated With Loss of Independence and Dementia Poststroke. Stroke 2020; 51:3531-3540. [DOI: 10.1161/strokeaha.120.031068] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background and Purpose:
Many patients with ischemic stroke present with multiple comorbidities that threaten survival and recovery. This study sought to determine the risks of adverse long-term stroke outcomes associated with multimorbid diabetes mellitus and depression.
Methods:
Retrospective analysis of prospectively collected data on consecutive patients without premorbid dementia admitted from the community for a first-ever acute ischemic stroke to comprehensive stroke centers across Ontario, Canada (2003–2013). Premorbid histories of diabetes mellitus and depression were ascertained within 5 years before stroke admission. Adjusted hazard ratios (aHR [95% CI]) of admission to long-term care, incident dementia, readmission for stroke or transient ischemic attack and all-cause mortality, over time among those discharged back into the community poststroke.
Results:
Among 23 579 stroke admissions, n=20 201 were discharged back into the community. Diabetes mellitus and depression were associated with synergistic hazards of admission to long-term care (X
2
=5.4;
P
=0.02) over a median follow-up of 5.6 years. This interaction was observed among women specifically; depression multimorbidity showed particularly high hazards of admission to long-term care (aHR
Depression
=1.57 [1.24–1.98]) and incident dementia (aHR
Depression
=1.85 [1.40–2.44]) among women with diabetes mellitus. In the whole cohort, diabetes mellitus and depression were associated individually with long-term care admission (aHR
Diabetes
=1.20 [1.12–1.29]; aHR
Depression
=1.19 [1.04–1.37]), incident dementia (aHR
Diabetes
=1.14 [1.06–1.23]; aHR
Depression
=1.27 [1.08–1.49]), stroke/transient ischemic attack readmission (aHR
Diabetes
=1.18 [1.10–1.26]; aHR
Depression
=1.24 [1.07–1.42]), and all-cause mortality (aHR
Diabetes
=1.29 [1.23–1.36]; aHR
Depression
=1.16 [1.05–1.29]).
Conclusions:
The risks of dementia and needing long-term care in the years after surviving a stroke were particularly elevated among women when premorbid diabetes mellitus and depression occurred together. Long-term stroke recovery strategies might target high-risk patients with mood and metabolic multimorbidity.
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Affiliation(s)
- Michael Ouk
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON (M.O., C.-Y.W., J.C.-M., N.H., K.L.L., E.L., R.H.S., S.E.B., B.J.M., W.S.)
- Department of Pharmacology and Toxicology (M.O., C.-Y.W., K.L.L., W.S.), University of Toronto, ON
| | - Che-Yuan Wu
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON (M.O., C.-Y.W., J.C.-M., N.H., K.L.L., E.L., R.H.S., S.E.B., B.J.M., W.S.)
- Department of Pharmacology and Toxicology (M.O., C.-Y.W., K.L.L., W.S.), University of Toronto, ON
| | - Jessica Colby-Milley
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON (M.O., C.-Y.W., J.C.-M., N.H., K.L.L., E.L., R.H.S., S.E.B., B.J.M., W.S.)
- Canadian Partnership for Stroke Recovery, Toronto, ON (J.C.-M., R.H.S., S.E.B., B.J.M., W.S.)
| | - Jiming Fang
- ICES, Toronto, ON (J.F., L.Z., B.R.S., R.H.S., M.K.K.)
| | - Limei Zhou
- ICES, Toronto, ON (J.F., L.Z., B.R.S., R.H.S., M.K.K.)
| | - Baiju R. Shah
- Department of Medicine and Institute for Health Policy, Management, and Evaluation, (B.R.S., M.K.K.), University of Toronto, ON
- ICES, Toronto, ON (J.F., L.Z., B.R.S., R.H.S., M.K.K.)
- Divisions of Endocrinology and Obstetric Medicine, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON (B.R.S.)
| | - Nathan Herrmann
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON (M.O., C.-Y.W., J.C.-M., N.H., K.L.L., E.L., R.H.S., S.E.B., B.J.M., W.S.)
- Department of Medicine (Psychiatry), Sunnybrook Health Sciences Centre (N.H., K.L.L.), University of Toronto, ON
| | - Krista L. Lanctôt
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON (M.O., C.-Y.W., J.C.-M., N.H., K.L.L., E.L., R.H.S., S.E.B., B.J.M., W.S.)
- Department of Pharmacology and Toxicology (M.O., C.-Y.W., K.L.L., W.S.), University of Toronto, ON
- Department of Medicine (Psychiatry), Sunnybrook Health Sciences Centre (N.H., K.L.L.), University of Toronto, ON
- University Health Network Toronto Rehabilitation Institute, Toronto, ON (K.L.L., M.L., W.S.)
| | - Elizabeth Linkewich
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON (M.O., C.-Y.W., J.C.-M., N.H., K.L.L., E.L., R.H.S., S.E.B., B.J.M., W.S.)
- Department of Occupational Science and Occupational Therapy (E.L.), University of Toronto, ON
| | - Marcus Law
- Department of Family and Community Medicine (M.L.), University of Toronto, ON
- University Health Network Toronto Rehabilitation Institute, Toronto, ON (K.L.L., M.L., W.S.)
| | - Richard H. Swartz
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON (M.O., C.-Y.W., J.C.-M., N.H., K.L.L., E.L., R.H.S., S.E.B., B.J.M., W.S.)
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre (R.H.S., S.E.B.), University of Toronto, ON
- Canadian Partnership for Stroke Recovery, Toronto, ON (J.C.-M., R.H.S., S.E.B., B.J.M., W.S.)
- ICES, Toronto, ON (J.F., L.Z., B.R.S., R.H.S., M.K.K.)
| | - Moira K. Kapral
- Department of Medicine and Institute for Health Policy, Management, and Evaluation, (B.R.S., M.K.K.), University of Toronto, ON
- ICES, Toronto, ON (J.F., L.Z., B.R.S., R.H.S., M.K.K.)
| | - Sandra E. Black
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON (M.O., C.-Y.W., J.C.-M., N.H., K.L.L., E.L., R.H.S., S.E.B., B.J.M., W.S.)
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre (R.H.S., S.E.B.), University of Toronto, ON
- Canadian Partnership for Stroke Recovery, Toronto, ON (J.C.-M., R.H.S., S.E.B., B.J.M., W.S.)
| | - Bradley J. MacIntosh
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON (M.O., C.-Y.W., J.C.-M., N.H., K.L.L., E.L., R.H.S., S.E.B., B.J.M., W.S.)
- Department of Medical Biophysics (B.J.M.), University of Toronto, ON
- Canadian Partnership for Stroke Recovery, Toronto, ON (J.C.-M., R.H.S., S.E.B., B.J.M., W.S.)
| | - Jodi D. Edwards
- University of Ottawa Heart Institute (J.D.E.), University of Ottawa, ON
- School of Epidemiology and Public Health (J.D.E.), University of Ottawa, ON
| | - Walter Swardfager
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON (M.O., C.-Y.W., J.C.-M., N.H., K.L.L., E.L., R.H.S., S.E.B., B.J.M., W.S.)
- Department of Pharmacology and Toxicology (M.O., C.-Y.W., K.L.L., W.S.), University of Toronto, ON
- Canadian Partnership for Stroke Recovery, Toronto, ON (J.C.-M., R.H.S., S.E.B., B.J.M., W.S.)
- University Health Network Toronto Rehabilitation Institute, Toronto, ON (K.L.L., M.L., W.S.)
