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Lee S, Shaheen AA, Campbell DJT, Naugler C, Jiang J, Walker RL, Quan H, Lee J. Evaluating the coding accuracy of type 2 diabetes mellitus among patients with non-alcoholic fatty liver disease. BMC Health Serv Res 2024; 24:218. [PMID: 38365631 PMCID: PMC10874028 DOI: 10.1186/s12913-024-10634-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 01/24/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) describes a spectrum of chronic fattening of liver that can lead to fibrosis and cirrhosis. Diabetes has been identified as a major comorbidity that contributes to NAFLD progression. Health systems around the world make use of administrative data to conduct population-based prevalence studies. To that end, we sought to assess the accuracy of diabetes International Classification of Diseases (ICD) coding in administrative databases among a cohort of confirmed NAFLD patients in Calgary, Alberta, Canada. METHODS The Calgary NAFLD Pathway Database was linked to the following databases: Physician Claims, Discharge Abstract Database, National Ambulatory Care Reporting System, Pharmaceutical Information Network database, Laboratory, and Electronic Medical Records. Hemoglobin A1c and diabetes medication details were used to classify diabetes groups into absent, prediabetes, meeting glycemic targets, and not meeting glycemic targets. The performance of ICD codes among these groups was compared to this standard. Within each group, the total numbers of true positives, false positives, false negatives, and true negatives were calculated. Descriptive statistics and bivariate analysis were conducted on identified covariates, including demographics and types of interacted physicians. RESULTS A total of 12,012 NAFLD patients were registered through the Calgary NAFLD Pathway Database and 100% were successfully linked to the administrative databases. Overall, diabetes coding showed a sensitivity of 0.81 and a positive predictive value of 0.87. False negative rates in the absent and not meeting glycemic control groups were 4.5% and 6.4%, respectively, whereas the meeting glycemic control group had a 42.2% coding error. Visits to primary and outpatient services were associated with most encounters. CONCLUSION Diabetes ICD coding in administrative databases can accurately detect true diabetic cases. However, patients with diabetes who meets glycemic control targets are less likely to be coded in administrative databases. A detailed understanding of the clinical context will require additional data linkage from primary care settings.
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Affiliation(s)
- Seungwon Lee
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 4Z6, Canada.
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Alberta Health Services, Calgary, AB, Canada.
- Data Intelligence for Health Lab, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Abdel Aziz Shaheen
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 4Z6, Canada
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - David J T Campbell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 4Z6, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christopher Naugler
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 4Z6, Canada
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jason Jiang
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
| | - Robin L Walker
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 4Z6, Canada
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Hude Quan
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 4Z6, Canada
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Joon Lee
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 4Z6, Canada
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Data Intelligence for Health Lab, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Alharbi M, Alharbi M, Surrati A, Alhilabi M, alrashdi A, Almokhalafi M. Dietary knowledge assessment among the patients with type 2 diabetes in Madinah: A cross-sectional study . F1000Res 2024; 12:416. [PMID: 38234376 PMCID: PMC10792270 DOI: 10.12688/f1000research.131518.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 01/19/2024] Open
Abstract
Background There is a huge burden of nutrition-related non-communicable diseases, and diabetes is one of the leading chronic nutrition-related diseases affecting more than 500 million people globally. Collecting information regarding the awareness of dietary and nutrition knowledge among diabetic patients is the first step to developing a disease prevention program. Thus, this study primarily aims at assessing the dietary awareness of diabetes patients attending the diabetic centre in Madinah governorate, Saudi Arabia. Methods The study was started in November 2020 and ended in October 2021. The study participants (315) were type 2 diabetes mellitus (T2DM) patients attending a diabetic centre in Madinah, Saudi Arabia. A self-prepared dietary knowledge questionnaire (DKQ) was used in this research. The variables include balanced diet, food type, food choice, carbohydrate, protein, and fat. Knowledge score was, and the total score was levelled/categorized into 'good', 'average', and 'poor'. Data were analysed by SPSS v.26. Results The study results identified the current knowledge of T2DM patients about different dietary items. The knowledge score of 62.2% of participants showed an average level of dietary knowledge, which is statistically significant. When we separately evaluated their understanding of different dietary components, we found that T2DM patients had poor knowledge of carbohydrates (30.15%), fat, food choices (47.7%), and type (34.6%). However, they had acceptable knowledge of proteins (56.5%). Conclusion Our participants exhibited acceptable knowledge about proteins but poorer knowledge of other food groups. A healthy, well-balanced diet is essential for excellent glycaemic control. Educating and arranging a health education program regarding dietary knowledge is recommended, specially designed for diabetic patients so that patients can opt for a healthier lifestyle.
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Affiliation(s)
| | | | - Amal Surrati
- Family and Community Medicine Department, College of Medicine, Taibah University, Madinah, Saudi Arabia
| | - Mashael Alhilabi
- Ministry of Health, King Abdullah Medical City,, Riyadh, Saudi Arabia
| | - Ayed alrashdi
- Riyadh Health Affairs, Ministry of Health, Riyadh, Saudi Arabia
| | - Majedah Almokhalafi
- Madinah Health Cluster, First Network, Riyadh Health Affairs, Ministry of Health, Riyadh, Saudi Arabia
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3
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Rivara AC, Galárraga O, Selu M, Arorae M, Wang R, Faasalele-Savusa K, Rosen R, Hawley NL, Viali S. Identifying patient preferences for diabetes care: A protocol for implementing a discrete choice experiment in Samoa. PLoS One 2023; 18:e0295845. [PMID: 38134044 PMCID: PMC10745180 DOI: 10.1371/journal.pone.0295845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023] Open
Abstract
In Samoa, adult Type 2 diabetes prevalence has increased within the past 30 years. Patient preferences for care are factors known to influence treatment adherence and are associated with reduced disease progression and severity. However, patient preferences for diabetes care, generally, are understudied, and other patient-centered factors such as willingness-to-pay (WTP) for diabetes treatment have never been explored in this setting. Discrete Choice Experiments (DCE) are useful tools to elicit preferences and WTP for healthcare. DCEs present patients with hypothetical scenarios composed of a series of multi-alternative choice profiles made up of attributes and levels. Patients choose a profile based on which attributes and levels may be preferable for them, thereby quantifying and identifying locally relevant patient-centered preferences. This paper presents the protocol for the design, piloting, and implementation of a DCE identifying patient preferences for diabetes care, in Samoa. Using an exploratory sequential mixed methods design, formative data from a literature review and semi-structured interviews with n = 20 Samoan adults living with Type 2 diabetes was used to design a Best-Best DCE instrument. Experimental design procedures were used to reduce the number of choice-sets and balance the instrument. Following pilot testing, the DCE is being administered to n = 450 Samoan adults living with diabetes, along with associated questionnaires, and anthropometrics. Subsequently, we will also be assessing longitudinally how preferences for care change over time. Data will be analyzed using progressive mixed Rank Order Logit models. The results will identify which diabetes care attributes are important to patients (p < 0.05), examine associations between participant characteristics and preference, illuminate the trade-offs participants are willing to make, and the probability of uptake, and WTP for specific attributes and levels. The results from this study will provide integral data useful for designing and adapting efficacious diabetes intervention and treatment approaches in this setting.
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Affiliation(s)
- Anna C. Rivara
- Department of Epidemiology (Chronic Diseases), Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Omar Galárraga
- Department of Health Services Policy and Practice, and International Health Institute, School of Public Health, Brown University, Providence, Rhode Island, United States of America
| | - Melania Selu
- Obesity Lifestyle and Genetic Adaptations (OLaGA) Research Center, Apia, Samoa
| | - Maria Arorae
- Obesity Lifestyle and Genetic Adaptations (OLaGA) Research Center, Apia, Samoa
| | - Ruiyan Wang
- Department of Epidemiology (Chronic Diseases), Yale School of Public Health, New Haven, Connecticut, United States of America
| | | | - Rochelle Rosen
- Centers for Behavioral and Preventative Medicine, The Miriam Hospital, Providence, Rhode Island, United States of America
- Department of Behavioral and Social Sciences, Brown University, School of Public Health, Providence, Rhode Island, United States of America
| | - Nicola L. Hawley
- Department of Epidemiology (Chronic Diseases), Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Satupaitea Viali
- Department of Epidemiology (Chronic Diseases), Yale School of Public Health, New Haven, Connecticut, United States of America
- School of Medicine, National University of Samoa, Apia, Samoa
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Ehrhardt N, Bouchonville M, Peek ME, Thomas CC, Zou T, Cuttriss N, Desimone M, Weinstock RS, Baer LG, Gabbay RA. Telementoring With Project ECHO: A New Era in Diabetes-Related Continuing Education for Primary Care to Address Health Disparities. J Diabetes Sci Technol 2023; 17:916-924. [PMID: 36879471 PMCID: PMC10348009 DOI: 10.1177/19322968231155150] [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] [Indexed: 03/08/2023]
Abstract
Project ECHO® is a telementoring workforce development model that targets under-resourced communities lacking access to specialty care. The model builds virtual communities of practice, including specialists and community primary care professionals (PCPs) to combat clinical inertia and health disparities. While the ECHO model has gained global recognition, implementation of the model related to diabetes is lagging compared to other specialty conditions. This review highlights diabetes-endocrine (ENDO)-focused ECHOs using data reported in the ECHO Institute's centralized data repository (iECHO) and the learning collaborative for diabetes ECHOs. It also describes the implementation of diabetes ECHOs and their evaluation. Learner and patient-centered outcomes related to diabetes ECHOs are reviewed. Program implementation and evaluations have demonstrated utility of the ECHO model for diabetes programs to (1) address unmet needs of diabetes care in the primary care setting, (2) improve knowledge and confidence in managing complex diabetes and change provider prescribing habits, (3) improve patient outcomes, and (4) address diabetes quality improvement practices in primary care. More studies with broader collaboration among sites are needed to evaluate the model related to diabetes, especially applied to addressing therapeutic inertia, adoption of diabetes technology, and reducing health disparities.
