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Lee DC, Ross L, Quintero Arias C, Rony M, Patel R, Jensen E, Petcu R, Imas D, Elbel B, Thorpe LE, Anthopolos R. Demographic and geographic distribution of diabetes and pre-diabetes risk in rural settings: results from a cross-sectional, countywide rural health survey in Sullivan County, New York. BMJ Open 2024; 14:e080831. [PMID: 39107030 PMCID: PMC11308904 DOI: 10.1136/bmjopen-2023-080831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 07/26/2024] [Indexed: 08/09/2024] Open
Abstract
OBJECTIVE To perform a detailed characterisation of diabetes burden and pre-diabetes risk in a rural county with previously documented poor health outcomes in order to understand the local within-county distribution of diabetes in rural areas of America. DESIGN, SETTING, AND PARTICIPANTS In 2021, we prospectively mailed health surveys to all households in Sullivan County, a rural county with the second-worst health outcomes of all counties in New York State. Our survey included questions on demographics, medical history and the American Diabetes Association's Pre-diabetes Risk Test. PRIMARY OUTCOME AND METHODS Our primary outcome was an assessment of diabetes burden within this rural county. To help mitigate non-response bias in our survey, raking adjustments were performed across strata of age, sex, race/ethnicity and health insurance. We analysed diabetes prevalence by demographic characteristics and used geospatial analysis to assess for clustering of diagnosed diabetes cases. RESULTS After applying raking procedures for the 4725 survey responses, our adjusted diagnosed diabetes prevalence for Sullivan County was 12.9% compared with the 2019 Behavioural Risk Factor Surveillance System (BRFSS) estimate of 8.6%. In this rural area, diagnosed diabetes prevalence was notably higher among non-Hispanic Black (21%) and Hispanic (15%) residents compared with non-Hispanic White (12%) residents. 53% of respondents without a known history of pre-diabetes or diabetes scored as high risk for pre-diabetes. Nearest neighbour analyses revealed that hotspots of diagnosed diabetes were primarily located in the more densely populated areas of this rural county. CONCLUSIONS Our mailed health survey to all residents in Sullivan County demonstrated higher diabetes prevalence compared with modelled BRFSS estimates that were based on small telephone samples. Our results suggest the need for better diabetes surveillance in rural communities, which may benefit from interventions specifically tailored for improving glycaemic control among rural residents.
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Affiliation(s)
- David C Lee
- Emergency Medicine, New York University School of Medicine, New York, New York, USA
- Population Health, New York University School of Medicine, New York, New York, USA
| | - Leah Ross
- Graduate School of Arts and Sciences, NYU, New York, New York, USA
| | | | - Melissa Rony
- Emergency Medicine, New York University School of Medicine, New York, New York, USA
| | - Rahi Patel
- Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Erica Jensen
- Touro College of Osteopathic Medicine Harlem Campus, New York, New York, USA
| | - Robert Petcu
- Medical College of Georgia, Augusta, Georgia, USA
| | - Daniel Imas
- Emergency Medicine, New York University School of Medicine, New York, New York, USA
| | - Brian Elbel
- Population Health, New York University School of Medicine, New York, New York, USA
- Wagner Graduate School of Public Service, NYU, New York, New York, USA
| | - Lorna E Thorpe
- Population Health, New York University School of Medicine, New York, New York, USA
| | - Rebecca Anthopolos
- Population Health, New York University School of Medicine, New York, New York, USA
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Patel J, Gonzalvo JD, Eckert GJ, Schmelz AN, Bhatwadekar AD. Pharmacist-Managed Diabetic Retinopathy in Hispanic/LatinX Population. J Pharm Pract 2024; 37:383-390. [PMID: 36325719 DOI: 10.1177/08971900221136897] [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] [Indexed: 02/16/2024]
Abstract
There are three major microvascular complications of diabetes, retinopathy, nephropathy, and neuropathy, among which diabetic retinopathy (DR) is the most common. Several studies suggest that the Hispanic/LatinX population exhibit the highest cases of both diabetes and DR. Strategies aimed at reducing risk factors that could minimize the likelihood of DR development or progression could be beneficial. This retrospective study assessed DR in the Hispanic/LatinX population in pharmacist-managed cardiovascular risk reduction services. A chart review was conducted for 60 individuals who visited clinics led by both a pharmacist and a primary care physician (intervention group) and 178 individuals who saw physicians only (control group). Demographics, metabolic parameters, DR severity, and pharmacist appointment data were collected. The highest benefit of pharmacist intervention was observed in terms of a greater but insignificant decrease in HbA1c; however, there was no benefit of pharmacist's intervention on DR in general, likely due to the longer duration of diabetes and higher HbA1c at the beginning of the study. When the DR progression was examined based on the frequency of pharmacy visits, individuals who met a pharmacist more than two times per year showed more stable and lesser worsening of DR. Overall, our studies suggest that pharmacist intervention could benefit retinopathy outcome; however, well-known determinants of DR such as good glycemic control and duration of diabetes still play a critical role, in addition to challenges in receiving healthcare by the Hispanic/LatinX population. Future strategies in a prospective manner could help retinopathy outcomes in these at-risk patient populations.
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Affiliation(s)
- Janvi Patel
- Department of Ophthalmology, Indiana University, Indianapolis, IN, USA
- Indiana University Purdue University, Indianapolis, IN, USA
| | - Jasmine D Gonzalvo
- Center for Health Equity and Innovation, College of Pharmacy, Purdue University, Indianapolis, IN, USA
| | - George J Eckert
- Department of Biostatistics and Health Data Science, Indiana University, Indianapolis, IN, USA
| | - Andrew N Schmelz
- College of Pharmacy and Health Sciences, Butler University, Indianapolis, IN, USA
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Yoon S, Ng JH, Kwan YH, Low LL. Healthcare Professionals' Views of Factors Influencing Diabetes Self-Management and the Utility of a mHealth Application and Its Features to Support Self-Care. Front Endocrinol (Lausanne) 2022; 13:793473. [PMID: 35282452 PMCID: PMC8907617 DOI: 10.3389/fendo.2022.793473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/28/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The perspectives of healthcare professionals (HCPs) are pivotal to co-development of self-management strategies for patients with diabetes. However, literature has been largely limited to perspectives of patients within the context of a Western healthcare setting. This study aims to explore factors influencing diabetes self-management in adult patients with diabetes from the perspectives of HCPs and their views of the value of mHealth application for diabetes self-management. MATERIALS AND METHODS We conducted focus group discussions (FGD) with purposively selected HCPs in Singapore. All FGDs were audio-recorded and transcribed verbatim. Thematic analysis was conducted using NVivo 12. RESULTS A total of 56 HCPs participated in the study. Barriers to self-management included limited patient commitment to lifestyle changes, suboptimal adherence to medication and treatment, patient resistance to insulin initiation and insufficient rapport between patients and HCPs. Patients' perceived susceptibility to complications, social support from family and community, multidisciplinary team care and patient's understanding of the benefits of self-care were viewed as facilitating self-management. HCPs saw mHealth apps as a vital opportunity to engage patients in the self-management of conditions and empower them to foster behavior changes. Yet, there were concerns regarding patient's limited digital literacy, lack of integration into routine electronic system and reluctance. DISCUSSION We identified a set of factors influencing self-management in adult patients with diabetes and useful app features that can empower patients to manage their conditions. Findings will inform the development of a mHealth application, and its features designed to improve self-care.
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Affiliation(s)
- Sungwon Yoon
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
| | - Jun Hao Ng
- Duke-NUS Medical School, Singapore, Singapore
| | - Yu Heng Kwan
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
- Internal Medicine Residency Programme, SingHealth Residency, Singapore, Singapore
| | - Lian Leng Low
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Singapore
- Post-Acute and Continuing Care, Outram Community Hospital, Singapore, Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Program, Singapore, Singapore
- *Correspondence: Lian Leng Low,
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Racial disparities in the screening and treatment of diabetic retinopathy. J Natl Med Assoc 2022; 114:171-181. [DOI: 10.1016/j.jnma.2021.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 12/29/2021] [Indexed: 11/24/2022]
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Kurani SS, Lampman MA, Funni SA, Giblon RE, Inselman JW, Shah ND, Allen S, Rushlow D, McCoy RG. Association Between Area-Level Socioeconomic Deprivation and Diabetes Care Quality in US Primary Care Practices. JAMA Netw Open 2021; 4:e2138438. [PMID: 34964856 PMCID: PMC8717098 DOI: 10.1001/jamanetworkopen.2021.38438] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Diabetes management operates under a complex interrelationship between behavioral, social, and economic factors that affect a patient's ability to self-manage and access care. OBJECTIVE To examine the association between 2 complementary area-based metrics, area deprivation index (ADI) score and rurality, and optimal diabetes care. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study analyzed the electronic health records of patients who were receiving care at any of the 75 Mayo Clinic or Mayo Clinic Health System primary care practices in Minnesota, Iowa, and Wisconsin in 2019. Participants were adults with diabetes aged 18 to 75 years. All data were abstracted and analyzed between June 1 and November 30, 2020. MAIN OUTCOMES AND MEASURES The primary outcome was the attainment of all 5 components of the D5 metric of optimal diabetes care: glycemic control (hemoglobin A1c <8.0%), blood pressure (BP) control (systolic BP <140 mm Hg and diastolic BP <90 mm Hg), lipid control (use of statin therapy according to recommended guidelines), aspirin use (for patients with ischemic vascular disease), and no tobacco use. The proportion of patients receiving optimal diabetes care was calculated as a function of block group-level ADI score (a composite measure of 17 US Census indicators) and zip code-level rurality (calculated using Rural-Urban Commuting Area codes). Odds of achieving the D5 metric and its components were assessed using logistic regression that was adjusted for demographic characteristics, coronary artery disease history, and primary care team specialty. RESULTS Among the 31 934 patients included in the study (mean [SD] age, 59 [11.7] years; 17 645 men [55.3%]), 13 138 (41.1%) achieved the D5 metric of optimal diabetes care. Overall, 4090 patients (12.8%) resided in the least deprived quintile (quintile 1) of block groups and 1614 (5.1%) lived in the most deprived quintile (quintile 5), while 9193 patients (28.8%) lived in rural areas and 2299 (7.2%) in highly rural areas. The odds of meeting the D5 metric were lower for individuals residing in quintile 5 vs quintile 1 block groups (odds ratio [OR], 0.72; 95% CI, 0.67-0.78). Patients residing in rural (OR, 0.84; 95% CI, 0.73-0.97) and highly rural (OR, 0.81; 95% CI, 0.72-0.91) zip codes were also less likely to attain the D5 metric compared with those in urban areas. CONCLUSIONS AND RELEVANCE This cross-sectional study found that patients living in more deprived and rural areas were significantly less likely to attain high-quality diabetes care compared with those living in less deprived and urban areas. The results call for geographically targeted population health management efforts by health systems, public health agencies, and payers.
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Affiliation(s)
- Shaheen Shiraz Kurani
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Michelle A. Lampman
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Shealeigh A. Funni
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Rachel E. Giblon
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota
| | - Jonathan W. Inselman
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Nilay D. Shah
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Summer Allen
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
- Department of Family Medicine, Mayo Clinic, Rochester, Minnesota
| | - David Rushlow
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
- Department of Family Medicine, Mayo Clinic, Rochester, Minnesota
| | - Rozalina G. McCoy
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
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Modica C, Lewis JH, Bay RC. The Value Transformation Framework: Applied to Diabetes Control in Federally Qualified Health Centers. J Multidiscip Healthc 2021; 14:3005-3014. [PMID: 34737572 PMCID: PMC8558033 DOI: 10.2147/jmdh.s284885] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/12/2021] [Indexed: 01/22/2023] Open
Abstract
Introduction Diabetes and pre-diabetes impact more than 114 million Americans. Federally qualified health centers (FQHCs) provide care to some of the most high-risk and underinsured individuals throughout the US, twenty-one percent of whom report being told they have diabetes, compared to 11% of the general adult population. It is widely agreed our health care system requires a transformation to effectively address diabetes and its complications. Objective By applying the Value Transformation Framework (VTF) in health centers, the National Association of Community Health Centers (NACHC) aims to show improvements in diabetes control. This systematic strategy to transform the way health centers operate can lead to improvements in health outcomes, patient and staff experiences, costs, and equity (Quintuple Aim). Special attention is paid to the health centers’ infrastructure, people systems and care delivery systems. Methods Evidence-based diabetes interventions, the learning community model, and the VTF were used together to drive system improvements and activate proven diabetes control practices within eight health centers. Multidisciplinary teams at select health centers in Georgia and Iowa, with their partner primary care associations, participated in this NACHC-led quality improvement project. Results During the one-year intervention (January 2017–December 2017), the mean raw percentage of patients with HbA1c Poor Control decreased from 50.9% (range, 23.7–70.4%) in January to 27.5% (range, 13.6–37.4%) in December. This represents a relative improvement in diabetes control of 46%. The 1-year-intervention data also showed trends in the desired direction with statistically significant improvements related to the following interventions: a formal written clinical policy, standing orders, patient recall/outreach, performance data shared at the provider/team-level, and performance data shared at the site/organization level. Conclusion A conceptual model focused on transforming health center systems, organized by the NACHC Value Transformation Framework and supported by a strong learning community, can lead to better diabetes control outcomes among patients seen at health centers.