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Chepulis L, Morison B, Lao C, Keenan R, Paul R, Lawrenson R. The prevalence of mental health medication use in a cohort of New Zealand patients with diabetes. Prim Care Diabetes 2020; 14:703-708. [PMID: 32723664 DOI: 10.1016/j.pcd.2020.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 06/08/2020] [Accepted: 07/16/2020] [Indexed: 11/18/2022]
Abstract
AIMS Diabetes is associated with depression, anxiety and psychosis via complex bidirectional relationships that are affected by factors such as the type of diabetes and socioeconomic status. The aim of the study was to estimate the prevalence of mental health conditions in patients with diabetes in a New Zealand primary care population using proxy medication dispensing data. METHODS Primary care data (July 1 2016 - June 30, 2018) was collected from the Patient Management System of 15 different general practices, and was linked via National Health Index number to clinical records at the Waikato District Health Board and the New Zealand Ministry of Health Pharmaceutical database. RESULTS A total of 3978 patients with diabetes were identified from an enrolled patient population of 74,250. Of these, 18.0% of patients with diabetes were dispensed an antidepressant, anxiolytic, or antipsychotic. These medications were prescribed more in New Zealand Europeans (20.9% versus 13.9% in Māori), women, type 2 diabetes, those on insulin, and those with a higher BMI (all P<0.001). CONCLUSIONS Approximately one fifth of patients with diabetes in primary care have mental health disorders. Appropriate management requires concomitant treatment of both the diabetes and the mental health disorder to improve patient outcomes.
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Affiliation(s)
- Lynne Chepulis
- Waikato Medical Research Centre, University of Waikato, Hamilton, New Zealand.
| | - Brittany Morison
- Waikato Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Chunhuan Lao
- Waikato Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Rawiri Keenan
- Waikato Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Ryan Paul
- Waikato Medical Research Centre, University of Waikato, Hamilton, New Zealand; Waikato Regional Diabetes Service, Waikato District Health Board, Hamilton, New Zealand
| | - Ross Lawrenson
- Waikato Medical Research Centre, University of Waikato, Hamilton, New Zealand; Waikato Regional Diabetes Service, Waikato District Health Board, Hamilton, New Zealand
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32
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Obeng IS, Ogamba IK. Service integration for improved diabetic and dental care: exploring an effective model for optimising health outcomes. JOURNAL OF INTEGRATED CARE 2020. [DOI: 10.1108/jica-07-2020-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThis study identifies and synthesizes existing literature on the integration of diabetic and dental services and explores a service integration model for optimising diabetic patient health outcomes and improving healthcare systems in low and middle-income countries.Design/methodology/approachPeer-reviewed literature that analysed the integration of health services regarding dental and medical services were reviewed. The articles were identified using the Academic Search Complete, Business Source Complete, CINAHL Complete, Google Scholar and MEDLINE databases and screened using the PRISMA guidelines.FindingsA total of 40 full-text articles were examined for eligibility out of which 26 were selected for analysis. Diabetes was shown to contribute significantly to the global disease burden and this is also reflected in most low and middle-income countries. It is found that the integration of medical and dental services could help alleviate this burden. Hence, locally adapted Rainbow-Modified Integrated Care model is proposed to fill this integration gap.OriginalityThe integration of dental and medical services has been proven to be useful in improving diabetic patient outcomes. Hence, the need to facilitate cross-professional collaboration between dentists and physicians cannot be overemphasised and this can be extended and locally adapted by different health systems across the world.Practice ImplicationsThe integration of dental and diabetic services using models such as the Rainbow Model of Integrated Care is recommended to optimise health outcomes of diabetic patients and enhancing service delivery, especially in resource-poor healthcare systems.
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33
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John JR, Jani H, Peters K, Agho K, Tannous WK. The Effectiveness of Patient-Centred Medical Home-Based Models of Care versus Standard Primary Care in Chronic Disease Management: A Systematic Review and Meta-Analysis of Randomised and Non-Randomised Controlled Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:6886. [PMID: 32967161 PMCID: PMC7558011 DOI: 10.3390/ijerph17186886] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/14/2020] [Accepted: 09/18/2020] [Indexed: 12/20/2022]
Abstract
Patient-centred care by a coordinated primary care team may be more effective than standard care in chronic disease management. We synthesised evidence to determine whether patient-centred medical home (PCMH)-based care models are more effective than standard general practitioner (GP) care in improving biomedical, hospital, and economic outcomes. MEDLINE, CINAHL, Embase, Cochrane Library, and Scopus were searched to identify randomised (RCTs) and non-randomised controlled trials that evaluated two or more principles of PCMH among primary care patients with chronic diseases. Study selection, data extraction, quality assessment using Joanna Briggs Institute (JBI) appraisal tools, and grading of evidence using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach were conducted independently. A quantitative synthesis, where possible, was pooled using random effects models and the effect size estimates of standardised mean differences (SMDs) and odds ratios (ORs) with 95% confidence intervals were reported. Of the 13,820 citations, we identified 78 eligible RCTs and 7 quasi trials which included 60,617 patients. The findings suggested that PCMH-based care was associated with significant improvements in depression episodes (SMD -0.24; 95% CI -0.35, -0.14; I2 = 76%) and increased odds of remission (OR 1.79; 95% CI 1.46, 2.21; I2 = 0%). There were significant improvements in the health-related quality of life (SMD 0.10; 95% CI 0.04, 0.15; I2 = 51%), self-management outcomes (SMD 0.24; 95% CI 0.03, 0.44; I2 = 83%), and hospital admissions (OR 0.83; 95% CI 0.70, 0.98; I2 = 0%). In terms of biomedical outcomes, with exception to total cholesterol, PCMH-based care led to significant improvements in blood pressure, glycated haemoglobin, and low-density lipoprotein cholesterol outcomes. The incremental cost of PCMH care was identified to be small and significantly higher than standard care (SMD 0.17; 95% CI 0.08, 0.26; I2 = 82%). The quality of individual studies ranged from "fair" to "good" by meeting at least 60% of items on the quality appraisal checklist. Additionally, moderate to high heterogeneity across studies in outcomes resulted in downgrading the included studies as moderate or low grade of evidence. PCMH-based care has been found to be superior to standard GP care in chronic disease management. Results of the review have important implications that may inform patient, practice, and policy-level changes.
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Affiliation(s)
- James Rufus John
- Translational Health Research Institute, Western Sydney University, Sydney, NSW 2560, Australia; (H.J.); (K.A.); (W.K.T.)
- Rozetta Institute, Level 4, 55 Harrington Street, Sydney, NSW 2000, Australia
| | - Hir Jani
- Translational Health Research Institute, Western Sydney University, Sydney, NSW 2560, Australia; (H.J.); (K.A.); (W.K.T.)
| | - Kath Peters
- School of Nursing and Midwifery, Western Sydney University, Sydney, NSW 2560, Australia;
| | - Kingsley Agho
- Translational Health Research Institute, Western Sydney University, Sydney, NSW 2560, Australia; (H.J.); (K.A.); (W.K.T.)
- School of Science and Health, Western Sydney University, Sydney, NSW 2560, Australia
| | - W. Kathy Tannous
- Translational Health Research Institute, Western Sydney University, Sydney, NSW 2560, Australia; (H.J.); (K.A.); (W.K.T.)