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Affiliation(s)
- Nicole Ehrhardt
- Division of Endocrinology, Diabetes and Metabolism, University of Washington Diabetes Institute, Seattle, WA, USA
| | - Matt Bouchonville
- Division of Endocrinology, Diabetes, and Metabolism, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Monica E. Peek
- Section of General Internal Medicine, Chicago Center for Diabetes Translation Research, The MacLean Center for Clinical Medical Ethics, and The University of Chicago, Chicago, IL, USA
| | - Celeste C. Thomas
- Section of Adult and Pediatric Endocrinology, Diabetes and Metabolism, The University of Chicago, Chicago, IL, USA
| | - Tracy Zou
- Division of Endocrinology, Diabetes and Metabolism, University of Washington Diabetes Institute, Seattle, WA, USA
| | - Nicolas Cuttriss
- ECHO Diabetes Action Network, ENDO Diabetes & Wellness, Washington, DC, USA
| | - Marisa Desimone
- Endocrinology, Diabetes and Metabolism, Joslin Diabetes Center, and SUNY Upstate Medical University, Syracuse, NY, USA
| | - Ruth S. Weinstock
- Endocrinology, Diabetes and Metabolism, Clinical Research Unit and Joslin Diabetes Center, and SUNY Upstate Medical University, Syracuse, NY, USA
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Cohen Rodrigues TR, Reijnders T, de Buisonjé DR, Breeman LD, van den Broek I, Janssen VR, Kraaijenhagen RA, Atsma DE, Evers AW. Lifestyle support preferences of patients with cardiovascular diseases: What lifestyle support might work best for whom? PEC INNOVATION 2022; 1:100071. [PMID: 37213735 PMCID: PMC10194186 DOI: 10.1016/j.pecinn.2022.100071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/15/2022] [Accepted: 08/12/2022] [Indexed: 05/23/2023]
Abstract
Background Lifestyle support is essential in preventing and treating cardiovascular diseases (CVD), and eHealth may be an easy and affordable solution to provide this support. However, CVD patients vary in their ability and interest to use eHealth. This study investigates demographic characteristics determining CVD patients' online and offline lifestyle support preferences. Methods We used a cross-sectional study design. 659 CVD patients (Harteraad panel) completed our questionnaire. We assessed demographic characteristics and preferred lifestyle support type (coach, eHealth, family/friends, self-supportive). Results Respondents mostly preferred being self-supportive (n = 179, 27.2%), and a coach in a group or individually (n = 145, 22.0%; n = 139, 21.1%). An app/internet to work independently (n = 89, 13.5%) or being in touch with other CVD patients (n = 44, 6.7%) was least preferred. Men were more likely to prefer being supported by family/friends (p = .016) or self-supportive (p < .001), while women preferred a coach individually or via an app/internet (p < .001). Older patients mostly preferred self-support (p = .001). Patients with low social support were more likely to prefer being coached individually (p < .001), but not support from family/friends (p = .002). Conclusion Men and older patients are more interested in being self-supportive, and patients with lower levels of social support could need extra support outside their social network. eHealth could provide a solution, but attention should be paid to spike interest for digital interventions among certain groups.
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Affiliation(s)
- Talia R. Cohen Rodrigues
- Health, Medical, and Neuropsychology Unit, Leiden University, the Netherlands
- Corresponding author at: Wassenaarseweg 52, 2333 AK Leiden, the Netherlands.
| | - Thomas Reijnders
- Health, Medical, and Neuropsychology Unit, Leiden University, the Netherlands
- Department of Human-Centered Design, Faculty of Industrial Design Engineering, TU Delft, Delft, the Netherlands
| | | | - Linda D. Breeman
- Health, Medical, and Neuropsychology Unit, Leiden University, the Netherlands
| | | | - Veronica R. Janssen
- Health, Medical, and Neuropsychology Unit, Leiden University, the Netherlands
- Department of Cardiology, Leiden University Medical Center, the Netherlands
| | - Roderik A. Kraaijenhagen
- NDDO Institute for Prevention and Early Diagnostics (NIPED), Amsterdam, the Netherlands
- Vital10, Amsterdam, the Netherlands
| | - Douwe E. Atsma
- Department of Cardiology, Leiden University Medical Center, the Netherlands
| | - Andrea W.M. Evers
- Health, Medical, and Neuropsychology Unit, Leiden University, the Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
- Medical Delta, Leiden University, Technical University of Delft, Erasmus University Rotterdam, the Netherlands
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Pourhabibi N, Sadeghi R, Mohebbi B, Shakibazadeh E, Sanjari M, Tol A, Yaseri M. Factors affecting nonadherence to treatment among type 2 diabetic patients with limited health literacy: Perspectives of patients, their families, and healthcare providers. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:388. [PMID: 36618458 PMCID: PMC9818700 DOI: 10.4103/jehp.jehp_804_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 08/02/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Treatment adherence is one of the behaviors associated with type 2 diabetes that predicts whether it will be successfully treated or develop complications and become uncontrolled. This study aimed to determine factors affecting nonadherence to treatment among diabetic patients with limited health literacy from the perspectives of patients, their families, and healthcare providers. MATERIALS AND METHODS This qualitative study with a content analysis approach was conducted on 84 eligible type 2 diabetes patients with limited health literacy and poor adherence to treatment, as well as their families and healthcare providers using a purposive sampling method, in Kerman city in 2021. Interviews were conducted using a semistructured interview guide with a broad, open-ended question to provide a general history of the disease separately. The interviewer asked participants to identify the perceived barriers to treatment nonadherence. Each interview lasted 45-60 min. MAXQDA version 20 and inductive content analysis were used to code and analyze extracted data. RESULTS Four major themes emerged from the patients' perspectives as "financial problems," "individual factors," "problems related to medication availability," and "healthcare providers' poor practices." Two major themes were classified from the perspective of patients' families as "financial problems" and "Individual factors," and four major themes were identified from the viewpoint of healthcare providers including "financial problems," "individual factors," "scarcity and medication availability," and "poor practice of the healthcare provider." These mentioned barriers were confirmed regarding treatment nonadherence among study participants. CONCLUSION Study findings revealed different factors of treatment nonadherence among diabetic patients with limited health literacy. Therefore, these factors should be considered in tailoring promotive educational and supportive interventions. Considering the importance of adherence to treatment patients, planning empowerment family-based interventions focusing on health literacy improvement seems necessary.
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Affiliation(s)
- Nasrin Pourhabibi
- Department of Health Promotion and Education, School of Public Health, Tehran 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
| | - Bahram Mohebbi
- Department of Cardiology, Cardiovascular Intervention Research Center, Cardio-Oncology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran 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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Sadeghi S, Mahani F, Amiri P, Alamdari S, Khalili D, Saadat N, Ebadi SA, Mahdavi Hazaveh AR, Shahrzad MK, Azizi F. Barriers Toward the National Program for Prevention and Control of Diabetes in Iran: A Qualitative Exploration. Int J Health Policy Manag 2022; 12:6908. [PMID: 36300256 PMCID: PMC10125058 DOI: 10.34172/ijhpm.2022.6908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 09/19/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Despite the achievements of the national program for the prevention and control of diabetes (NPPCD) over the past two decades, the available evidence indicates a high prevalence of this disease in Iran. This qualitative study aims to investigate barriers to the NPPCD by pursuing the perspectives of relevant policy-makers, planners, and healthcare workers. METHODS A grounded theory approach was used to analyze participants' perceptions and experiences. Semi-structured interviews (n=23) and eight focus groups (n=109) were conducted with relevant policy-makers, planners, and healthcare workers in charge of Iran's national diabetes management program. Of the 132 participants, ages ranged from 25 to 56 years, and 53% were female. Constant comparative analysis of the data was conducted manually, and open, axial, and selective coding was applied to the data. RESULTS Two main themes emerged from data analysis: implementation barriers and inefficient policy-making/ planning. Insufficient financial resources, staff shortage and insufficient motivation, inadequate knowledge of some healthcare workers, and defects in the referral system were recognized as the NPPCD implementation barriers. Inappropriate program prioritizing, the lack of or poor intersectoral collaboration, and the lack of an effective evaluation system were the inefficient policy-making/planning problems. CONCLUSION Current results highlighted that inefficient policy-making and planning have led to several implementation problems. Moreover, the key strategies to promote this program are prioritizing the NPPCD, practical intersectoral collaboration, and utilizing a more efficient evaluation system to assess the program and staff performance.
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Affiliation(s)
- Sohila Sadeghi
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Endocrinology & Metabolism, Internal Medicine, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Mahani
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parisa Amiri
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahram Alamdari
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Navid Saadat
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Alireza Ebadi
- Department of Endocrinology & Metabolism, Internal Medicine, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Reza Mahdavi Hazaveh
- Ministry of Health and Medical Education, Center for Non-communicable Disease Control, Tehran, Iran
| | - Mohammad Karim Shahrzad
- Internal Medicine and Endocrinology Shohada Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Castillo-Laborde C, Hirmas-Adauy M, Matute I, Jasmen A, Urrejola O, Molina X, Awad C, Frey-Moreno C, Pumarino-Lira S, Descalzi-Rojas F, Ruiz TJ, Plass B. Barriers and Facilitators in Access to Diabetes, Hypertension, and Dyslipidemia Medicines: A Scoping Review. Public Health Rev 2022; 43:1604796. [PMID: 36120091 PMCID: PMC9479461 DOI: 10.3389/phrs.2022.1604796] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 07/27/2022] [Indexed: 12/03/2022] Open
Abstract
Objective: Identify barriers and facilitators in access to medicines for diabetes, hypertension, and dyslipidemia, considering patient, health provider, and health system perspectives. Methods: Scoping review based on Joanna Briggs methodology. The search considered PubMed, Cochrane Library, CINAHL, Academic Search Ultimate, Web of Science, SciELO Citation Index, and grey literature. Two researchers conducted screening and eligibility phases. Data were thematically analyzed. Results: The review included 219 documents. Diabetes was the most studied condition; most of the evidence comes from patients and the United States. Affordability and availability of medicines were the most reported dimension and specific barrier respectively, both cross-cutting concerns. Among high- and middle-income countries, identified barriers were cost of medicines, accompaniment by professionals, long distances to facilities, and cultural aspects; cost of transportation emerges in low-income settings. Facilitators reported were financial accessibility, trained health workers, medicines closer to communities, and patients’ education. Conclusion: Barriers and facilitators are determined by socioeconomic and cultural conditions, highlighting the role of health systems in regulatory and policy context (assuring financial coverage and free medicines); providers’ role bringing medicines closer; and patients’ health education and disease management.
