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Lu Y, Liu C, Wells Y, Yu D. Challenges in detecting and managing mild cognitive impairment in primary care: a focus group study in Shanghai, China. BMJ Open 2022; 12:e062240. [PMID: 36127116 PMCID: PMC9490618 DOI: 10.1136/bmjopen-2022-062240] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Detection of mild cognitive impairment (MCI) is essential in slowing progression to dementia. Primary care plays a vital role in detecting and managing MCI. The chronic care model (CCM) provides effective methods to manage chronic diseases. OBJECTIVE This study aimed to explore how MCI services are delivered in primary care in China. METHODS Focus group interviews were conducted face to face among MCI stakeholders from six community health centres (CHCs) involved in the 'friendly community programme' in Shanghai, China. A total of 124 MCI stakeholders were interviewed, consisting of 6 groups (n=42) of general practitioners (GPs), 3 groups (n=18) of CHC managers, 4 groups (n=32) of people with MCI and 4 groups (n=32) of informal caregivers. Content and thematic analyses were performed using a combination of induction and deduction approaches. RESULTS Three major themes emerged from the data corresponding to the CCM framework: hesitant patients, unprepared providers and misaligned environments. While the public are hesitant to seek medical attention for MCI problems, due to misunderstanding, social stigma and a lack of perceived benefits, GPs and CHCs are not well prepared either, due to lack of knowledge and a shortage of GPs, and a lack of policy, funding and information support. None of these issues can be addressed separately without tackling the others. CONCLUSION This study combined the diverse perceptions of all the main stakeholders to detect and manage MCI in primary care settings in China. A vicious circle was found among the three interconnected CCM domains, creating a gridlock that should be addressed through a system's approach targeting all of the above-mentioned aspects.
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Affiliation(s)
- Yuan Lu
- Department of General Practice, Tongji University Affiliated Yangpu Hospital, Shanghai, China
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Yvonne Wells
- School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Dehua Yu
- Department of General Practice, Tongji University Affiliated Yangpu Hospital, Shanghai, China
- Shanghai General Practice and Community Health Development Research Center, Shanghai, China
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Casales-Hernández MG, Molina-Cuevas V, Gloria-Hernández LE, Díaz-Aguilera MA, Malo-Serrano HM. Resultados preliminares de la Iniciativa HEARTS en México: facilitadores y barreras de los sistemas de información. Rev Panam Salud Publica 2022; 46:e167. [PMID: 36133431 PMCID: PMC9484328 DOI: 10.26633/rpsp.2022.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/08/2022] [Indexed: 11/24/2022] Open
Abstract
Objetivo. Comparar la diferencia en la cobertura y proporción de pacientes controlados con hipertensión arterial sistémica entre diciembre de 2020 y diciembre de 2021 en los establecimientos de salud con implementación de la Iniciativa HEARTS, y explorar los facilitadores y las barreras relacionados con los sistemas de información en México. Métodos. Estudio observacional ecológico descriptivo. Se compararon los resultados de los establecimientos de salud que han iniciado la implementación de la Iniciativa HEARTS (n=29) en Chiapas y Sonora, respecto a las variables de cobertura de atención y control de la hipertensión, en 4 periodos (semestres) del 2020 al 2021. Resultados. Existe mayor número de mujeres en tratamiento y en control respecto de los hombres en los diferentes grupos de edad. Se identificaron algunas barreras (p. ej.multiplicidad de sistemas, falta de interoperabilidad, conectividad limitada a internet en los establecimientos de salud) y facilitadores (p. ej.acceso libre a la información, disponibilidad de datos desde años previos, generación de estimaciones y proyecciones) en los sistemas de información. Conclusiones. El 55% de los establecimientos bajo implementación (16 establecimientos) mejoraron la proporción de pacientes controlados en el periodo analizado. Es importante monitorear indicadores a nivel de procesos, lo cual debe ir acompañado de una redistribución de las funciones de los equipos de salud y asegurar el abastecimiento de medicamentos para potenciar la efectividad de la estrategia. Se sugiere fortalecer la implementación con los impulsores clave para el control de la hipertensión.
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Miller-Rosales C, Lewis VA, Shortell SM, Rodriguez HP. Adoption of Patient Engagement Strategies by Physician Practices in the United States. Med Care 2022; 60:691-699. [PMID: 35833416 PMCID: PMC9378564 DOI: 10.1097/mlr.0000000000001748] [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: 11/25/2022]
Abstract
BACKGROUND Patient engagement strategies can equip patients with tools to navigate treatment decisions and improve patient-centered outcomes. Despite increased recognition about the importance of patient engagement, little is known about the extent of physician practice adoption of patient engagement strategies nationally. METHODS We analyzed data collected from the National Survey of Healthcare Organizations and Systems (NSHOS) on physician practice adoption of patient engagement strategies. Stratified-cluster sampling was used to select physician practices operating under different organizational structures. Multivariable linear regression models estimated the association of practice ownership, health information technology functionality, use of screening activities, patient responsiveness, chronic care management processes, and the adoption of patient engagement strategies, including shared decision-making, motivational interviewing, and shared medical appointments. All regression models controlled for participation in payment reforms, practice size, Medicaid revenue percentage, and geographic region. RESULTS We found modest and varied adoption of patient engagement strategies by practices of different ownership types, with health system-owned practices having the lowest adoption of ownership types. Practice capabilities, including chronic care management processes, routine screening of medical and social risks, and patient care dissemination strategies were associated with greater practice-level adoption of patient engagement strategies. CONCLUSIONS This national study is the first to characterize the adoption of patient engagement strategies by US physician practices. We found modest adoption of shared decision-making and motivational interviewing, and low adoption of shared medical appointments. Risk-based payment reform has the potential to motivate greater practice-level patient engagement, but the extent to which it occurs may depend on internal practice capabilities.
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Affiliation(s)
| | - Valerie A Lewis
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Stephen M Shortell
- Division of Health Policy and Management, University of California, Berkeley, School of Public Health, Berkeley, CA
| | - Hector P Rodriguez
- Division of Health Policy and Management, University of California, Berkeley, School of Public Health, Berkeley, CA
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54
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Desse TA, Mc Namara K, Yifter H, Manias E. Current practices and future preferences of type 2 diabetes care in Ethiopia: A qualitative study on the perspectives of patients, health professionals, and policymakers. Diabetes Metab Syndr 2022; 16:102585. [PMID: 35939942 DOI: 10.1016/j.dsx.2022.102585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS This study aimed to examine perspectives of patients, health professionals, and policymakers on current practices and their future preferences for type 2 diabetes care in a tertiary hospital in Ethiopia. METHODS An exploratory qualitative study was undertaken through interviews and focus groups with patients, health professionals, and policymakers. The participants were purposively sampled. Thematic analysis was undertaken. RESULTS Fifty-nine participants were involved in the study. Participants' perspectives on current practices and future preferences comprised three themes: organisation of type 2 diabetes care delivery and infrastructure; continuity of care; and structured diabetes education. The current organisation comprised physicians, such as endocrinologists and endocrinology fellows, and nurses. Some nurses received training on diabetes foot and diabetic eye, which enabled patients to receive diabetes foot and diabetic eye care, respectively. The hospital lacked essential resources, such as medications, laboratory and diagnostic services, and diabetes educators, which hindered patient-centred care. Patients complained that the physical set-up at the hospital was not conducive to their privacy during consultations. Participants reported infrequent patient follow-up and monitoring, which contributed to uncontrolled diabetes. Future preferences involved access to essential resources and comprehensive diabetes care, such as structured diabetes education for improved patient outcomes. Participants sought out the development of tailored and context-specific diabetes management approaches that could meet specific patient needs and preferences. CONCLUSIONS The findings have implications for designing patient-centred diabetes care tailored to the hospital's context and key stakeholders' preferences. This tailoring requires strong leadership to ensure availability of essential resources.
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Affiliation(s)
- Tigestu Alemu Desse
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia; College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Kevin Mc Namara
- Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Geelong, Australia; Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Helen Yifter
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
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Mikkonen K, Yamakawa M, Tomietto M, Tuomikoski A, Utsumi M, Jarva E, Kääriäinen M, Oikarinen A. Randomised controlled trials addressing how the clinical application of information and communication technology impacts the quality of patient care—A systematic review and meta‐analysis. J Clin Nurs 2022. [DOI: 10.1111/jocn.16448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/04/2022] [Accepted: 06/23/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Kristina Mikkonen
- Research Unit of Health Sciences and Technology University of Oulu Oulu Finland
- The Finnish Centre for Evidence‐Based Health Care: A JOANNA Briggs Institute Centre of Excellence Helsinki Finland
- Medical Research Center Oulu Oulu University Hospital and University of Oulu Oulu Finland
| | - Miyae Yamakawa
- Department of Evidence‐Based Clinical Nursing Division of Health Sciences Graduate School of Medicine Osaka University Asakayama General Hospital Osaka Japan
| | - Marco Tomietto
- Department of Nursing, Midwifery and Healthcare Faculty of Health and Life Sciences Northumbria University Newcastle upon Tyne UK
- Research Unit of Nursing Science and Health Management University of Oulu Oulu Finland
| | - Anna‐Maria Tuomikoski
- The Finnish Centre for Evidence‐Based Health Care: A JOANNA Briggs Institute Centre of Excellence Helsinki Finland
- Oulu University Hospital Oulu Finland
| | - Momoe Utsumi
- Department of Evidence‐Based Clinical Nursing Division of Health Sciences Graduate School of Medicine Osaka University Asakayama General Hospital Osaka Japan
| | - Erika Jarva
- Research Unit of Health Sciences and Technology University of Oulu Oulu Finland
- The Finnish Centre for Evidence‐Based Health Care: A JOANNA Briggs Institute Centre of Excellence Helsinki Finland
| | - Maria Kääriäinen
- Research Unit of Health Sciences and Technology University of Oulu Oulu Finland
- The Finnish Centre for Evidence‐Based Health Care: A JOANNA Briggs Institute Centre of Excellence Helsinki Finland
- Medical Research Center Oulu Oulu University Hospital and University of Oulu Oulu Finland
| | - Anne Oikarinen
- Research Unit of Health Sciences and Technology University of Oulu Oulu Finland
- The Finnish Centre for Evidence‐Based Health Care: A JOANNA Briggs Institute Centre of Excellence Helsinki Finland
- Medical Research Center Oulu Oulu University Hospital and University of Oulu Oulu Finland
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Molayaghobi NS, Abazari P, Taleghani F, Iraj B. Lived Experiences of Diabetes Team and Patients about Diabetes Care System after Redesigning Delivery System and Supporting Self-Management in Iran: A Qualitative Research. Int J Prev Med 2022; 13:85. [PMID: 35958364 PMCID: PMC9362745 DOI: 10.4103/ijpvm.ijpvm_238_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 11/27/2020] [Indexed: 11/13/2022] Open
Abstract
Background Diabetes as a chronic disease requires a change in the paradigm of treatment and health care system based on acute illnesses to chronic conditions. Chronic Care Model has been designed to address this need. This study aimed to explore the lived experiences of the diabetes team and diabetic patients regarding the health care system after redesigning delivery system and supporting self-management based on the Chronic Care Model in Iran. Methods Research was conducted with a qualitative descriptive approach in one of the Isfahan city clinics in 2018. The participants were diabetes team (composed of diabetes physician, nurse, assistant nurse and dean of the clinic) and 17 type- 2 diabetic patients who were selected through purposive sampling. Data collection was performed through semi-structured interviews and then were analyzed using content analysis with an inductive approach. Results The findings of this study were composed of the following two main categories: (1) educational function change, including the sub-categories of evidence-based nurse education and patients' demand to ongoing participation in the training classes; and (2) treatment and care method upgrade, including the sub-categories of nurse's role change in a team approach, continuity in cares and upgrading patients' self-care behaviors. Conclusions Delivery system redesign and diabetes self-management support based on Chronic Care Model changed organizational structure and performance of the diabetes care system. It also reformed the structure of treatment providers from a vertical and hierarchical form to a team arrangement. Nurse's educational function became evidence-based and patients' self-care behaviors upgraded.