- School of Business, Western Sydney University, Sydney, NSW 2150, Australia
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34
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Diaz Bustamante L, Ghattas KN, Ilyas S, Al-Refai R, Maharjan R, Khan S. Does Treatment for Depression With Collaborative Care Improve the Glycemic Levels in Diabetic Patients with Depression? A Systematic Review. Cureus 2020; 12:e10551. [PMID: 33101799 PMCID: PMC7575321 DOI: 10.7759/cureus.10551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 09/20/2020] [Indexed: 11/05/2022] Open
Abstract
Diabetes is a chronic disease with a high prevalence in the United States. If not treated adequately, it can have serious complications. Furthermore, when depression affects concomitantly, adherence to treatment can be decreased. Therefore, a cascade of complications may develop, affecting the quality of life and increasing the risk of death. Depression is underdiagnosed in patients with diabetes, and even if diagnosed, the treatment for both diabetes and depression is not well established in primary care. This study aims to evaluate if treatment for depression with collaborative care can improve glycemic levels and depression treatment response in diabetic patients with depression. As well, we will investigate if treatment with antidepressants will aid in improving glycemic levels. For this systematic review, we followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and used PubMed, PubMed Central, and MEDLINE as database. Keywords: "diabetes improvement with depression treatment'. For collaborative care intervention, we selected three systematic reviews and meta-analysis. These three studies gave us a total of 1637 patients evaluated for the glycemic outcome and 1793 patients for depression outcomes. For the intervention with antidepressants, we included two articles. One systematic review and meta-analysis that evaluated the effect of selective serotonin reuptake inhibitors (SSRIs) on glycemic levels and the second article involved was a systematic review that assessed the effect of antidepressants on glycemia. A total of 4119 diabetic patients taking antidepressants were evaluated for glucose levels of the outcome. For the collaborative care outcome: two of the three studies showed non-significant improvement of glycemic levels with intervention. However, one study that had a bigger sample size exhibited significant improvement of glycemia with collaborative care. It is necessary to elaborate on new studies to confirm this finding. For the glycemic outcome with antidepressants: SSRIs improve glycemic levels. This class of antidepressants is the most studied, and it would be interesting to perform trials comparing different classes of antidepressants with a bigger sample size and run for a more extended period. According to our review, collaborative care improves glycemia and depression treatment response. At the same time, it improves the adherence to treatment of both oral hypoglycemic drugs and antidepressants. SSRIs demonstrated to be more effective in glycemic control. The most studied and effective SSRIs are fluoxetine, escitalopram, and citalopram.
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Affiliation(s)
- Liliana Diaz Bustamante
- Family Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Kyrillos N Ghattas
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Shahbakht Ilyas
- Surgery, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
- Medicine and Surgery, CMH Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Reham Al-Refai
- Pathology, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Reeju Maharjan
- Neurology, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Safeera Khan
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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Padmapriya C, Pushkarapriya S, Shanmugapriya N, Sushmitha KP, Karthik S, Rajanandh MG. Effect of sertraline in patients with newly diagnosed depression and type 2 diabetes mellitus or hypertension: An observational study from south India. Diabetes Metab Syndr 2020; 14:1065-1068. [PMID: 32645649 DOI: 10.1016/j.dsx.2020.06.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND AIMS Patients with either type II diabetes mellitus (T2DM) or hypertension (HTN) are more prone to develop depression when compared with the general population. Along with comorbid of either T2DM or HTN, treatment of depression may become an even bigger challenge. The present study aimed to observe the effect of sertraline in newly diagnosed depression patients with T2DM or HTN. METHODS A prospective, observational study was conducted in the T2DM or HTN patients who were newly diagnosed as depression patients. Parameters such as, glycated hemoglobin (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP) and Hamilton Depression Rating Scale (HAM-D) score for depression were measured before and after initiating sertraline therapy (50 mg, twice daily). Paired t-test was used to find out the statistical significance. RESULT Of the 546 enrolled patients, 291 patients were in T2DM and 255 patients with HTN. No statistically significant difference (p > 0.05) was observed between baseline and 12th week of comparison with respect to HbA1c, SBP and DBP values. While at the end of treatment, the number of patients suffered from depression in severe state were improved to moderate to a mild state of depression. Statistically significant difference (p < 0.001) was observed in both T2DM and HTN groups when comparing the total score of HAM-D before and after sertraline treatment. CONCLUSION Sertraline is effective in the management of newly diagnosed depression among T2DM or HTN patients. However, the results should be confirmed by a double blinded placebo studies.
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Affiliation(s)
- C Padmapriya
- Department of Psychiatry, Sri Ramachandra Medical College and Research Institute, India
| | - S Pushkarapriya
- Department of Pharmacy Practice, Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Deemed to be University (DU), Porur, Chennai, 600 116, Tamil Nadu, India
| | - N Shanmugapriya
- Department of Pharmacy Practice, Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Deemed to be University (DU), Porur, Chennai, 600 116, Tamil Nadu, India
| | - K P Sushmitha
- Department of Pharmacy Practice, Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Deemed to be University (DU), Porur, Chennai, 600 116, Tamil Nadu, India
| | - S Karthik
- Department of Pharmacy Practice, Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Deemed to be University (DU), Porur, Chennai, 600 116, Tamil Nadu, India.
| | - M G Rajanandh
- Department of Pharmacy Practice, Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Deemed to be University (DU), Porur, Chennai, 600 116, Tamil Nadu, India.
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Akambase JA, Miller NE, Garrison GM, Stadem P, Talley H, Angstman KB. Depression Outcomes in Smokers and Nonsmokers: Comparison of Collaborative Care Management Versus Usual Care. J Prim Care Community Health 2020; 10:2150132719861265. [PMID: 31303098 PMCID: PMC6628524 DOI: 10.1177/2150132719861265] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Depression is common in the primary care setting and tobacco use is more prevalent among individuals with depression. Recent research has linked smoking to poorer outcomes of depression treatment. We hypothesized that in adult primary care patients with the diagnosis of depression, current smoking would have a negative impact on clinical outcomes, regardless of treatment type (usual primary care [UC] vs collaborative care management [CCM]). Methods: A retrospective chart review study of 5155 adult primary care patients with depression in a primary care practice in southeast Minnesota was completed. Variables obtained included age, gender, marital status, race, smoking status, initial Patient Health Questionnaire-9 (PHQ-9), and 6-month PHQ-9. Clinical remission (CR) was defined as 6-month PHQ-9 <5. Persistent depressive symptoms (PDS) were defined as PHQ-9 ≥10 at 6 months. Treatment in both CCM and UC were compared. Results: Using intention to treat analysis, depressed smokers treated with CCM were 4.60 times as likely (95% CI 3.24-6.52, P < .001) to reach CR and were significantly less likely to have PDS at 6 months (adjusted odds ratio [AOR] 0.19, 95% CI 0.14-0.25, P < .001) compared with smokers in UC. After a 6-month follow-up, depressed smokers treated with CCM were 1.75 times as likely (95% CI 1.18-2.59, P = .006) to reach CR and were significantly less likely to have PDS (AOR 0.45, 95% CI 0.31-0.64, P < .001) compared with smokers in UC. Conclusions: CCM significantly improved depression outcomes for smokers at 6 months compared with UC. However, in the UC group, smoking outcomes were not statistically different at 6 months for either remission or PDS. Also, nonsmokers in CCM had the best clinical outcomes at 6 months in both achieving clinical remission and reduction of PDS when compared with smokers in UC as the reference group.