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Affiliation(s)
- Carla Castillo-Laborde
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- *Correspondence: Carla Castillo-Laborde,
| | - Macarena Hirmas-Adauy
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Isabel Matute
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Anita Jasmen
- Biblioteca Biomédica, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Oscar Urrejola
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Xaviera Molina
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Camila Awad
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Catalina Frey-Moreno
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Sofia Pumarino-Lira
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Fernando Descalzi-Rojas
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Tomás José Ruiz
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Barbara Plass
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
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Vaughan EM, Johnson E, Naik AD, Amspoker AB, Balasubramanyam A, Virani SS, Ballantyne CM, Johnston CA, Foreyt JP. Long-Term Effectiveness of the TIME Intervention to Improve Diabetes Outcomes in Low-Income Settings: a 2-Year Follow-Up. J Gen Intern Med 2022; 37:3062-3069. [PMID: 35132555 PMCID: PMC8821843 DOI: 10.1007/s11606-021-07363-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 12/16/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND We previously found that a 6-month multidimensional diabetes program, TIME (Telehealth-Supported, Integrated Community Health Workers, Medication-Access) resulted in improved clinical outcomes. OBJECTIVE To follow TIME participant clinical outcomes for 24 months PARTICIPANTS: Low-income Latino(a)s with type 2 diabetes DESIGN AND INTERVENTION: We collected post-intervention clinical data for five cohorts (n = 101, mean n = 20/cohort) who participated in TIME programs from 2018 to 2020 in Houston, Texas. MAIN MEASURES We gathered HbA1c (primary outcome), weight, body mass index (BMI), and blood pressure data at baseline, 6 months (intervention end), and semiannually thereafter until 24 months after baseline to assess sustainability. We also evaluated participant loss to follow-up until 24 months. KEY RESULTS Participants decreased HbA1c levels during the intervention (p < 0.0001) and maintained these improvements at each timepoint from baseline to 24 months (p range: < 0.0001 to 0.015). Participants reduced blood pressure levels during TIME and maintained these changes at each timepoint from baseline until 18 months (systolic p range < 0.0001 to 0.0005, diastolic p range: < 0.0001 to 0.008) but not at 24 months (systolic: p = 0.065; diastolic: p = 0.85). There were no significant weight changes during TIME or post-intervention: weight (p range = 0.07 to 0.77), BMI (p range = 0.11 to 0.71). Attrition rates (loss to follow-up during the post-intervention period) were 5.9% (6 months), 24.8% (12 months), 35.6% (18 months), and 41.8% (24 months). CONCLUSIONS It is possible for vulnerable populations to maintain long-term glycemic and blood pressure improvements using a multiple dimensional intervention. Attrition rates rose over time but show promise given the majority of post-intervention timepoints occurred during the COVID-19 pandemic when low-income populations were most susceptible to suboptimal healthcare access. Future studies are needed to evaluate longitudinal outcomes of diabetes interventions conducted by local clinics rather than research teams.
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Affiliation(s)
- Elizabeth M Vaughan
- Division of Atherosclerosis and Vascular Medicine, Department of Medicine, Baylor College of Medicine (Baylor), Houston, TX, USA.
- Division of General Internal Medicine, Baylor, Houston, TX, USA.
| | - Evan Johnson
- School of Health Professions, Baylor, Houston, TX, USA
| | - Aanand D Naik
- Houston Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, TX, USA
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Amber B Amspoker
- Houston Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, TX, USA
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | | | - Salim S Virani
- Division of Atherosclerosis and Vascular Medicine, Department of Medicine, Baylor College of Medicine (Baylor), Houston, TX, USA
- Houston Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, TX, USA
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Christie M Ballantyne
- Division of Atherosclerosis and Vascular Medicine, Department of Medicine, Baylor College of Medicine (Baylor), Houston, TX, USA
| | - Craig A Johnston
- Department of Health and Human Performance, University of Houston, Houston, TX, USA
| | - John P Foreyt
- Division of Atherosclerosis and Vascular Medicine, Department of Medicine, Baylor College of Medicine (Baylor), Houston, TX, USA
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10
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Campbell DJ, Ghuttora H, Mladenovic A, Smith J, Leigh R, Desveaux L, Ivers N, Manns B, Tonelli M, Naugler C, Hemmelgarn B, McBrien KA. Variation in Patient-Described Barriers to and Facilitators of Diabetes Management by Individual-Level Characteristics: A Cross-Sectional, Open-Ended Survey. Clin Diabetes 2022; 40:283-296. [PMID: 35983416 PMCID: PMC9331623 DOI: 10.2337/cd21-0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study analyzed patient-described barriers and facilitators related to diabetes management, focusing on how these differ by glycemia and across individual characteristics. A cross-sectional telephone survey was conducted with adult patients with diabetes in Alberta, Canada, asking two open-ended questions to describe the most helpful and difficult components of their diabetes management. Responses were analyzed using directed content analysis using the Theoretical Domains Framework as a template. The most frequently cited facilitator was care context and information, and the most frequently cited barriers were cognitive challenges and structural barriers, with patient-perceived barriers and facilitators varying by individual-level factors.
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Affiliation(s)
- David J.T. Campbell
- Department of Medicine, Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Harleen Ghuttora
- Department of Medicine, Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada
| | - Ana Mladenovic
- Richmond Division of Family Practice, Port Coquitlam, British Columbia, Canada
| | - Jordan Smith
- Department of Physics, Faculty of Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Ryan Leigh
- Department of Emergency Medicine, Valley Regional Hospital, Nova Scotia Health, Nova Scotia, Canada
| | - Laura Desveaux
- Women’s College Research Institute, Toronto, Ontario, Canada
| | - Noah Ivers
- Women’s College Research Institute, Toronto, Ontario, Canada
| | - Braden Manns
- Department of Medicine, Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Marcello Tonelli
- Department of Medicine, Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Christopher Naugler
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Brenda Hemmelgarn
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Kerry A. McBrien
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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11
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Mphasha MH, Mothiba TM, Skaal L. Assessment of diabetes dietary knowledge and its impact on intake of patients in Senwabarwana, Limpopo, South Africa. JOURNAL OF ENDOCRINOLOGY, METABOLISM AND DIABETES OF SOUTH AFRICA 2021. [DOI: 10.1080/16089677.2021.1927584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- MH Mphasha
- Department of Public Health, University of Limpopo, Polokwane, South Africa
| | - TM Mothiba
- Faculty of Health Sciences, University of Limpopo, Polokwane, South Africa
| | - L Skaal
- Department of Public Health, University of Limpopo, Polokwane, South Africa
- School of Health Care Sciences, University of Limpopo, Polokwane, South Africa
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12
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Sauder KA, Stafford JM, Ehrlich S, Lawrence JM, Liese AD, Marcovina S, Mottl AK, Pihoker C, Saydah S, Shah AS, D'Agostino RB, Dabelea D. Disparities in Hemoglobin A 1c Testing During the Transition to Adulthood and Association With Diabetes Outcomes in Youth-Onset Type 1 and Type 2 Diabetes: The SEARCH for Diabetes in Youth Study. Diabetes Care 2021; 44:dc202983. [PMID: 34376501 PMCID: PMC8929181 DOI: 10.2337/dc20-2983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 07/12/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To identify correlates of hemoglobin A1c (HbA1c) testing frequency and associations with HbA1c levels and microvascular complications in youth-onset diabetes. RESEARCH DESIGN AND METHODS The SEARCH for Diabetes in Youth study collected data from individuals diagnosed with diabetes before age 20 at 8 years (n=1,885 type 1, n=230 type 2) and 13 years (n=649 type 1, n = 84 type 2) diabetes duration. We identified correlates of reporting ≥3 HbA1c tests/year using logistic regression. We examined associations of HbA1c testing with HbA1c levels and microvascular complications (retinopathy, neuropathy, or nephropathy) using sequentially adjusted linear and logistic regression. RESULTS For type 1 diabetes, odds of reporting ≥3 HbA1c tests/year at 8 and 13 years diabetes duration decreased with older age at diagnosis (odds ratio [OR] 0.91 [95% CI 0.88-0.95]), longer duration of diabetes (OR 0.90 [0.82-0.99]), not having a personal doctor (OR 0.44 [0.30-0.65]), and lapses in health insurance (OR 0.51 [0.27-0.96]). HbA1c testing ≥3 times/year over time was associated with lower HbA1c levels (OR -0.36% [-0.65 to -0.06]) and lower odds of microvascular complications (OR 0.64 [0.43-0.97]) at 13 years duration, but associations were attenuated after adjustment for HbA1c testing correlates (OR -0.17 [-0.46 to 0.13] and 0.70 [0.46-1.07], respectively). For type 2 diabetes, not seeing an endocrinologist decreased the odds of reporting ≥3 HbA1c tests/year over time (OR 0.19 [0.06-0.63]), but HbA1c testing frequency was not associated with HbA1c levels or microvascular complications. CONCLUSIONS We observed disparities in HbA1c testing frequency predominately by health care-related factors, which were associated with diabetes outcomes in type 1 diabetes.
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Affiliation(s)
- Katherine A Sauder
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado, Aurora, CO
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO
| | - Jeanette M Stafford
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Shelley Ehrlich
- Cincinnati Children's Hospital Medical Center and The University of Cincinnati, Cincinnati, OH
| | - Jean M Lawrence
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Angela D Liese
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, SC
| | - Santica Marcovina
- Northwest Lipid Research Laboratory, University of Washington, Seattle, WA
| | - Amy K Mottl
- Division of Nephrology and Hypertension, University of North Carolina School of Medicine, Chapel Hill, NC
| | | | - Sharon Saydah
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Amy S Shah
- Cincinnati Children's Hospital Medical Center and The University of Cincinnati, Cincinnati, OH
| | - Ralph B D'Agostino
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
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13
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Abdulrhim S, Sankaralingam S, Ibrahim MIM, Diab MI, Hussain MAM, Al Raey H, Ismail MT, Awaisu A. Collaborative care model for diabetes in primary care settings in Qatar: a qualitative exploration among healthcare professionals and patients who experienced the service. BMC Health Serv Res 2021; 21:192. [PMID: 33653324 PMCID: PMC7927378 DOI: 10.1186/s12913-021-06183-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 02/16/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Diabetes mellitus is highly prevalent and associated with huge economic burden globally. The conventional care and management of diabetes mellitus is highly fragmented and complex, warranting the need for a comprehensive Collaborative Care Model (CCM). Little is known about the perception of patients with diabetes and their healthcare providers about CCM, its barriers and facilitators. This study aimed to explore the value of CCM in diabetes care at a primary healthcare (PHC) setting from the perspective of patients with diabetes and healthcare professionals (HCPs), in an effort to expand our current knowledge on collaborative care in diabetes at primary care level for the purpose of quality improvement and service expansion. METHODS Using an exploratory case study approach, semi-structured interviews were conducted among patients and HCPs who encountered CCM in Qatar during 2019 and 2020. The semi-structured interviews were transcribed verbatim and the data were analysed and interpreted using a deductive-inductive thematic analysis approach. RESULTS Twelve patients and 12 HCPs at a diabetes clinic participated in one-to-one interviews. The interviews resulted in five different themes: the process and components of collaborative care model (four subthemes), current organizational support and resources (three subthemes), impact of collaborative care model on diabetes outcomes (three subthemes), enablers of collaborative care model (three subthemes), and barriers to collaborative care model (three subthemes). The participants indicated easy access to and communication with competent and pleasant HCPs. The patients appreciated the extra time spent with HCPs, frequent follow-up visits, and health education, which empowered them to self-manage diabetes. HCPs believed that successful CCM provision relied on their interest and commitment to care for patients with diabetes. Generally, participants identified barriers and facilitators that are related to patients, HCPs, and healthcare system. CONCLUSIONS The providers and users of CCM had an overall positive perception and appreciation of this model in PHC settings. Barriers to CCM such as undesirable attributes of HCPs and patients, unsupportive hospital system, and high workload must be addressed before implementing the model in other PHC settings.