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Affiliation(s)
- Cheryl Modica
- National Association of Community Health Centers, Bethesda, MD, USA
| | - Joy H Lewis
- Medicine and Public Health, SOMA Department of Public Health, School of Osteopathic Medicine in Arizona, A.T. Still University, Meza, AZ, USA
| | - R Curtis Bay
- Department of Interdisciplinary Health Sciences, Arizona School of Health Sciences, A.T. Still University, Mesa, AZ, USA
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Bross R, Genter P, Lu Y, Serpas L, Campa D, Ipp E. Barriers to Healthy Eating and Diabetes Diet Education: Divergent Perspectives of Patients and Their Providers. HEALTH EDUCATION & BEHAVIOR 2021; 49:658-666. [PMID: 34713743 DOI: 10.1177/10901981211052241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients report that adhering to diet is the most challenging aspect of diabetes management. Provision of diet education is often delegated to health care providers, despite a lack of nutrition education and training and limited awareness of environmental and cultural challenges faced by patients. Aim. We examined perceived barriers to diet self-management among low-income minority patients with type 2 diabetes and their health care providers within a single ecosystem, to test whether providers understood patient barriers. Method. We surveyed 149 members of a safety-net clinic (99 patients, 50 providers), using barriers derived from the literature. Binomial logistic regression was applied to investigate relationships between barriers and patients' sociodemographic variables and Pearson's χ2 was used to compare differences in perceived barriers between patients and providers. Results. Providers expressed divergent perceptions of patients' barriers to healthy eating, including more total barriers and little agreement with patients on their relative importance. Largest differences in providers' perceptions of patient barriers included poor motivation, high use of fast food, inadequate family support, and lack of cooking skills-all suggesting patient inadequacy. In contrast, patients showed evidence of high motivation-in rate of blood glucose measurement and desire for diet education. Patients identified primary care providers as a main source of nutrition education, yet providers indicated lack of time for diet discussion and preferred other staff do the teaching. Conclusion. The findings from this study strongly suggest that health systems need to consider patient, provider, and system barriers when implementing nutrition education and management programs.
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Affiliation(s)
- Rachelle Bross
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA USA
| | - Pauline Genter
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA USA
| | - Yang Lu
- California State University Long Beach, Long Beach, CA, USA
| | - Lilian Serpas
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA USA
| | - David Campa
- Los Angeles County Department of Health Services, Los Angeles, CA, USA
| | - Eli Ipp
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA USA
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L Marshoudi S, Ahmed F, Peeran S, AlBurji A, Al-Kalbani K, Yousf S. Short screening for diabetic foot disease in an omani population at Al-Dahira, Sultanate of Oman: A cross-sectional study. DENTISTRY AND MEDICAL RESEARCH 2021. [DOI: 10.4103/dmr.dmr_4_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Zamorano LS, Calero Magaña P, García Cisneros E, Martínez AV, Martín LF. Cocoa olein glycerolysis with lipase Candida antarctica in a solvent free system. GRASAS Y ACEITES 2020. [DOI: 10.3989/gya.0794191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In this paper we present the valorization of cocoa olein obtained from the acid fat-splitting of soapstocks. The aim is to develop a solvent free process (enzymatically catalyzed) to maximize the production of a final product with high content of monoglycerides (MAG) and diglycerides (DAG). The effect of the enzyme dose, glycerol content, reaction times as well as the modification of the raw material and pressure were studied. The yield of the reaction increased up to 90-95% when using a vacuum of 2-3 mbar at 65 °C, enough to evaporate the water which is generated as a by-product, an enzyme dose of 1% and molar ratio oil:glycerol of 1:2. The highest yield in terms of MAG and DAG production was obtained by starting from a raw material which was rich in free acidity (FFA), rendering oil with 33.4 and 44.2% MAG and DAG, respectively. Short reaction times (6-8 h) were observed compared to previously reported results (24 h).
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Thorsen M, McGarvey R, Thorsen A. Diabetes management at community health centers: Examining associations with patient and regional characteristics, efficiency, and staffing patterns. Soc Sci Med 2020; 255:113017. [PMID: 32413683 PMCID: PMC7295229 DOI: 10.1016/j.socscimed.2020.113017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/04/2020] [Accepted: 04/28/2020] [Indexed: 01/22/2023]
Abstract
A major source of primary health care for millions of Americans, community health centers (CHCs) act as a key point of access for diabetes care. The ability of a CHC to deliver high quality care, that supports patients' management of their diabetes, may be impacted by the unique set of resources and constraints it faces, both in terms of characteristics of its patient population and aspects of operations. This study examines how patient and regional characteristics, staffing patterns, and efficiency were associated with diabetes management at CHCs (percentage of patients with uncontrolled diabetes, HbA1C > 9%). Data on a sample of 1229 CHCs came from multiple sources. CHC-level information was obtained from the Uniform Data System and regional-level information from the Behavioral Risk Factor Surveillance System and the US Census American Community Survey. A clustering methodology, latent class analysis, identified seven underlying staffing patterns at CHCs. Data envelopment analysis was performed to evaluate the efficiency of CHCs, relative to centers with similar staffing patterns. Finally, generalized linear models were used to examine the association between staffing patterns, efficiency, and patient and regional-level characteristics. Findings from this study have sociological, practical, and methodological implications. Findings highlight that the intersection of patient racial composition with regional racial composition is significant; diabetes control appears to be worse at CHCs serving racial minorities living in predominantly White areas. Findings suggest that CHCs that incorporate more behavioral health care into their staffing mix have lower rates of uncontrolled diabetes among their patients. Finally, greater efficiency in CHC operations is associated with better diabetes control among patients. By identifying sociodemographic and operational characteristics associated with better hemoglobin control among diabetes patients, the current study contributes to our understanding of both health care operations and health inequalities.
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Affiliation(s)
- Maggie Thorsen
- Department of Sociology and Anthropology, Montana State University, P.O. Box 172380, Bozeman, MT, 59717, USA.
| | - Ronald McGarvey
- Department of Industrial and Manufacturing Systems Engineering and Truman School of Public Affairs, University of Missouri, E3437H Lafferre Hall, Columbia, MO, 65211, USA.
| | - Andreas Thorsen
- Jake Jabs College of Business and Entrepreneurship, Montana State University, P.O. Box 173040, Bozeman, MT, 59717, USA.
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Abstract
PURPOSE OF REVIEW Community health centers (CHCs) provide care to millions of vulnerable patients in the USA, including a disproportionate number with diabetes. Policies affecting diabetes management in CHCs therefore have broad implications for clinical practice and patient outcomes nationwide. We describe prior policies that have influenced diabetes management in CHCs, discuss current policies and programs, as well as present emerging innovations and future directions for diabetes care in this setting. RECENT FINDINGS Domains for current diabetes policies and programs in CHCs include coverage requirements, quality reporting and incentives, prescription discounts, healthy behavior incentives, and team-based care. Policies in these areas affect the management of diabetes at multiple levels, from organizations that support CHCs to individual health centers, and the providers and patients based there. Several domains of interrelated policies and programs impact CHC diabetes management at multiple levels. Stakeholders' understanding of these policies and programs may identify opportunities to improve diabetes care.
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Affiliation(s)
- A Taylor Kelley
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, 50 North Medical Dr. 5R341, Salt Lake City, UT, 84132, USA.
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA.
| | - Robert S Nocon
- Department of Medicine, Section of General Internal Medicine, University of Chicago, Chicago, IL, USA
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Matthew J O'Brien
- Department of Internal Medicine, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Man REK, Fenwick EK, Gan ATL, Sabanayagam C, Gupta P, Aravindhan A, Wong TY, Tan GSW, Lamoureux EL. Association Between Perceived Barriers to Diabetes Self-management and Diabetic Retinopathy in Asian Patients With Type 2 Diabetes. JAMA Ophthalmol 2019; 135:1387-1393. [PMID: 29145552 DOI: 10.1001/jamaophthalmol.2017.4888] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance A patient’s perceived barriers to diabetes self-management (DSM) may affect his or her risk of diabetic retinopathy (DR); however, few studies have examined this association. Objective To examine the association between perceived barriers to DSM and the severity spectrum of DR in Asian patients with type 2 diabetes. Design, Setting, and Participants A cross-sectional clinic-based study, the Singapore Diabetes Management Project, was conducted from December 28, 2010, to March 20, 2013, at the Singapore National Eye Centre, a tertiary eye care institute. After excluding patients with type 1 diabetes and ungradable fundus images, 361 participants were included in the analyses. Statistical analysis was conducted from July 20 to September 8, 2017. Exposure The degree of perceived barriers to DSM was assessed using a 23-item questionnaire comprising items about knowledge of DSM, access to care, and confidence in health care professionals. Rasch analysis was used to optimize the scale’s psychometric properties, with lower scores indicating a higher degree of self-perceived barriers. Main Outcomes and Measures Diabetic retinopathy was graded from 2-field retinal images into categories of no DR (Early Treatment Diabetic Retinopathy Study levels 10-15; n = 154), mild to moderate DR (levels 20-43; n = 112), and severe DR (levels ≥53 and/or presence of clinically significant macular edema; n = 95) using the modified Airlie House classification system of DR. Multinomial logistic regression models were used to assess the association between perceived barriers and severity of DR in the worse-affected eye. Results Among the 361 participants (105 women and 256 men; mean [SD] age, 57 [8] years), a greater magnitude of perceived barriers to DSM was independently associated with higher odds of having any DR (odds ratio, 1.32; 95% CI, 1.06-1.66), mild to moderate DR (odds ratio, 1.30; 95% CI, 1.01-1.68), and severe DR (odds ratio, 1.36; 95% CI, 1.03-1.79). This association was independent of diabetes control (hemoglobin A1c, blood pressure, and lipid levels), presenting visual acuity, and socioeconomic indicators. Conclusions and Relevance These results suggest that greater perceived barriers to DSM are independently associated with severity of DR. Although longitudinal data are needed, these findings suggest that evidence-based interventions to reduce patient-, practitioner-, and system-related barriers to diabetes care may help reduce the risk of DR.
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Affiliation(s)
- Ryan Eyn Kidd Man
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Eva K Fenwick
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore,Duke-National University of Singapore Medical School, Singapore,Centre for Eye Research Australia, University of Melbourne, Victoria, Australia
| | | | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore,Duke-National University of Singapore Medical School, Singapore
| | - Preeti Gupta
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Amudha Aravindhan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore,Duke-National University of Singapore Medical School, Singapore,Singapore National Eye Centre, Singapore
| | | | - Ecosse L Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore,Duke-National University of Singapore Medical School, Singapore
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Mogre V, Johnson NA, Tzelepis F, Paul C. Attitudes towards, facilitators and barriers to the provision of diabetes self-care support: A qualitative study among healthcare providers in Ghana. Diabetes Metab Syndr 2019; 13:1745-1751. [PMID: 31235088 DOI: 10.1016/j.dsx.2019.03.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 03/26/2019] [Indexed: 11/17/2022]
Abstract
STATEMENT OF THE PROBLEM Self-care support provided by healthcare providers (HCPs) is critical to diabetes self-care. However, a number of barriers prevent HCPs from providing self-care support to people with diabetes. We explored attitudes towards, barriers and facilitators of the provision of diabetes self-care support among Ghanaian HCPs. METHODS Fourteen semi-structured interviews were conducted among HCPs recruited from three diabetes clinics in Tamale, Ghana. All interviews were digitally recorded and transcribed verbatim. Transcripts were coded and analysed thematically. RESULTS HCPs reported a sense of responsibility and urgency to provide self-care education to diabetes patients; while believing it was the patients' responsibility to self-care for their diabetes condition. Accordingly, HCPs perceived their role to be limited to information sharing rather than behaviour change interventions. Facilitators to the provision of self-care support included patients' motivation, and team work among healthcare professionals. Barriers that hindered self-care support included language barriers and poor inter-professional collaboration. Furthermore, HCPs discussed that they felt inadequately trained to provide self-care support. Healthcare-system-related barriers were inadequate office space, lack of professional development programmes, high patient numbers, inadequate staff numbers, inadequate health insurance and a lack of sufficient supplies and equipment in the hospital. CONCLUSION HCPs attitudes were generally favourable towards supporting self-care, albeit with a focus on information provision rather than behaviour change. Training in effective strategies for providing self-care support are needed, and better use of the resources that are available.