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Affiliation(s)
| | | | | | - Paul Stadem
- 2 University of Minnesota Twin Cities, Minneapolis, MN, USA
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Sheckter CC, Li K, Carrougher GJ, Pham TN, Gibran NS, Stewart BT. The Impact of Comorbid Conditions on Long-Term Patient-Reported Outcomes From Burn Survivors. J Burn Care Res 2020; 41:956-962. [PMID: 32582952 DOI: 10.1093/jbcr/iraa090] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Preburn comorbidities increase the risk of death in the acute phase, and negatively impact quality of life among survivors. Investigations to date have only evaluated comorbidities as indices, limiting the ability to target conditions and develop strategies for risk reduction. Therefore, we aimed to evaluate the differential effects of specific conditions on long-term, patient-reported outcomes after burn injury. A prospectively maintained trauma registry was merged with a longitudinal database of patient-reported outcomes from a regional burn center from 2007 to 2018. Demographic data, injury-specific information, and the prevalence of 20 comorbidities were systematically documented. The impact of comorbidities on responses to Short Form-12/Veterans RAND 12 (SF/VR-12) health surveys at 6, 12, and 24 months postinjury was evaluated with generalized linear models. The merged dataset included 493 adult participants. Median age was 46 years (interquartile range, IQR 32-57 years), and 72% were male. Median burn size was 14% TBSA (IQR 5-28%). Seventy percent of participants had ≥1 comorbidity (median 1 comorbidity/participant; IQR 0-2 comorbidities). SF/VR-12 mental component summary scores at 6 and 12 months postinjury were negatively associated with mental illness (P < .001, P = .013). SF/VR-12 physical component summary (PCS) scores were negatively associated with smoking (P = .019), diabetes (P = .001), and alcohol use disorder (P = .001) at 6-month follow-up. Twelve-month SF/VR-12 PCS scores were negatively associated with prior trauma admission (P = .001) and diabetes (P = .042). Twenty-four-month SF/VR-12 PCS scores were negatively associated with mental illness (P = .003). Smoking, alcohol use disorder, and diabetes were associated with lower PCS scores 6 months after injury; diabetes persisted as a negatively associated covariate at 12 months. Mental component summary scores were negatively associated with mental illness 6 and 12 months postinjury. Integrated models of postdischarge comorbidity management need to be tested in burn patients.
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Affiliation(s)
- Clifford C Sheckter
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University, California
| | - Kevin Li
- Division of Trauma, Burn, & Critical Care Surgery, Department of Surgery, University of Washington, Seattle
| | - Gretchen J Carrougher
- Division of Trauma, Burn, & Critical Care Surgery, Department of Surgery, University of Washington, Seattle
| | - Tam N Pham
- Division of Trauma, Burn, & Critical Care Surgery, Department of Surgery, University of Washington, Seattle
| | - Nicole S Gibran
- Division of Trauma, Burn, & Critical Care Surgery, Department of Surgery, University of Washington, Seattle
| | - Barclay T Stewart
- Division of Trauma, Burn, & Critical Care Surgery, Department of Surgery, University of Washington, Seattle
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Wong J, Mehta G. Efficacy of Depression Management in an Integrated Psychiatric-Diabetes Education Clinic for Comorbid Depression and Diabetes Mellitus Types 1 and 2. Can J Diabetes 2020; 44:455-460. [PMID: 32653155 DOI: 10.1016/j.jcjd.2020.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 03/25/2020] [Accepted: 03/27/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Patients with type 1 and type 2 diabetes mellitus (DM) are 2 times as predisposed to developing mood disorders, such as major depressive disorder (MDD), compared with patients without diabetes. Management of comorbid MDD and DM remains a challenge because patients often suffer from poor medication compliance, lifestyle factors and refractory depression. Integration of psychiatric care into diabetes education clinics (DECs) has been suggested as an effective method of managing the comorbid conditions. As this strategy is being implemented into clinical care, its effectiveness in practice warrants further research. METHODS A retrospective chart review of 24 patients (10 men and 14 women) followed by an integrated psychiatry-DEC in Newmarket, Ontario, Canada, between April 2016 and July 2019 was performed. Depressive symptom severity at each appointment was assessed with the Patient Health Questionnaire-9 (PHQ-9) depression rating scale. RESULTS There was no significant change in PHQ-9 depression rating scale scoring between the first and most recent appointments (paired t test, p=0.356); however, patients who had improved PHQ-9 scoring were more likely to have more clinic visits (analysis of variance, p=0.0271). A significant negative correlation was found between both number of visits (Pearson coefficient, -0.56; p=0.005) and overall time the patients were followed by DEC (Pearson coefficient, -0.42; p=0.040) and PHQ-9 score changes between the first and most recent appointments. PHQ-9 change between individual appointments also displayed a positive correlation with time between appointments (Pearson coefficient, 0.26; p=0.027). CONCLUSIONS Regular follow up in a psychiatry-DEC service might be beneficial in managing MDD symptom severity for comorbid MDD and DM.
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Affiliation(s)
- Jackson Wong
- University College Cork, School of Medicine, Cork, Ireland
| | - Gaurav Mehta
- Southlake Regional Health Centre, Newmarket, Ontario, Canada; University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada.
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Cross AJ, Elliott RA, Petrie K, Kuruvilla L, George J. Interventions for improving medication-taking ability and adherence in older adults prescribed multiple medications. Cochrane Database Syst Rev 2020; 5:CD012419. [PMID: 32383493 PMCID: PMC7207012 DOI: 10.1002/14651858.cd012419.pub2] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Older people taking multiple medications represent a large and growing proportion of the population. Managing multiple medications can be challenging, and this is especially the case for older people, who have higher rates of comorbidity and physical and cognitive impairment than younger adults. Good medication-taking ability and medication adherence are necessary to ensure safe and effective use of medications. OBJECTIVES To evaluate the effectiveness of interventions designed to improve medication-taking ability and/or medication adherence in older community-dwelling adults prescribed multiple long-term medications. SEARCH METHODS We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, CINAHL Plus, and International Pharmaceutical Abstracts from inception until June 2019. We also searched grey literature, online trial registries, and reference lists of included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs), quasi-RCTs, and cluster-RCTs. Eligible studies tested interventions aimed at improving medication-taking ability and/or medication adherence among people aged ≥ 65 years (or of mean/median age > 65 years), living in the community or being discharged from hospital back into the community, and taking four or more regular prescription medications (or with group mean/median of more than four medications). Interventions targeting carers of older people who met these criteria were also included. DATA COLLECTION AND ANALYSIS Two review authors independently reviewed abstracts and full texts of eligible studies, extracted data, and assessed risk of bias of included studies. We conducted meta-analyses when possible and used a random-effects model to yield summary estimates of effect, risk ratios (RRs) for dichotomous outcomes, and mean differences (MDs) or standardised mean differences (SMDs) for continuous outcomes, along with 95% confidence intervals (CIs). Narrative synthesis was performed when meta-analysis was not possible. We assessed overall certainty of evidence for each outcome using Grades of Recommendation, Assessment, Development and Evaluation (GRADE). Primary outcomes were medication-taking ability and medication adherence. Secondary outcomes included health-related quality of life (HRQoL), emergency department (ED)/hospital admissions, and mortality. MAIN RESULTS We identified 50 studies (14,269 participants) comprising 40 RCTs, six cluster-RCTs, and four quasi-RCTs. All included studies evaluated interventions versus usual care; six studies also reported a comparison between two interventions as part of a three-arm RCT design. Interventions were grouped on the basis of their educational and/or behavioural components: 14 involved educational components only, 7 used behavioural strategies only, and 29 provided mixed educational and behavioural interventions. Overall, our confidence in results regarding the effectiveness of interventions was low to very low due to a high degree of heterogeneity of included studies and high or unclear risk of bias across multiple domains in most studies. Five studies evaluated interventions for improving medication-taking ability, and 48 evaluated interventions for improving medication adherence (three studies evaluated both outcomes). No studies involved educational or behavioural interventions alone for