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Affiliation(s)
- Sara Abdulrhim
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | | | | | - Mohammed Issam Diab
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | | | - Hend Al Raey
- Qatar Petroleum Healthcare Center, Dukhan, Qatar
| | | | - Ahmed Awaisu
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar.
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14
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Wikström K, Lamidi ML, Rautiainen P, Tirkkonen H, Kivinen P, Laatikainen T. The effect of the integration of health services on health care usage among patients with type 2 diabetes in North Karelia, Finland. BMC Health Serv Res 2021; 21:65. [PMID: 33441132 PMCID: PMC7805148 DOI: 10.1186/s12913-021-06059-2] [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] [Received: 09/22/2020] [Accepted: 01/02/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The need to improve the care of people with complex care requirements has been driving the reforms integrating care processes. This study examines the effect of the integration of health services on health care usage and the processes and outcomes of care among type 2 diabetes patients. METHODS Data include all type 2 diabetes patients who lived in North Karelia, Finland, between 2014 and 2018. Health care contacts and glycated haemoglobin (HbA1c) measurements were obtained from the electronic health records. Logistic, Poisson and linear models with generalised estimating equations and the Friedman test were used to study the differences between years. RESULTS The health care usage was highest in 2017, the first year of a new organisation, and smallest in the following year. Before the new organisation, the health care usage was lowest in 2014, being slightly higher compared with 2018. Between the last two years, the mean number of contacts per person declined from 3.25 to 2.88 (-0.37, p < 0.001). The decreasing pattern seen in total health care usage was most obvious among contacts with primary health care nurses. The number of contacts increased only among specialised care nurses between the last two years. The number of HbA1c measurements was also in its lowest in 2018 but in its highest in 2015. Between the years 2014 and 2018, the difference in the mean number of contacts was - 0.05 (p = 0.011) for those not measured, -0.02 (p = 0.225) for those measured and within the target level of HbA1c, and 0.12 (p = 0.001) for those measured and not at the target level of HbA1c. CONCLUSIONS Health care integration first increased the health care usage but then brought it to a slightly lower level than before. The changes were most obvious in primary health care nurses' appointments, and no decline was observed in secondary-level care. Even though the numbers of HbA1c measurements and the proportion measured declined, measurements increased among those with poor glycaemic control. The observed changes might reflect the better targeting and more concordant services in different service units.
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Affiliation(s)
- Katja Wikström
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, PO Box 1627, 70211, Kuopio, Finland. .,Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland.
| | - Marja-Leena Lamidi
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, PO Box 1627, 70211, Kuopio, Finland
| | - Päivi Rautiainen
- Joint Municipal Authority for North Karelia Social and Health Services, Joensuu, Finland
| | - Hilkka Tirkkonen
- Joint Municipal Authority for North Karelia Social and Health Services, Joensuu, Finland
| | - Petri Kivinen
- Joint Municipal Authority for North Karelia Social and Health Services, Joensuu, Finland
| | - Tiina Laatikainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, PO Box 1627, 70211, Kuopio, Finland.,Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland.,Joint Municipal Authority for North Karelia Social and Health Services, Joensuu, Finland
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15
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Chepulis L, Morison B, Cassim S, Norman K, Keenan R, Paul R, Lawrenson R. Barriers to Diabetes Self-Management in a Subset of New Zealand Adults with Type 2 Diabetes and Poor Glycaemic Control. J Diabetes Res 2021; 2021:5531146. [PMID: 34136579 PMCID: PMC8177985 DOI: 10.1155/2021/5531146] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/02/2021] [Accepted: 05/21/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Despite the fact that there is an increasingly effective armoury of medications to treat diabetes, many people continue to have substantially elevated blood glucose levels. The purpose of this study was to explore what the barriers to diabetes management are in a cohort of people with diabetes and poor glycaemic control. METHODS Qualitative semistructured interviews were carried out with 10 people with diabetes who had known diabetes and a recent HbA1c of >11.3% (100 mmol/mol) to explore their experiences of barriers to diabetes self-management and glycaemic control. RESULTS Barriers to diabetes management were based around two key themes: biopsychosocial factors and knowledge about diabetes. Specifically, financial concerns, social stigma, medication side effects, and cognitive impairment due to hyperglycaemia were commonly reported as barriers to medication use. Other barriers included a lack of knowledge about their own condition, poor relationships with healthcare professionals, and a lack of relevant resources to support diet and weight loss. CONCLUSION People with diabetes with poor glycaemic control experience many of the same barriers as those reported elsewhere, but also experience issues specifically related to their severe hyperglycaemia. Management of diabetes could be improved via the increased use of patient education and availability of locally relevant resources.
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Affiliation(s)
- Lynne Chepulis
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Brittany Morison
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Shemana Cassim
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Kimberley Norman
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Rawiri Keenan
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Ryan Paul
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
- Waikato District Health Board, Waikato, Hamilton, New Zealand
| | - Ross Lawrenson
- Medical Research Centre, University of Waikato, Hamilton, New Zealand
- Waikato District Health Board, Waikato, Hamilton, New Zealand
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16
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Coleman CM, Bossick AS, Zhou Y, Hopkins-Johnson L, Otto MG, Nair AS, Willens DE, Wegienka GR. Introduction of a community health worker diabetes coach improved glycemic control in an urban primary care clinic. Prev Med Rep 2020; 21:101267. [PMID: 33364150 PMCID: PMC7750165 DOI: 10.1016/j.pmedr.2020.101267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 11/19/2020] [Accepted: 11/24/2020] [Indexed: 12/14/2022] Open
Abstract
Community health worker (CHW) care benefits diabetes management. Propensity score weighting was used to assess diabetes intervention effectiveness. CHW coaching reduced hemoglobin A1c by at least 1.0% for most participants. Most participants with diabetes working with the CHW met glycemic control.
The burden of diabetes is higher in urban areas and among racial and ethnic minorities. The purpose of this research was to evaluate the effectiveness of extending a diabetes intervention program (DIP) by engaging a team, including a community health worker (CHW), to provide care for patients to meet glycemic control, specifically in a predominantly urban, minority patient population. The DIP enrolled diabetic patients from an internal medicine clinic. A CHW facilitated the collection of glucose meter readings. The CHW coached patients on glycemic control while the CHW’s registered nurse partner titrated the patient’s recommended insulin dose. Subsequent HbA1c values for participants were compared to those seen at the same clinic who were not enrolled. The DIP was deployed for nine months. One hundred forty-four patients were enrolled in the DIP and 348 patients constituted the comparator group. Ninety-three DIP participants had pre- and post-intervention HbA1c values and were compared to 348 non-DIP participants. Propensity score weighted adjusted analyses suggest that participants were more likely to reduce their HbA1c values by at least 1.0% and have HbA1c values of less than 8.0% (64 mmol/mol) than non-participants (adjusted odds ratio = aOR = 1.47, 95% CI 1.26–1.71, and aOR = 1.23, 95% CI 1.06–1.43, respectively). CHW coaches as part of a team in a clinical setting improved glycemic control in a predominantly urban, minority patient population.
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Affiliation(s)
- Chad M Coleman
- Public Health Sciences, Henry Ford Health System, 1 Ford Place, Detroit, MI 48202, USA
| | - Andrew S Bossick
- Public Health Sciences, Henry Ford Health System, 1 Ford Place, Detroit, MI 48202, USA
| | - Yueren Zhou
- Public Health Sciences, Henry Ford Health System, 1 Ford Place, Detroit, MI 48202, USA
| | - Linda Hopkins-Johnson
- Academic Internal Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - Mira G Otto
- Academic Internal Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - Anupama S Nair
- Academic Internal Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - David E Willens
- Academic Internal Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA
| | - Ganesa R Wegienka
- Public Health Sciences, Henry Ford Health System, 1 Ford Place, Detroit, MI 48202, USA
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17
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Jafari S, Ahmadipour H. Self-Management Barriers Perceived by Patients with Type 2 Diabetes: A Confirmatory Factor Analysis. Int J Prev Med 2020; 11:152. [PMID: 33209222 PMCID: PMC7643576 DOI: 10.4103/ijpvm.ijpvm_195_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 08/12/2019] [Indexed: 11/30/2022] Open
Abstract
Background: Self-management remains poor among most of the diabetic patients due to various individual and environmental barriers which affect it. These barriers should be identified and intervened promptly. The current study aimed to determine self-management barriers perceived by patients with type 2 diabetes. Methods: A cross-sectional study carried out on 681 patients with type 2 diabetes who referred to the diabetes center which is affiliated to Kerman University of Medical Sciences, Kerman, Iran during 2018. Through a structured interview, demographic and disease-related data were recorded and the Persian version of the modified Personal Diabetes Questionnaire (PDQ) was used to assess self-management barriers. The tool has four subscales including diet, medication, monitoring, and exercise barriers. The higher score in each subscale indicates a higher level of barriers in that section. Data analyzed by SPSS 20 using T-test, ANOVA, and multiple linear regressions. Results: The majority of the patients (62.8%) were female, married (78.3%) with monthly income 10 to 20 million IRRLs (78.4%) and the mean age of 55.65 ± 14.65 years. Body Mass Index, marital status, monthly income, and HbA1C significantly predicted the barriers' score. The instrument had excellent reliability (α = 0.95). In confirmatory factor analysis, the fit indices had approximately acceptable levels. Conclusions: The Persian version of modified PDQ had good psychometric properties and can be used as a valid and reliable instrument in the primary health care setting. The significant perceived barriers should be identified and intervened by health care providers through the comprehensive management of diabetic patients.
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Affiliation(s)
- Shohreh Jafari
- Department of Community and Family Medicine, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Habibeh Ahmadipour
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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18
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Shah BR, Lipscombe LL, Booth GL. Glycemic Control Among People With Diabetes in Ontario: A Population-Based Cross-Sectional Study. Can J Diabetes 2020; 45:313-318. [PMID: 33221136 DOI: 10.1016/j.jcjd.2020.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/31/2020] [Accepted: 09/20/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Our aim in this study was to determine the distribution of glycated hemoglobin (A1C) in the Ontario diabetes population and identify subgroups with a high risk of poor glycemic control. METHODS In this cross-sectional study, we used real-world clinical data linked with health-care administrative data to identify all people with prevalent diabetes on December 31, 2019. We then identified their most recent A1C result during the year. The distribution of A1C was assessed, and the proportion of those with an A1C of >8.0% was determined, stratified by various sociodemographic and clinical characteristics. RESULTS In the population of 1,009,938 individuals with diabetes, mean ± standard deviation A1C was 7.2±1.4%, with 43.4% of them having an A1C of >7.0% and 19.0% with an A1C of >8.0%. Younger age, remote location of residence, longer diabetes duration and other surrogates for diabetes severity were associated with poor control. CONCLUSIONS The mean A1C among people with diabetes in Ontario was 7.2%, but nearly 20% had an A1C of >8%. There were notable disparities in glycemic control that identified several high-risk groups, including younger people, people with longer disease duration and people living in remote areas. Better clinical and policy approaches are needed to improve diabetes care for these populations.