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Affiliation(s)
- Victor Mogre
- Department of Health Professions Education and Innovative Learning, School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana; School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia.
| | - Natalie A Johnson
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia; Hunter Medical Research Institute, Locked Bag 1000, New Lambton, New South Wales, 2305, Australia
| | - Flora Tzelepis
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia; Hunter Medical Research Institute, Locked Bag 1000, New Lambton, New South Wales, 2305, Australia; Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales, 2287, Australia
| | - Christine Paul
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia; Hunter Medical Research Institute, Locked Bag 1000, New Lambton, New South Wales, 2305, Australia
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Singh K, Ali MK, Devarajan R, Shivashankar R, Kondal D, Ajay VS, Menon VU, Varthakavi PK, Viswanathan V, Dharmalingam M, Bantwal G, Sahay RK, Masood MQ, Khadgawat R, Desai A, Prabhakaran D, Narayan KMV, Phillips VL, Tandon N. Rationale and protocol for estimating the economic value of a multicomponent quality improvement strategy for diabetes care in South Asia. Glob Health Res Policy 2019; 4:7. [PMID: 30923749 PMCID: PMC6421672 DOI: 10.1186/s41256-019-0099-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/05/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Economic dimensions of implementing quality improvement for diabetes care are understudied worldwide. We describe the economic evaluation protocol within a randomised controlled trial that tested a multi-component quality improvement (QI) strategy for individuals with poorly-controlled type 2 diabetes in South Asia. METHODS/DESIGN This economic evaluation of the Centre for Cardiometabolic Risk Reduction in South Asia (CARRS) randomised trial involved 1146 people with poorly-controlled type 2 diabetes receiving care at 10 diverse diabetes clinics across India and Pakistan. The economic evaluation comprises both a within-trial cost-effectiveness analysis (mean 2.5 years follow up) and a microsimulation model-based cost-utility analysis (life-time horizon). Effectiveness measures include multiple risk factor control (achieving HbA1c < 7% and blood pressure < 130/80 mmHg and/or LDL-cholesterol< 100 mg/dl), and patient reported outcomes including quality adjusted life years (QALYs) measured by EQ-5D-3 L, hospitalizations, and diabetes related complications at the trial end. Cost measures include direct medical and non-medical costs relevant to outpatient care (consultation fee, medicines, laboratory tests, supplies, food, and escort/accompanying person costs, transport) and inpatient care (hospitalization, transport, and accompanying person costs) of the intervention compared to usual diabetes care. Patient, healthcare system, and societal perspectives will be applied for costing. Both cost and health effects will be discounted at 3% per year for within trial cost-effectiveness analysis over 2.5 years and decision modelling analysis over a lifetime horizon. Outcomes will be reported as the incremental cost-effectiveness ratios (ICER) to achieve multiple risk factor control, avoid diabetes-related complications, or QALYs gained against varying levels of willingness to pay threshold values. Sensitivity analyses will be performed to assess uncertainties around ICER estimates by varying costs (95% CIs) across public vs. private settings and using conservative estimates of effect size (95% CIs) for multiple risk factor control. Costs will be reported in US$ 2018. DISCUSSION We hypothesize that the additional upfront costs of delivering the intervention will be counterbalanced by improvements in clinical outcomes and patient-reported outcomes, thereby rendering this multi-component QI intervention cost-effective in resource constrained South Asian settings. TRIAL REGISTRATION ClinicalTrials.gov: NCT01212328.
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Affiliation(s)
- Kavita Singh
- Public Health Foundation of India, Center of Excellence - Center for CArdio-metabolic Risk Reduction in South Asia, 4th Floor, Plot No. 47, Sector 44, Institutional Area, Gurgaon, Haryana 122 002 India
- Centre for Chronic Disease Control, C 1/52, Second Floor, Safdarjung Development Area, New Delhi, 110016 India
| | - Mohammed K. Ali
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Rm CNR 7041, Atlanta, GA 30322 USA
| | - Raji Devarajan
- Public Health Foundation of India, Center of Excellence - Center for CArdio-metabolic Risk Reduction in South Asia, 4th Floor, Plot No. 47, Sector 44, Institutional Area, Gurgaon, Haryana 122 002 India
- Centre for Chronic Disease Control, C 1/52, Second Floor, Safdarjung Development Area, New Delhi, 110016 India
| | - Roopa Shivashankar
- Centre for Chronic Disease Control, C 1/52, Second Floor, Safdarjung Development Area, New Delhi, 110016 India
| | - Dimple Kondal
- Public Health Foundation of India, Center of Excellence - Center for CArdio-metabolic Risk Reduction in South Asia, 4th Floor, Plot No. 47, Sector 44, Institutional Area, Gurgaon, Haryana 122 002 India
- Centre for Chronic Disease Control, C 1/52, Second Floor, Safdarjung Development Area, New Delhi, 110016 India
| | - Vamadevan S. Ajay
- Public Health Foundation of India, Center of Excellence - Center for CArdio-metabolic Risk Reduction in South Asia, 4th Floor, Plot No. 47, Sector 44, Institutional Area, Gurgaon, Haryana 122 002 India
- Centre for Chronic Disease Control, C 1/52, Second Floor, Safdarjung Development Area, New Delhi, 110016 India
| | - V. Usha Menon
- Department of Endocrinology & Diabetes, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Ponekkara P.O., Kochi, Kerala 682 041 India
| | - Premlata K. Varthakavi
- Department of Endocrinology, TNM College & BYL Nair Charity Hospital, Dr. A. L. Nair Road, Mumbai Central, Mumbai, Maharashtra 400 008 India
| | - Vijay Viswanathan
- MV Hospital for Diabetes & Diabetes Research Centre, No 4, West Madha Church Street, Royapuram, Chennai, Tamil Nadu 600 013 India
| | - Mala Dharmalingam
- Bangalore Endocrinology & Diabetes Research Centre, #35, 5th Cross, Malleswaram Circle, Bangalore, Karnataka 560 003 India
| | - Ganapati Bantwal
- Department of Endocrinology, St. John’s Medical College & Hospital, Sarjapur Road, Koramangala, Bangalore, Karnataka 560 034 India
| | - Rakesh Kumar Sahay
- Department of Endocrinology, Osmania General Hospital, 2nd Floor, Golden Jubilee Block, Afzalgunj, Hyderabad, Telangana 500 012 India
| | - Muhammad Qamar Masood
- Department of Medicine, Section of Endocrinology and Diabetes, Aga Khan University, Stadium Road, Karachi, 74800 Pakistan
| | - Rajesh Khadgawat
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, Biotechnology Block, 3rd Floor, Ansari Nagar, New Delhi, 110 029 India
| | - Ankush Desai
- Endocrine Unit, Department of Medicine, Goa Medical College, Bambolim, Goa 403202 India
| | - Dorairaj Prabhakaran
- Public Health Foundation of India, 4th Floor, Plot No. 47, Sector 44, Institutional Area, Gurgaon, Haryana 122 002 India
- Centre for Chronic Disease Control, C 1/52, Second Floor, Safdarjung Development Area, New Delhi, 110016 India
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT UK
| | - K. M. Venkat Narayan
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Rm CNR 7049, Atlanta, GA 30322 USA
| | - Victoria L. Phillips
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322 USA
| | - Nikhil Tandon
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, Biotechnology Block, 3rd Floor, Rm #312, Ansari Nagar, New Delhi, 110 029 India
| | - On behalf of the CARRS Trial Group
- Public Health Foundation of India, Center of Excellence - Center for CArdio-metabolic Risk Reduction in South Asia, 4th Floor, Plot No. 47, Sector 44, Institutional Area, Gurgaon, Haryana 122 002 India
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Rm CNR 7041, Atlanta, GA 30322 USA
- Department of Endocrinology & Diabetes, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Ponekkara P.O., Kochi, Kerala 682 041 India
- Department of Endocrinology, TNM College & BYL Nair Charity Hospital, Dr. A. L. Nair Road, Mumbai Central, Mumbai, Maharashtra 400 008 India
- MV Hospital for Diabetes & Diabetes Research Centre, No 4, West Madha Church Street, Royapuram, Chennai, Tamil Nadu 600 013 India
- Bangalore Endocrinology & Diabetes Research Centre, #35, 5th Cross, Malleswaram Circle, Bangalore, Karnataka 560 003 India
- Department of Endocrinology, St. John’s Medical College & Hospital, Sarjapur Road, Koramangala, Bangalore, Karnataka 560 034 India
- Department of Endocrinology, Osmania General Hospital, 2nd Floor, Golden Jubilee Block, Afzalgunj, Hyderabad, Telangana 500 012 India
- Department of Medicine, Section of Endocrinology and Diabetes, Aga Khan University, Stadium Road, Karachi, 74800 Pakistan
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, Biotechnology Block, 3rd Floor, Ansari Nagar, New Delhi, 110 029 India
- Endocrine Unit, Department of Medicine, Goa Medical College, Bambolim, Goa 403202 India
- Public Health Foundation of India, 4th Floor, Plot No. 47, Sector 44, Institutional Area, Gurgaon, Haryana 122 002 India
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Rm CNR 7049, Atlanta, GA 30322 USA
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322 USA
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, Biotechnology Block, 3rd Floor, Rm #312, Ansari Nagar, New Delhi, 110 029 India
- Centre for Chronic Disease Control, C 1/52, Second Floor, Safdarjung Development Area, New Delhi, 110016 India
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT UK
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Abstract
PURPOSE OF REVIEW Obesity and type 2 diabetes (T2D) are closely linked metabolic diseases. Most individuals with T2D are overweight or obese, which raises their cardiovascular risk. The etiology of both diseases is multifaceted, thus requiring a multidisciplinary approach to control them. This review describes the most effective multidisciplinary approach to weight management in patients with T2D in real-world clinical practice. RECENT FINDINGS Weight management programs in real-world clinical settings lead to long-term weight loss for up to 5 years. Multidisciplinary approach to manage obesity and T2D through weight reduction is feasible in real-world clinical practice and is recommended as part of the treatment plan for patients with T2D who are overweight or obese. Recent data demonstrates that multidisciplinary approach to weight management in patients with T2D results in long-term weight loss and is associated with improved cardiovascular risk factors.
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Affiliation(s)
- Osama Hamdy
- Joslin Diabetes Center, Harvard Medical School, One Joslin Place, Boston, MA, 02215, USA.
| | - Sahar Ashrafzadeh
- Joslin Diabetes Center, Harvard Medical School, One Joslin Place, Boston, MA, 02215, USA
| | - Adham Mottalib
- Joslin Diabetes Center, Harvard Medical School, One Joslin Place, Boston, MA, 02215, USA
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Tourkmani AM, Abdelhay O, Alkhashan HI, Alaboud AF, Bakhit A, Elsaid T, Alawad A, Alobaikan A, Alqahtani H, Alqahtani A, Mishriky A, Bin Rsheed A, Alharbi TJ. Impact of an integrated care program on glycemic control and cardiovascular risk factors in patients with type 2 diabetes in Saudi Arabia: an interventional parallel-group controlled study. BMC FAMILY PRACTICE 2018; 19:1. [PMID: 29291706 PMCID: PMC5748946 DOI: 10.1186/s12875-017-0677-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 12/11/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Long intervals between patient visits and limited time with patients can result in clinical inertia and suboptimal achievement of treatment goals. These obstacles can be improved with a multidisciplinary care program. The present study aimed to assess the impact of such a program on glycemic control and cardiovascular risk factors. METHODS In a randomized, parallel-group trial, we assigned 263 patients with poorly controlled type 2 diabetes mellitus (T2DM) to either a control group, standard care program, or a multidisciplinary care program involving a senior family physician, clinical pharmacy specialist, dietician, diabetic educator, health educator, and social worker. The participants were followed for a median of 10 months, between September 2013 and September 2014. Glycated hemoglobin (HbA1c), fasting blood glucose (FBG), lipid profiles, and blood pressure (BP) were measured. The assignment was blinded for the assessors of the study outcomes. The study registry number is. RESULTS In the intervention group, there were statistically significant (p < 0.05) post-intervention (relative) reductions in the levels of HbA1c (-27.1%, 95% CI = -28.9%, -25.3%), FBG (-17.10%, 95% CI = -23.3%, -10.9%), total cholesterol (-9.93%, 95% CI = -12.7%, -7.9%), LDL cholesterol (-11.4%, 95% CI = -19.4%, -3.5%), systolic BP (-1.5%, 95% CI = -2.9%, -0.03%), and diastolic BP (-3.4%, 95% CI = -5.2%, -1.7%). There was a significant decrease in the number of patients with a HbA1c ≥10 (86 mmol/mol) from 167 patients at enrollment to 11 patients after intervention (p < 0.001). However, the intervention group experienced a statistically significant increase in body weight (3.7%, 95% CI = 2.9%, 4.5%). In the control group, no statistically significant changes were noticed in different outcomes with the exception of total cholesterol (-4.10%, p = 0.07). In the linear regression model, the intervention and the total number of clinic visits predicted HbA1c improvement. CONCLUSIONS Implementation of a patient-specific integrated care program involving a multidisciplinary team approach, frequent clinic visits, and intensified insulin treatment was associated with marked improvement in glycemic control and cardiovascular risk factors of poorly controlled T2DM patients in a safe and reproducible manner. TRIAL REGISTRATION ISRCTN Identifier: ISRCTN83437562 September 19, 2016 Retrospectively registered.