improving medication-taking ability. Low-quality evidence from five studies, each using a different measure of medication-taking ability, meant that we were unable to determine the effects of mixed interventions on medication-taking ability. Low-quality evidence suggests that behavioural only interventions (RR 1.22, 95% CI 1.07 to 1.38; 4 studies) and mixed interventions (RR 1.22, 95% CI 1.08 to 1.37; 12 studies) may increase the proportions of people who are adherent compared with usual care. We could not include in the meta-analysis results from two studies involving mixed interventions: one had a positive effect on adherence, and the other had little or no effect. Very low-quality evidence means that we are uncertain of the effects of educational only interventions (5 studies) on the proportions of people who are adherent. Low-quality evidence suggests that educational only interventions (SMD 0.16, 95% CI -0.12 to 0.43; 5 studies) and mixed interventions (SMD 0.47, 95% CI -0.08 to 1.02; 7 studies) may have little or no impact on medication adherence assessed through continuous measures of adherence. We excluded 10 studies (4 educational only and 6 mixed interventions) from the meta-analysis including four studies with unclear or no available results. Very low-quality evidence means that we are uncertain of the effects of behavioural only interventions (3 studies) on medication adherence when assessed through continuous outcomes. Low-quality evidence suggests that mixed interventions may reduce the number of ED/hospital admissions (RR 0.67, 95% CI 0.50 to 0.90; 11 studies) compared with usual care, although results from six further studies that we were unable to include in meta-analyses indicate that the intervention may have a smaller, or even no, effect on these outcomes. Similarly, low-quality evidence suggests that mixed interventions may lead to little or no change in HRQoL (7 studies), and very low-quality evidence means that we are uncertain of the effects on mortality (RR 0.93, 95% CI 0.67 to 1.30; 7 studies). Moderate-quality evidence shows that educational interventions alone probably have little or no effect on HRQoL (6 studies) or on ED/hospital admissions (4 studies) when compared with usual care. Very low-quality evidence means that we are uncertain of the effects of behavioural interventions on HRQoL (1 study) or on ED/hospital admissions (2 studies). We identified no studies evaluating effects of educational or behavioural interventions alone on mortality. Six studies reported a comparison between two interventions; however due to the limited number of studies assessing the same types of interventions and comparisons, we are unable to draw firm conclusions for any outcomes. AUTHORS' CONCLUSIONS Behavioural only or mixed educational and behavioural interventions may improve the proportion of people who satisfactorily adhere to their prescribed medications, but we are uncertain of the effects of educational only interventions. No type of intervention was found to improve adherence when it was measured as a continuous variable, with educational only and mixed interventions having little or no impact and evidence of insufficient quality to determine the effects of behavioural only interventions. We were unable to determine the impact of interventions on medication-taking ability. The quality of evidence for these findings is low due to heterogeneity and methodological limitations of studies included in the review. Further well-designed RCTs are needed to investigate the effects of interventions for improving medication-taking ability and medication adherence in older adults prescribed multiple medications.
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Affiliation(s)
- Amanda J Cross
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Rohan A Elliott
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
- Pharmacy Department, Austin Health, Heidelberg, Australia
| | - Kate Petrie
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Lisha Kuruvilla
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
- Pharmacy Department, Barwon Health, North Geelong, Australia
| | - Johnson George
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
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Bunn C, Harwood E, Akhter K, Simmons D. Integrating care: the work of diabetes care technicians in an integrated care initiative. BMC Health Serv Res 2020; 20:235. [PMID: 32192474 PMCID: PMC7082957 DOI: 10.1186/s12913-020-05109-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/13/2020] [Indexed: 11/24/2022] Open
Abstract
Background As diabetes prevalence rises world-wide, the arrangement of clinics and care packages is increasingly debated by health care professionals (HCPs), health service researchers, patient groups and policy makers. ‘Integrated care’, while representing a range of approaches, has been positioned as a promising solution with potential to benefit patients and health systems. This is particularly the case in rural populations which are often removed from centres of specialist care. The social arrangements within diabetes integrated care initiatives are understudied but are of particular importance to those implementing such initiatives. In this paper we explore the ‘work’ of integration through an analysis of the role played by Health Care Assistants (HCAs) who were specially trained in aspects of diabetes care and given the title ‘Diabetes Care Technician’ (DCT). Methods Using thematic analysis of interview (n = 55) and observation data (n = 40), we look at: how the role of DCTs was understood by patients and other HCPs, as well as the DCTs; and explore what DCTs did within the integrated care initiative. Results Our findings suggested that the DCTs saw their role as part of a hierarchy, providing links between members of the integrated team, and explaining and validating clinical decisions. Patients characterised DCTs as friends and advisors who provided continuity. Other HCPs perceived the DCTs as supportive, providing long-term monitoring and doing a different job to conventional HCAs. We found that DCTs had to navigate local terrain (social, ethical and physical), engage in significant conversation and negotiate treatment plans created through integrated care. The analysis suggests that relationships between patients and the DCTs were strong, had the quality of friendship and mitigated loneliness. Conclusions DCTs played multidimensional roles in the integrated care initiative that required great social and emotional skill. Building friendships with patients was central to their work, which mitigated loneliness and facilitated the care they provided.
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Affiliation(s)
- Christopher Bunn
- Institute of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, G12 8RS, UK
| | - Elissa Harwood
- Faculty of Health, Education, Medicine & Social Care, Anglia Ruskin University, Cambridge, CB1 1PT, UK
| | - Kalsoom Akhter
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB2 0SR, UK
| | - David Simmons
- Wolfson Diabetes and Endocrinology Clinic, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK. .,School of Medicine, Western Sydney University, Campbelltown, NSW, 2560, Australia.
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Moriarty AS, Coventry PA, Hudson JL, Cook N, Fenton OJ, Bower P, Lovell K, Archer J, Clarke R, Richards DA, Dickens C, Gask L, Waheed W, Huijbregts KM, van der Feltz-Cornelis C, Ali S, Gilbody S, McMillan D. The role of relapse prevention for depression in collaborative care: A systematic review. J Affect Disord 2020; 265:618-644. [PMID: 31791677 DOI: 10.1016/j.jad.2019.11.105] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 10/01/2019] [Accepted: 11/21/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Relapse (the re-emergence of depression symptoms before full recovery) is common in depression and relapse prevention strategies are not well researched in primary care settings. Collaborative care is effective for treating acute phase depression but little is known about the use of relapse prevention strategies in collaborative care. We undertook a systematic review to identify and characterise relapse prevention strategies in the context of collaborative care. METHODS We searched for Randomised Controlled Trials (RCTs) of collaborative care for depression. In addition to published material, we obtained provider and patient manuals from authors to provide more detail on intervention content. We reported the extent to which collaborative care interventions addressed four relapse prevention components. RESULTS 93 RCTs were identified. 31 included a formal relapse prevention plan; 42 had proactive monitoring and follow-up after the acute phase; 39 reported strategies for optimising sustained medication adherence; and 20 of the trials reported psychological or psycho-educational treatments persisting beyond the acute phase or focussing on long-term health/relapse prevention. 30 (32.3%) did not report relapse prevention approaches. LIMITATIONS We did not receive trial materials for approximately half of the trials, which limited our ability to identify relevant features of intervention content. CONCLUSION Relapse is a significant risk amongst people treated for depression and interventions are needed that specifically address and minimise this risk. Given the advantages of collaborative care as a delivery system for depression care, there is scope for more consistency and increased effort to implement and evaluate relapse prevention strategies.