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Affiliation(s)
| | - Parvaneh Abazari
- Department of Nursing, Najafabad Branch Islamic Azad University, Najafabad, Iran
| | - Fariba Taleghani
- RN, Professor, MSN, BSN, Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bijan Iraj
- Associate Professor of Endocrinology, Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Brown JA, Leonard M, Clinton T, Bower JK, Gillespie SL, Fareed N, Thomas N, Prater L, Lorenz A, May S, Voisin C, Thung S, Oza-Frank R, Bose Brill S. Mothers' Perspectives on a Mother/Infant Dyad Postpartum Primary Care Program Following Gestational Diabetes Mellitus: A Qualitative Pilot Study. Sci Diabetes Self Manag Care 2022; 48:247-257. [PMID: 35658777 DOI: 10.1177/26350106221100539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study is to characterize mothers' experiences within a mother/infant dyad postpartum primary care program (Dyad) following gestational diabetes mellitus (GDM) to inform improvements in the delivery of care. METHODS A qualitative pilot study of women (n = 10) enrolled in a mother/infant Dyad program was conducted in a primary care practice at a large, urban academic medical center. Respondents were asked a series of open-ended questions about their experience with GDM, the Dyad program, and health behaviors. Interviews were audio-recorded, transcribed verbatim, and analyzed using ground theory with NVivo 12 Plus software. RESULTS Three key themes emerged: (1) Dyad program experience, (2) implementation of health behavior changes, and (3) acknowledgment of future GDM and type 2 diabetes mellitus (T2DM) health risks. Respondents found the Dyad program respondents felt that the program conveniently served mother and infant health care needs in a single appointment. Respondents also valued support from primary care providers when implementing health behavior changes. The Dyad program provided an opportunity for respondents to understand their current and future risk for developing GDM and T2DM. CONCLUSIONS Postpartum women enrolled in the Dyad program received highly personalized primary care services. The results of our study will help integrate patient-centered strategies into models for GDM care to maintain patient engagement in postpartum clinical services.
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Affiliation(s)
- Jordyn A Brown
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, Ohio.,Division of General Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Melissa Leonard
- Ohio Colleges of Medicine Government Resource Center, Columbus, Ohio
| | - Tiffany Clinton
- Department of Obstetrics and Gynecology, Henry Ford Health System, Detroit, Michigan
| | - Julie K Bower
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, Ohio
| | - Shannon L Gillespie
- The Martha S. Pitzer Center for Women, Children and Youth, The Ohio State College of Nursing, Columbus, Ohio
| | - Naleef Fareed
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Nikki Thomas
- Division of General Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Laura Prater
- Division of General Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio.,Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle, Washington.,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Allison Lorenz
- Ohio Colleges of Medicine Government Resource Center, Columbus, Ohio
| | - Sara May
- Ohio Colleges of Medicine Government Resource Center, Columbus, Ohio
| | - Christiane Voisin
- Division of General Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Stephen Thung
- Division of General Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Reena Oza-Frank
- Bureau of Maternal, Child and Family Health, Ohio Department of Health, Columbus, Ohio
| | - Seuli Bose Brill
- Division of General Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio
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Kirkegaard A, Ball L, Mitchell L, Williams LT. The Quality in Nutrition Care (QUINCE) model: development of a model based on Australian healthcare consumer perspectives. Fam Pract 2022; 39:471-478. [PMID: 34676397 DOI: 10.1093/fampra/cmab136] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Primary healthcare is the ideal setting to address diet-related disease through delivery of nutrition services. However, quality nutrition care has not previously been defined from the healthcare consumer perspective. OBJECTIVES To explore, and develop a theoretical model of, healthcare consumer expectations of quality nutrition care in the primary healthcare setting. METHODS A qualitative study design collected data describing healthcare consumer expectations of nutrition care. Consumers were recruited through social media and research networks, screened, and invited to participate in a semi-structured telephone interview. Interviews explored experiences and views of nutrition care. Interviews were thematically analysed, and informed development of a model using an iterative process. RESULTS Twenty-three healthcare consumers participated in an interview. Five themes were identified. The Quality in Nutrition Care consumer model developed from these themes comprised 5 interconnected components, these being: (i) quality nutrition care occurs within an integrated societal system; (ii) quality nutrition care is available, accessible, and affordable; (iii) quality nutrition care is up-to-date and evidence based; (iv) quality nutrition care is underpinned by positive relationships; and (v) quality nutrition care is personalized to consumer needs. CONCLUSIONS The consumer-derived model of quality nutrition care can be used by providers to inform activities that enhance primary healthcare practice, outcomes, and impact. The model has important implications for primary healthcare system reform and policy. Future research should explore the provision of dietetic services in primary care, with specific focus on factors that influence quality care, and investigate how quality is monitored and improved.
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Affiliation(s)
- Amy Kirkegaard
- Griffith University Menzies Health Institute of Queensland, Gold Coast 4222, Australia.,School of Health Sciences and Social Work, Griffith University, Gold Coast 4222, Australia
| | - Lauren Ball
- Griffith University Menzies Health Institute of Queensland, Gold Coast 4222, Australia.,School of Health Sciences and Social Work, Griffith University, Gold Coast 4222, Australia
| | - Lana Mitchell
- Griffith University Menzies Health Institute of Queensland, Gold Coast 4222, Australia.,School of Health Sciences and Social Work, Griffith University, Gold Coast 4222, Australia
| | - Lauren T Williams
- Griffith University Menzies Health Institute of Queensland, Gold Coast 4222, Australia.,School of Health Sciences and Social Work, Griffith University, Gold Coast 4222, Australia
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Johnson PJ, Mentzer KM, Jou J, Upchurch DM. Unmet healthcare needs among midlife adults with mental distress and multiple chronic conditions. Aging Ment Health 2022; 26:775-783. [PMID: 33792432 PMCID: PMC10843861 DOI: 10.1080/13607863.2021.1904830] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Limited attention has focused on midlife health. Yet, this is a time of great change, including onset of chronic conditions and changes in mental health. OBJECTIVE To examine unmet healthcare needs among midlife adults (50-64 years) in the US with severe psychological distress (SPD) and/or multiple chronic conditions (MCC). METHODS Nationally representative data for midlife adults (50-64 years) from NHIS 2014-2018 were examined (n = 39,329). Multimorbidity status: no MCC/SPD, MCC alone, SPD alone, or both. We used logistic regression to estimate adjusted odds ratios (AOR) of delayed or foregone care by multimorbidity status. RESULTS Nearly 40% of midlife adults had MCC, SPD, or SPD/MCC. SPD with or without MCC had higher prevalence of social disadvantage, fair/poor health, activity limitations, and delayed/foregone healthcare. Compared to those with neither, adults with SPD/MCC were more likely to delay care due to limited office hours (AOR = 4.2, 95% CI 3.1-5.5) and had nearly three to four times higher odds of delays for all other reasons. Those with SPD/MCC had higher odds of needing but not getting mental healthcare (AOR = 6.4, 95% CI 4.5-9.1), prescriptions (AOR = 4.8, 95% CI 3.9-5.9), or follow-up care (AOR = 5.0, 95% CI 3.7-6.6), and three to four times higher odds of all other types of foregone care. CONCLUSIONS Midlife adults with SPD/MCC have substantial unmet healthcare needs. Midlife is a critical time to manage both chronic conditions and mental illness. Coordinated efforts by policymakers and healthcare systems are crucial to address complex healthcare needs of this population at a critical stage of the life-course.
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Affiliation(s)
- Pamela Jo Johnson
- Department of Public Health, North Dakota State University, Fargo, ND, USA
| | | | - Judy Jou
- Health Science Department, California State University-Long Beach, Long Beach, CA, USA
| | - Dawn M Upchurch
- Department of Community Health Sciences, Fielding School of Public Health, UCLA, Los Angeles, CA, USA
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Reeves N. Utilization and evaluation of a diabetes screening assessment tool (DSAT) in an interprofessional student-led community-based clinic. TEACHING AND LEARNING IN NURSING 2022. [DOI: 10.1016/j.teln.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Davis J, Fischl AH, Beck J, Browning L, Carter A, Condon JE, Dennison M, Francis T, Hughes PJ, Jaime S, Lau KHK, McArthur T, McAvoy K, Magee M, Newby O, Ponder SW, Quraishi U, Rawlings K, Socke J, Stancil M, Uelmen S, Villalobos S. 2022 National Standards for Diabetes Self-Management Education and Support. Diabetes Spectr 2022; 35:137-149. [PMID: 35668879 PMCID: PMC9160547 DOI: 10.2337/ds22-ps02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | | | - Joni Beck
- The University of Oklahoma Health Science Center, Oklahoma City, OK
| | | | | | - Jo Ellen Condon
- Anne Arundel Medical Center, Annapolis, MD
- Diabetes Alliance Network, Naples, FL
| | | | | | | | | | | | | | | | - Michelle Magee
- MedStar Diabetes and Research Institutes, Georgetown University School of Medicine, Washington, DC
| | - Olivia Newby
- The Healthy Living Center Diabetes Education Program, Norfolk, VA
| | | | | | | | | | | | - Sacha Uelmen
- Association of Diabetes Care & Education Specialists, Chicago, IL
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Coke LA, Deedwania PC, Hinnen D, Magwire M, Miller NH. GLP-1 receptor agonists and cardiovascular outcomes in patients with type 2 diabetes: Clinical evidence and best practice. J Am Assoc Nurse Pract 2022; 34:418-440. [PMID: 35120085 DOI: 10.1097/jxx.0000000000000661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 09/02/2021] [Indexed: 12/13/2022]
Abstract
ABSTRACT Cardiovascular disease (CVD) is a major cause of death and disability among people with type 2 diabetes (T2D), presenting a significant impact on longevity, patient quality of life, and health care costs. In the United States, attainment of recommended glycemic targets is low and T2D-related cardiovascular complications remain a significant burden. Many glucose-lowering treatment options are available, but glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 (SGLT-2) inhibitors are recommended in recent guidelines as the preferred add-on therapy to metformin to improve glycemic control. This is particularly the case for patients with T2D and established atherosclerotic CVD, at high risk of atherosclerotic CVD, and/or with chronic kidney disease. Recommendations were based on GLP-1RA and SGLT-2 inhibitor cardiovascular outcomes trials (CVOTs), which consistently showed that these agents pose no additional cardiovascular risk compared with placebo. Three GLP-1RAs (liraglutide, dulaglutide, and subcutaneous semaglutide) demonstrated significantly lower major adverse cardiovascular events versus placebo and are now approved for this indication. However, to realize improvement in outcomes in the clinical setting, organized, systematic, and coordinated approaches to patient management are also needed. For example, nurse-led diabetes self-management education and support programs have been shown to be effective. This article explores T2D management with emphasis on cardiovascular risk and CVOTs performed to date and reviews the clinical experience with GLP-1RAs for managing hyperglycemia and their impact on cardiovascular risk. In addition, practical guidance is given for key health care providers involved in the care of patients with T2D with cardiovascular risk outside of diabetes clinics/endocrinology centers.