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Affiliation(s)
- Baiju R Shah
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Division of Endocrinology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
| | - Lorraine L Lipscombe
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Division of Endocrinology, Women's College Hospital, Toronto, Ontario, Canada
| | - Gillian L Booth
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Division of Endocrinology, St. Michael's Hospital, Toronto, Ontario, Canada
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19
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Ferdinand AO, Akinlotan MA, Callaghan T, Towne SD, Bolin JN. Factors affecting the likelihood of a hospitalization following a diabetes-related emergency department visit: A regional and urban-rural analysis. J Diabetes 2020; 12:686-696. [PMID: 32436371 DOI: 10.1111/1753-0407.13066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/08/2020] [Accepted: 05/12/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The objective of this study is to examine place-based and individual-level predictors of diabetes-related hospitalizations that stem from emergency department (ED) visits. METHODS We conducted a pooled cross-sectional analysis of the National Inpatient Sample (NIS) for 2009 to 2014 to identify ED-initiated hospitalizations that were driven by the need for diabetes care. The odds of an ED-initiated diabetes-related hospitalization were assessed for the United States as a whole and separately for each census region. RESULTS Nationally, residents of noncore areas (odds ratio [OR] 1.10; CI 1.08, 1.12), the South (OR 8.03; CI 6.84, 9.42), Blacks (OR 2.49; CI 2.47, 2.52), Hispanics (OR 2.32; CI 2.29, 2.35), Asians or Pacific Islanders (OR 1.20; CI 1.16, 1.23), Native Americans (OR 2.18; CI 2.10, 2.27), and the uninsured (OR 2.14; CI 2.11, 2.27) were significantly more likely to experience an ED-initiated hospitalization for diabetes care. Census region-stratified models showed that noncore residents of the South (OR 1.17; CI 1.14, 1.20) and Midwest (OR 1.06; CI 1.02, 1.11) had higher odds of a diabetes-related ED-initiated hospitalization. CONCLUSIONS As continued efforts are made to reduce place-based disparities in diabetes care and management, targeted focus should be placed on residents of noncore areas in the South and Midwest, racial and ethnic minorities, as well as the uninsured population.
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Affiliation(s)
- Alva O Ferdinand
- Department of Health Policy & Management, Texas A&M University, School of Public Health, College Station, Texas, USA
- Southwest Rural Health Research Center, Texas A&M University, School of Public Health, College Station, Texas, USA
| | - Marvellous A Akinlotan
- Department of Health Policy & Management, Texas A&M University, School of Public Health, College Station, Texas, USA
- Southwest Rural Health Research Center, Texas A&M University, School of Public Health, College Station, Texas, USA
- College of Nursing, Texas A&M University, Bryan, Texas, USA
| | - Timothy Callaghan
- Department of Health Policy & Management, Texas A&M University, School of Public Health, College Station, Texas, USA
- Southwest Rural Health Research Center, Texas A&M University, School of Public Health, College Station, Texas, USA
| | - Samuel D Towne
- Southwest Rural Health Research Center, Texas A&M University, School of Public Health, College Station, Texas, USA
- Department of Health Management & Informatics, University of Central Florida, Orlando, Florida, USA
- Disability, Aging, & Technology Faculty Cluster Initiative, University of Central Florida, Orlando, Florida, USA
| | - Jane N Bolin
- Department of Health Policy & Management, Texas A&M University, School of Public Health, College Station, Texas, USA
- Southwest Rural Health Research Center, Texas A&M University, School of Public Health, College Station, Texas, USA
- College of Nursing, Texas A&M University, Bryan, Texas, USA
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Arai K, Nishikawa T, Yuasa S, Shirabe SI, Matsuzawa Y, Ohtsu S, Hirao K, Mori H. Nationwide Survey on Actual Interventions for Type 2 Diabetes by Japanese Practitioners (NSAID Study-1): Glycemic, Weight, and Blood Pressure Management. Diabetes Ther 2020; 11:1497-1511. [PMID: 32440836 PMCID: PMC7324449 DOI: 10.1007/s13300-020-00837-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Considering the increase in the number of patients with diabetes, the quality of diabetes care provided by general practitioners (GP) is critical for preventing complications. We performed a nationwide survey to determine whether the diabetic management provided to patients with type 2 diabetes mellitus (T2DM) by Japanese practitioners is appropriate. METHODS We randomly selected 463 clinics throughout Japan; 8070 patients with T2DM (6525 and 1545 under the care of GP and specialists [SP], respectively) were enrolled. We obtained information on hemoglobin A1c (HbA1c) levels, age, height, body weight, diabetes type and treatment modality, blood pressure (BP), and hypertension or dyslipidemia from each patient. Additionally, we surveyed the collaborations among physicians. RESULTS The median HbA1c level of patients treated by GP was lower than that of patients treated by SP (6.8 [6.2-7.3], median [interquartile range] vs. 6.9 [6.5-7.5], p < 0.0001). The percentage of patients receiving insulin therapy was also higher (23.8%) among patients treated by SP than among those treated by GP (8.6%). Patients not receiving insulin therapy showed lower median HbA1c levels than those receiving insulin therapy, irrespective of the care provider. The mean body mass index of patients with HbA1c levels < 6.9% or > 9.0% cared for by SP was lower than that of those cared for by GP. The rate of target BP (< 140/90 mmHg) achievement was 73.2% and 73.3% among patients with T2DM and hypertension cared for by GP and SP, respectively. Furthermore, 88.2% of GP reported that consulting with SP was easy. CONCLUSION The present study clearly demonstrated that many patients with T2DM are appropriately cared for by general practitioners instead of diabetes specialists in Japan, although the number of diabetes specialists is insufficient to cover all patients with diabetes.
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Affiliation(s)
- Keiko Arai
- Arai Clinic, Yokohama, Japan.
- Department of Clinical Research of Kanagawa Association of Medical and Dental Practitioners, Yokohama, Japan.
| | - Tetsuo Nishikawa
- Nisikawa Clinic, Yokohama, Japan
- Department of Clinical Research of Kanagawa Association of Medical and Dental Practitioners, Yokohama, Japan
| | - Shohei Yuasa
- Syohei Clinic, Kamakura, Japan
- Department of Clinical Research of Kanagawa Association of Medical and Dental Practitioners, Yokohama, Japan
| | - Shin-Ichiro Shirabe
- Health Education Center Science Clinic, Yokohama, Japan
- Department of Clinical Research of Kanagawa Association of Medical and Dental Practitioners, Yokohama, Japan
| | - Yoko Matsuzawa
- Matsuzawa Diabetes Clinic, Yokohama, Japan
- Department of Clinical Research of Kanagawa Association of Medical and Dental Practitioners, Yokohama, Japan
| | - Shigeyuki Ohtsu
- Nakanoshima Diabetes Clinic, Kawasaki, Japan
- Department of Clinical Research of Kanagawa Association of Medical and Dental Practitioners, Yokohama, Japan
| | - Koich Hirao
- Health Education Center Science Clinic, Yokohama, Japan
- Department of Clinical Research of Kanagawa Association of Medical and Dental Practitioners, Yokohama, Japan
| | - Hisao Mori
- Yokohama Sotetsu Building Clinic of Internal Medicine, Yokohama, Japan
- Department of Clinical Research of Kanagawa Association of Medical and Dental Practitioners, Yokohama, Japan
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Silva-Tinoco R, Cuatecontzi-Xochitiotzi T, De la Torre-Saldaña V, León-García E, Serna-Alvarado J, Guzmán-Olvera E, Cabrera D, Gay JG, Prada D. Role of social and other determinants of health in the effect of a multicomponent integrated care strategy on type 2 diabetes mellitus. Int J Equity Health 2020; 19:75. [PMID: 32448267 PMCID: PMC7245830 DOI: 10.1186/s12939-020-01188-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 05/11/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Although important advances in treatment strategies have been developed in type 2 diabetes mellitus (T2DM), large gaps exist in achieving glycemic control and preventing complications, particularly in low-and middle-income countries, which suggests a potential effect of social determinants of health (SDH, i.e., education level and socioeconomic status). However, few studies have determined the role of SDH and other determinants of health (ODH, i.e., diabetes knowledge and self-care scores) in achieving T2DM goals during effective multidisciplinary interventions. We aimed to examine a multicomponent integrated care (MIC) program on diabetes care goals and determine the effect of SDH and ODH on T2DM patients. METHODS A before-and-after design (a pretest, a 5-month intervention, and a follow-up) was used in a T2DM population from Mexico City. The SDH included education level and socioeconomic status; the ODH included diabetes knowledge, self-care scores, and deltas (i.e., differences between baseline and follow-up scores). The triple-target goal (glycated hemoglobin, blood pressure, and LDL-cholesterol) was established as a measurement of T2DM goals. RESULTS The DIABEMPIC (DIABetes EMPowerment and Improvement of Care) intervention (n = 498) reduced the glycated hemoglobin levels (mean reduction 2.65%, standard deviation [SD]: 2.02%) and cardiometabolic parameters; it also improved health-related quality of life. From 1.81% at baseline, 25.9% of participants (p-value< 0.001) achieved the triple-target goal. We found a significant association between education level (p-value = 0.010), diabetes knowledge at baseline (p-value = 0.004), and self-care scores at baseline (p-value = 0.033) in the delta (change between baseline and follow-up assessments) of HbA1c levels. Improvements (increase) in diabetes knowledge (p-value = 0.006) and self-care scores (p-value = 0.002) were also associated with greater reductions in HbA1c. CONCLUSIONS MIC strategies in urban primary care settings contribute to control of T2DM. SDH, such as education level, and ODH (diabetes knowledge and self-care scores at baseline) play a key role in improving glycemic control in these settings.
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Affiliation(s)
- Rubén Silva-Tinoco
- Clínica Especializada en el Manejo de la Diabetes de la Ciudad de México-Iztapalapa, Servicios de Salud Pública de la Ciudad de México, Iztapalapa, 09060, Mexico City, Mexico.
| | - Teresa Cuatecontzi-Xochitiotzi
- Clínica Especializada en el Manejo de la Diabetes de la Ciudad de México-Iztapalapa, Servicios de Salud Pública de la Ciudad de México, Iztapalapa, 09060, Mexico City, Mexico
| | - Viridiana De la Torre-Saldaña
- Clínica Especializada en el Manejo de la Diabetes de la Ciudad de México-Iztapalapa, Servicios de Salud Pública de la Ciudad de México, Iztapalapa, 09060, Mexico City, Mexico
| | - Enrique León-García
- Servicios de Salud Pública del Gobierno de la Ciudad de México, Mexico City, Mexico
| | | | - Eileen Guzmán-Olvera
- Servicios de Salud Pública del Gobierno de la Ciudad de México, Mexico City, Mexico
| | - Dolores Cabrera
- Servicios de Salud Pública del Gobierno de la Ciudad de México, Mexico City, Mexico
| | - Juan G Gay
- Tecnología e Información para la Salud, TIS, Mexico City, Mexico
| | - Diddier Prada
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología - Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, San Fernando 22, Colonia Sección XVI, Tlalpan, 14080, Mexico City, Mexico. .,Department of Biomedical Informatics, Faculty of Medicine, Universidad Nacional Autónoma de México, Av. Universidad 3000, Circuito Exterior S/N Delegación Coyoacán, 04510, Mexico City, Mexico. .,Department of Environmental Health Science, Mailman School of Public Health, Columbia University, New York City, 10032, USA.