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Affiliation(s)
- Andrew S Moriarty
- Department of Health Sciences and the Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK.
| | - Peter A Coventry
- Department of Health Sciences and Centre for Reviews and Dissemination, University of York, Heslington, York, YO10 5DD, UK.
| | - Joanna L Hudson
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK.
| | - Natalie Cook
- Department of Health Sciences and the Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK.
| | - Oliver J Fenton
- Tees, Esk and Wear Valleys NHS Foundation Trust, South and West Community Mental Health Team, Acomb Garth, 2 Oak Rise, York, YO24 4LJ, UK.
| | - Peter Bower
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK.
| | - Karina Lovell
- Division of Nursing, Midwifery & Social Work, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK.
| | - Janine Archer
- School of Health and Society, University of Salford, Mary Seacole Building, Broad St, Frederick Road Campus, Salford, M6 6PU, UK.
| | - Rose Clarke
- Sheffield IAPT, St George's Community Health Centre, Winter Street, Sheffield, South Yorkshire, S3 7ND, UK.
| | - David A Richards
- Institute of Health Research, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Chris Dickens
- Institute of Health Research, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Linda Gask
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK.
| | - Waquas Waheed
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK.
| | - Klaas M Huijbregts
- GGNet, Mental Health, RGC SKB Winterswijk, Beatrixpark 1, 7101 BN Winterswijk, The Netherlands.
| | | | - Shehzad Ali
- Epidemiology and Biostatistics Department, Schulich School of Medicine & Dentistry, Western University, Kresge Building, Room K201, London, Ontario, N6A 5C1, Canada; Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK.
| | - Simon Gilbody
- Department of Health Sciences and the Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK.
| | - Dean McMillan
- Department of Health Sciences and the Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK.
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Abrahamian H, Kautzky-Willer A, Rießland-Seifert A, Fasching P, Ebenbichler C, Kautzky A, Hofmann P, Toplak H. [Mental disorders and diabetes mellitus (Update 2019)]. Wien Klin Wochenschr 2019; 131:186-195. [PMID: 30980168 DOI: 10.1007/s00508-019-1458-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Psychiatric disorders and psychological problems are common in patients with diabetes mellitus. There is a twofold increase in depression which is associated with suboptimal glycemic control and increased morbidity and mortality. Other psychiatric disorders with a higher incidence of diabetes mellitus are cognitive impairment, dementia, disturbed eating behavior, anxiety disorders, schizophrenia, bipolar disorders and borderline personality disorder. The coincidence of mental disorders and diabetes mellitus has unfavorable influences on metabolic control and micro- and macroangiopathic complications. Improvement of therapeutic outcome is a challenge in the modern health care system. The intentions behind this position paper are to rise awareness of this special set of problems, to intensify cooperation between involved health care providers and to reduce incidence of diabetes mellitus as well as morbidity and mortality from diabetes in this patient group.
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Affiliation(s)
- Heidemarie Abrahamian
- Internistisches Zentrum, Sozialmedizinisches Zentrum Baumgartner Höhe, Otto-Wagner-Spital, 1140, Wien, Österreich.
| | - Alexandra Kautzky-Willer
- Gender Medicine Unit, Klinische, Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Angelika Rießland-Seifert
- 1. Psychiatrische Abteilung mit Zentrum für Psychotherapie und Psychosomatik, Sozialmedizinisches Zentrum Baumgartner Höhe, Otto-Wagner-Spital, Wien, Österreich
| | - Peter Fasching
- 5. Medizinische Abteilung für Endokrinologie, Rheumatologie und Akutgeriatrie, Wilhelminenspital der Stadt Wien, Wien, Österreich
| | - Christoph Ebenbichler
- Universitätsklinik für Innere Medizin I, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Alexander Kautzky
- Klinische Abteilung für Sozialpsychiatrie, Medizinische Universitätsklinik für Psychiatrie und Psychotherapie, Wien, Österreich
| | - Peter Hofmann
- Universitätsklinik für Psychiatrie und Psychotherapeutische Medizin, Medizinische Universität Graz, Graz, Österreich
| | - Hermann Toplak
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Österreich
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Garcia ML, Castañeda SF, Allison MA, Elder JP, Talavera GA. Correlates of low-adherence to oral hypoglycemic medications among Hispanic/Latinos of Mexican heritage with Type 2 Diabetes in the United States. Diabetes Res Clin Pract 2019; 155:107692. [PMID: 30954512 PMCID: PMC9494711 DOI: 10.1016/j.diabres.2019.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 02/18/2019] [Accepted: 04/01/2019] [Indexed: 12/19/2022]
Abstract
AIMS We examined psychosocial- and social/economic factors related to low medication adherence, and sex differences, among 279 adults of Mexican heritage with Type 2 Diabetes. METHODS Self-report and health record data were used for cross-sectional analyses. Bivariate analyses tested the association of demographic, psychosocial (depression, anxiety, stress) and social/economic factors (insurance type, health literacy, social support) and medication adherence measured by proportion of days covered. Hierarchical regression analyses examined associations between demographic, psychosocial- and social/economic- related factors and low medication adherence stratified by sex. RESULTS More males than females demonstrated low adherence to hypoglycemic medications (75.0.% vs. 70.3%) (p < 0.05). We found significant differences between levels social support and medication adherence (p < 0.05). In hierarchical models, being US born and higher levels of social support were associated with low adherence among males (p < 0.05, and p < 0.001). CONCLUSIONS Approximately 72% of Mexican heritage adults demonstrated low adherence (PDC ≤ 0.50) to their hypoglycemic regimen, and gender differences exist. Interventions should address gender differences in preferences for social support to improve medication-taking behaviors among Mexican heritage males.
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Affiliation(s)
- Melawhy L Garcia
- Division of Health Promotion and Behavioral Science, School of Public Health, San Diego State University and Institute for Behavioral and Community Health, 9245 Sky Park Court, Suite 221 San Diego, CA 92123-4311, USA; Department of Family Medicine and Public Health, School of Medicine and Women's Cardiovascular Research Center, University of California San Diego, 8950 Villa La Jolla Drive, Suite A2016, La Jolla, CA 92307, USA.
| | - Sheila F Castañeda
- Division of Health Promotion and Behavioral Science, School of Public Health, San Diego State University and Institute for Behavioral and Community Health, 9245 Sky Park Court, Suite 221 San Diego, CA 92123-4311, USA
| | - Matthew A Allison
- Department of Family Medicine and Public Health, School of Medicine and Women's Cardiovascular Research Center, University of California San Diego, 8950 Villa La Jolla Drive, Suite A2016, La Jolla, CA 92307, USA
| | - John P Elder
- Division of Health Promotion and Behavioral Science, School of Public Health, San Diego State University and Institute for Behavioral and Community Health, 9245 Sky Park Court, Suite 221 San Diego, CA 92123-4311, USA
| | - Gregory A Talavera
- Division of Health Promotion and Behavioral Science, School of Public Health, San Diego State University and Institute for Behavioral and Community Health, 9245 Sky Park Court, Suite 221 San Diego, CA 92123-4311, USA
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Félix IB, Guerreiro MP, Cavaco A, Cláudio AP, Mendes A, Balsa J, Carmo MB, Pimenta N, Henriques A. Development of a Complex Intervention to Improve Adherence to Antidiabetic Medication in Older People Using an Anthropomorphic Virtual Assistant Software. Front Pharmacol 2019; 10:680. [PMID: 31281256 PMCID: PMC6597679 DOI: 10.3389/fphar.2019.00680] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/24/2019] [Indexed: 12/15/2022] Open
Abstract
Introduction: Improving adherence to antidiabetic medication is crucial, resulting in improved health outcomes, cost reduction, and minimization of waste. A lack of underlying theory in existing interventions may explain the limited success in sustaining behavior change. This paper describes the development of a theory and evidence-based complex intervention to improve adherence to oral antidiabetics in older people via a software prototype with an anthropomorphic virtual assistant. Methods: The Behavior Change Wheel (BCW) was used to develop a theoretical understanding of the change process, corresponding to the first phase of the Medical Research Council Framework for developing and evaluating complex interventions. At the BCW core is a model of human behavior (COM-B), which posits that human behavior (B) results from the interaction between capabilities (C), opportunities (O), and motivation (M). Literature-derived medication adherence determinants were mapped onto COM-B components. Then, intervention functions (IFs) were selected employing the APEASE criteria. Finally, standardized behavior change techniques (BCTs) were chosen based on their suitability and their effectiveness on medication adherence trials. The prototype was developed for android devices; its core was implemented in Unity3D, using a female 3D virtual assistant, named Vitória. Results: Two COM-B components were identified as main targets for behavior change—psychological capability and reflective motivation; these were linked with four IFs—education, persuasion, enablement, and environmental restructuring. Eleven BCTs were, in turn, linked with the IFs. An example of a BCT is “problem solving”; it requires users to pinpoint factors influencing non-adherence and subsequently offers strategies to achieve the desired behavior. BCTs were operationalized into the dialogues with Vitória and into supplementary software features. Vitória communicates with users verbally and non-verbally, expressing emotions. Input options consist of buttons or recording values, such as medication taken. Conclusion: The present approach enabled us to derive the most appropriate BCTs for our intervention. The use of an explicit bundle of BCTs, often overlooked in interventions promoting medication adherence, is expected to maximize effectiveness and facilitates replication. The first prototype is being refined with users and health professionals’ contributions. Future work includes subjecting the prototype to usability tests and a feasibility trial.