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Affiliation(s)
- Lola A Coke
- Kirkhof College of Nursing, Grand Valley State University, Allendale, Michigan
| | | | - Debbie Hinnen
- University of Colorado Health, Diabetes Clinic, Colorado Springs, Colorado
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Bronstein JM, Huang L, Shelley JP, Levitan EB, Presley CA, Agne AA, Mondesir FL, Riggs KR, Pisu M, Cherrington AL. Primary care visits and ambulatory care sensitive diabetes hospitalizations among adult Alabama Medicaid beneficiaries. Prim Care Diabetes 2022; 16:116-121. [PMID: 34772648 PMCID: PMC8840986 DOI: 10.1016/j.pcd.2021.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 10/25/2021] [Accepted: 10/29/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE To describe patterns of care use for Alabama Medicaid adult beneficiaries with diabetes and the association between primary care utilization and ambulatory care sensitive (ACS) diabetes hospitalizations. METHODS This retrospective cohort study analyzes Alabama Medicaid claims data from January 2010 to April 2018 for 52,549 covered adults ages 19-64 with diabetes. Individuals were characterized by demographics, comorbidities, and health care use including primary, specialty, mental health and hospital care. Characteristics of those with and without any ACS diabetes hospitalization are reported. A set of 118,758 observations was created, pairing information on primary care use in one year with ACS hospitalizations in the following year. Logistic regression analysis was used to assess the impact of primary care use on the occurrence of an ACS hospitalization. RESULTS One third of the cohort had at least one ACS diabetes hospitalization over their observed periods; hospital users tended to have multiple ACS hospitalizations. Hospital users had more comorbidities and pharmaceutical and other types of care use than those with no ACS hospitalizations. Controlling for other types of care use, comorbidities and demographics, having a primary care visit in one year was significantly associated with a reduced likelihood of ACS hospitalization in the following year (odds ratio comparing 1-2 visits versus none 0.79, 95% confidence interval 0.73-0.85). CONCLUSIONS Program and population health interventions that increase access to primary care can have a beneficial effect of reducing excess inpatient hospital use for Medicaid covered adults with diabetes.
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Affiliation(s)
- Janet M Bronstein
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, 1665 University Blvd, Birmingham AL, 35294, United States
| | - Lei Huang
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1665 University Blvd, Birmingham AL, 35294, United States
| | - John P Shelley
- School of Medicine, Vanderbilt University, 2209 Garland Ave, Nashville TN, 37232, United States
| | - Emily B Levitan
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1665 University Blvd, Birmingham AL, 35294, United States
| | - Caroline A Presley
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Birmingham AL, 35205, United States
| | - April A Agne
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Birmingham AL, 35205, United States
| | - Favel L Mondesir
- Division of Cardiovascular Medicine, School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Kevin R Riggs
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Birmingham AL, 35205, United States
| | - Maria Pisu
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Birmingham AL, 35205, United States
| | - Andrea L Cherrington
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, 1717 11th Avenue South, Birmingham AL, 35205, United States.
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Davis J, Fischl AH, Beck J, Browning L, Carter A, Condon JE, Dennison M, Francis T, Hughes PJ, Jaime S, Lau KHK, McArthur T, McAvoy K, Magee M, Newby O, Ponder SW, Quraishi U, Rawlings K, Socke J, Stancil M, Uelmen S, Villalobos S. 2022 National Standards for Diabetes Self-Management Education and Support. Diabetes Care 2022; 45:484-494. [PMID: 35050365 DOI: 10.2337/dc21-2396] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 11/17/2021] [Indexed: 02/03/2023]
Affiliation(s)
| | | | - Joni Beck
- The University of Oklahoma Health Science Center, Oklahoma City, OK
| | | | | | - Jo Ellen Condon
- Anne Arundel Medical Center, Annapolis, MD
- Diabetes Alliance Network, Naples, FL
| | | | | | | | | | | | | | | | - Michelle Magee
- 15MedStar Diabetes and Research Institutes, Georgetown University School of Medicine, Washington, D.C
| | - Olivia Newby
- 16The Healthy Living Center Diabetes Education Program, Norfolk, VA
| | | | | | | | | | | | - Sacha Uelmen
- 22Association of Diabetes Care & Education Specialists, Chicago, IL
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Davis J, Fischl AH, Beck J, Browning L, Carter A, Condon JE, Dennison M, Francis T, Hughes PJ, Jaime S, Lau KHK, McArthur T, McAvoy K, Magee M, Newby O, Ponder SW, Quraishi U, Rawlings K, Socke J, Stancil M, Uelmen S, Villalobos S. 2022 National Standards for Diabetes Self-Management Education and Support. Sci Diabetes Self Manag Care 2022; 48:44-59. [PMID: 35049403 DOI: 10.1177/26350106211072203] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The National Standards for Diabetes Self-Management Education and Support (DSMES) provide guidance and evidence-based, quality practice for all DSMES services. Due to the dynamic nature of health care and diabetes research, the National Standards are reviewed and revised approximately every 5 years by key stakeholders and experts within the diabetes care and education community. For each revision, the Task Force is charged with reviewing the current National Standards for appropriateness, relevance, and scientific basis and making updates based on current evidence and expert consensus. In 2021, the group was tasked with reducing administrative burden related to DSMES implementation across diverse care settings. CONCLUSION The evidence supporting the 2022 National Standards clearly identifies the need to provide person-centered services that embrace cultural differences, social determinants of health, and the ever-increasing technological engagement platforms and systems. Payers are invited to review the National Standards as a tool to inform and modernize DSMES reimbursement requirements and to align with the evolving needs of people with diabetes (PWD) and physicians/other qualified health care professionals. The American Diabetes Association and the Association of Diabetes Care & Education Specialists strongly advocate for health equity to ensure all PWD have access to this critical service proven to improve outcomes both related to and beyond diabetes. The 2022 National Standards update is meant to be a universal document that is easy to understand and can be implemented by the entire health care community. DSMES teams in collaboration with primary care have been shown to be the most effective approach to overcome therapeutic inertia.
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Affiliation(s)
| | | | - Joni Beck
- The University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
| | | | | | - Jo Ellen Condon
- Anne Arundel Medical Center, Annapolis, Maryland, and Diabetes Alliance Network, Naples, Florida
| | | | | | | | - Stephen Jaime
- El Centro Regional Medical Center, El Centro, California
| | | | | | - Karen McAvoy
- Yale New Haven Health System, New Haven, Connecticut
| | - Michelle Magee
- MedStar Diabetes and Research Institutes, Georgetown University School of Medicine, Washington, DC
| | - Olivia Newby
- The Healthy Living Center Diabetes Education Program, Norfolk, Virginia
| | | | | | | | | | | | - Sacha Uelmen
- Association of Diabetes Care & Education Specialists, Chicago, Illinois
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Karlsen TH, Sheron N, Zelber-Sagi S, Carrieri P, Dusheiko G, Bugianesi E, Pryke R, Hutchinson SJ, Sangro B, Martin NK, Cecchini M, Dirac MA, Belloni A, Serra-Burriel M, Ponsioen CY, Sheena B, Lerouge A, Devaux M, Scott N, Hellard M, Verkade HJ, Sturm E, Marchesini G, Yki-Järvinen H, Byrne CD, Targher G, Tur-Sinai A, Barrett D, Ninburg M, Reic T, Taylor A, Rhodes T, Treloar C, Petersen C, Schramm C, Flisiak R, Simonova MY, Pares A, Johnson P, Cucchetti A, Graupera I, Lionis C, Pose E, Fabrellas N, Ma AT, Mendive JM, Mazzaferro V, Rutter H, Cortez-Pinto H, Kelly D, Burton R, Lazarus JV, Ginès P, Buti M, Newsome PN, Burra P, Manns MP. The EASL-Lancet Liver Commission: protecting the next generation of Europeans against liver disease complications and premature mortality. Lancet 2022; 399:61-116. [PMID: 34863359 DOI: 10.1016/s0140-6736(21)01701-3] [Citation(s) in RCA: 270] [Impact Index Per Article: 135.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/10/2021] [Accepted: 07/15/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Tom H Karlsen
- Department of Transplantation Medicine and Research Institute for Internal Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital Rikshospitalet and University of Oslo, Oslo, Norway.
| | - Nick Sheron
- Institute of Hepatology, Foundation for Liver Research, Kings College London, London, UK
| | - Shira Zelber-Sagi
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel; Department of Gastroenterology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Patrizia Carrieri
- Aix-Marseille University, Inserm, Institut de recherche pour le développement, Sciences Economiques et Sociales de la Santé et Traitement de l'Information Médicale (SESSTIM), ISSPAM, Marseille, France
| | - Geoffrey Dusheiko
- School of Medicine, University College London, London, UK; Kings College Hospital, London, UK
| | - Elisabetta Bugianesi
- Department of Medical Sciences, Division of Gastroenterology, University of Torino, Torino, Italy
| | | | - Sharon J Hutchinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Clinical and Protecting Health Directorate, Public Health Scotland, Glasgow, UK
| | - Bruno Sangro
- Liver Unit, Clinica Universidad de Navarra-IDISNA and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Pamplona, Spain
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA; Population Health Sciences, University of Bristol, Bristol, UK
| | - Michele Cecchini
- Health Division, Organisation for Economic Co-operation and Development, Paris, France
| | - Mae Ashworth Dirac
- Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA; Department of Family Medicine, University of Washington, Seattle, WA, USA; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Annalisa Belloni
- Health Economics and Modelling Division, Public Health England, London, UK
| | - Miquel Serra-Burriel
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Cyriel Y Ponsioen
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Brittney Sheena
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Alienor Lerouge
- Health Division, Organisation for Economic Co-operation and Development, Paris, France
| | - Marion Devaux
- Health Division, Organisation for Economic Co-operation and Development, Paris, France
| | - Nick Scott
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
| | - Margaret Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia; Department of Infectious Diseases, Alfred Hospital, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Doherty Institute and School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Henkjan J Verkade
- Paediatric Gastroenterology and Hepatology, Department of Paediatrics, University Medical Centre Groningen, University of Groningen, Netherlands; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Ekkehard Sturm
- Division of Paediatric Gastroenterology and Hepatology, University Children's Hospital Tübingen, Tübingen, Germany; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | | | | | - Chris D Byrne
- Department of Nutrition and Metabolism, Faculty of Medicine, University of Southampton, Southampton, UK; Southampton National Institute for Health Research, Biomedical Research Centre, University Hospital Southampton and Southampton General Hospital, Southampton, UK
| | - Giovanni Targher
- Department of Medicine, Section of Endocrinology, Diabetes, and Metabolism, University of Verona, Verona, Italy
| | - Aviad Tur-Sinai
- Department of Health Systems Management, The Max Stern Yezreel Valley College, Yezreel Valley, Israel
| | - Damon Barrett
- School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Tatjana Reic
- European Liver Patients Organization, Brussels, Belgium; Croatian Society for Liver Diseases-Hepatos, Split, Croatia
| | | | - Tim Rhodes
- London School of Hygiene & Tropical Medicine, London, UK
| | - Carla Treloar
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Claus Petersen
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Christoph Schramm
- Martin Zeitz Center for Rare Diseases, Hamburg Center for Translational Immunology (HCTI), and First Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Robert Flisiak
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, Poland
| | - Marieta Y Simonova
- Department of Gastroenterology, HPB Surgery and Transplantation, Clinic of Gastroentrology, Military Medical Academy, Sofia, Bulgaria
| | - Albert Pares
- Liver Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; CIBEREHD, Madrid, Spain
| | - Philip Johnson
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Alessandro Cucchetti
- Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Isabel Graupera
- Liver Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; CIBEREHD, Madrid, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Spain
| | - Christos Lionis
- Clinic of Social and Family Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Elisa Pose
- Liver Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Spain
| | - Núria Fabrellas
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; CIBEREHD, Madrid, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Spain
| | - Ann T Ma
- Liver Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Juan M Mendive
- Prevention and Health Promotion Research Network (redIAPP), Institute of Health Carlos III, Madrid, Spain; La Mina Health Centre, Catalan Institute of Health (ICS), Barcelona, Spain
| | - Vincenzo Mazzaferro
- HPB Surgery and Liver Transplantation, Istituto Nazionale Tumori IRCCS Foundation (INT), Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Helena Cortez-Pinto
- Clínica Universitária de Gastrenterologia and Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Deirdre Kelly
- Liver Unit, Birmingham Women's and Children's Hospital and University of Birmingham, UK
| | - Robyn Burton
- Alcohol, Drugs, Tobacco and Justice Division, Public Health England, London, UK
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, Barcelona, Spain
| | - Pere Ginès
- Liver Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; CIBEREHD, Madrid, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Spain
| | - Maria Buti
- CIBEREHD del Instituto de Salud Carlos III, Madrid, Spain; Liver Unit, Hospital Universitario Valle Hebron, Barcelona, Spain
| | - Philip N Newsome
- National Institute for Health Research Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Birmingham, UK
| | - Patrizia Burra
- Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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4. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Medical Care in Diabetes-2022. Diabetes Care 2022; 45:S46-S59. [PMID: 34964869 PMCID: PMC8935396 DOI: 10.2337/dc22-s004] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Montgomery AH, Best LR, Kitzman H, Khan M, Mamun A, Aguillon A, Granberry K. Effect of Comprehensive Multi-Provider Primary Care Visits in Type 2 Diabetes Management in a Primarily Uninsured, Ethnic Minority Population: The Comprehensive Care Initiative (CCI) Program. J Prim Care Community Health 2022; 13:21501319221088819. [PMID: 35352594 PMCID: PMC8972911 DOI: 10.1177/21501319221088819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The Comprehensive Care Initiative (CCI) utilized a quasi-experimental design to evaluate the effects of same room, multi-provider primary care visits on the management of type 2 diabetes (T2D). Patients with T2D were invited to enroll in CCI if they had T2D with glycated hemoglobin (HbA1c) >8.0% or T2D with BMI >30. CCI intervention included delivery of comprehensive same room multi-provider visits with a primary care physician, community health worker, pharmacist, dietitian, medical assistant, and licensed social worker at the same appointment. CCI patients were compared with a propensity score matched control group receiving usual care (n = 56, 50 ± 11 years old, 77% female, 41% African American, 95% uninsured). After 6 months, the adjusted average reduction in HbA1c in the CCI group was 0.97% (SE = 0.45) in comparison to 0.05% (SE = 0.20) in the control group (P = .04). This pilot study showed promising results in lowering HbA1c in an uninsured, ethnic minority population of T2D patients through delivery of comprehensive multi-provider primary care visits.