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Branfield Day L, Austin PC, Shah BR. Universal drug coverage and income-related disparities in glycaemic control. Diabet Med 2020; 37:822-827. [PMID: 31197880 DOI: 10.1111/dme.14051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2019] [Indexed: 11/27/2022]
Abstract
AIMS To examine whether income-related disparities in glycaemic control decline after the age of 65 years, when publicly funded universal drug insurance is acquired in Ontario, Canada. METHODS We conducted a population-based cross-sectional study using linked administrative healthcare databases. Adults with diabetes, aged 40-89 years, with available HbA1c data were included (N = 716 297). Income was based on median neighbourhood household income. Multiple linear regression was used to test for effect modification of age ≥65 years on the relationship between income and HbA1c . RESULTS There was a significant inverse association between income and HbA1c level. After adjusting for baseline factors, the effect of income on HbA1c level was significantly greater for individuals aged <65 years (mean difference HbA1c for lowest vs highest income group +2.5 mmol/mol, 95% CI +2.3 to +2.7 [+0.23%, 95% CI 0.21 to 0.24]) than for those aged ≥65 years (+1.2 mmol/mol, 95% CI +1.0 to +1.3 [+0.11%, 95% CI 0.10 to 0.12]; P < 0.0001 for interaction). CONCLUSIONS Despite universal access to healthcare, people with diabetes with lower incomes had significantly worse glycaemic control compared with their counterparts on higher incomes. However, income gradients in glycaemic control were markedly reduced after the age of 65 years, possibly as a result of access to prescription drug coverage.
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Affiliation(s)
- L Branfield Day
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - P C Austin
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Toronto, ON, Canada
| | - B R Shah
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Toronto, ON, Canada
- Division of Endocrinology and Metabolism, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Walker RJ, Garacci E, Palatnik A, Ozieh MN, Egede LE. The Longitudinal Influence of Social Determinants of Health on Glycemic Control in Elderly Adults With Diabetes. Diabetes Care 2020; 43:759-766. [PMID: 32029639 PMCID: PMC7085811 DOI: 10.2337/dc19-1586] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 01/13/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study aimed to understand the longitudinal relationship between financial, psychosocial, and neighborhood social determinants and glycemic control (HbA1c) in older adults with diabetes. RESEARCH DESIGN AND METHODS Data from 2,662 individuals with self-reported diabetes who participated in the Health and Retirement Study (HRS) were used. Participants were followed from 2006 through 2014. Financial hardship, psychosocial, and neighborhood-level social determinant factors were based on validated surveys from the biennial core interview and RAND data sets. All social determinant factors and measurements of HbA1c from the time period were used and treated as time varying in analyses. SAS PROC GLIMMIX was used to fit a series of hierarchical linear mixed models. Models controlled for nonindependence among the repeated observations using a random intercept and treating each individual participant as a random factor. Survey methods were used to apply HRS weighting. RESULTS Before adjustment for demographics, difficulty paying bills (β = 0.18 [95% CI 0.02, 0.24]) and medication cost nonadherence (0.15 [0.01, 0.29]) were independently associated with increasing HbA1c over time, and social cohesion (-0.05 [-0.10, -0.001]) was independently associated with decreasing HbA1c over time. After adjusting for both demographics and comorbidity count, difficulty paying bills (0.13 [0.03, 0.24]) and religiosity (0.04 [0.001, 0.08]) were independently associated with increasing HbA1c over time. CONCLUSIONS Using a longitudinal cohort of older adults with diabetes, this study found that financial hardship factors, such as difficulty paying bills, were more consistently associated with worsening glycemic control over time than psychosocial and neighborhood factors.
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Affiliation(s)
- Rebekah J Walker
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Emma Garacci
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Anna Palatnik
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI
| | - Mukoso N Ozieh
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
- Division of Nephrology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
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Rodzen M. Putting the Patient in Charge. PHYSICIAN ASSISTANT CLINICS 2020. [DOI: 10.1016/j.cpha.2019.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Modeling the Research Landscapes of Artificial Intelligence Applications in Diabetes (GAP RESEARCH). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17061982. [PMID: 32192211 PMCID: PMC7143845 DOI: 10.3390/ijerph17061982] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/28/2020] [Accepted: 03/09/2020] [Indexed: 11/17/2022]
Abstract
The rising prevalence and global burden of diabetes fortify the need for more comprehensive and effective management to prevent, monitor, and treat diabetes and its complications. Applying artificial intelligence in complimenting the diagnosis, management, and prediction of the diabetes trajectory has been increasingly common over the years. This study aims to illustrate an inclusive landscape of application of artificial intelligence in diabetes through a bibliographic analysis and offers future direction for research. Bibliometrics analysis was combined with exploratory factor analysis and latent Dirichlet allocation to uncover emergent research domains and topics related to artificial intelligence and diabetes. Data were extracted from the Web of Science Core Collection database. The results showed a rising trend in the number of papers and citations concerning AI applications in diabetes, especially since 2010. The nucleus driving the research and development of AI in diabetes is centered around developed countries, mainly consisting of the United States, which contributed 44.1% of the publications. Our analyses uncovered the top five emerging research domains to be: (i) use of artificial intelligence in diagnosis of diabetes, (ii) risk assessment of diabetes and its complications, (iii) role of artificial intelligence in novel treatments and monitoring in diabetes, (iv) application of telehealth and wearable technology in the daily management of diabetes, and (v) robotic surgical outcomes with diabetes as a comorbid. Despite the benefits of artificial intelligence, challenges with system accuracy, validity, and confidentiality breach will need to be tackled before being widely applied for patients’ benefits.
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Ferdinand AO, Akinlotan MA, Callaghan T, Towne SD, Bolin J. Diabetes-related hospital mortality in the U.S.: A pooled cross-sectional study of the National Inpatient Sample. J Diabetes Complications 2019; 33:350-355. [PMID: 30910276 DOI: 10.1016/j.jdiacomp.2019.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/29/2019] [Accepted: 01/31/2019] [Indexed: 01/22/2023]
Abstract
AIMS Despite advancements in the diagnosis and treatment of diabetes in the U.S., place-based disparities still exist. The purpose of this study is to determine place-based and other individual-level variations in diabetes-related hospital deaths. METHODS A pooled cross-sectional study of the 2009-2015 National Inpatient Sample was conducted to examine the odds of a diabetes-related hospital death. The main predictors were rurality and census region. Individual-level socio-demographic factors were also examined. RESULTS Approximately 1.5% (n = 147,069) of diabetes-related hospitalizations resulted in death. In multivariable analysis, the odds of diabetes-related hospital deaths increased across the urban-rural continuum, except for large fringe metropolitan areas, with the highest odds of such deaths occurring among residents of micropolitan (OR = 1.16, 95% C.I. = 1.14, 1.18) and noncore areas (OR = 1.21, 95% C.I. = 1.19, 1.24). Compared to residents of the Northeast, residents in the South, West and Midwest regions were significantly more likely to experience a diabetes-related hospital death. Asian or Pacific Islanders, Medicaid-covered patients and the uninsured were also more likely to die during a diabetes-related hospitalization. CONCLUSIONS Place-based disparities in diabetes-related hospital deaths exist. Targeted focus should be placed on the control of diabetic complications in the South, West and Midwest census regions, and among rural residents.
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Affiliation(s)
- Alva O Ferdinand
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX, United States of America; Southwest Rural Health Research Center, School of Public Health, Texas A&M University, College Station, TX, United States of America.
| | - Marvellous A Akinlotan
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX, United States of America; Southwest Rural Health Research Center, School of Public Health, Texas A&M University, College Station, TX, United States of America
| | - Timothy Callaghan
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX, United States of America; Southwest Rural Health Research Center, School of Public Health, Texas A&M University, College Station, TX, United States of America
| | - Samuel D Towne
- Southwest Rural Health Research Center, School of Public Health, Texas A&M University, College Station, TX, United States of America; Department of Health Management and Informatics, University of Central Florida, Orlando, FL, United States of America; Disability, Aging, and Technology Cluster, University of Central Florida, Orlando, FL, United States of America
| | - Jane Bolin
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX, United States of America; Southwest Rural Health Research Center, School of Public Health, Texas A&M University, College Station, TX, United States of America
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Diabetes Self-Management Education and Medical Nutrition Therapy: A Multisite Study Documenting the Efficacy of Registered Dietitian Nutritionist Interventions in the Management of Glycemic Control and Diabetic Dyslipidemia through Retrospective Chart Review. J Acad Nutr Diet 2019; 119:449-463. [DOI: 10.1016/j.jand.2018.06.303] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 06/25/2018] [Indexed: 11/22/2022]
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Rising KL, LaNoue M, Gentsch AT, Doty AMB, Cunningham A, Carr BG, Hollander JE, Latimer L, Loebell L, Weingarten G, White N, Mills G. The power of the group: comparison of interviews and group concept mapping for identifying patient-important outcomes of care. BMC Med Res Methodol 2019; 19:7. [PMID: 30621586 PMCID: PMC6323717 DOI: 10.1186/s12874-018-0656-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 12/27/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Data are limited regarding how to effectively and efficiently identify patient priorities for research or clinical care. Our goal was to compare the comprehensiveness and efficiency of group concept mapping (GCM), a group participatory method, to interviews for identifying patient goals when seeking care. METHODS We engaged patients with moderately- to poorly-controlled diabetes mellitus in either GCM or an individual interview. The primary outcome was the comprehensiveness of GCM brainstorming (the first stage of GCM) as compared to interviews for eliciting patient-important outcomes (PIOs) related to seeking care. Secondary outcomes included 1) comprehensiveness of GCM brainstorming and interviews compared to a master list of PIOs and 2) efficiency of GCM brainstorming, the entire GCM process and interviews. RESULTS We engaged 89 interview participants and 52 GCM participants (across 3 iterations of GCM) to identify outcomes most important to patients when making decisions related to diabetes management. We identified 26 PIOs in interviews, 33 PIOs in the first GCM brainstorming session, and 38 PIOs across all three GCM brainstorming sessions. The initial GCM brainstorming session identified 77% (20/26) of interview PIOs, and all 3 GCM brainstorming sessions combined identified 88% (23/26). When comparing GCM brainstorming and interviews to the master list of PIOs, the initial GCM brainstorming sessions identified 80% (33/41), all 3 GCM brainstorming sessions identified 93% (38/41) and interviews identified 63% (26/41) of all PIOs. Compared to interviews, GCM brainstorming required less research team time, more patient time, and had a lowest cost. The entire GCM process still required less research team time than interviews, though required more patient time and had a higher cost than interviews. CONCLUSIONS GCM brainstorming is a powerful tool for effectively and efficiently identifying PIOs in certain scenarios, though it does not provide the breadth and depth of individual interviews or the higher level conceptual organization of the complete process of GCM. Selection of the optimal method for patient engagement should include consideration of multiple factors including depth of patient input desired, research team expertise, resources, and the population to be engaged. TRIAL REGISTRATION Registered on ClinicalTrials.gov , NCT02792777. Registration information submitted 6/2/2016, with the registration first posted on the ClinicalTrials.gov website 6/8/2016. Data collection began on 4/29/2016.