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Affiliation(s)
- Isa Brito Félix
- Unidade de Investigação e Desenvolvimento em Enfermagem (UI&DE), Lisbon Nursing School, Lisbon, Portugal
| | - Mara Pereira Guerreiro
- Unidade de Investigação e Desenvolvimento em Enfermagem (UI&DE), Lisbon Nursing School, Lisbon, Portugal.,Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz, Monte de Caparica, Portugal
| | - Afonso Cavaco
- iMed.ULisboa, Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
| | - Ana Paula Cláudio
- Biosystems & Integrative Sciences Institute (BioISI), Faculty of Sciences, University of Lisbon, Lisbon, Portugal
| | - Anabela Mendes
- Unidade de Investigação e Desenvolvimento em Enfermagem (UI&DE), Lisbon Nursing School, Lisbon, Portugal
| | - João Balsa
- Biosystems & Integrative Sciences Institute (BioISI), Faculty of Sciences, University of Lisbon, Lisbon, Portugal
| | - Maria Beatriz Carmo
- Biosystems & Integrative Sciences Institute (BioISI), Faculty of Sciences, University of Lisbon, Lisbon, Portugal
| | - Nuno Pimenta
- Sport Sciences School of Rio Maior, Polytechnic Institute of Santarém, Santarém, Portugal
| | - Adriana Henriques
- Unidade de Investigação e Desenvolvimento em Enfermagem (UI&DE), Lisbon Nursing School, Lisbon, Portugal
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Kumar PR, Chatterjee A, P. Behera J, Patnaik S. Effect of Sertraline as an Add-on Therapy in T2DM Patients with Comorbid Depression: An Open Label Randomized Controlled Trial. Indian J Endocrinol Metab 2019; 23:357-362. [PMID: 31641639 PMCID: PMC6683678 DOI: 10.4103/ijem.ijem_67_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES To study the effect of sertraline on depression in type 2 diabetes mellitus (T2DM) patients with comorbid depression. MATERIALS AND METHODS An open label randomized control study. Patients with T2DM and moderate to severe depression were randomized to sertraline or control therapy for six months. The primary objective was the change in depression score and the secondary objectives were changes in glycemic parameters, wellbeing, and drug adherence scores at three and six months. RESULTS The present study includes 160 T2DM patients with moderate to severe depression. Depression in these patients was evaluated using a self-reporting version of Patient Health Questionnaire (PHQ-9). A total of 80 patients each were randomized to sertraline and control groups. Sertraline significantly improved depression scores in patients with T2DM and moderate to severe depression both at 3 months and 6 months compared to the control group. The wellbeing and treatment adherence scores improved significantly in the sertraline group at 6 months. However, sertraline had no significant effect on glycemic parameters when compared to control group both at 3 months and 6 months. CONCLUSION Sertraline significantly improves depression and drug adherence in T2DM patients with depression but has no effect on glycemic parameters.
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Affiliation(s)
- Padala R. Kumar
- Department of Endocrinology, MKCG Medical College, Berhampur, Odisha, India
| | | | - Jayanti P. Behera
- Department of Endocrinology, MKCG Medical College, Berhampur, Odisha, India
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Cummings DM, Lutes LD, Littlewood K, Solar C, Carraway M, Kirian K, Patil S, Adams A, Ciszewski S, Edwards S, Gatlin P, Hambidge B. Randomized Trial of a Tailored Cognitive Behavioral Intervention in Type 2 Diabetes With Comorbid Depressive and/or Regimen-Related Distress Symptoms: 12-Month Outcomes From COMRADE. Diabetes Care 2019; 42:841-848. [PMID: 30833367 DOI: 10.2337/dc18-1841] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 02/04/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study evaluated the effect of cognitive behavioral therapy (CBT) plus lifestyle counseling in primary care on hemoglobin A1c (HbA1c) in rural adult patients with type 2 diabetes (T2D) and comorbid depressive or regimen-related distress (RRD) symptoms. RESEARCH DESIGN AND METHODS This study was a randomized controlled trial of a 16-session severity-tailored CBT plus lifestyle counseling intervention compared with usual care. Outcomes included changes in HbA1c, RRD, depressive symptoms, self-care behaviors, and medication adherence across 12 months. RESULTS Patients included 139 diverse, rural adults (mean age 52.6 ± 9.5 years; 72% black; BMI 37.0 ± 9.0 kg/m2) with T2D (mean HbA1c 9.6% [81 mmol/mol] ± 2.0%) and comorbid depressive or distress symptoms. Using intent-to-treat analyses, patients in the intervention experienced marginally significant improvements in HbA1c (-0.92 ± 1.81 vs. -0.31 ± 2.04; P = 0.06) compared with usual care. However, intervention patients experienced significantly greater improvements in RRD (-1.12 ± 1.05 vs. -0.31 ± 1.22; P = 0.001), depressive symptoms (-3.39 ± 5.00 vs. -0.90 ± 6.17; P = 0.01), self-care behaviors (1.10 ± 1.30 vs. 0.58 ± 1.45; P = 0.03), and medication adherence (1.00 ± 2.0 vs. 0.17 ± 1.0; P = 0.02) versus usual care. Improvement in HbA1c correlated with improvement in RRD (r = 0.3; P = 0.0001) and adherence (r = -0.23; P = 0.007). CONCLUSIONS Tailored CBT with lifestyle counseling improves behavioral outcomes and may improve HbA1c in rural patients with T2D and comorbid depressive and/or RRD symptoms.