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Affiliation(s)
- Ayla M Tourkmani
- Family and Community Medicine Department, Prince Sultan Military Medical City, P.O. Box 7897, Riyadh, 11159, Saudi Arabia
| | - Osama Abdelhay
- Family and Community Medicine Department, Prince Sultan Military Medical City, P.O. Box 7897, Riyadh, 11159, Saudi Arabia
| | - Hesham I Alkhashan
- Family and Community Medicine Department, Prince Sultan Military Medical City, P.O. Box 7897, Riyadh, 11159, Saudi Arabia
| | - Aboud F Alaboud
- Family and Community Medicine Department, Prince Sultan Military Medical City, P.O. Box 7897, Riyadh, 11159, Saudi Arabia
| | - Ahmed Bakhit
- Family and Community Medicine Department, Prince Sultan Military Medical City, P.O. Box 7897, Riyadh, 11159, Saudi Arabia
| | - Tarek Elsaid
- Family and Community Medicine Department, Prince Sultan Military Medical City, P.O. Box 7897, Riyadh, 11159, Saudi Arabia
| | - Ahmed Alawad
- Family and Community Medicine Department, Prince Sultan Military Medical City, P.O. Box 7897, Riyadh, 11159, Saudi Arabia
| | - Aljohara Alobaikan
- Family and Community Medicine Department, Prince Sultan Military Medical City, P.O. Box 7897, Riyadh, 11159, Saudi Arabia
| | - Hala Alqahtani
- Family and Community Medicine Department, Prince Sultan Military Medical City, P.O. Box 7897, Riyadh, 11159, Saudi Arabia
| | - Abdulaziz Alqahtani
- Family and Community Medicine Department, Prince Sultan Military Medical City, P.O. Box 7897, Riyadh, 11159, Saudi Arabia
| | - Adel Mishriky
- Family and Community Medicine Department, Prince Sultan Military Medical City, P.O. Box 7897, Riyadh, 11159, Saudi Arabia
| | - Abdulaziz Bin Rsheed
- Family and Community Medicine Department, Prince Sultan Military Medical City, P.O. Box 7897, Riyadh, 11159, Saudi Arabia
| | - Turki J Alharbi
- Family and Community Medicine Department, Prince Sultan Military Medical City, P.O. Box 7897, Riyadh, 11159, Saudi Arabia.
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Barsegian A, Kotlyar B, Lee J, Salifu MO, McFarlane SI. Diabetic Retinopathy: Focus on Minority Populations. INTERNATIONAL JOURNAL OF CLINICAL ENDOCRINOLOGY AND METABOLISM 2017; 3:034-45. [PMID: 29756128 PMCID: PMC5945200 DOI: 10.17352/ijcem.000027] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Diabetic retinopathy is a major cause of blindness in the United States. With rise of the epidemic of obesity and diabetes in the USA and around the globe, serious and common diabetic complications are evolving as a major public health problem, particularly among minority populations. These populations are disproportionately affected by diabetes and 2-3 times more likely to develop visually significant complications. In this highly illustrated review article, we discuss the diabetic epidemic, highlighting the biology and the pathophysiologic mechanisms of this disorder on the anatomy of the eye. We also discuss the risk factors and the implications for minority populations. For the health care providers, we provide cutting edge information and imminently relevant information to help evaluate, manage, and know when to refer their patients to a specialist in ophthalmology to quell the tide of the epidemic.
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Affiliation(s)
- Arpine Barsegian
- Department of Ophthalmology, SUNY-Downstate Medical Center and Kings County Hospital, Brooklyn, NY 11203, USA
| | - Boleslav Kotlyar
- Department of Ophthalmology, SUNY-Downstate Medical Center and Kings County Hospital, Brooklyn, NY 11203, USA
| | - Justin Lee
- Department of Medicine, SUNY-Downstate Medical Center and Kings County Hospital, Brooklyn, NY 11203, USA
| | - Moro O Salifu
- Department of Medicine, SUNY-Downstate Medical Center and Kings County Hospital, Brooklyn, NY 11203, USA
| | - Samy I McFarlane
- Department of Medicine, SUNY-Downstate Medical Center and Kings County Hospital, Brooklyn, NY 11203, USA
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DiZazzo-Miller R, Pociask FD, Bertran EA, Fritz HA, Abbas M, Tarakji S, Lysack CL, Jaber LA, Arnetz J. Diabetes Is Devastating, and Insulin Is a Death Sentence: Provider Perspectives of Diabetes Self-Management in Arab-American Patients. Clin Diabetes 2017; 35:43-50. [PMID: 28144045 PMCID: PMC5241769 DOI: 10.2337/cd15-0030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
IN BRIEF The purpose of this qualitative study was to examine providers' perspectives on cultural barriers and facilitators to diabetes self-management (DSM) in Arab Americans to identify factors to enhance DSM education in the Arab-American community. The main barriers to DSM from the providers' perspective were the disease itself and patients' denial or refusal to recognize it, reflecting the stigma of the disease. Cultural aspects also included overlapping themes that both facilitated and presented barriers to DSM. These results suggest that DSM education for Arab Americans will be most effective if developed and delivered in a manner consistent with the cultural facilitators and barriers noted by providers.
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Martinez NC, Tripp-Reimer T. Diabetes Nurse Educators' Prioritized Elder Foot Care Behaviors. DIABETES EDUCATOR 2016; 31:858-68. [PMID: 16288093 DOI: 10.1177/0145721705282252] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this study was to identify diabetes nurse educators' perceptions of the most important foot care behaviors for elderly people to enact in daily care. Methods A structured, open-ended questionnaire was mailed to a regionally stratified random sample of 90 diabetes nurse educators. Subjects were asked to identify and rank order 8 foot care behaviors perceived important for elderly people with diabetes to enact daily. Data were transcribed and coded into categories and domains using descriptive content analysis. Results Forty-seven diabetes nurse educators responded with a total of 346 foot care behaviors perceived important for elders. Twenty-one major foot care behavior content categories were grouped into 4 domains of descending importance: foot/nail care, footwear/shoes, general health, and foot emergencies. Conclusions Diabetes nurse educators generated a range of baseline data for developing a reliable, valid, and patient foot care knowledge outcome measure to support national diabetes patient education and self-management program guidelines.
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Fritz H, DiZazzo-Miller R, Bertran EA, Pociask FD, Tarakji S, Arnetz J, Lysack CL, Jaber LA. Diabetes self-management among Arab Americans: patient and provider perspectives. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2016; 16:22. [PMID: 27582174 PMCID: PMC5006513 DOI: 10.1186/s12914-016-0097-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 08/20/2016] [Indexed: 11/30/2022]
Abstract
Background Arab Americans have a high burden of diabetes and poor outcomes compared to the general U.S. population. Diabetes self-management (DSM) requires a partnership between patients and providers that fosters mutual understanding and shared decision-making. Cultural factors influence this process; however, little is known regarding the cultural impact on DSM or if perceptions differ between patients and providers. Methods Qualitative content analysis was used to analyze five focus groups–two groups with Arab American providers (n = 8) and three groups with adult Arab Americans with diabetes (n = 23). Focus groups examined patient and provider perspectives on the meaning of DSM and cultural barriers and facilitators among Arab American patients. Results Four distinct themes included limited resources for DSM education and support, stigma as a barrier to ongoing support, family support as an opportunity and challenge, and Arab American patient-provider relationships. Conclusions Findings indicate several domains should be considered for clinical practice including a need to develop linguistically and culturally reliant educational materials and relevant supports for use in the Arab American population. Findings highlight differing views among providers and patients on the familial role in supporting DSM efforts and why some patients feel dissatisfied with clinical encounters.
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Affiliation(s)
- Heather Fritz
- Institute of Gerontology, Wayne State University, 87 East Ferry Street, 226 Knapp Building, Detroit, MI, 48202, USA
| | - Rosanne DiZazzo-Miller
- Department of Health Care Sciences, Wayne State University, 259 Mack Ave, Detroit, MI, 48201, USA.
| | - Elizabeth A Bertran
- Department of Pharamacy Practice, Wayne State University, 259 Mack Ave, Detroit, MI, 48201, USA
| | - Fredrick D Pociask
- Department of Health Care Sciences, Wayne State University, 259 Mack Ave, Detroit, MI, 48201, USA
| | - Sandra Tarakji
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI, 48202, USA
| | - Judith Arnetz
- Department of Family Medicine, Michigan State University, 788 Service Rd., B103 Clinical Center, East Lansing, MI, 48824, USA
| | - Catherine L Lysack
- Institute of Gerontology, Wayne State University, 87 East Ferry Street, 226 Knapp Building, Detroit, MI, 48202, USA
| | - Linda A Jaber
- Department of Pharamacy Practice, Wayne State University, 259 Mack Ave, Detroit, MI, 48201, USA
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McBain H, Mulligan K, Lamontagne-Godwin F, Jones J, Haddad M, Flood C, Thomas D, Simpson A. Implementation of recommended type 2 diabetes care for people with severe mental illness - a qualitative exploration with healthcare professionals. BMC Psychiatry 2016; 16:222. [PMID: 27391590 PMCID: PMC4938935 DOI: 10.1186/s12888-016-0942-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 06/20/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to explore the barriers and facilitators healthcare professionals experience when managing type 2 diabetes in people with severe mental illness (SMI). METHODS A qualitative semi-structured interview approach was employed. Questions were structured according to the Theoretical Domains Framework (TDF), which outlines 14 domains that can act as barriers and facilitators to changing behaviour. Interviews were audio-recorded and transcribed verbatim. The data were coded according to the 14 domains of the TDF, belief statements were created within each domain and the most relevant belief statements within each domain identified through a consensus approach. Analyses were conducted by two researchers, and discrepancies agreed with a third researcher. RESULTS Sixteen healthcare professionals, from a range of services, involved in the care of people with type 2 diabetes and SMI took part in an interview. Inter-rater reliability for each of the domains varied (25 %-74 %). All fourteen domains were deemed relevant, with 42 specific beliefs identified as important to the target behaviour. Participants identified having relevant knowledge and skills for diabetes management, prioritising this area of health, and reviewing health behaviours to develop action plans, as particularly important. At an organisational level, integrated care provision and shared information technology (IT) services between mental health and physical services, and clearly defined roles and responsibilities for the different professions, with designated time to undertake the work were identified as crucial. CONCLUSIONS The findings highlight that healthcare professionals' experience a range of barriers and enablers when attempting to manage type 2 diabetes in people with SMI. These include organisational factors and individual beliefs, suggesting that interventions need to be targeted at both an organisation and individual level in order to change behaviour. Further work is needed to model these relationships in a larger sample of participants in line with the MRC guidance for developing complex interventions.
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Affiliation(s)
- Hayley McBain
- School of Health Sciences, City University London, Northampton Square, London, EC1V 0HB UK ,East London NHS Foundation Trust, 9 Alie Street, London, E1 8DE UK
| | - Kathleen Mulligan
- School of Health Sciences, City University London, Northampton Square, London, EC1V 0HB UK ,East London NHS Foundation Trust, 9 Alie Street, London, E1 8DE UK
| | | | - Julia Jones
- School of Health Sciences, City University London, Northampton Square, London, EC1V 0HB UK
| | - Mark Haddad
- School of Health Sciences, City University London, Northampton Square, London, EC1V 0HB UK ,East London NHS Foundation Trust, 9 Alie Street, London, E1 8DE UK
| | - Chris Flood
- School of Health Sciences, City University London, Northampton Square, London, EC1V 0HB UK ,East London NHS Foundation Trust, 9 Alie Street, London, E1 8DE UK
| | - David Thomas
- School of Health Sciences, City University London, Northampton Square, London, EC1V 0HB UK
| | - Alan Simpson
- School of Health Sciences, City University London, Northampton Square, London, EC1V 0HB, UK. .,East London NHS Foundation Trust, 9 Alie Street, London, E1 8DE, UK.