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Affiliation(s)
- Kristin L. Rising
- Department of Emergency Medicine, Thomas Jefferson University, 1025 Walnut St, Suite 300, Philadelphia, PA 19107 USA
| | - Marianna LaNoue
- College of Population Health, Thomas Jefferson University, Philadelphia, PA USA
- School of Medicine, Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA USA
| | - Alexzandra T. Gentsch
- Department of Emergency Medicine, Thomas Jefferson University, 1025 Walnut St, Suite 300, Philadelphia, PA 19107 USA
| | - Amanda M. B. Doty
- Department of Emergency Medicine, Thomas Jefferson University, 1025 Walnut St, Suite 300, Philadelphia, PA 19107 USA
| | - Amy Cunningham
- School of Medicine, Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA USA
| | - Brendan G. Carr
- Department of Emergency Medicine, Thomas Jefferson University, 1025 Walnut St, Suite 300, Philadelphia, PA 19107 USA
| | - Judd E. Hollander
- Department of Emergency Medicine, Thomas Jefferson University, 1025 Walnut St, Suite 300, Philadelphia, PA 19107 USA
| | - Lori Latimer
- Department of Emergency Medicine, Thomas Jefferson University, 1025 Walnut St, Suite 300, Philadelphia, PA 19107 USA
| | | | | | - Neva White
- Center for Urban Health, Thomas Jefferson University, Philadelphia, PA USA
| | - Geoffrey Mills
- School of Medicine, Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA USA
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Eligibility Criteria for Lower Extremity Joint Replacement May Worsen Racial and Socioeconomic Disparities. Clin Orthop Relat Res 2018; 476:2301-2308. [PMID: 30303879 PMCID: PMC6259890 DOI: 10.1097/corr.0000000000000511] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Cost-containment strategies may discourage hospitals from performing surgery for patients with preexisting risk factors such as those with high body mass index (BMI), those with high hemoglobin A1c (HbA1c), or those who smoke cigarettes. Because these risk factors may not appear in equal proportions across the population, using these risk factors as inflexible eligibility criteria for lower extremity joint arthroplasty may exacerbate existing racial-ethnic, gender, and socioeconomic disparities pertaining to access to an operation that can improve health and quality of life. However, any effects on such disparities have not yet been quantified nor have the groups been identified that may be most affected by inflexible eligibility criteria. QUESTIONS/PURPOSES Does the use of inflexible eligibility criteria related to (1) BMI; (2) HbA1c level; and (3) smoking status potentially decrease the odds of lower extremity joint arthroplasty eligibility for members of racial-ethnic minority groups, women, and those of lower socioeconomic status more than it does for non-Hispanic whites, men, and those of higher socioeconomic status? METHODS We pooled data from 21,294 adults aged ≥ 50 years from the 1999-2014 National Health and Nutrition Examination Survey (NHANES). NHANES is a nationally administered series of surveys that assess the health and nutritional status of the US population and collect information on many risk factors for diseases. NHANES is uniquely suited to examine our study questions because it includes data from physical examinations and laboratory assessments as well as comprehensive questionnaires, and it is nationally representative. We determined the odds of lower extremity arthroplasty eligibility by running separate multivariable logistic regressions for each criterion (that is, for each dependent variable): (1) BMI < 35 kg/m; (2) BMI < 40 kg/m; (3) HbA1c < 8%; and (4) current nonsmoker status. Independent variables of interest were race-ethnicity, gender, educational level, and annual household income. Each model included all independent variables of interest, age, and survey year. RESULTS The BMI < 35-kg/m criterion resulted in lower arthroplasty eligibility for non-Hispanic blacks compared with non-Hispanic whites (odds ratio [OR], 0.62; 95% confidence interval [CI], 0.55-0.70; p < 0.001), women versus men (OR, 0.61; 95% CI, 0.55-0.69; p < 0.001), individuals of lower socioeconomic status versus those of higher socioeconomic status (annual household income < USD 45,000 versus ≥ USD 45,000 [OR, 0.81; 95% CI, 0.71-0.93; p = 0.002], and those with a high school degree or less versus those with a degree beyond a high school degree (OR, 0.66; 95% CI, 0.57-0.77; p < 0.001). The HbA1c < 8% criterion resulted in lower arthroplasty eligibility for non-Hispanic blacks (OR, 0.44; 95% CI, 0.37-0.53; p < 0.001) and Hispanics (OR, 0.41; 95% CI, 0.33-0.51; p < 0.001) versus non-Hispanic whites, for individuals of lower socioeconomic status versus those of higher socioeconomic status (OR, 0.73; 95% CI, 0.56-0.94; p = 0.015), and for those with a high school degree or less versus those with a degree beyond a high school degree (OR, 0.58; 95% CI, 0.44-0.77; p < 0.001). Excluding smokers resulted in lower arthroplasty eligibility for non-Hispanic blacks versus non-Hispanic whites (OR, 0.84; 95% CI, 0.73-0.97; p = 0.019), for individuals of lower socioeconomic status versus those of higher socioeconomic status (OR, 0.53; 95% CI, 0.47-0.61; p < 0.001), and for those with a high school degree or less versus those with a degree beyond a high school degree (OR, 0.29; 95% CI, 0.24-0.35; p < 0.001). CONCLUSIONS Payment structures and clinical decision-making algorithms that set inflexible cutoffs with respect to BMI, HbA1c, and smoking status disproportionately discourage performing lower extremity arthroplasty for non-Hispanic blacks and individuals of lower socioeconomic status. We do not advocate performing elective surgery for patients with multiple, uncontrolled medical comorbidities. However, ample evidence suggests that many patients whose BMI values are > 35 kg/m (or even > 40 kg/m) may be reasonable candidates for arthroplasty surgery, and BMI is not an easily modifiable risk factor for many patients. We discourage across-the-board cutoff parameters in these domains because such cutoffs will worsen current racial-ethnic, gender-based, and socioeconomic disparities and limit access to an operation that can improve quality of life. LEVEL OF EVIDENCE Level III, economic and decision analysis.
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Abstract
The current epidemic of type 2 diabetes (T2D) represents a significant global and national health concern. Globally, the prevalence of diabetes has doubled between 1980 and 2014. In 2014 the World Health Organization estimated that there were 422 million adults living with diabetes worldwide. In the USA, the number of people diagnosed with T2D is estimated to increase to over 70 million by 2050, putting an immense strain on the US healthcare system. Achieving glycemic control is widely acknowledged as the key goal of treatment in T2D and is critical for reducing the onset and progression of diabetes-related complications such as cardiovascular diseases, neuropathies, retinopathies, and nephropathies. Despite the increase in the availability of antihyperglycemic medications and evidence-based treatment guidelines, the proportion of people with T2D who fail to achieve glycemic goals continues to rise. One major contributor is a delay in treatment intensification despite suboptimal glycemic control, referred to as clinical or therapeutic inertia. Clinical inertia prolongs the duration of patients' hyperglycemia which subsequently puts them at increased risk of diabetes-associated complications and reduced life expectancy. Clinical inertia results from a complex interaction between patient, healthcare providers, and healthcare system barriers that need to be addressed together, rather than as separate entities. In this article we provide an overview of clinical inertia in the clinical management of T2D and provide suggestions for overcoming aspects that may have a negative impact on patient care.Funding: Sanofi US, Inc.
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Affiliation(s)
- Jennifer Okemah
- Western Washington Medical Group, Diabetes and Nutrition Education, Bothell, WA, USA.
| | - John Peng
- Virginia Mason Medical Center, Lynnwood, WA, USA
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Martinez W, Threatt AL, Rosenbloom ST, Wallston KA, Hickson GB, Elasy TA. A Patient-Facing Diabetes Dashboard Embedded in a Patient Web Portal: Design Sprint and Usability Testing. JMIR Hum Factors 2018; 5:e26. [PMID: 30249579 PMCID: PMC6231745 DOI: 10.2196/humanfactors.9569] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 07/17/2018] [Accepted: 07/17/2018] [Indexed: 12/13/2022] Open
Abstract
Background Health apps and Web-based interventions designed for patients with diabetes offer novel and scalable approaches to engage patients and improve outcomes. However, careful attention to the design and usability of these apps and Web-based interventions is essential to reduce the barriers to engagement and maximize use. Objective The aim of this study was to apply design sprint methodology paired with mixed-methods, task-based usability testing to design and evaluate an innovative, patient-facing diabetes dashboard embedded in an existing patient portal and integrated into an electronic health record. Methods We applied a 5-day design sprint methodology developed by Google Ventures (Alphabet Inc, Mountain View, CA) to create our initial dashboard prototype. We identified recommended strategies from the literature for using patient-facing technologies to enhance patient activation and designed a dashboard functionality to match each strategy. We then conducted a mixed-methods, task-based usability assessment of dashboard prototypes with individual patients. Measures included validated metrics of task performance on 5 common and standardized tasks, semistructured interviews, and a validated usability satisfaction questionnaire. After each round of usability testing, we revised the dashboard prototype in response to usability findings before the next round of testing until the majority of participants successfully completed tasks, expressed high satisfaction, and identified no new usability concerns (ie, stop criterion was met). Results The sample (N=14) comprised 5 patients in round 1, 3 patients in round 2, and 6 patients in round 3, at which point we reached our stop criterion. The participants’ mean age was 63 years (range 45-78 years), 57% (8/14) were female, and 50% (7/14) were white. Our design sprint yielded an initial patient-facing diabetes dashboard prototype that displayed and summarized 5 measures of patients’ diabetes health status (eg, hemoglobin A1c). The dashboard used graphics to visualize and summarize health data and reinforce understanding, incorporated motivational strategies (eg, social comparisons and gamification), and provided educational resources and secure-messaging capability. More than 80% of participants were able to successfully complete all 5 tasks using the final prototype. Interviews revealed usability concerns with design, the efficiency of use, and content and terminology, which led to improvements. Overall satisfaction (0=worst and 7=best) improved from the initial to the final prototype (mean 5.8, SD 0.4 vs mean 6.7, SD 0.5). Conclusions Our results demonstrate the utility of the design sprint methodology paired with mixed-methods, task-based usability testing to efficiently and effectively design a patient-facing, Web-based diabetes dashboard that is satisfying for patients to use.