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Affiliation(s)
| | - Lydia R Best
- Baylor Scott and White Health and Wellness Center, Dallas, TX, USA
| | - Heather Kitzman
- Baylor Scott and White Health and Wellness Center, Dallas, TX, USA.,Robbins Institute for Health Policy and Leadership, Baylor University, Waco, TX, USA
| | - Mahbuba Khan
- Baylor Scott and White Health and Wellness Center, Dallas, TX, USA
| | - Abdullah Mamun
- Baylor Scott and White Health and Wellness Center, Dallas, TX, USA
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Fang A, Abdelgadir D, Gopalan A, Ross T, Uratsu CS, Sterling SA, Grant RW, Iturralde E. Engaging patients in population-based chronic disease management: A qualitative study of barriers and intervention opportunities. PATIENT EDUCATION AND COUNSELING 2022; 105:182-189. [PMID: 33975772 PMCID: PMC8566319 DOI: 10.1016/j.pec.2021.04.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/05/2021] [Accepted: 04/29/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Cardiovascular disease (CVD) continues to be a leading cause of morbidity in the U.S. Managing CVD risk factors, such as diabetes or hypertension, can be challenging for many individuals. We investigated the barriers experienced by patients who persistently struggled to reach their CVD risk factor control goals. METHODS This qualitative study examined patient, clinician, and researcher observations of individuals' experiences in a chronic disease management program. All participants (n = 332) were enrolled in a clinical trial testing a skills-based group intervention seeking to improve healthcare engagement. Data were analyzed through a general inductive approach and resulting themes were structured along the Capability-Opportunity-Motivation-Behavior framework. RESULTS Analyses identified care engagement barriers related to participants' communication skills and activation, care team relationship processes, and emotional factors. Although most participants reported benefitting from skills training, persistent barriers included distrust of their providers, shame about health challenges, and dissatisfaction with care team interactions that were described as impersonal or unresponsive. CONCLUSIONS AND PRACTICE IMPLICATIONS Efforts to support engagement in CVD risk factor management programs should address whether patients and their care team have the necessary skills, opportunities and confidence to proactively communicate health needs and engage in non-judgmental interactions for goal-setting, rapport-building, and shared decision-making.
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Affiliation(s)
- Anya Fang
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Dana Abdelgadir
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Anjali Gopalan
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Thekla Ross
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Connie S Uratsu
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Stacy A Sterling
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
| | - Richard W Grant
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA.
| | - Esti Iturralde
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA
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El Asmar ML, Dharmayat KI, Vallejo-Vaz AJ, Irwin R, Mastellos N. Effect of computerised, knowledge-based, clinical decision support systems on patient-reported and clinical outcomes of patients with chronic disease managed in primary care settings: a systematic review. BMJ Open 2021; 11:e054659. [PMID: 34937723 PMCID: PMC8705223 DOI: 10.1136/bmjopen-2021-054659] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Chronic diseases are the leading cause of disability globally. Most chronic disease management occurs in primary care with outcomes varying across primary care providers. Computerised clinical decision support systems (CDSS) have been shown to positively affect clinician behaviour by improving adherence to clinical guidelines. This study provides a summary of the available evidence on the effect of CDSS embedded in electronic health records on patient-reported and clinical outcomes of adult patients with chronic disease managed in primary care. DESIGN AND ELIGIBILITY CRITERIA Systematic review, including randomised controlled trials (RCTs), cluster RCTs, quasi-RCTs, interrupted time series and controlled before-and-after studies, assessing the effect of CDSS (vs usual care) on patient-reported or clinical outcomes of adult patients with selected common chronic diseases (asthma, chronic obstructive pulmonary disease, heart failure, myocardial ischaemia, hypertension, diabetes mellitus, hyperlipidaemia, arthritis and osteoporosis) managed in primary care. DATA SOURCES Medline, Embase, CENTRAL, Scopus, Health Management Information Consortium and trial register clinicaltrials.gov were searched from inception to 24 June 2020. DATA EXTRACTION AND SYNTHESIS Screening, data extraction and quality assessment were performed by two reviewers independently. The Cochrane risk of bias tool was used for quality appraisal. RESULTS From 5430 articles, 8 studies met the inclusion criteria. Studies were heterogeneous in population characteristics, intervention components and outcome measurements and focused on diabetes, asthma, hyperlipidaemia and hypertension. Most outcomes were clinical with one study reporting on patient-reported outcomes. Quality of the evidence was impacted by methodological biases of studies. CONCLUSIONS There is inconclusive evidence in support of CDSS. A firm inference on the intervention effect was not possible due to methodological biases and study heterogeneity. Further research is needed to provide evidence on the intervention effect and the interplay between healthcare setting features, CDSS characteristics and implementation processes. PROSPERO REGISTRATION NUMBER CRD42020218184.
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Affiliation(s)
| | - Kanika I Dharmayat
- Department of Primary Care and Public Health, Imperial Centre for Cardiovascular Disease Prevention, Imperial College London, London, UK
| | - Antonio J Vallejo-Vaz
- Imperial Centre for Cardiovascular Disease Prevention (ICCP), Department of Primary Care and Public Health, School of Public Health, Imperial College London. London, United Kingdom, London, UK
- Department of Medicine, Faculty of Medicine, University of Seville, Seville, Spain
- Clinical Epidemiology and Vascular Risk, Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen del Rocío/Universidad de Sevilla/CSIC, Seville, Spain
| | - Ryan Irwin
- Department of Primary Care Clinical Sciences, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Nikolaos Mastellos
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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Wongrith P, Thirarattanasunthon P, Kaewsawat S. Glycemic control outcome in patients with type 2 diabetes mellitus: chronic care management support of family care team in Thailand. J Diabetes Metab Disord 2021; 20:1269-1279. [PMID: 34900778 DOI: 10.1007/s40200-021-00851-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/03/2021] [Indexed: 11/27/2022]
Abstract
Purpose We aimed to ascertain diabetic self-management predictors in the family care team chronic care model, and to analyze the factors associated with glycemic control. Methods A cross-sectional study was conducted with type 2 diabetes mellitus (T2DM) patients at Pak Phun Municipality Hospital, Thailand, from 2019 to 2020. The 282 participants' compraised 16 health care providers, 128 healthy volunteers, and 138 T2DM patients. Data were collected using a questionnaire. The statistics were descriptive, association and multiple regression were tested. Results Of the T2DM patients, 68.1% were female, overweight (body mass index 25.8 ± 3.99 kg/m2), had diabetic periods of 8.2 ± 4.65 y, high fasting plasma glucose (FPG) (139.3 ± 44.59 mg/dL), uncontrolled A1C (7.8 ± 1.57%), and presented with diabetic nephropathy (61.6%). Diabetic self-management was at a high level (76.8%). The factors significantly associated with A1C were income (p < 0.001), low-density lipoprotein (p < 0.05) estimated glomerular filtration rate, and FPG (p < 0.001). A1C was predicted by self-efficacy (SE) (38.0%; p < 0.001), social support (SO) (40.8%; p < 0.001), health providers evaluated by the Assessment of Chronic Illness Care (ACIC) (22.8%; p < 0.001), and patients' perception by Patient Assessment of Care for Chronic Conditions (PACIC) (17%; p < 0.01). Conclusion In order to reduce diabetes complications, the family care team played a critical role. Self-efficacy and social support were important factors in managing diabetes. The chronic care model begins with a procedure of self-management support and intervention by stakeholders such as caregivers in the community.
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Affiliation(s)
- Paleeratana Wongrith
- School of Public Health, Walailak University, 222 Thaiburi, Tha Sala, Nakhon Si Thammarat, 80161 Thailand
| | - Phiman Thirarattanasunthon
- School of Public Health, Walailak University, 222 Thaiburi, Tha Sala, Nakhon Si Thammarat, 80161 Thailand
| | - Supreecha Kaewsawat
- School of Public Health, Walailak University, 222 Thaiburi, Tha Sala, Nakhon Si Thammarat, 80161 Thailand
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73
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Medea G. Care networks, integrated care models, and primary care. JOURNAL OF GERONTOLOGY AND GERIATRICS 2021. [DOI: 10.36150/2499-6564-n465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Digitally Enabled Health Service for the Integrated Management of Hypertension: A Participatory User-Centred Design Process. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312442. [PMID: 34886167 PMCID: PMC8656774 DOI: 10.3390/ijerph182312442] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/19/2021] [Accepted: 11/24/2021] [Indexed: 11/17/2022]
Abstract
This article describes a user-centred approach taken by a group of five procurers to set specifications for the procurement of value-based research and development services for IT-supported integrated hypertension management. The approach considered the unmet needs of patients and health systems of the involved regions. The procurers established a framework for requirements and a solution design consisting of nine building blocks, divided into three domains: service delivery, devices and integration, and health care organisation. The approach included the development of questionnaires, capturing patients’ and professionals’ views on possible system functionalities, and a template collecting information about the organisation of healthcare, professionals involved and existing IT systems at the procurers’ premises. A total of 28 patients diagnosed with hypertension and 26 professionals were interviewed. The interviewees identified 98 functional requirements, grouped in the nine building blocks. A total of nine use cases and their corresponding process models were defined by the procurers’ working group. As result, a digitally enabled integrated approach to hypertension has been designed to allow citizens to learn how to prevent the development of hypertension and lead a healthy lifestyle, and to receive comprehensive, individualised treatment in close collaboration with healthcare professionals.