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Lee M, Sobralske M, Raney E, Carino B. Interpretation time in an ethnically diverse pediatric orthopedic clinic. J Health Organ Manag 2016; 30:530-40. [PMID: 27296876 DOI: 10.1108/jhom-02-2015-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose - The purpose of this paper is to determine whether there were differences in clinical encounter time between patients who speak English and those who require an interpretation service in an ethnically diverse pediatric clinic. Design/methodology/approach - Encounter time with patients requiring interpretation was compared to encounter time with patients who spoke English. The sample consisted of 310 encounters at a pediatric orthopedic clinic where patients spoke over 18 primary languages. Data were analyzed using ANOVA to compare four types of encounters. Findings - Approximately 12 percent (n=38) required interpretation and encounters requiring interpretation took 30 percent (nine minutes) longer than those that did not, p < 0.01(25 vs 16 minutes). Furthermore, this difference was mainly among new patients: Approximately, 53 percent increase in time for new patient encounters requiring interpretation (36 vs 23 minutes) while only 25 percent increase in encounter time for established patients (20 vs 16 minutes) was detected. Research limitations/implications - Preventing problems due to language barriers requires time for interpretation which places demands on staff resources and presents clinical challenges. However, long-term benefits of quality health care outweigh the costs associated with interpretation service. Originality/value - To the knowledge, this is the first study to investigate actual encounter time differences in a pediatric clinical setting. The authors found that clinical encounters requiring interpretation took approximately nine minutes longer in general and four minutes longer for established patients. These findings could give much needed information for hospital administrators to allocate appropriate amounts of time and resources to care for those who need interpretation services. However, they also indicate a broader concern of the reduction of clinical encounter time for overall health care system in the country that might need further investigation.
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Affiliation(s)
- Moon Lee
- Department of Public Relations, University of Florida, Gainesville, Florida, USA
| | - Mary Sobralske
- Transcultural Health Consultants, Spokane, Washington, USA
| | - Ellen Raney
- Shriners Hospitals for Children, Portland, Oregon, USA AND Orthopaedics and Rehabilitation, Oregon Health Sciences, Portland, Oregon, USA
| | - Brian Carino
- Department of Orthopaedic Surgery, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
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Morgan HM, Entwistle VA, Cribb A, Christmas S, Owens J, Skea ZC, Watt IS. We need to talk about purpose: a critical interpretive synthesis of health and social care professionals' approaches to self-management support for people with long-term conditions. Health Expect 2016; 20:243-259. [PMID: 27075246 PMCID: PMC5354019 DOI: 10.1111/hex.12453] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2016] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Health policies internationally advocate 'support for self-management', but it is not clear how the promise of the concept can be fulfilled. OBJECTIVE To synthesize research into professional practitioners' perspectives, practices and experiences to help inform a reconceptualization of support for self-management. DESIGN Critical interpretive synthesis using systematic searches of literature published 2000-2014. FINDINGS We summarized key insights from 164 relevant papers in an annotated bibliography. The literature illustrates striking variations in approaches to support for self-management and interpretations of associated concepts. We focused particularly on the somewhat neglected question of the purpose of support. We suggest that this can illuminate and explain important differences between narrower and broader approaches. Narrower approaches support people to manage their condition(s) well in terms of disease control. This purpose can underpin more hierarchical practitioner-patient communication and more limited views of patient empowerment. It is often associated with experiences of failure and frustration. Broader approaches support people to manage well with their condition(s). They can keep work on disease control in perspective as attention focuses on what matters to people and how they can be supported to shape their own lives. Broader approaches are currently less evident in practice. DISCUSSION AND CONCLUSION Broader approaches seem necessary to fulfil the promise of support for self-management, especially for patient empowerment. A commitment to enable people to live well with long-term conditions could provide a coherent basis for the forms and outcomes of support that policies aspire to. The implications of such a commitment need further attention.
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Affiliation(s)
| | | | - Alan Cribb
- Centre for Public Policy Research, King's College London, London, UK
| | - Simon Christmas
- Centre for Public Policy Research, King's College London, London, UK
| | - John Owens
- Centre for Public Policy Research, King's College London, London, UK
| | - Zoë C Skea
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Ian S Watt
- Department of Health Sciences/Hull York Medical School, Faculty of Science, University of York, Heslington, York, UK
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Booth GL, Shah BR, Austin PC, Hux JE, Luo J, Lok CE. Early specialist care for diabetes: who benefits most? A propensity score-matched cohort study. Diabet Med 2016; 33:111-8. [PMID: 25981183 DOI: 10.1111/dme.12801] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2015] [Indexed: 11/28/2022]
Abstract
AIMS To examine whether early endocrinologist care reduces the risk of cardiovascular complications among newly diagnosed patients with diabetes of differing complexity. METHODS We conducted a population-based propensity score-matched cohort study using provincial health data from Ontario, Canada. Adults (≥ 30 years) diagnosed with diabetes between 1 April 1998 and 31 March 2006 who received endocrinologist care in the first year of diagnosis were matched to a comparison group receiving primary care alone (N = 79 020) based on propensity scores and medical complexity (assigned using information on chronic conditions). Individuals were followed for 3- and 5-year outcomes, including non-fatal acute myocardial infarction or coronary heart disease death (primary endpoint), major cardiovascular events (acute myocardial infarction, stroke) or all-cause death, amputation and end-stage renal disease. RESULTS Among medically complex patients, early endocrinologist care was associated with a lower 3-year incidence of the primary endpoint (hazard ratio 0.89, 95% CI 0.78-1.01) and major cardiovascular events or all-cause death (hazard ratio 0.91, 95% CI 0.85-0.97). These effects persisted after accounting for a higher incidence of end-stage renal disease on follow-up and were greatest in those with ≥ 3 visits to an endocrinologist (primary endpoint: hazard ratio 0.69, 95% CI 0.56-0.86 and 0.61, 95% CI 0.45-0.82, for unadjusted and end-stage renal disease adjusted analyses, respectively). In contrast, no benefit was observed in the non-medically complex subgroup. Overall effects were similar at 5 years. CONCLUSIONS Early endocrinologist care is associated with a lower incidence of cardiovascular events and death among newly diagnosed patients with diabetes who have comorbid medical conditions.
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Affiliation(s)
- G L Booth
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - B R Shah
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - P C Austin
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - J E Hux
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - J Luo
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - C E Lok
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- The University Health Network, Toronto, ON, Canada
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Richard P, Shin P, Beeson T, Burke LS, Wood SF, Rosenbaum S. Quality and Cost of Diabetes Mellitus Care in Community Health Centers in the United States. PLoS One 2015; 10:e0144075. [PMID: 26636324 PMCID: PMC4670225 DOI: 10.1371/journal.pone.0144075] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 11/12/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To examine variations in the quality and cost of care provided to patients with diabetes mellitus by Community Health Centers (CHCs) compared to other primary care settings. RESEARCH DESIGN AND METHODS We used data from the 2005-2008 Medical Expenditure Panel Survey (N = 2,108). We used two dependent variables: quality of care and ambulatory care expenditures. Our primary independent variable was whether the respondent received care in a Community Health Centers (CHCs) or not. We estimated logistic regression models to determine the probability of quality of care, and used generalized linear models with log link and gamma distribution to predict expenditures for CHC users compared to non-users of CHCs, conditional on patients with positive expenditures. RESULTS Results showed that variations of quality between CHC users and non-CHC users were not statistically significant. Patients with diabetes mellitus who used CHCs saved payers and individuals approximately $1,656 in ambulatory care costs compared to non-users of CHCs. CONCLUSIONS These findings suggest an opportunity for policymakers to control costs for diabetes mellitus patients without having a negative impact on quality of care.
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Affiliation(s)
- Patrick Richard
- Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
| | - Peter Shin
- Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, United States of America
| | - Tishra Beeson
- Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, United States of America
- Central Washington University, Ellensburg, Washington, United States of America
| | - Laura S. Burke
- Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
| | - Susan F. Wood
- Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, United States of America
| | - Sara Rosenbaum
- Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, United States of America
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Newlin Lew K, Arbauh N, Banach P, Melkus G. Diabetes: Christian worldview, medical distrust and self-management. JOURNAL OF RELIGION AND HEALTH 2015; 54:1157-1172. [PMID: 25735754 PMCID: PMC4673985 DOI: 10.1007/s10943-015-0022-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
To inform the development of a combined diabetes prevention and self-management intervention in partnership with church communities, this study sampled African American church leaders and members (N = 44) to qualitatively study religious beliefs and practices, diabetes prevention and self-management behaviors, and related community actions. Prior to commencing the study, internal review board approval was obtained. Although not required, community consent was officially provided by the church pastors. Individual consent was subsequently obtained from eligible community members who expressed an interest in participating in the study. Following a participatory action research approach, the inquiry group method was used. Qualitative data were analyzed with content analysis. Findings revealed Christian worldview, medical distrust and self-management as prominent themes. Findings suggest that diabetes providers address religious orientation in the provision of care with attention to rebuilding trust with the African-American community to improve health outcomes.
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Hung SLL, Fu SN, Lau PS, Wong SYS. A qualitative study on why did the poorly-educated Chinese elderly fail to attend nurse-led case manager clinic and how to facilitate their attendance. Int J Equity Health 2015; 14:10. [PMID: 25636857 PMCID: PMC4322441 DOI: 10.1186/s12939-015-0137-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 01/06/2015] [Indexed: 11/25/2022] Open
Abstract
Objectives This study explored the views, barriers and facilitators of the poorly-educated elderly who were non-attendee of the nurse-led case manager clinic. The case managers provide assessment for diabetes complication screening and can refer patients to the appropriate multidisciplinary team in public outpatient primary care setting. Methods We adopted qualitative research method by individual semi-structured face to face interviews. Nineteen Chinese type 2 diabetes mellitus subjects aged ≥ 60 who failed to attend the nurse-led case manager clinic were interviewed. They all came from a socially deprived urban district in Hong Kong. Content and thematic analysis was performed. Results Seven men and twelve women aged 60 to 89 were interviewed. Nine of them received no formal education and ten of them attended up to primary school. The reasons for non-attendance included attitude and poor knowledge towards diabetes complication screening and confusion of the nurse-led clinic as an educational talk. Most respondents could not understand the reason for the screening of diabetic complications, the concept of multidisciplinary care and the procedure and outcomes of nurse assessment. Five respondents were unable to follow multiple appointments because they could not read. Other reasons included physical barriers and comorbidity, family and financial constraint. They either had a tight daily schedule because of the need to take care of family members, or the family members who brought them to clinic had difficulty in attending multiple appointments. Enhanced understanding of the importance and procedure of diabetes multidisciplinary management, a flexible appointment system and a single clear appointment sheet may facilitate their attendance. Conclusion Poorly-educated Chinese elderly with DM and their care givers faced physical, social and psychological barriers when attending the nurse-led case manager clinic. Strategies targeting on their low literacy include effective communication and education by health care professionals to arrive a shared understanding of care plan as well as a flexible appointment and schedule system.
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Affiliation(s)
- Susanna Lok Lam Hung
- Department of Family Medicine and Primary Health Care, Kowloon West Cluster, Hospital Authority, 1/F, Our Lady of Maryknoll Hospital, Wong Tai Sin, Kowloon, Hong Kong S.A.R., China.
| | - Sau Nga Fu
- Department of Family Medicine and Primary Health Care, Kowloon West Cluster, Hospital Authority, 1/F, Our Lady of Maryknoll Hospital, Wong Tai Sin, Kowloon, Hong Kong S.A.R., China.
| | - Po Shan Lau
- Department of Family Medicine and Primary Health Care, Kowloon West Cluster, Hospital Authority, 1/F, Our Lady of Maryknoll Hospital, Wong Tai Sin, Kowloon, Hong Kong S.A.R., China.
| | - Samuel Yeung Shan Wong
- Division of Family Medicine and Primary Healthcare, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, 4/F, School of Public Health, Prince of Wales Hospital, Shatin, N.T., Hong Kong S.A.R., China.