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Affiliation(s)
- William Martinez
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Anthony L Threatt
- Health Information Technology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - S Trent Rosenbloom
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
| | | | - Gerald B Hickson
- Quality, Safety & Risk Prevention, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Tom A Elasy
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States
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Tran AT, Bakke Å, Berg TJ, Gjelsvik B, Mdala I, Nøkleby K, Shakil Rai A, Cooper JG, Claudi T, Løvaas K, Thue G, Sandberg S, Jenum AK. Are general practitioners characteristics associated with the quality of type 2 diabetes care in general practice? Results from the Norwegian ROSA4 study from 2014. Scand J Prim Health Care 2018; 36:170-179. [PMID: 29717939 PMCID: PMC6066292 DOI: 10.1080/02813432.2018.1459238] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To explore the associations between general practitioners (GPs) characteristics such as gender, specialist status, country of birth and country of graduation and the quality of care for patients with type 2 diabetes (T2DM). DESIGN Cross-sectional survey. SETTING AND SUBJECTS The 277 GPs provided care for 10082 patients with T2DM in Norway in 2014. The GPs characteristics were self-reported: 55% were male, 68% were specialists in General Practice, 82% born in Norway and 87% had graduated in Western Europe. Of patients, 81% were born in Norway and 8% in South Asia. Data regarding diabetes care were obtained from electronic medical records and manually verified. MAIN OUTCOME MEASURES Performance of recommended screening procedures, prescribed medication and level of HbA1c, blood pressure and LDL-cholesterol stratified according to GPs characteristics, adjusted for patient and GP characteristics. RESULT Female GPs, specialists, GPs born in Norway and GPs who graduated in Western Europe performed recommended procedures more frequently than their counterparts. Specialists achieved lower mean HbA1c (7.14% vs. 7.25%, p < 0.01), a larger proportion of their patients achieved good glycaemic control (HbA1c = 6.0%-7.0%) (49.1% vs. 44.4%, p = 0.018) and lower mean systolic blood pressure (133.0 mmHg vs. 134.7 mmHg, p < 0.01) compared with non-specialists. GPs who graduated in Western Europe achieved lower diastolic blood pressure than their counterparts (76.6 mmHg vs. 77.8 mmHg, p < 0.01). CONCLUSION Several quality indicators for type 2 diabetes care were better if the GPs were specialists in General Practice. Key Points Research on associations between General Practitioners (GPs) characteristics and quality of care for patients with type 2 diabetes is limited. Specialists in General Practice performed recommended procedures more frequently, achieved better HbA1c and blood pressure levels than non-specialists. GPs who graduated in Western Europe performed screening procedures more frequently and achieved lower diastolic blood pressure compared with their counterparts. There were few significant differences in the quality of care between GP groups according to their gender and country of birth.
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Affiliation(s)
- Anh Thi Tran
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway;
- CONTACT Anh Thi TranDepartment of General Practice, Institute of Health and Society, University of Oslo, Pb 1130 Blindern, 0317Oslo, Norway
| | - Åsne Bakke
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway;
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway;
| | - Tore J Berg
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway;
- Department of Endocrinology, Morbid Obestiy and Preventive Medicine, Oslo University Hospital, Oslo, Norway;
| | - Bjørn Gjelsvik
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway;
| | - Ibrahimu Mdala
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway;
| | - Kjersti Nøkleby
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway;
| | - Anam Shakil Rai
- Department of Public Health, Sport and Nutrition, University of Agder, Kristiansand, Norway;
| | - John G Cooper
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway;
- Norwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen, Norway;
| | - Tor Claudi
- Department of Endocrinology, Nordlandssykehuset, Bodø, Norway;
| | - Karianne Løvaas
- Norwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen, Norway;
| | - Geir Thue
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway;
- Norwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen, Norway;
| | - Sverre Sandberg
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway;
- Norwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen, Norway;
- Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway
| | - Anne K Jenum
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway;
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Ding H, Fatehi F, Russell AW, Karunanithi M, Menon A, Bird D, Gray LC. User Experience of an Innovative Mobile Health Program to Assist in Insulin Dose Adjustment: Outcomes of a Proof-Of-Concept Trial. Telemed J E Health 2017; 24:536-543. [PMID: 29261476 DOI: 10.1089/tmj.2017.0190] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Many patients with diabetes require insulin therapy to achieve optimal glycemic control. Initiation and titration of insulin often require an insulin dose adjustment (IDA) program, involving frequent exchange of blood glucose levels (BGLs) and insulin prescription advice between the patient and healthcare team. This process is time consuming with logistical barriers. OBJECTIVE To develop an innovative mobile health (m-Health) mobile-based IDA program (mIDA) and evaluate the user adherence and experience through a proof-of-concept trial. METHODS In the program, an m-Health system was designed to be integrated within a clinical IDA service, comprising a Bluetooth-enabled glucose meter, smartphone application, and clinician portal. Insulin-requiring patients with type-2 diabetes mellitus and stable BGL were recruited to use the m-Health system to record and exchange BGL entries, insulin dosages, and clinical messages for 2 weeks. The user experience was evaluated by a Likert scale questionnaire. RESULTS Nine participants, aged 58 ± 14 years (mean ± SD), completed the trial with average daily records of 3.1 BGL entries and 1.2 insulin dosage entries. The participants recognized the potential value of the clinical messages. They felt confident about managing their diabetes and were positive regarding ease of use and family support of the system, but disagreed that there were no technical issues. Finally, they were satisfied with the program and would continue to use it if possible. CONCLUSIONS The m-Health system for IDA showed promising levels of adherence, usability, perception of usefulness, and satisfaction. Further research is required to assess the feasibility and cost-effectiveness of using this system in outpatient settings.
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Affiliation(s)
- Hang Ding
- 1 The Australian e-Health Research Centre , CSIRO, Brisbane, Australia
| | - Farhad Fatehi
- 1 The Australian e-Health Research Centre , CSIRO, Brisbane, Australia .,2 Centre for Online Health, Centre for Health Services Research, Faculty of Medicine, The University of Queensland , Brisbane, Australia .,3 Tehran University of Medical Sciences , Tehran, Iran
| | - Anthony W Russell
- 4 Department of Diabetes and Endocrinology, The Princess Alexandra Hospital , Brisbane, Australia .,5 Faculty of Medicine, The University of Queensland , Brisbane, Australia
| | - Mohan Karunanithi
- 1 The Australian e-Health Research Centre , CSIRO, Brisbane, Australia
| | - Anish Menon
- 2 Centre for Online Health, Centre for Health Services Research, Faculty of Medicine, The University of Queensland , Brisbane, Australia .,4 Department of Diabetes and Endocrinology, The Princess Alexandra Hospital , Brisbane, Australia
| | - Dominique Bird
- 2 Centre for Online Health, Centre for Health Services Research, Faculty of Medicine, The University of Queensland , Brisbane, Australia
| | - Leonard C Gray
- 2 Centre for Online Health, Centre for Health Services Research, Faculty of Medicine, The University of Queensland , Brisbane, Australia
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Zamani-Alavijeh F, Araban M, Mohammadi V, Goodarzi F. Development and psychometric evaluation of a new instrument to assess nutritional perceptions and behaviors of diabetic men. Diabetes Metab Syndr 2017; 11 Suppl 2:S949-S955. [PMID: 28709854 DOI: 10.1016/j.dsx.2017.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 07/01/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND It is obvious that unhealthy nutritional behaviors have caused the increasing incidence of diabetes. This study aimed to design the Measure of Nutritional Perceptions and Behaviors in diabetic men and to evaluate its psychometric properties. METHODS A questionnaire was developed within 7 factors. Three methods of face validity, content validity, and construct validity were employed to ensure the validity of the scale. 206 men with diabetes completed the questionnaires. Internal was used to evaluate the reliability of the scale. RESULTS The mean age of men was 58.26 (9.74) years. Results showed that each item in the final questionnaire was highly correlated with the total score of each dimension P<0.05. Moreover, factor analysis led to the extraction of 36 items with acceptable factor loadings in the range of 0.41 to 0.84, which could account for 51% of the total variance. The Cronbach's alpha coefficient equal to 0.83 was obtained for the whole scale. CONCLUSION The reliability and validity of diabetic men's beliefs about healthy nutritional behaviors were desired and the overall structure of the questions was confirmed. This questionnaire can be used to identify individuals at risk for unhealthy nutritional behaviors and also to conduct and evaluate the impact of educational interventions.
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Affiliation(s)
- Fereshteh Zamani-Alavijeh
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marzieh Araban
- Social Determinants of Health Research Center, Dept. of Health Education and Promotion, Public Health School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Vida Mohammadi
- Department of Community Nutrition and Food Security Research Center, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fataneh Goodarzi
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
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Buschur EO, Glick B, Kamboj MK. Transition of care for patients with type 1 diabetes mellitus from pediatric to adult health care systems. Transl Pediatr 2017; 6:373-382. [PMID: 29184818 PMCID: PMC5682376 DOI: 10.21037/tp.2017.09.06] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Planning for the transition from pediatric to adult healthcare is broadly understood to be beneficial to the quality of care of patients with chronic illness. Due to the level of self-care that is necessary in the maintenance of most chronic diseases, it is important that pediatric settings can offer support during a time when adolescents are beginning to take more responsibility in all areas of their lives. Lack of supportive resources for adolescents with chronic conditions often results in both decreased access to care and impaired health and function likely leading to increased medical costs later. Additionally, fundamental differences in health care delivery exist between pediatric and adult care settings. There is limited empiric data and information on best practices in transition care. In this article we address the importance of bridging pediatric and adult care settings and highlight the challenges and successes of the implementation of the young adult transition clinic program for patients with type 1 diabetes at our facility. We provide recommendations for further research and program implementation with the transition population.
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Affiliation(s)
- Elizabeth O Buschur
- Department of Endocrinology, Diabetes, and Metabolism, the Ohio State University Wexner Medical Center/Nationwide Children's Hospital, Columbus, OH, USA
| | - Bethany Glick
- Department of Endocrinology, Diabetes, and Metabolism, the Ohio State University Wexner Medical Center/Nationwide Children's Hospital, Columbus, OH, USA
| | - Manmohan K Kamboj
- Department of Endocrinology, Diabetes, and Metabolism, the Ohio State University Wexner Medical Center/Nationwide Children's Hospital, Columbus, OH, USA
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