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Lim S, Wyatt LC, Mammen S, Zanowiak JM, Mohaimin S, Troxel AB, Lindau ST, Gold HT, Shelley D, Trinh-Shevrin C, Islam NS. Implementation of a multi-level community-clinical linkage intervention to improve glycemic control among south Asian patients with uncontrolled diabetes: study protocol of the DREAM initiative. BMC Endocr Disord 2021; 21:233. [PMID: 34814899 PMCID: PMC8609264 DOI: 10.1186/s12902-021-00885-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/22/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND A number of studies have identified patient-, provider-, and community-level barriers to effective diabetes management among South Asian Americans, who have a high prevalence of type 2 diabetes. However, no multi-level, integrated community health worker (CHW) models leveraging health information technology (HIT) have been developed to mitigate disease among this population. This paper describes the protocol for a multi-level, community-clinical linkage intervention to improve glycemic control among South Asians with uncontrolled diabetes. METHODS The study includes three components: 1) building the capacity of primary care practices (PCPs) to utilize electronic health record (EHR) registries to identify patients with uncontrolled diabetes; 2) delivery of a culturally- and linguistically-adapted CHW intervention to improve diabetes self-management; and 3) HIT-enabled linkage to culturally-relevant community resources. The CHW intervention component includes a randomized controlled trial consisting of group education sessions on diabetes management, physical activity, and diet/nutrition. South Asian individuals with type 2 diabetes are recruited from 20 PCPs throughout NYC and randomized at the individual level within each PCP site. A total of 886 individuals will be randomized into treatment or control groups; EHR data collection occurs at screening, 6-, 12-, and 18-month. We hypothesize that individuals receiving the multi-level diabetes management intervention will be 15% more likely than the control group to achieve ≥0.5% point reduction in hemoglobin A1c (HbA1c) at 6-months. Secondary outcomes include change in weight, body mass index, and LDL cholesterol; the increased use of community and social services; and increased health self-efficacy. Additionally, a cost-effectiveness analysis will focus on implementation and healthcare utilization costs to determine the incremental cost per person achieving an HbA1c change of ≥0.5%. DISCUSSION Final outcomes will provide evidence regarding the effectiveness of a multi-level, integrated EHR-CHW intervention, implemented in small PCP settings to promote diabetes control among an underserved South Asian population. The study leverages multisectoral partnerships, including the local health department, a healthcare payer, and EHR vendors. Study findings will have important implications for the translation of integrated evidence-based strategies to other minority communities and in under-resourced primary care settings. TRIAL REGISTRATION This study was registered with clinicaltrials.gov: NCT03333044 on November 6, 2017.
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Affiliation(s)
- Sahnah Lim
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA.
| | - Laura C Wyatt
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Shinu Mammen
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Jennifer M Zanowiak
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Sadia Mohaimin
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Andrea B Troxel
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Stacy Tessler Lindau
- Departments of Obstetrics and Gynecology and Medicine-Geriatrics, The University of Chicago, 5841 Maryland Avenue MC 2050, Chicago, IL, 60637, USA
| | - Heather T Gold
- Department of Population Health, NYU Grossman School of Medicine, 550 First Ave, VZ30, 6th floor, New York, NY, 10016, USA
| | - Donna Shelley
- Department of Public Health Policy and Management Department, NYU Global School of Public Health, 665 Broadway, 11th Floor, New York, NY, 10012, USA
| | - Chau Trinh-Shevrin
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Nadia S Islam
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
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Abstract
Chronic care management is a multidimensional phenomenon involving multilayered interaction, reaction, and adaptation responses to feedback within chronic care micro/macro- systems. Complex adaptive systems (CASs) consider interconnected dynamic relationships between discrete components of systems' internal and external environments. CAS is an applicable framework to examine components and networks within chronic care models. This article considers CAS as a framework for an alternate integrated patient-centered model that incorporates a holistic approach to chronic care. Recognizing relationships, behavioral patterns, and adaptive mechanisms informs health systems and health policy to influence service excellence improvements and quality of care and life within chronic disease populations.
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Davis H, Heilmann R, Milchak J, Delate T. Factors associated with A1C reduction with GLP-1 agonist or SGLT-2 inhibitor use. Fam Pract 2021; 38:623-629. [PMID: 33755123 DOI: 10.1093/fampra/cmab021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND While use of glucagon-like peptide-1 (GLP-1) agonists and sodium-glucose cotransporter-2 (SGLT-2) inhibitors reduces the risk of atherosclerotic cardiovascular disease outcomes and lowers glycosylated haemoglobin (A1C), evidence on patient characteristics associated with clinically relevant A1C reduction is lacking. OBJECTIVE The objective of this retrospective cohort study was to identify patient characteristics associated with A1C reduction with initial GLP-1 or SGLT-2 use. METHODS Patients with type 2 diabetes and a baseline A1C ≥7% who were dispensed a GLP-1 or SGLT-2 between 01/01/10 and 12/31/17 were included. Patients were categorized as having a ≥1% or <1% A1C reduction during the 90-365 days after GLP-1/SGLT-2 initiation. Patient characteristics were collected during the 180 days prior to initiation. Multivariable logistic and linear regression modelling was performed to identify characteristics associated with a ≥1% A1C reduction and absolute change in A1C, respectively. RESULTS Five hundred and seventy-two patients were included with 261 (46%) and 311 (54%) having and not having an ≥1% A1C reduction. Patients were primarily middle-aged, female, white, non-Hispanic and had a high burden of chronic disease. Characteristics associated with a ≥1% A1C reduction included: GLP-1/SGLT-2 persistence, congestive heart failure comorbidity, phentermine dispensing, care management team (CMT) enrollee and higher baseline A1C. Characteristics associated with absolute A1C reduction included: age, baseline A1C, CMT enrollee, GLP-1/SGLT-2 persistence and a phentermine dispensing. CONCLUSIONS The results of this study provide practitioners with guidance on the patients who are most likely to have a clinically relevant A1C reduction with GLP-1 or SGLT-2 use.
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Affiliation(s)
- Hanifah Davis
- Ambulatory Care Department, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, OK, USA
| | - Rachel Heilmann
- Pharmacy Department, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Jessica Milchak
- Pharmacy Department, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Thomas Delate
- Drug Evaluation, Strategy, and Outcomes Department, Pharmacy Outcomes Research Group, Kaiser Permanente National Pharmacy, Aurora, CO, USA.,Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Heisler M, Simmons D, Piatt GA. Update on Approaches to Improve Delivery and Quality of Care for People with Diabetes. Endocrinol Metab Clin North Am 2021; 50:e1-e20. [PMID: 34763822 DOI: 10.1016/j.ecl.2021.07.010] [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: 10/20/2022]
Abstract
To translate improvements in diabetes management into improved outcomes, it is essential to improve care delivery. To help guide clinicians and health organizations in their efforts to achieve these improvements, this article briefly describes key components underpinning effective diabetes care and six categories of innovations in approaches to improve diabetes care delivery: (1) team-based clinical care; (2) cross-specialty collaboration/integration; (3) virtual clinical care/telehealth; (4) use of community health workers (CHWs) and trained peers to provide pro-active self-management support; (5) incorporating screening for and addressing social determinants of health into clinical practice; and (6) cross-sectoral clinic/community partnerships.
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Affiliation(s)
- Michele Heisler
- Department of Internal Medicine, University of Michigan Medical School; Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System; Department of Health Behavior and Health Education, School of Public Health, University of Michigan.
| | - David Simmons
- School of Medicine, Western Sydney University, Sydney, Australia; Macarthur Clinical School, Campbelltown Hospital, Therry Road, Campbelltown, New South Wales 2560, Australia
| | - Gretchen A Piatt
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan; Department of Learning Health Sciences, University of Michigan Medical School, 1111 E. Catherine Street, Victor Vaughan Building, Room 225, Ann Arbor, MI 48109, USA
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Young M, Villgran V, Ledgerwood C, Schmetzer A, Cheema T. Developing a Multidisciplinary Approach to the COPD Care Pathway. Crit Care Nurs Q 2021; 44:121-127. [PMID: 33234865 DOI: 10.1097/cnq.0000000000000345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is characterized as a predominately preventable and treatable inflammatory lung disease caused by progressive obstructed airflow from the lungs. In the United States and worldwide, it is becoming a major cause in hospital admissions as well as an increase in morbidity and mortality. The rising total cost of care for COPD is concerning for all health care industries. The disease has significant impact on the patient's quality of life and psychological well-being. A worldwide initiative is underway in developing a care model that is multifactorial through continuous monitoring of patients to manage and control symptoms, achieve medication adherence, and provide socioeconomic resources. The primary aim of this study was to prevent exacerbations, hospital admissions, and readmissions. Various models have shown positive results; however, the significant financial investment is the major barrier to success. Recently, one health system in the United States was able to improve care, decrease readmissions, and reduce total cost of care by investing in a multidisciplinary team of specialists. In the utilization of the care model, the primary endpoint will conclude that COPD is financially and socioeconomically manageable.
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Affiliation(s)
- Meilin Young
- Division of Pulmonary Critical Care Medicine (Drs Young, Villgran, Schmetzer, and Cheema) and Medicine Institute (Dr Ledgerwood), Allegheny Health Network, Allegheny General Hospital, Pittsburgh, Pennsylvania
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Effect of Practicing Health Behaviors on Unmet Needs among Patients with Chronic Diseases: A Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157977. [PMID: 34360268 PMCID: PMC8345616 DOI: 10.3390/ijerph18157977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/21/2021] [Accepted: 07/24/2021] [Indexed: 11/17/2022]
Abstract
With the growing prevalence of chronic diseases, the proportion of unmet needs is increasing. In this study, we investigated the effect of practicing health behaviors on unmet needs among patients with chronic diseases, using data from the Korea Health Panel Survey conducted between 2014–2017. Participants (n = 4069) aged 19 or older, with at least one chronic disease (hypertension, diabetes mellitus, dyslipidemia, or arthrosis) and with existing follow up data were selected. Health behaviors combined three variables: not presently smoking, not belonging to high-risk drinking group, and indulging in moderate- or high-intensity exercise. Those who met all three criteria were classified as the practicing health behaviors group. Generalized Estimating Equation analysis was performed to consider correlated data within a subject. Of the participants, 23.9% practiced health behaviors. Participants who did not practice health behaviors were significantly more likely to have unmet needs compared with those who did (OR: 1.24, 95% CI: 1.10–1.39). Further research would be needed to verify the impact of practicing health behavior on unmet needs.
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81
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Paciocco S, Kothari A, Licskai CJ, Ferrone M, Sibbald SL. Evaluating the implementation of a chronic obstructive pulmonary disease management program using the Consolidated Framework for Implementation Research: a case study. BMC Health Serv Res 2021; 21:717. [PMID: 34289847 PMCID: PMC8293496 DOI: 10.1186/s12913-021-06636-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/14/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a prevalent chronic disease that requires comprehensive approaches to manage; it accounts for a significant portion of Canada's annual healthcare spending. Interprofessional teams are effective at providing chronic disease management that meets the needs of patients. As part of an ongoing initiative, a COPD management program, the Best Care COPD program was implemented in a primary care setting. The objectives of this research were to determine site-specific factors facilitating or impeding the implementation of a COPD program in a new setting, while evaluating the implementation strategy used. METHODS A qualitative case study was conducted using interviews, focus groups, document analysis, and site visits. Data were deductively analyzed using the Consolidated Framework for Implementation Research (CFIR) to assess the impact of each of its constructs on Best Care COPD program implementation at this site. RESULTS Eleven CFIR constructs were determined to meaningfully affect implementation. Five were identified as the most influential in the implementation process. Cosmopolitanism (partnerships with other organizations), networks and communication (amongst program providers), engaging (key individuals to participate in program implementation), design quality and packaging (of the program), and reflecting and evaluating (throughout the implementation process). A peer-to-peer implementation strategy included training of registered respiratory therapists (RRT) as certified respiratory educators and the establishment of a communication network among RRTs to discuss experiences, collectively solve problems, and connect with the program lead. CONCLUSIONS This study provides a practical example of the various factors that facilitated the implementation of the Best Care COPD program. It also demonstrates the potential of using a peer-to-peer implementation strategy. Focusing on these factors will be useful for informing the continued spread and success of the Best Care COPD program and future implementation of other chronic care programs.
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Affiliation(s)
- Stefan Paciocco
- Health and Rehabilitation Sciences, Western University, London, Canada
| | - Anita Kothari
- School of Health Studies, Faculty of Health Sciences, Western University, London, Canada
| | - Christopher J Licskai
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | | | - Shannon L Sibbald
- School of Health Studies, Faculty of Health Sciences, Department of Family Medicine, Schulich School of Medicine and Dentistry, The Schulich Interfaculty Program in Public Health, Schulich School of Medicine and Dentistry, Western University, London, Canada.