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Baptista DR, Thieme RD, Reis WCT, Pontarolo R, Correr CJ. Proportion of Brazilian diabetes patients that achieve treatment goals: implications for better quality of care. Diabetol Metab Syndr 2015; 7:113. [PMID: 26672722 PMCID: PMC4678462 DOI: 10.1186/s13098-015-0107-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 11/24/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Diabetes and its complications are substantial causes of morbidity and mortality, and caused approximately 5.1 million deaths worldwide in 2013. Early detection and treatment of diabetes complications can prevent their progression. OBJECT This study compared the proportions of patients with type 1 and 2 diabetes mellitus (T1DM and T2DM, respectively) who achieved the goals of good clinical control. METHODS Adults and elderly patients with T1DM and T2DM at a public outpatient endocrinology service in Brazil were retrospectively evaluated between 2012 and 2013. Clinical and socio demographic data were obtained from medical records and evaluated in accordance with the Brazilian Diabetes Society Guidelines. Care process measures, outcomes indicators, and supporting process measures were evaluated. RESULTS A total of 1031 records were analyzed: 29 and 71 % of patients had T1DM and T2DM, respectively. T2DM patients had significantly higher BMI than T1DM patients (overweight and obesity in 85.1 vs. 47.5 %, p < 0.01). The follow-up periods for diabetes and number of clinical visits to the endocrinology service were significantly greater among T1DM patients than T2DM patients (p < 0.01). However, T2DM patients required significantly more other (i.e., non-endocrinological) healthcare services (p < 0.01). HbA1c was significantly lower in T2DM patients (p < 0.01). Moreover, blood pressure and triglycerides were significantly higher in T2DM patients (p < 0.01), whereas total cholesterol and low-density lipoprotein were significantly lower in T2DM patients (p < 0.01). Only 0.5 % of the patients achieved all targets, and 1.1 % did not achieve any. CONCLUSIONS The achievement of goals of good clinical practice varies among the parameters evaluated. Almost no patients achieved all targets. Many patients are overweight and do not achieve targets for HbA1c, lipid profile, or blood pressure control.
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Affiliation(s)
- Deise Regina Baptista
- />Post Graduate Program in Pharmaceutical Sciences, Federal University of Parana, Av. Pref. Lothario Meissner, 632, Jardim Botânico, Curitiba, PR Brazil
| | - Rubia Daniela Thieme
- />CNPq (Conselho Nacional de Desenvolvimento Científico e Tecnológico), Brasilia, Brazil
| | | | - Roberto Pontarolo
- />Program of Pharmaceutical Sciences, Federal University of Parana, Curitiba, Brazil
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Goldwater JC. Human Factors and Usability in Mobile Health Design – Factors for Sustained Patient Engagement in Diabetes Care. ACTA ACUST UNITED AC 2014. [DOI: 10.1177/2327857914031009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The degree of health care resource consumption within the United States is significant, even with the passage of the Patient Protection and Affordable Care Act (PPACA), with annual expenditures expected to reach 14% of the US gross domestic product by 2016. This suggests the need for population-level solutions that cover the spectrum of both clinical and non-clinical care for the primary prevention of chronic disease, in particular diabetes, which affects over eight percent of the population and costs over $100 billion annually. Over the past decade, there have been an abundance of technological solutions that provide the potential of mitigating the risk issues associated with diabetes and improving self-management practices. One such technology in particular is emerging that may become very important to the delivery of health care: mobile phones. In 2012, a study undertook a comprehensive assessment of the use of mobile health (mHealth) in the management and treatment of diabetes. This study encompassed the review of over 514 articles, as well as series of key informant interviews and site visits, to determine the effectiveness and utility of mHealth in managing and treating diabetes. The research suggested that the usability of mHealth applications could be understood and assessed according to four major factors: user-friendliness, user design, user satisfaction and user confidence. The first two primarily deal with the type of technology and the design of the interface. The last two concern user perception and are crucial in appropriately evaluating how well the application meets a patient’s expectations, which is a critical component of both quality of care and patient outcomes.
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Prevalence and correlates of complementary and alternative medicine use among diabetic patients in Beirut, Lebanon: a cross-sectional study. Altern Ther Health Med 2014; 14:185. [PMID: 24906634 PMCID: PMC4074134 DOI: 10.1186/1472-6882-14-185] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 05/29/2014] [Indexed: 11/10/2022]
Abstract
Background Patients with Type 2 Diabetes Mellitus (T2DM) are increasingly using complementary and alternative medicine (CAM) therapies due to difficulty in adhering to the therapeutic regimens and lifestyle changes necessary for disease management. Little is known about the prevalence and mode of CAM use among patients with T2DM in Lebanon. Objective To assess the prevalence and modes of CAM use among patients with T2DM residing in Beirut, Lebanon. Methods A cross-sectional survey of T2DM patients was conducted on patients recruited from two major referral centers in Beirut- a public hospital and a private academic medical center. In a face-to-face interview, participants completed a questionnaire comprised of three sections: socio-demographic, diabetes characteristics and types and modes of CAM use. Descriptive statistics, univariate and multivariate logistic regression analyses were utilized to assess the prevalence and correlates of CAM use, as well as whether the use was complementary or alternative to mainstream medicine. The main outcome in this study, CAM use, was defined as using CAM at least once since diagnosis with T2DM. Results A total of 333 T2DM patients completed the survey (response rate: 94.6%). Prevalence of CAM use since diagnosis with the disease was 38%. After adjustment, CAM use was significantly associated with a “married” status, a longer duration of T2DM, the presence of disease complications, and a positive family history of the disease. Folk foods and herbs were the most commonly used CAM followed by natural health products. One in five patients used CAM as alternative to conventional treatment. Only 7% of CAM users disclosed the CAM use to their treating physician. Health care practitioners were the least cited (7%) as influencing the choice of CAM among users. Conclusion The use of CAM therapies among T2DM patients in Lebanon is prevalent. Decision makers and care providers must fully understand the potential risks and benefits of CAM therapies to appropriately advise their patients. Attention must be dedicated to educating T2DM patients on the importance of disclosing CAM use to their physicians especially patients with a family history of diabetes, and those who have had the disease for a long time.
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Maneze D, Dennis S, Chen HY, Taggart J, Vagholkar S, Bunker J, Liaw ST. Multidisciplinary care: experience of patients with complex needs. Aust J Prim Health 2014; 20:20-6. [PMID: 23021199 DOI: 10.1071/py12072] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 09/03/2012] [Indexed: 11/23/2022]
Abstract
The rapidly increasing prevalence of diabetes with its high morbidity and mortality raises the need for an integrated multidisciplinary service from health care providers across health sectors. The aim of this study was to explore the diabetic patients' experience of multidisciplinary care, in particular their perceptions, perceived barriers and facilitators. Thirteen patients with type-2 diabetes admitted to the emergency department of a local hospital in NSW were interviewed and completed a demographic questionnaire. Results showed that patients found it inconvenient to be referred to many health professionals because of multiple physical and psychosocial barriers. Separate sets of instructions from different health professionals were overwhelming, confusing and conflicting. Lack of a dedicated coordinator of care, follow up and support for self-management from health professionals were factors that contributed to patients' challenges in being actively involved in their care. The presence of multiple co-morbidities made it more difficult for patients to juggle priorities and 'commitments' to many health professionals. In addition, complex socioeconomic and cultural issues, such as financial difficulties, lack of transport and language barriers, intensified the challenge for these patients to navigate the health system independently. Few patients felt that having many health professionals involved in their care improved their diabetes control. Communication among the multidisciplinary care team was fragmented and had a negative effect on the coordination of care. The patients' perspective is important to identify the problems they experience and to formulate strategies for improving multidisciplinary care for patients with diabetes.
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Affiliation(s)
- Della Maneze
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney NSW 2052, Australia
| | - Sarah Dennis
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney NSW 2052, Australia
| | - Huei-Yang Chen
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney NSW 2052, Australia
| | - Jane Taggart
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney NSW 2052, Australia
| | - Sanjyot Vagholkar
- South Western Sydney Local Health District General Practice Unit, PO Box 5, Fairfield, NSW 1860, Australia
| | - Jeremy Bunker
- South Western Sydney Local Health District General Practice Unit, PO Box 5, Fairfield, NSW 1860, Australia
| | - Siaw Teng Liaw
- South Western Sydney Local Health District General Practice Unit, PO Box 5, Fairfield, NSW 1860, Australia
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Ratanawongsa N, Handley MA, Sarkar U, Quan J, Pfeifer K, Soria C, Schillinger D. Diabetes health information technology innovation to improve quality of life for health plan members in urban safety net. J Ambul Care Manage 2014; 37:127-37. [PMID: 24594561 PMCID: PMC3990277 DOI: 10.1097/jac.0000000000000019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Safety net systems need innovative diabetes self-management programs for linguistically diverse patients. A low-income government-sponsored managed care plan implemented a 27-week automated telephone self-management support/health coaching intervention for English-, Spanish-, and Cantonese-speaking members from 4 publicly funded clinics in a practice-based research network. Compared to waitlist, immediate intervention participants had greater 6-month improvements in overall diabetes self-care behaviors (standardized effect size [ES] = 0.29, P < .01) and 12-Item Short Form Health Survey physical scores (ES = 0.25, P = .03); changes in patient-centered processes of care and cardiometabolic outcomes did not differ. Automated telephone self-management is a strategy for improving patient-reported self-management and may also improve some outcomes.
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Affiliation(s)
- Neda Ratanawongsa
- General Internal Medicine and UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, University of California, San Francisco, CA, 1001 Potrero Avenue, Box 1364, San Francisco, CA 94110
| | - Margaret A. Handley
- General Internal Medicine and UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, University of California, San Francisco, CA, 1001 Potrero Avenue, Box 1364, San Francisco, CA 94110
- Department of Epidemiology and Biostatistics, Division of Preventive Medicine and Public Health, University of California, San Francisco, CA
| | - Urmimala Sarkar
- General Internal Medicine and UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, University of California, San Francisco, CA, 1001 Potrero Avenue, Box 1364, San Francisco, CA 94110
| | - Judy Quan
- General Internal Medicine and UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, University of California, San Francisco, CA, 1001 Potrero Avenue, Box 1364, San Francisco, CA 94110
| | - Kelly Pfeifer
- San Francisco Health Plan, 201 3rd Street, 7th Floor, San Francisco, CA 94103
| | - Catalina Soria
- General Internal Medicine and UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, University of California, San Francisco, CA, 1001 Potrero Avenue, Box 1364, San Francisco, CA 94110
| | - Dean Schillinger
- General Internal Medicine and UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, University of California, San Francisco, CA, 1001 Potrero Avenue, Box 1364, San Francisco, CA 94110
- California Diabetes Program, California Department of Public Health, PO Box 997377, MS 7211, Sacramento, CA 95899-7377
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Tucker CM, Lopez MT, Campbell K, Marsiske M, Daly K, Nghiem K, Rahim-Williams B, Jones J, Hariton E, Patel A. The effects of a culturally sensitive, empowerment-focused, community-based health promotion program on health outcomes of adults with type 2 diabetes. J Health Care Poor Underserved 2014; 25:292-307. [PMID: 24509027 PMCID: PMC3920466 DOI: 10.1353/hpu.2014.0044] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The purpose of the present study was to test the effects of a culturally sensitive, health empowerment-focused, community-based health promotion program tailored to adult patients with type 2 diabetes on these patients' body mass index (BMI), blood pressure, and self-reported blood glucose levels, treatment adherence, and stress levels. Study participants (N = 130) consisted mostly of African Americans (70%) and Hispanic/Latinos (22.3%) who were divided almost evenly between an intervention group and wait-list control group. The tested health promotion program is informed by Health Self-Empowerment Theory. At post-test, program participants in the intervention group as compared to those in the control group demonstrated significantly lower levels of BMI, diastolic blood pressure, and physical stress. Implications of these study findings for future similar programs and research are discussed.
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Sohng HY, Kuniyuki A, Edelson J, Weir RC, Song H, Tu SP. Capability for Change at Community Health Centers Serving Asian Pacific Islanders: An Exploratory Study of a Cancer Screening Evidence-based Intervention. Asian Pac J Cancer Prev 2013; 14:7451-7. [DOI: 10.7314/apjcp.2013.14.12.7451] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Intrinsic and extrinsic factors affecting patient engagement in diabetes self-management: perspectives of a certified diabetes educator. Clin Ther 2013; 35:170-8. [PMID: 23411000 DOI: 10.1016/j.clinthera.2013.01.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 12/18/2012] [Accepted: 01/07/2012] [Indexed: 11/21/2022]
Abstract
Patients with diabetes are responsible for the vast majority of management requirements of their condition. However, their ability and motivation to engage in required self-management behaviors may be mitigated by multiple intrinsic and extrinsic factors. Intrinsic barriers include attitudes and health beliefs, limited diabetes knowledge and technical skill, reduced functional health literacy, and inadequate self-efficacy to promote positive behavior change. Extrinsic barriers include financial considerations, inadequate family and community support systems, ineffective clinical relationships, and limited access to effective diabetes health care delivery. Diabetes providers have opportunities for enhancing patient engagement with clinical recommendations and diabetes self-management through effective communication, including efforts to contextually assess patients' perceptions of diabetes and how the condition fits within the context of their changing lives. This article provides a conceptual framework for establishing and building an effective clinical alliance with patients with the goal of empowering them to take more control of their diabetes and reduce their risks for poor diabetes outcomes.