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Affiliation(s)
- Doyle M Cummings
- Department of Family Medicine, Brody School of Medicine, East Carolina University, Greenville, NC .,Center for Health Disparities, East Carolina University, Greenville, NC
| | - Lesley D Lutes
- Department of Psychology, University of British Columbia, Kelowna, British Columbia, Canada
| | | | - Chelsey Solar
- Department of Psychology, East Carolina University, Greenville, NC
| | - Marissa Carraway
- Department of Family Medicine, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Kari Kirian
- Department of Family Medicine, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Shivajirao Patil
- Department of Family Medicine, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Alyssa Adams
- Department of Family Medicine, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Stefanie Ciszewski
- Department of Psychology, University of British Columbia, Kelowna, British Columbia, Canada
| | - Sheila Edwards
- Department of Family Medicine, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Peggy Gatlin
- Department of Family Medicine, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Bertha Hambidge
- Department of Family Medicine, Brody School of Medicine, East Carolina University, Greenville, NC
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Mori K, Mori T, Nagata T, Nagata M, Iwasaki M, Sakai H, Kimura K, Shinzato N. Factors of occurrence and improvement methods of presenteeism attributed to diabetes: A systematic review. J Occup Health 2019; 61:36-53. [PMID: 30698334 PMCID: PMC6499359 DOI: 10.1002/1348-9585.12034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 11/11/2018] [Indexed: 01/22/2023] Open
Abstract
Objective A systematic review was performed to study factors of occurrence and improvement methods of presenteeism attributed to diabetes. Methods We set 2 clinical questions; (a) how comorbidities and complications of diabetes induce presenteeism and (b) what interventions or conditions effectively improve presenteeism. Then, we conducted a comprehensive search with MEDLINE/PubMed and Scopus databases and extracted those that met the clinical questions. Results Eighteen papers studied occurrence of presenteeism by comorbidities and complications of diabetes. Most studies were cross‐sectional and had a low quality of evidence. However, the associations of hypoglycemia, diabetic neuropathy, and mood disorders with presenteeism were relatively well studied. The papers that discussed effective interventions or conditions for improving presenteeism were very limited. Conclusions Our review suggests that presenteeism attributed to diabetes is mainly caused by hypoglycemia, diabetic neuropathy, and mood disorders. There are very limited evidences, but available information suggests that improving glycemic control, adjusting treatment regimen by evaluating the impact on work, providing psychological support, and developing suitable work accommodations may effectively reduce presenteeism.
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Affiliation(s)
- Koji Mori
- Department of Occupational Health Practice and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Takahiro Mori
- Department of Occupational Health Practice and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Tomohisa Nagata
- Department of Occupational Health Practice and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masako Nagata
- Department of Occupational Health Practice and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Mahoko Iwasaki
- Department of Occupational Health Practice and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Hiroki Sakai
- Department of Occupational Health Practice and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Koki Kimura
- Department of Occupational Health Practice and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Natsumi Shinzato
- Department of Occupational Health Practice and Management, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
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Abstract
PURPOSE OF REVIEW Mental and physical disorders commonly co-occur leading to higher morbidity and mortality in people with mental and substance use disorders (collectively called behavioral health disorders). Models to integrate primary and behavioral health care for this population have not yet been implemented widely across health systems, leading to efforts to adapt models for specific subpopulations and mechanisms to facilitate more widespread adoption. RECENT FINDINGS Using examples from the UK and USA, we describe recent advances to integrate behavioral and primary care for new target populations including people with serious mental illness, people at the extremes of life, and for people with substance use disorders. We summarize mechanisms to incentivize integration efforts and to stimulate new integration between health and social services in primary care. We then present an outline of recent enablers for integration, concentrating on changes to funding mechanisms, developments in quality outcome measurements to promote collaborative working, and pragmatic guidance aimed at primary care providers wishing to enhance provision of behavioral care. Integrating care between primary care and behavioral health services is a complex process. Established models of integrated care are now being tailored to target specific patient populations and policy initiatives developed to encourage adoption in particular settings. Wholly novel approaches to integrate care are significantly less common. Future efforts to integrate care should allow for flexibility and innovation around implementation, payment models that support delivery of high value care, and the development of outcome measures that incentivize collaborative working practices.
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Self-reported adherence to foot care in type 2 diabetes patients: do illness representations and distress matter? Prim Health Care Res Dev 2018; 20:e40. [PMID: 30095065 PMCID: PMC6536758 DOI: 10.1017/s1463423618000531] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Aim This study examined the differences and the predictive role of clinical variables, illness representations, anxiety, and depression symptoms, on self-reported foot care adherence, in patients recently diagnosed with type 2 diabetes mellitus (T2DM) and assessed no longer than a year after the diagnosis (T1) and four months later (T2). Background The high rate of diabetes worldwide is one of the major public health challenges. Foot care is the behavior least performed by patients although regular foot care could prevent complications such as diabetic foot and amputation. Psychosocial processes such as illness representations and distress symptoms may contribute to explain adherence to foot self-care behaviors. Methods This is a longitudinal study with two assessment moments. The sample included 271 patients, who answered the Revised Summary of Diabetes Self-Care Activities, Brief-Illness Perception Questionnaire, and Hospital Anxiety and Depression Scale. Findings Patients reported better foot care adherence at T2. Having a higher duration of T2DM and the perception of more consequences of diabetes were associated with better self-reported foot care adherence, at T1. At T2, the predictors were lower levels of HbA1c, better self-reported foot care adherence at T1, higher comprehension about T2DM, as well as fewer depressive symptoms. Interventions to promote adherence to foot care should have in consideration these variables. The results of the present study may help health professionals in designing interventions that early detect depressive symptoms and address illness beliefs, in order to promote foot self-care behaviors reducing the incidence of future complications.
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Giri B, Dey S, Das T, Sarkar M, Banerjee J, Dash SK. Chronic hyperglycemia mediated physiological alteration and metabolic distortion leads to organ dysfunction, infection, cancer progression and other pathophysiological consequences: An update on glucose toxicity. Biomed Pharmacother 2018; 107:306-328. [PMID: 30098549 DOI: 10.1016/j.biopha.2018.07.157] [Citation(s) in RCA: 272] [Impact Index Per Article: 38.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/15/2018] [Accepted: 07/31/2018] [Indexed: 02/09/2023] Open
Abstract
Chronic exposure of glucose rich environment creates several physiological and pathophysiological changes. There are several pathways by which hyperglycemia exacerbate its toxic effect on cells, tissues and organ systems. Hyperglycemia can induce oxidative stress, upsurge polyol pathway, activate protein kinase C (PKC), enhance hexosamine biosynthetic pathway (HBP), promote the formation of advanced glycation end-products (AGEs) and finally alters gene expressions. Prolonged hyperglycemic condition leads to severe diabetic condition by damaging the pancreatic β-cell and inducing insulin resistance. Numerous complications have been associated with diabetes, thus it has become a major health issue in the 21st century and has received serious attention. Dysregulation in the cardiovascular and reproductive systems along with nephropathy, retinopathy, neuropathy, diabetic foot ulcer may arise in the advanced stages of diabetes. High glucose level also encourages proliferation of cancer cells, development of osteoarthritis and potentiates a suitable environment for infections. This review culminates how elevated glucose level carries out its toxicity in cells, metabolic distortion along with organ dysfunction and elucidates the complications associated with chronic hyperglycemia.
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Affiliation(s)
- Biplab Giri
- Department of Physiology, University of Gour Banga, Mokdumpur, Malda 732103, India; Experimental Medicine and Stem Cell Research Laboratory, Department of Physiology, West Bengal State University, Barasat, Kolkata 700126, India.
| | - Sananda Dey
- Department of Physiology, University of Gour Banga, Mokdumpur, Malda 732103, India; Experimental Medicine and Stem Cell Research Laboratory, Department of Physiology, West Bengal State University, Barasat, Kolkata 700126, India
| | - Tanaya Das
- Experimental Medicine and Stem Cell Research Laboratory, Department of Physiology, West Bengal State University, Barasat, Kolkata 700126, India
| | - Mrinmoy Sarkar
- Experimental Medicine and Stem Cell Research Laboratory, Department of Physiology, West Bengal State University, Barasat, Kolkata 700126, India
| | - Jhimli Banerjee
- Department of Physiology, University of Gour Banga, Mokdumpur, Malda 732103, India
| | - Sandeep Kumar Dash
- Department of Physiology, University of Gour Banga, Mokdumpur, Malda 732103, India.
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