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Batte C, Mukisa J, Rykiel N, Mukunya D, Checkley W, Knauf F, Kalyesubula R, Siddharthan T. Acceptability of patient-centered hypertension education delivered by community health workers among people living with HIV/AIDS in rural Uganda. BMC Public Health 2021; 21:1343. [PMID: 34233648 PMCID: PMC8264981 DOI: 10.1186/s12889-021-11411-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 06/29/2021] [Indexed: 12/03/2022] Open
Abstract
Background The prevalence of hypertension is increasing among people living with HIV/AIDS (PLWHA) in low- and middle-income countries (LMICs). However, knowledge of the complications and management of hypertension among PLWHA in Uganda remains low. We explored the acceptability of implementing hypertension (HTN) specific health education by community health workers (CHWs) among PLWHA in rural Uganda. Methods We conducted a qualitative study consisting of 22 in-depth interviews (14 PLWHA/HTN and 8 CHWs), 3 focus group discussions (FGDs), 2 with PLWHA/HTN and 1 with CHWs from Nakaseke district, Uganda. Participants were interviewed after a single session interaction with the CHW. Data were transcribed from luganda (local language) into English and analyzed using thematic analysis. We used Sekhon’s model of acceptability of health Interventions to explore participants’ perceptions. Results Participants believed CHWs utilized easy-to-understand, colloquial, non-technical language during education delivery, had a pre-existing rapport with the CHWs that aided faster communication, and had more time to explain illness than medical doctors had. Participants found the educational material (PocketDoktor™) to be simple and easy to understand, and perceived that the education would lead to improved health outcomes. Participants stated their health was a priority and sought further disease-specific information. We also found that CHWs were highly motivated to carry out the patient-centered education. While delivering the education, CHWs experienced difficulties in keeping up with the technical details regarding hypertension in the PocketDoktor™, financial stress and patient questions beyond their self-perceived skill level and experience. PLWHA/HTN had challenges accessing the health facility where the intervention was delivered and preferred a household setting. Conclusions Hypertension patient-centered education delivered by CHWs using the PocketDoktor™ was acceptable to PLWHA and hypertension in Nakaseke area in rural, Uganda. There is need for further studies to determine the cost implications of delivering this intervention among PLWHA across LMIC settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11411-6.
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Affiliation(s)
- Charles Batte
- School of Medicine, Lung Institute, Makerere University College of Health Sciences, Upper Hill Mulago Hill, Kampala, Uganda.
| | - John Mukisa
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Natalie Rykiel
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA.,Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, USA
| | - David Mukunya
- Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA.,Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, USA
| | - Felix Knauf
- Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Robert Kalyesubula
- School of Medicine, Lung Institute, Makerere University College of Health Sciences, Upper Hill Mulago Hill, Kampala, Uganda
| | - Trishul Siddharthan
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, USA.,Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, USA
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Han KT, Kim SJ. Association between early treatment hospitals, serum cholesterol level and cardiovascular disease risk in dyslipidemia patients. Eur J Public Health 2021; 31:265-271. [PMID: 33038217 DOI: 10.1093/eurpub/ckaa139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 06/04/2020] [Accepted: 07/08/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Studies have shown the importance of managing chronic diseases, such as cardiovascular disease (CVD), at the primary treatment level. Here, we aimed to evaluate the association between medical treatment institutions and health outcomes in patients with dyslipidemia, a major risk of CVD, to provide evidence for increasing chronic disease management at the primary care level in Korea. METHODS We used National Health Insurance Sampling cohort data, of which 37 506 patients were newly diagnosed with dyslipidemia during 2009-14. CVD risk and changes in serum cholesterol level after dyslipidemia diagnosis were outcome variable examined. A generalized estimating equation model was used to identify associations between initial medical institution, CVD risk and changes in serum cholesterol levels. The Cox proportional-hazard ratio was used to assess the association between initial medical institutions and detailed CVD risk. Subgroup analyses were conducted to assess CVD risk following treatment with prescription medication. RESULTS Our analyses demonstrate that CVD risk was lower at primary care-level community health centers and clinics compared to tertiary hospitals, with a statistically significant difference observed in clinics. Ischemic heart disease was lower at community health centers and clinics. However, all medical institution types were associated with significantly lower serum cholesterol levels compared to the baseline. CONCLUSIONS Management of patients with dyslipidemia at primary care institutions was associated with reduced CVD risk and decreased serum cholesterol levels. Therefore, policymakers should strengthen the quality of healthcare at primary care institutions and educate patients that these institutions are appropriate for managing chronic disease.
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Affiliation(s)
- Kyu-Tae Han
- Division of Cancer Management Policy, National Cancer Center, Goyang, Republic of Korea
| | - Seung Ju Kim
- Department of Nursing, College of Nursing, Eulji University, Seongnam, Republic of Korea
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Eldor R, Merzon E, Shpigelman M, Tamir O, Vinker S, Raz I, Merhasin I, Wald D, Golan-Cohen A. Effect of a primary-care-team focused diabetes educational program project on diabetes care quality indicators in a large health maintenance organization. Diabetes Res Clin Pract 2021; 177:108896. [PMID: 34098056 DOI: 10.1016/j.diabres.2021.108896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 05/09/2021] [Accepted: 05/31/2021] [Indexed: 11/25/2022]
Abstract
AIMS In 2011 the central district of Leumit Health Services (LHS) (a health maintenance organization in Israel) implemented a chronic care program to improve diabetes care in general practice: MESSAGE program (Motivation, Education, Skills and Supervision to Achieve better diabetes care in General practice Environment), included training phase and ongoing time allocation for diabetes care. METHODS A population-based retrospective analysis of LHS Electronic Medical Records of all patients with diabetes in LHS between 1 June 2015 and 31 May 2018. Data was processed according to the definitions of the Israeli national program for quality indicators in community healthcare. ~442,000 adults were included, ~49,000 in MESSAGE engaged clinics. RESULTS The prevalence of diabetes in LHS was ~9.7-9.31% during study period. Over 3 years follow up, the prevalence of patients with A1C ≥ 9% declined in all districts of LHS but to a significantly greater extent in MESSAGE clinics [2015: MESSAGE 12.4%, LHS-combined 13.09%; OR 0.92 (0.83-1.01) p = 0.075; 2018: MESSAGE 8.51%, LHS-combined 10.85%; 0.76 (0.69-0.85) p < 0.001]. Other indicators of diabetes care did not change. CONCLUSION The MESSAGE intervention program resulted in improved glycemic control. It is currently being modified to address all aspects of diabetes care and is implemented across all districts of LHS in Israel.
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Affiliation(s)
- Roy Eldor
- Leumit Health Services, Medical Division, Tel-Aviv, Israel; Diabetes Unit, Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel; The Sackler Faculty of Medicine, Tel-Aviv University, Israel; D-Cure Foundation, Petah-Tikva, Israel
| | - Eugene Merzon
- Leumit Health Services, Medical Division, Tel-Aviv, Israel; Department of Family Medicine, Sackler School of Medicine, Tel Aviv University, Israel.
| | - Miriam Shpigelman
- Leumit Health Services, Central District Headquarter, Netanya, Israel
| | - Orly Tamir
- The Pesach Segal Israeli Center for Diabetes Research and Policy, Sheba Medical Center, Ramat Gan, Israel; The Sackler Faculty of Medicine, Tel-Aviv University, Israel; D-Cure Foundation, Petah-Tikva, Israel
| | - Shlomo Vinker
- Leumit Health Services, Medical Division, Tel-Aviv, Israel; Department of Family Medicine, Sackler School of Medicine, Tel Aviv University, Israel
| | - Itamar Raz
- The Pesach Segal Israeli Center for Diabetes Research and Policy, Sheba Medical Center, Ramat Gan, Israel
| | - Ilya Merhasin
- Leumit Health Services, Central District Headquarter, Netanya, Israel
| | - David Wald
- Leumit Health Services, Central District Headquarter, Netanya, Israel
| | - Avivit Golan-Cohen
- Leumit Health Services, Medical Division, Tel-Aviv, Israel; Department of Family Medicine, Sackler School of Medicine, Tel Aviv University, Israel
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The Role of Community-Based Organizations in Improving Chronic Care for Safety-Net Populations. J Am Board Fam Med 2021; 34:698-708. [PMID: 34312263 PMCID: PMC9875859 DOI: 10.3122/jabfm.2021.04.200591] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/29/2021] [Accepted: 02/08/2021] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Social determinants of health (SDoH) influence health outcomes and contribute to disparities in chronic disease in vulnerable populations. To inform health system strategies to address SDoH, we conducted a multi-stakeholder qualitative study to capture the multi-level influences on health for those living in socio-economically deprived contexts. METHODS Varied qualitative inquiry methods - in-depth interviews, participant-led neighborhood tours, and clinic visit observations - involving a total of 23 participants (10 patients with chronic illnesses in San Francisco neighborhoods with high chronic disease rates, 10 community leaders serving the same neighborhoods, and 3 providers from San Francisco's public health care delivery system). Qualitative analyses were guided by the Chronic Care Model (CCM). RESULTS Several key themes emerged from this study. First, we enumerated a large array, neighborhood resources such as food pantries, parks/green spaces, and financial assistance services that interact with patients' self-management. Health service providers leveraged these resources to address patients' social needs but suggested a clear need for expanding this work. Second, analyses uncovered multiple essential mechanisms by which community-based organizations (CBOs) provided and navigated among many neighborhood health resources, including social support and culturally aligned knowledge. Finally, many examples of how structural issues such as institutional racism, transportation, and housing inequities are intertwined with health and social service delivery were elucidated. CONCLUSION The results contribute new evidence toward the community domain of the CCM. Health care systems must intentionally partner with CBOs to address SDoH and improve community resources for chronic care management, and directly address structural issues to make progress.
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Putri LP, Mawarni D, Trisnantoro L. Challenges of Shifting Diabetes Mellitus Care From Secondary- to Primary-Level Care in Urban and Rural Districts: A Qualitative Inquiry Among Health Providers. J Prim Care Community Health 2021; 11:2150132720924214. [PMID: 32517534 PMCID: PMC7288842 DOI: 10.1177/2150132720924214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objectives: The study aims to understand the acceptability of
Prolanis, a program that shifts the diabetes mellitus type 2 (T2DM) patient
management from secondary to primary care, among Indonesian primary health care
providers. Method: We completed face-to-face semistructured
interviews with 14 health professionals from 3 urban and 4 rural
government-owned primary health care clinics (Puskesmas) in 4
districts. We performed content analysis using the theoretical framework of
acceptability (TFA) to understand which factors could facilitate or reduce
acceptability. Results: Our study identifies that lack of health
care providers’ acceptability to Prolanis was attributable to the negative
affective attitude, low perceived effectiveness, poor self-efficacy, and work
burden. The use of Prolanis output as one of the pay-for-performance indicators
was deemed unsuitable because it could demotivate health providers to capture
more undetected T2DM cases. This, compounded by lacking perceived benefit for
the health care providers, leading to negative attitudes. Participants believed
that the program improved patients’ adherence to visiting clinics routinely;
however, the absence of a formal evaluation of reductions of key T2DM
indicators—blood glucose level and HbA1c—causing the health providers to doubt
the program effectiveness. Availability of or access to adequate blood glucose
testing equipment is also of paramount importance to improve acceptability.
Although the significant increase in patient load only occurred to
Puskesmas with lacking doctors, an increased workload
burden due to clerical works was experienced by the nonmedical workforce. The
program appears to be more acceptable for health care providers in urban
Puskesmas compared with their rural counterparts,
attributable to better geographical accessibility and care-seeking behavior
among people living in urban locations. Conclusions: This study
highlights critical issues that should be addressed to improve the acceptability
of Prolanis among health care professionals. Government or stakeholders play a
critical role in improving program acceptability. More study is needed to
capture wider variety of health care facilities’ characteristics.