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Shrivastava SR, Shrivastava PS, Ramasamy J. Role of self-care in management of diabetes mellitus. J Diabetes Metab Disord 2013; 12:14. [PMID: 23497559 PMCID: PMC3599009 DOI: 10.1186/2251-6581-12-14] [Citation(s) in RCA: 463] [Impact Index Per Article: 42.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 02/28/2013] [Indexed: 12/14/2022]
Abstract
Diabetes mellitus (DM) is a chronic progressive metabolic disorder characterized by hyperglycemia mainly due to absolute (Type 1 DM) or relative (Type 2 DM) deficiency of insulin hormone. World Health Organization estimates that more than 346 million people worldwide have DM. This number is likely to more than double by 2030 without any intervention. The needs of diabetic patients are not only limited to adequate glycemic control but also correspond with preventing complications; disability limitation and rehabilitation. There are seven essential self-care behaviors in people with diabetes which predict good outcomes namely healthy eating, being physically active, monitoring of blood sugar, compliant with medications, good problem-solving skills, healthy coping skills and risk-reduction behaviors. All these seven behaviors have been found to be positively correlated with good glycemic control, reduction of complications and improvement in quality of life. Individuals with diabetes have been shown to make a dramatic impact on the progression and development of their disease by participating in their own care. Despite this fact, compliance or adherence to these activities has been found to be low, especially when looking at long-term changes. Though multiple demographic, socio-economic and social support factors can be considered as positive contributors in facilitating self-care activities in diabetic patients, role of clinicians in promoting self-care is vital and has to be emphasized. Realizing the multi-faceted nature of the problem, a systematic, multi-pronged and an integrated approach is required for promoting self-care practices among diabetic patients to avert any long-term complications.
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Affiliation(s)
- Saurabh RamBihariLal Shrivastava
- Department of Community Medicine, Shri Sathya Sai Medical College & Research Institute, Ammapettai village, Thiruporur - Guduvancherry Main Road, Sembakkam Post, 603108 Kancheepuram, Tamil Nadu India
| | - Prateek Saurabh Shrivastava
- Department of Community Medicine, Shri Sathya Sai Medical College & Research Institute, Ammapettai village, Thiruporur - Guduvancherry Main Road, Sembakkam Post, 603108 Kancheepuram, Tamil Nadu India
| | - Jegadeesh Ramasamy
- Department of Community Medicine, Shri Sathya Sai Medical College & Research Institute, Ammapettai village, Thiruporur - Guduvancherry Main Road, Sembakkam Post, 603108 Kancheepuram, Tamil Nadu India
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Newlin K, Dyess SM, Allard E, Chase S, Melkus GD. A methodological review of faith-based health promotion literature: advancing the science to expand delivery of diabetes education to Black Americans. JOURNAL OF RELIGION AND HEALTH 2012; 51:1075-97. [PMID: 21487842 PMCID: PMC3336031 DOI: 10.1007/s10943-011-9481-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Non-traditional avenues, such as faith-based organizations (FBOs), must be explored to expand delivery of diabetes self-management education (DSME) to benefit Black Americans with type 2 diabetes (T2D). The purpose of this study was to methodologically review the faith-based health promotion literature relevant to Blacks with T2D. A total of 14 intervention studies were identified for inclusion in the review. These studies detailed features of methods employed to affect health outcomes that DSME similarly targets. Analysis of the faith-based studies' methodological features indicated most studies used (1) collaborative research approaches, (2) pre-experimental designs, (3) similar recruitment and retention strategies, and (4) culturally sensitive, behaviorally oriented interventions with incorporation of social support to achieve positive health outcomes in Black Americans. Findings indicate FBOs may be a promising avenue for delivering DSME to Black Americans. Informed by the findings, a focused discussion on advancing the science of faith-based interventions to expand delivery of DSME to Black Americans with diabetes is provided.
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Affiliation(s)
- Kelley Newlin
- College of Nursing, New York University, New York, NY, USA.
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Hunsberger ML, Donatelle RJ, Lindsay K, Rosenberg KD. Physician care patterns and adherence to postpartum glucose testing after gestational diabetes mellitus in Oregon. PLoS One 2012; 7:e47052. [PMID: 23071709 PMCID: PMC3469538 DOI: 10.1371/journal.pone.0047052] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 09/07/2012] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This study examines obstetrician/gynecologists and family medicine physicians' reported care patterns, attitudes and beliefs and predictors of adherence to postpartum testing in women with a history of gestational diabetes mellitus. RESEARCH DESIGN AND METHODS In November-December 2005, a mailed survey went to a random, cross-sectional sample of 683 Oregon licensed physicians in obstetrician/gynecologists and family medicine from a population of 2171. RESULTS Routine postpartum glucose tolerance testing by both family physicians (19.3%) and obstetrician/gynecologists physicians (35.3%) was reportedly low among the 285 respondents (42% response rate). Factors associated with high adherence to postpartum testing included physician stated priority (OR 4.39, 95% CI: 1.69-7.94) and physician beliefs about norms or typical testing practices (OR 3.66, 95% CI: 1.65-11.69). Specialty, sex of physician, years of practice, location, type of practice, other attitudes and beliefs were not associated with postpartum glucose tolerance testing. CONCLUSIONS Postpartum glucose tolerance testing following a gestational diabetes mellitus pregnancy was not routinely practiced by responders to this survey. Our findings indicate that physician knowledge, attitudes and beliefs may in part explain suboptimal postpartum testing. Although guidelines for postpartum care are established, some physicians do not prioritize these guidelines in practice and do not believe postpartum testing is the norm among their peers.
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Affiliation(s)
- Monica L Hunsberger
- University of Gothenburg, Public Health Epidemiology and Community Medicine, Gothenburg, Sweden.
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Bursell SE, Brazionis L, Jenkins A. Telemedicine and ocular health in diabetes mellitus. Clin Exp Optom 2012; 95:311-27. [PMID: 22594547 DOI: 10.1111/j.1444-0938.2012.00746.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Teleretinal/teleophthalmological programs that use existing health information technology infrastructure solutions for people with diabetes increase access to and adherence to appropriate eye care. Teleophthalmological studies indicate that the single act of patients viewing their own retinal images improves self-management behaviour and clinical outcomes. In some settings this can be done at lower cost and with improved visual outcomes compared with standard eye care. Cost-effective and sustainable teleretinal surveillance for detection of diabetic retinopathy requires a combination of an inexpensive portable device for taking low light-level retinal images without the use of pharmacological dilation of the pupil and a computer-assisted methodology for rapidly detecting and diagnosing diabetic retinopathy. A more holistic telehealth-care paradigm augmented with the use of health information technology, medical devices, mobile phone and mobile health applications and software applications to improve health-care co-ordination, self-care management and education can significantly impact a broad range of health outcomes, including prevention of diabetes-associated visual loss. This approach will require a collaborative, transformational, patient-centred health-care program that integrates data from medical record systems with remote monitoring of data and a longitudinal health record. This includes data associated with social media applications and personal mobile health technology and should support continuous interactions between the patient, health-care team and the patient's social environment. Taken together, this system will deliver contextually and temporally relevant decision support to patients to facilitate their well-being and to reduce the risk of diabetic complications.
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Affiliation(s)
- Sven-Erik Bursell
- The University of Melbourne, Department of Medicine, St Vincent's Hospital, Melbourne, Australia.
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Shen C, Sambamoorthi U. Associations between health-related quality of life and financial barriers to care among women veterans and women non-veterans. Women Health 2012; 52:1-17. [PMID: 22324355 DOI: 10.1080/03630242.2011.641713] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The authors of this study examined the association between health-related quality of life and financial barriers to care, defined as not getting the needed care due to cost considerations. To better understand health-related quality of life among women veterans, the authors compared women veterans to women non-veterans. The authors conducted cross-sectional analyses using data from the 2009 Behavioral Risk Factor Surveillance System survey. The authors assessed four health-related quality of life measures: (1) general health; (2) physical health; (3) mental health; and (4) functional status. The authors performed multinomial logistic regressions to examine the relationship between financial barriers to receiving healthcare and health-related quality of life measures after controlling for other independent variables. The authors included women veterans not in active military duty (N = 3,747) and a matched sample of women non-veterans (N = 3,747), selected using a propensity score method so that they would have distributions of demographic and socioeconomic characteristics similar to those of the veterans. Overall, 14% of women reported financial barriers. Women who reported financial barriers to receiving healthcare were more likely to have poor health-related quality of life in all four dimensions than those who did not report such barriers. Compared to women non-veterans, women veterans did not differ in reported financial barriers but were more likely to report poor health-related quality of life. Reporting financial barriers to receiving needed healthcare was significantly associated with poor health-related quality of life among women. Veteran status was also significantly associated with poor health-related quality of life. These findings suggest the need for healthcare policy makers and practitioners to align emerging new models of healthcare delivery to improve health-related quality of life for women veterans.
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Affiliation(s)
- Chan Shen
- Department of Biostatistics, Universityof Texas, 1400 Pressler Street, Anderson Cancer Center, Houston, TX 77030, USA.
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What patients want: relevant health information technology for diabetes self-management. HEALTH AND TECHNOLOGY 2012. [DOI: 10.1007/s12553-012-0022-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Davis TC, Seligman HK, Dewalt DA, Platt DJ, Reynolds C, Timm DF, Arnold CL. Diabetes Implementation of a Self-management Program in Resource Poor and Rural Community Clinics. J Prim Care Community Health 2012; 3:239-42. [PMID: 23804167 DOI: 10.1177/2150131911435673] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To evaluate the implementation of a brief diabetes self-management support intervention designed for resource-poor community clinics. METHODS The authors conducted a pilot study among patients with type 2 diabetes in 3 community clinics. The intervention consisted of research assistants introducing and reviewing a diabetes self-management guide, helping patients set an achievable behavioral action plan, and following up with 2 telephone sessions. The primary outcome was patients' success setting and achieving behavioral goals. RESULTS All participants set an action plan (N = 247); most focused on physical activity or diet (97%). The initial session took an average of 15 minutes. At 2 to 4 weeks, 200 participants were contacted; 68% recalled their action plan; and 84% of these achieved it. At 6 to 9 weeks, approximately half of those who completed the first call were reached for the second call. Of those who remained in the intervention, 79% recalled their action plan, and 80% of these achieved it. At the end of the study, 62% of those initially enrolled reported behavior change. Most participants who did not complete the intervention could not be reached for telephone follow-up. CONCLUSIONS Although only about a third of patients remained engaged through the 2 follow-up calls, most of those who did reported they had achieved their action plan. This pilot study provides insight into initiating brief diabetes self-management strategies in resource-poor community clinics. Although telephone follow-up was challenging, using the self-management guide and action plan framework, particularly during the initial clinic visit, helped focus patients on behavior change.
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Affiliation(s)
- Terry C Davis
- Louisiana State University Health Sciences Center, Shreveport, Louisiana
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Welch G, Allen NA, Zagarins SE, Stamp KD, Bursell SE, Kedziora RJ. Comprehensive diabetes management program for poorly controlled Hispanic type 2 patients at a community health center. DIABETES EDUCATOR 2012; 37:680-8. [PMID: 21918206 DOI: 10.1177/0145721711416257] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Technology and improved care coordination models can help diabetes educators and providers meet national care standards and provide culturally sensitive diabetes education that may improve diabetes outcomes. The purpose of the study was to evaluate the clinical usefulness of a nurse-led diabetes care program (Comprehensive Diabetes Management Program, CDMP) for poorly controlled Hispanic type 2 diabetes (T2DM) patients in an urban community health center setting. Patients were randomized to the intervention condition (IC; n = 21) or an attention control condition (AC; n = 18). IC and AC conditions were compared on rates of adherence to national clinical practice guidelines (blood glucose, blood pressure, foot exam, eye exam), and levels of diabetes distress, depression, and treatment satisfaction. IC patients had a significant improvement in A1C from baseline to 12-month follow-up compared with AC (-1.6% ± 1.4% versus -0.6% ± 1.1%; P = .01). The proportion of IC patients meeting clinical goals at follow-up tended to be higher than AC for A1c (IC = 45%; AC = 28%), systolic blood pressure (IC = 55%; AC = 28%), eye screening (IC = 91%; AC = 78%), and foot screening, (IC = 86%; AC = 72%). Diabetes distress and treatment satisfaction also showed greater improvement for IC than AC (P = .05 and P = .06, respectively), with no differences for depression. The CDMP intervention was more effective than an attention control condition in helping patients meet evidence-based guidelines for diabetes care.