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Affiliation(s)
- Likke Prawidya Putri
- Universitas Gadjah Mada, Yogyakarta, Indonesia.,Monash University, Bendigo, Victoria, Australia
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87
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Lesser LI, Behal R. Change in Glycemic Control for Patients Enrolled in a Membership-Based Primary Care Program: Longitudinal Observational Study. JMIR Diabetes 2021; 6:e27453. [PMID: 33999830 PMCID: PMC8235285 DOI: 10.2196/27453] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/19/2021] [Accepted: 05/13/2021] [Indexed: 01/23/2023] Open
Abstract
Background Both primary care practices based on the chronic care model (CCM) and digital therapeutics have been shown to improve the care of patients with diabetes. Objective The aim of this observational study was to examine the change in diabetes control for patients enrolled in a membership-based primary care service that is based on the CCM. Methods Using a diabetes registry, we analyzed the change in glycated hemoglobin (HbA1c) for patients with uncontrolled diabetes mellitus (initial HbA1c≥9%). All patients had access to a technology-enhanced primary care practice built on the CCM. Results The registry included 621 patients diagnosed with uncontrolled diabetes. All patients had at least two HbA1c measurements, with the average time between the first and last measurement of 1.2 years (SD 0.4). The average starting value of HbA1c was 10.7, which decreased to 8.7, corresponding to a reduction of 2.03 (P<.001). Secondary analyses showed statistically significant reductions in total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides. Conclusions Patients with initially uncontrolled diabetes who undergo care in a technology-enhanced primary care practice based on the CCM have long-term clinically meaningful reductions in HbA1c.
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Affiliation(s)
| | - Raj Behal
- One Medical, San Francisco, CA, United States
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88
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Talavera GA, Castañeda SF, Mendoza PM, Lopez-Gurrola M, Roesch S, Pichardo MS, Garcia ML, Muñoz F, Gallo LC. Latinos understanding the need for adherence in diabetes (LUNA-D): a randomized controlled trial of an integrated team-based care intervention among Latinos with diabetes. Transl Behav Med 2021; 11:1665-1675. [PMID: 34057186 DOI: 10.1093/tbm/ibab052] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
We developed and tested a culturally appropriate, team-based, integrated primary care and behavioral health intervention in low income, Spanish-speaking Latinos with type 2 diabetes, at a federally qualified health center. This pragmatic randomized controlled trial included 456 Latino adults, 23-80 years, 63.7% female, with diabetes [recruitment glycosylated hemoglobin (HbA1c) ≥ 7.0%/53.01 mmol/mol)]. The Special Intervention occurred over 6 months and targeted improvement of HbA1c, blood pressure, and lipids. The intervention included: (i) four, same-day integrated medical and behavioral co-located visits; (ii) six group diabetes self-management education sessions addressing the cultural dimensions of diabetes and lifestyle messages; (iii) and care coordination. Usual Care participants received primary care provider led standard diabetes care, with referrals to health education and behavioral health as needed. HbA1c and lipids were obtained through electronic health records abstraction. Blood pressure was measured by trained research staff. Multi-level models showed a significant group by time interaction effect (B = -0.32, p < .01, 95% CI -0.49, -0.15), indicating statistically greater improvement in HbA1c level over 6 months in the Special Intervention group (ΔHbA1c = -0.35, p = <.01) versus Usual Care (ΔHbA1c = -0.02, p = .72). Marginally significant group by time interactions were also found for total cholesterol and diastolic blood pressure, with significant improvements in the Special Intervention group (p < .05). This culturally appropriate model of highly integrated care offers strategies that can assist with self-management goals and disease management for Latinos with diabetes in a federally qualified health center setting.
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Affiliation(s)
- Gregory A Talavera
- South Bay Latino Research Center, Chula Vista, CA, USA.,Department of Psychology, San Diego State University, San Diego, CA, USA
| | | | | | | | - Scott Roesch
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Margaret S Pichardo
- College of Medicine, Howard University, Washington, DC, USA.,Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Melawhy L Garcia
- Center for Latino Community Health, Evaluation, and Leadership Training, Department of Health Science, California State University Long Beach, Long Beach, CA, USA
| | - Fatima Muñoz
- Department of Research, San Ysidro Health, San Diego, CA, USA
| | - Linda C Gallo
- South Bay Latino Research Center, Chula Vista, CA, USA.,Department of Psychology, San Diego State University, San Diego, CA, USA
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89
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Aleandri M, Scalorbi S, Pirazzini MC. Electronic nursing care plans through the use of NANDA, NOC, and NIC taxonomies in community setting: A descriptive study in northern Italy. Int J Nurs Knowl 2021; 33:72-80. [PMID: 33960713 PMCID: PMC9290471 DOI: 10.1111/2047-3095.12326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/02/2021] [Accepted: 04/10/2021] [Indexed: 11/29/2022]
Abstract
Purpose To carry on a descriptive analysis of nursing standardized language through the use of a software within outpatient facilities in northern Italy, organized according to the Chronic Care Model (CCM) and called Community Health Centers (CHC). Methods A descriptive design was adopted for the study. NANDA‐I, NOC, and NIC taxonomies have been used to analyze care plans pulled from the software. Both qualitative and quantitative data were analyzed. Findings The average of nursing diagnosis correctly identified with respect to the nursing assessment is 83.7% (SD 29.9%). Class 4 diagnoses from Domains 4 have been identified as the most prevalent (22.4%), followed by risk for unstable blood glucose level 00179 (16.4%) and risk for overweight 00234 (13%). The main nursing outcomes were vital signs 0802 (22.5%), blood glucose level 2300 (16%), and weight loss behavior 1627 (11%). The most prevalent nursing interventions are wound care 3660 (27%), medication administration: intramuscular 2313 (19%), and health education 5510 (14%). The analysis shows ability in identifying nursing diagnoses, but a larger variability with outcomes and interventions. The study highlights the nursing role within CHC and identifies the main areas of expertise in chronic disease management: prevention and health education. Conclusions Nurses’ role is fundamental for chronic disease management within CHC; NANDA‐I taxonomy helps to analyze care plans. Implications for nursing practice ‐ A taxonomy such as NANDA‐I represents a valid opportunity to make more visible how much nursing skills affect the achievement of a higher level of health in chronic patients. ‐ This study is useful in the further training of outpatient nurses who works in CHC. ‐ The study represents the starting point for future research to deepen the development of a standardized nursing language in outpatient facilities.
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90
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Simonsen N, Koponen AM, Suominen S. Empowerment among adult patients with type 2 diabetes: age differentials in relation to person-centred primary care, community resources, social support and other life-contextual circumstances. BMC Public Health 2021; 21:844. [PMID: 33933065 PMCID: PMC8088546 DOI: 10.1186/s12889-021-10855-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 04/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rising prevalence of type 2 diabetes (T2D), also among younger adults, constitutes a growing public health challenge. According to the person-centred Chronic Care Model, proactive care and self-management support in combination with community resources enhance quality of healthcare and health outcomes for patients with T2D. However, research is scarce concerning the importance of person-centred care and community resources for such outcomes as empowerment, and the relative impact of various patient support sources for empowerment is not known. Moreover, little is known about the association of age with these variables in this patient-group. This study, carried out among patients with T2D, examined in three age-groups (27-54, 55-64 and 65-75 years) whether person-centred care and diabetes-related social support, including community support and possibilities to influence community health issues, are associated with patient empowerment, when considering possible confounding factors, such as other quality of care indicators and psychosocial wellbeing. We also explored age differentials in empowerment and in the proposed correlates of empowerment. METHOD Individuals from a register-based sample with T2D participated in a cross-sectional survey (participation 56%, n = 2866). Data were analysed by descriptive statistics and multivariate logistic regression analyses. RESULTS Respondents in the youngest age-group were more likely to have low empowerment scores, less continuity of care, and lower wellbeing than the other age-groups, and to perceive less social support, but a higher level of person-centred care than the oldest group. Community support, including possibilities to influence community health issues, was independently and consistently associated with high empowerment in all three age-groups, as was person-centred care in the two older age-groups. Community support was the social support variable with the strongest association with empowerment across age-groups. Moreover, vitality was positively and diabetes-related distress negatively associated with high empowerment in all age-groups, whereas continuity of care, i.e. having a family/regular nurse, was independently associated in the youngest age-group only. CONCLUSION Person-centred care and community support, including possibilities to influence community health issues, supports empowerment among adults with T2D. Findings suggest that age is related to most correlates of empowerment, and that younger adults with T2D have specific healthcare needs.
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Affiliation(s)
- Nina Simonsen
- Folkhälsan Research Center, Public Health Research Program, P.O. Box 211, 00251 Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Anne M. Koponen
- Folkhälsan Research Center, Public Health Research Program, P.O. Box 211, 00251 Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Sakari Suominen
- Department of Public Health, University of Turku, Turku University Hospital, Lemminkäisenkatu 1, Turun yliopisto, 20014 Turku, Finland
- School of Health and Education, University of Skövde, Skövde, Sweden
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91
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Factors Influencing Healthcare Experience of Patients with Self-Declared Diabetes: A Cross-Sectional Population-Based Study in the Basque Country. Healthcare (Basel) 2021; 9:healthcare9050509. [PMID: 33925113 PMCID: PMC8145886 DOI: 10.3390/healthcare9050509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/22/2021] [Accepted: 04/24/2021] [Indexed: 01/03/2023] Open
Abstract
Background: Diabetes affects more than 400 million people around the world. Few published studies incorporate questionnaires that comprehensively cover every aspect of a patient’s experience of healthcare. This study analyzes potential differences in the healthcare experience for patients with diabetes based on their sociodemographic, economic, and health-related characteristics from a comprehensive viewpoint in an integrated delivery system. Methods: We used data from the 2018 Basque Health Survey, which includes a questionnaire for the measurement of the experiences of patients with chronic problems. We present descriptive and regression analyses to explore differences by sociodemographic, economic, and health-related characteristics of patients’ experiences with different healthcare services. Results: Having diabetes plus other comorbidities significantly decreases the quality of the experience with all healthcare services and decreases the global healthcare experience score. When comorbidities are present, the elderly seem to report better experiences than younger patients. Some differences in experience can be explained by sociodemographic and economic factors. No differences exist between conditions co-occurring with diabetes. Conclusion: Patients with diabetes who also suffer from other conditions report worse experiences than individuals who suffer from diabetes only. No specific conditions explain the differences in care experience.
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92
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Jones A, Bardram JE, Bækgaard P, Cramer-Petersen CL, Skinner T, Vrangbæk K, Starr L, Nørgaard K, Lind N, Bechmann Christensen M, Glümer C, Wang-Sattler R, Laxy M, Brander E, Heinemann L, Heise T, Schliess F, Ladewig K, Kownatka D. Integrated personalized diabetes management goes Europe: A multi-disciplinary approach to innovating type 2 diabetes care in Europe. Prim Care Diabetes 2021; 15:360-364. [PMID: 33184011 DOI: 10.1016/j.pcd.2020.10.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/15/2020] [Accepted: 10/18/2020] [Indexed: 10/23/2022]
Abstract
Type 2 diabetes mellitus represents a multi-dimensional challenge for European and global societies alike. Building on an iterative six-step disease management process that leverages feedback loops and utilizes commodity digital tools, the PDM-ProValue study program demonstrated that integrated personalized diabetes management, or iPDM, can improve the standard of care for persons living with diabetes in a sustainable way. The novel "iPDM Goes Europe" consortium strives to advance iPDM adoption by (1) implementing the concept in a value-based healthcare setting for the treatment of persons living with type 2 diabetes, (2) providing tools to assess the patient's physical and mental health status, and (3) exploring new avenues to take advantage of emerging big data resources.