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Affiliation(s)
- Garry Welch
- The Department of Behavioral Medicine Research, Baystate Health Systems, Springfield, Massachusetts (Dr Welch, Dr Zagarins)
| | - Nancy A Allen
- William F Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts (Dr Allen, Dr Stamp)
| | - Sofija E Zagarins
- The Department of Behavioral Medicine Research, Baystate Health Systems, Springfield, Massachusetts (Dr Welch, Dr Zagarins)
| | - Kelly D Stamp
- William F Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts (Dr Allen, Dr Stamp)
| | - Sven-Erik Bursell
- Telehealth Research Institute, John A. BurnsSchool of Medicine, University of Hawaii at Manoa (Dr Bursell)
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Ratanawongsa N, Handley MA, Quan J, Sarkar U, Pfeifer K, Soria C, Schillinger D. Quasi-experimental trial of diabetes Self-Management Automated and Real-Time Telephonic Support (SMARTSteps) in a Medicaid managed care plan: study protocol. BMC Health Serv Res 2012; 12:22. [PMID: 22280514 PMCID: PMC3276419 DOI: 10.1186/1472-6963-12-22] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2011] [Accepted: 01/26/2012] [Indexed: 12/11/2022] Open
Abstract
Background Health information technology can enhance self-management and quality of life for patients with chronic disease and overcome healthcare barriers for patients with limited English proficiency. After a randomized controlled trial of a multilingual automated telephone self-management support program (ATSM) improved patient-centered dimensions of diabetes care in safety net clinics, we collaborated with a nonprofit Medicaid managed care plan to translate research into practice, offering ATSM as a covered benefit and augmenting ATSM to promote medication activation. This paper describes the protocol of the Self-Management Automated and Real-Time Telephonic Support Project (SMARTSteps). Methods/Design This controlled quasi-experimental trial used a wait-list variant of a stepped wedge design to enroll 362 adult health plan members with diabetes who speak English, Cantonese, or Spanish and receive care at 4 publicly-funded clinics. Through language-stratified randomization, participants were assigned to four intervention statuses: SMARTSteps-ONLY, SMARTSteps-PLUS, or wait-list for either intervention. In addition to usual primary care, intervention participants received 27 weekly calls in their preferred language with rotating queries and response-triggered education about self-care, medication adherence, safety concerns, psychological issues, and preventive services. Health coaches from the health plan called patients with out-of-range responses for collaborative goal setting and action planning. SMARTSteps-PLUS also included health coach calls to promote medication activation, adherence and intensification, if triggered by ATSM-reported non-adherence, refill non-adherence from pharmacy claims, or suboptimal cardiometabolic indicators. Wait-list patients crossed-over to SMARTSteps-ONLY or -PLUS at 6 months. For participants who agreed to structured telephone interviews at baseline and 6 months (n = 252), primary outcomes will be changes in quality of life and functional status with secondary outcomes of 6-month changes in self-management behaviors/efficacy and patient-centered processes of care. We will also evaluate 6-month changes in cardiometabolic (HbA1c, blood pressure, and LDL) and utilization indicators for all participants. Discussion Outcomes will provide evidence regarding real-world implementation of ATSM within a Medicaid managed care plan serving safety net settings. The evaluation trial will provide insight into translating and scaling up health information technology interventions for linguistically and culturally diverse vulnerable populations with chronic disease. Trial Registration ClinicalTrials.gov: NCT00683020
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Affiliation(s)
- Neda Ratanawongsa
- General Internal Medicine and UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, University of California, 94110, USA.
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Kollannoor-Samuel G, Chhabra J, Fernandez ML, Vega-López S, Pérez SS, Damio G, Calle MC, D'Agostino D, Pérez-Escamilla R. Determinants of fasting plasma glucose and glycosylated hemoglobin among low income Latinos with poorly controlled type 2 diabetes. J Immigr Minor Health 2011; 13:809-17. [PMID: 21181446 DOI: 10.1007/s10903-010-9428-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The objective of this study was to identify demographic, socio-economic, acculturation, lifestyle, sleeping pattern, and biomedical determinants of fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c), among Latinos with type 2 diabetes (T2D). Latino adults (N = 211) with T2D enrolled in the DIALBEST trial were interviewed in their homes. Fasting blood samples were also collected in the participants' homes. Because all participants had poor glucose control, above-median values for FPG (173 mg/dl) and HbA1c (9.2%) were considered to be indicative of poorer glycemic control. Multivariate analyses showed that receiving heating assistance (OR: 2.20; 95% CI: 0.96-4.96), and having a radio (3.11, 1.16-8.35), were risk factors for higher FPG levels, and lower income (10.4, 1.54-69.30) was a risk factor for higher HbA1c levels. Lower carbohydrate intake during the previous day (0.04; 0.005-0.37), as well as regular physical activity (0.30; 0.13-0.69), breakfast (2.78; 1.10-6.99) and dinner skipping (3.9; 1.03-14.9) during previous week were significantly associated with FPG concentrations. Being middle aged (2.24, 1.12-4.47), 30-60 min of sleep during the day time (0.07, 0.01-0.74) and having medical insurance (0.31, 0.10-0.96) were predictors of HbA1c. Results suggest that contemporaneous lifestyle behaviors were associated with FPG and contextual biomedical factors such as health care access with HbA1c. Lower socio-economic status indicators were associated with poorer FPG and HbA1c glycemic control.
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Beard L, Schein R, Morra D, Wilson K, Keelan J. The challenges in making electronic health records accessible to patients. J Am Med Inform Assoc 2011; 19:116-20. [PMID: 22120207 DOI: 10.1136/amiajnl-2011-000261] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
It is becoming increasingly apparent that there is a tension between growing consumer demands for access to information and a healthcare system that may not be prepared to meet these demands. Designing an effective solution for this problem will require a thorough understanding of the barriers that now stand in the way of giving patients electronic access to their health data. This paper reviews the following challenges related to the sharing of electronic health records: cost and security concerns, problems in assigning responsibilities and rights among the various players, liability issues and tensions between flexible access to data and flexible access to physicians.
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Affiliation(s)
- Leslie Beard
- Centre for Innovation in Complex Care, University Health Network, Toronto, Canada
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Shin JY, Choi NK, Jung SY, Kim YJ, Seong JM, Park BJ. Overlapping medication associated with healthcare switching among Korean elderly diabetic patients. J Korean Med Sci 2011; 26:1461-8. [PMID: 22065902 PMCID: PMC3207049 DOI: 10.3346/jkms.2011.26.11.1461] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Accepted: 09/21/2011] [Indexed: 01/21/2023] Open
Abstract
This study was performed to describe the patterns of healthcare switching with overlapping use of anti-diabetic medication in the elderly using the Korea Health Insurance Review and Assessment Service's claims data. The study subjects were ambulatory elderly diabetic patients (ICD-10, E10-14) receiving at least one oral anti-diabetic drug or insulin, and visiting healthcare facilities more than two times between January and December 2005. A total of 457,975 elderly diabetic ambulatory care patients were identified. The mean of visiting frequencies was 9.0 ( ± 3.6) and switching frequencies was 1.5 ( ± 0.8) during 2005. Switching group consisted of 33% of total study subject. Healthcare switching was common in female patients who were older, and had treated polytherapy more in rural areas. The movement among primary care medical services was very common among the patients in the switching group (52.6%). A statistically significant correlation was observed between the healthcare switching and concomitant drug use (rho = 0.96), and overlapping days (rho = 0.57). The use of overlapping anti-diabetic medication increased with the extent of healthcare switching. Further, frequent switching of healthcare between primary clinics was observed. Efforts should be made to establish continuity for the elderly diabetic patients with the identification of frequent switching with overlapping medication.
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Affiliation(s)
- Ju-Young Shin
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Nam-Kyong Choi
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea
| | - Sun-Young Jung
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Ye-Jee Kim
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jong-Mi Seong
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Byung-Joo Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea
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Bhattacharyya OK, Rasooly IR, Naqshbandi M, Estey EA, Esler J, Toth E, Macaulay AC, Harris SB. Challenges to the provision of diabetes care in first nations communities: results from a national survey of healthcare providers in Canada. BMC Health Serv Res 2011; 11:283. [PMID: 22018097 PMCID: PMC3212958 DOI: 10.1186/1472-6963-11-283] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Accepted: 10/21/2011] [Indexed: 11/10/2022] Open
Abstract
Background Aboriginal peoples globally, and First Nations peoples in Canada particularly, suffer from high rates of type 2 diabetes and related complications compared with the general population. Research into the unique barriers faced by healthcare providers working in on-reserve First Nations communities is essential for developing effective quality improvement strategies. Methods In Phase I of this two-phased study, semi-structured interviews and focus groups were held with 24 healthcare providers in the Sioux Lookout Zone in north-western Ontario. A follow-up survey was conducted in Phase II as part of a larger project, the Canadian First Nations Diabetes Clinical Management and Epidemiologic (CIRCLE) study. The survey was completed with 244 healthcare providers in 19 First Nations communities in 7 Canadian provinces, representing three isolation levels (isolated, semi-isolated, non-isolated). Interviews, focus groups and survey questions all related to barriers to providing optimal diabetes care in First Nations communities. Results the key factors emerging from interviews and focus group discussions were at the patient, provider, and systemic level. Survey results indicated that, across three isolation levels, healthcare providers' perceived patient factors as having the largest impact on diabetes care. However, physicians and nurses were more likely to rank patient factors as having a large impact on care than community health representatives (CHRs) and physicians were significantly less likely to rank patient-provider communication as having a large impact than CHRs. Conclusions Addressing patient factors was considered the highest impact strategy for improving diabetes care. While this may reflect "patient blaming," it also suggests that self-management strategies may be well-suited for this context. Program planning should focus on training programs for CHRs, who provide a unique link between patients and clinical services. Research incorporating patient perspectives is needed to complete this picture and inform quality improvement initiatives.
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Affiliation(s)
- Onil K Bhattacharyya
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1M8, Canada.
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Community Health Workers “101” for Primary Care Providers and Other Stakeholders in Health Care Systems. J Ambul Care Manage 2011; 34:210-20. [DOI: 10.1097/jac.0b013e31821c645d] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Nazar R, Al Ansari Y, Abdulmajeed A. Quality Care of Patients with Diabetes Mellitus in the Diabetic Clinic at Al Wakra Healthcare Center, Qatar. Qatar Med J 2011. [DOI: 10.5339/qmj.2011.1.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Introduction: Diabetes mellitus is a chronic illness that requires continuous medical care. Patient health education and self-management aim to prevent acute complications and to reduce the risk of long-term complications. Care of diabetic patients is a complex process and requires many issues beyond glycemic control. This study is conducted to assess quality of care of diabetic patients in the diabetic clinic at Al Wakra Healthcare Center and to determine some factors that may affect the quality of this care.
Methodology: This is a descriptive, cross-sectional study. The target population was all diabetic patients (Type 2) that meet the inclusion criteria and registered at the center. Two checklists assessed the structure of diabetic care; the first checklist is for the essential items of care (thirteen items) and the second one is for the less essential items (ten items). The indicators of the process of diabetic care was assessed by a scoring system that depends on ten items for standard diabetic care by the primary care physicians in the past year. Assessment of the outcome was done according to an international quality assurance protocol and it includes: the degree of diabetic control, obesity, smoking among the diabetic patients and control of blood pressure. We added HbA1c to this list. Another questionnaire was designed to determine factors that may affect quality of diabetic care-related to patient's knowledge and attitude and it is divided into 4 sections: personal data, patient knowledge about diabetes, patient attitude toward care and clinical and biochemical assessments. A pilot study was carried out to test the questionnaires. Epi-info. Six statistical package was used for data entry and statistical analysis. Chi square or Fisher exact tests were used to test the significance, and P value < 0.05 was considered significant.
Results: The study showed that diabetic care at Primary Healthcare Centers (PHC) in Qatar represented by Al Wakra Primary Healthcare Center is better when compared to the care in other studies in different countries. 86.7% of physicians show that most of the structure items are good to fair except for the absence of chiropodist and identification cards for diabetic patients. Assessment of the process of care showed that there is good to fair recording in 91.75% of cases; foot examination is not recorded in most of cases; and fundus examination is not recorded in 31.7%. The outcome indicators showed that patient knowledge about diabetes is poor in 35% of cases, uncontrolled FBS in 75.6% of cases, uncontrolled HbA1 c in 57.8%; obesity in 63.5% and control of blood pressure is not achieved in 49% of cases.
Conclusion: Diabetic Clinic at Al Wakra Primary Healthcare Center provides good care for diabetic patients in terms of structure, process and outcome; however, more efforts are needed for refining these services.
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Affiliation(s)
- R Nazar
- *Family Medicine Department, PHC
| | - Y Al Ansari
- **Endocrinology Section, Department of Medicine, HMC, Doha, Qatar
| | - A Abdulmajeed
- ***Family Medicine Department, Suez Canal University, Egypt
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