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Affiliation(s)
- Allan Jones
- Roche Diabetes Care GmbH, Mannheim, Germany.
| | | | - Per Bækgaard
- Technical University of Denmark, Lyngby, Denmark
| | | | | | | | - Laila Starr
- University of Copenhagen, Copenhagen, Denmark
| | | | - Nanna Lind
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | | | | | - Rui Wang-Sattler
- German Research Centre for Environmental Health, Neuherberg, Germany; German Center for Diabetes Research, Germany
| | - Michael Laxy
- German Research Centre for Environmental Health, Neuherberg, Germany; German Center for Diabetes Research, Germany
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93
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Dyb K, Berntsen GR, Kvam L. Adopt, adapt, or abandon technology-supported person-centred care initiatives: healthcare providers' beliefs matter. BMC Health Serv Res 2021; 21:240. [PMID: 33731078 PMCID: PMC7968358 DOI: 10.1186/s12913-021-06262-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/08/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Technology support and person-centred care are the new mantra for healthcare programmes in Western societies. While few argue with the overarching philosophy of person-centred care or the potential of information technologies, there is less agreement on how to make them a reality in everyday clinical practice. In this paper, we investigate how individual healthcare providers at four innovation arenas in Scandinavia experienced the implementation of technology-supported person-centred care for people with long-term care needs by using the new analytical framework nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability (NASSS) of health and care technologies. We also discuss the usability and sensitivity of the NASSS framework for those seeking to plan, implement, and evaluate technology-supported healthcare programmes. This study is part of an interdisciplinary research and development project called Patients and Professionals in Partnership (2016-2020). It originates at one of ten work packages in this project. METHOD The main data consist of ethnographic field observations at the four innovation arenas and 29 interviews with involved healthcare providers. To ensure continuous updates and status on work in the four innovation arenas, we have also participated in a total of six annual network meetings arranged by the project. RESULTS While the NASSS framework is very useful for identifying and communicating challenges with the adoption and spread of technology-supported person-centred care initiatives, we found it less sensitive towards capturing the dedication, enthusiasm, and passion for care transformation that we found among the healthcare providers in our study. When it comes to technology-supported person-centred care, the point of no return has passed for the involved healthcare providers. To them, it is already a definite part of the future of healthcare services. How to overcome barriers and obstacles is pragmatically approached. CONCLUSION Increased knowledge about healthcare providers and their visions as potential assets for care transformation might be critical for those seeking to plan, implement, and evaluate technology-supported healthcare programmes.
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Affiliation(s)
- Kari Dyb
- Norwegian Centre for E-health Research, University Hospital of North Norway, P.O. Box 35, N-9038, Tromsø, Norway.
| | - Gro Rosvold Berntsen
- Norwegian Centre for E-health Research, University Hospital of North Norway, P.O. Box 35, N-9038, Tromsø, Norway
| | - Lisbeth Kvam
- Department of Mental Health, Faculty of Medicine and Health Sciences, Trondheim, Norway
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94
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Firestone R, Faeamani G, Okiakama E, Funaki T, Henry A, Prapavessis D, Masaga J, Firestone J, Tiatia-Seath J, Matheson A, Brown B, Schleser M, Kaholokula K, Ing C, Borman B, Ellison-Loschmann L. Pasifika Prediabetes Youth Empowerment Programme: learnings from a youth-led community-based intervention study. THE NEW ZEALAND MEDICAL JOURNAL 2021; 134:57-68. [PMID: 33651778 PMCID: PMC8816523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
AIM Using a co-design approach, we describe exploratory findings of a community-based intervention to mobilise Pasifika communities into action, with the intent of reducing the risk factors of prediabetes. METHOD A group of 25 Pasifika youth aged 15-24 years from two distinctive Pasifika communities in New Zealand were trained to lead a small-scale, community-based intervention programme (among 29 participants) over the course of eight weeks. The intervention, which targeted adults aged 25-44 years who were overweight or obese, employed both an empowerment-based programme and a co-design approach to motivate community members to participate in a physical-activity-based intervention programme. RESULTS Findings show significant reductions in total body weight and waist circumference, as well as improved physical activity. CONCLUSIONS The strength of this intervention was evident in the innovative approach of utilising Pasifika-youth-led and co-designed approaches to motivate communities into healthier lifestyles. The approaches used in this project could be utilised in a primary healthcare setting as a community-wide strategy to reduce diabetes risk, particularly among Pasifika peoples.
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Affiliation(s)
- Ridvan Firestone
- Senior Research Officer/Principal Investigator, Centre for Public Health Research, Massey University
| | - Gavin Faeamani
- The Fono, 411 Great North Road, Henderson, Auckland 0612, New Zealand
| | - Elizabeth Okiakama
- South Waikato Pacific Islands Community Services, 1 Maraetai Road, Tokoroa 3444, New Zealand
| | - Tevita Funaki
- The Fono, 411 Great North Road, Henderson, Auckland 0612, New Zealand
| | - Akarere Henry
- South Waikato Pacific Islands Community Services, 1 Maraetai Road, Tokoroa 3444, New Zealand
| | - Danielle Prapavessis
- Centre for Public Health Research, Massey University, PO Box 756, Wellington 6140, New Zealand
| | - Jennifer Masaga
- Centre for Public Health Research, Massey University, PO Box 756, Wellington 6140, New Zealand
| | - Justice Firestone
- Centre for Public Health Research, Massey University, PO Box 756, Wellington 6140, New Zealand
| | - Jemaima Tiatia-Seath
- School of Māori Studies and Pacific Studies, Faculty of Arts, University of Auckland, Bldg 273, 20 Wynyard Street, Auckland 1010, New Zealand
| | - Anna Matheson
- School of Health, Faculty of Health, Victoria University of Wellington, Level 1, Student Union Building, Wellington, New Zealand
| | - Blakely Brown
- School of Public and Community Health Sciences, College of Health Professions & Biomedical Sciences, University of Montana, 340 Skaggs Building, Missoula, MT 59812, USA
| | - Max Schleser
- Department of Film and Animation, School of Arts, Social Sciences and Humanities, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne 3122, Australia
| | - Keawe'aimoku Kaholokula
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawaii at Manoa, 677 Ala Moana Blvd. 1016, Honolulu, Hawaii 96813
| | - Claire Ing
- Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawaii at Manoa, 677 Ala Moana Blvd. 1016, Honolulu, Hawaii 96813
| | - Barry Borman
- Centre for Public Health Research, Massey University, PO Box 756, Wellington 6140, New Zealand
| | - Lis Ellison-Loschmann
- Centre for Public Health Research, Massey University, PO Box 756, Wellington 6140, New Zealand
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95
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Beck J, Greenwood DA, Blanton L, Bollinger ST, Butcher MK, Condon JE, Cypress M, Faulkner P, Fischl AH, Francis T, Kolb LE, Lavin-Tompkins JM, MacLeod J, Maryniuk M, Mensing C, Orzeck EA, Pope DD, Pulizzi JL, Reed AA, Rhinehart AS, Siminerio L, Wang J. 2017 National Standards for Diabetes Self-Management Education and Support. Sci Diabetes Self Manag Care 2021; 47:14-29. [PMID: 34078205 DOI: 10.1177/0145721720987926] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE The purpose of this study is to review the literature for Diabetes Self-Management Education and Support (DSMES) to ensure the National Standards for DSMES (Standards) align with current evidence-based practices and utilization trends. METHODS The 10 Standards were divided among 20 interdisciplinary workgroup members. Members searched the current research for diabetes education and support, behavioral health, clinical, health care environment, technical, reimbursement, and business practice for the strongest evidence that guided the Standards revision. RESULTS Diabetes Self-Management Education and Support facilitates the knowledge, skills, and ability necessary for diabetes self-care as well as activities that assist a person in implementing and sustaining the behaviors needed to manage their condition on an ongoing basis. The evidence indicates that health care providers and people affected by diabetes are embracing technology, and this is having a positive impact of DSMES access, utilization, and outcomes. CONCLUSION Quality DSMES continues to be a critical element of care for all people with diabetes. The DSMES services must be individualized and guided by the concerns, preferences, and needs of the person affected by diabetes. Even with the abundance of evidence supporting the benefits of DSMES, it continues to be underutilized, but as with other health care services, technology is changing the way DSMES is delivered and utilized with positive outcomes.
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Affiliation(s)
- Joni Beck
- From the University of Oklahoma Health Sciences Center, College of Medicine, Oklahoma City, Oklahoma.,Technical Writer, Washington, DC (Wahowiak)
| | - Deborah A Greenwood
- Consultant, Granite Bay, California.,Technical Writer, Washington, DC (Wahowiak)
| | - Lori Blanton
- Florida Hospital, Tampa, Florida.,Technical Writer, Washington, DC (Wahowiak)
| | - Sandra T Bollinger
- Health Priorities, Cape Girardeau, Missouri.,Technical Writer, Washington, DC (Wahowiak)
| | - Marcene K Butcher
- Montana Diabetes Program, Lewistown, Montana.,Technical Writer, Washington, DC (Wahowiak)
| | - Jo Ellen Condon
- American Diabetes Association, Arlington, Virginia.,Technical Writer, Washington, DC (Wahowiak)
| | - Marjorie Cypress
- Consultant, Albuquerque, New Mexico.,Technical Writer, Washington, DC (Wahowiak)
| | - Priscilla Faulkner
- University of Northern Colorado, Fort Collins, Colorado.,Technical Writer, Washington, DC (Wahowiak)
| | - Amy Hess Fischl
- University of Chicago, Chicago, Illinois.,Technical Writer, Washington, DC (Wahowiak)
| | - Theresa Francis
- San Diego City College, San Diego, California.,Technical Writer, Washington, DC (Wahowiak)
| | - Leslie E Kolb
- American Association of Diabetes Educators, Chicago, Illinois.,Technical Writer, Washington, DC (Wahowiak)
| | | | - Janice MacLeod
- WellDoc, Columbia, Maryland.,Technical Writer, Washington, DC (Wahowiak)
| | - Melinda Maryniuk
- Joslin Diabetes Center, Boston, Massachusetts.,Technical Writer, Washington, DC (Wahowiak)
| | - Carolé Mensing
- National Certification Board for Diabetes Educators, Arlington Heights, Illinois.,Technical Writer, Washington, DC (Wahowiak)
| | - Eric A Orzeck
- Endocrinology Associates, Houston, Texas.,Technical Writer, Washington, DC (Wahowiak)
| | - David D Pope
- Creative Pharmacists, Evans, Georgia.,Technical Writer, Washington, DC (Wahowiak)
| | - Jodi L Pulizzi
- Livongo, Mountain View, California.,Technical Writer, Washington, DC (Wahowiak)
| | - Ardis A Reed
- TMF Health Quality Institute, Austin, Texas.,Technical Writer, Washington, DC (Wahowiak)
| | | | - Linda Siminerio
- University of Pittsburgh Diabetes Institute, Pittsburgh, Pennsylvania.,Technical Writer, Washington, DC (Wahowiak)
| | - Jing Wang
- The University of Texas Health Science Center at Houston, Houston, Texas.,Technical Writer, Washington, DC (Wahowiak)
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96
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Michaud TL, Hill JL, Estabrooks PA, Su D. Cost analysis of a remote patient monitoring programme for post-discharge patients with type 2 diabetes. J Telemed Telecare 2021:1357633X20985393. [PMID: 33497310 DOI: 10.1177/1357633x20985393] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Assessing costs of an evidence-based health promotion programme is crucial to understand the economic feasibility of adopting or sustaining the programme. This study conducted a cost analysis of a remote patient monitoring (RPM) programme to enhance the post-discharge management of type 2 diabetes. METHODS Using retrospective data collected during RPM implementation from September 2014 to February 2018, we estimated the costs of implementing an RPM in the primary care setting. Measures included total and average annual costs, costs per participant who was enrolled or completed the programme, and costs per person-day. We further conducted sensitivity and scenario analyses to examine variations in estimated programme costs associated with varying programme efficiencies and alternative personnel compositions of the RPM team. RESULTS The total RPM implementation costs were estimated at US$4,374,544 with an average annual programme costs of US$1,249,870, which translated to US$3207 per participant (n = 1364) completing the three-month programme. The per person-day cost was averaged at US$24 (182,932 person-days). Sensitivity and scenario analyses results indicate that the sustainment costs were approximately US$1.6 million annually and the per-person-day costs were between US$21 and US$29 with each nurse coach on average serving a panel of 62-93 patients. CONCLUSION The implementation and sustainment costs of an RPM programme, estimated under various assumptions of programme efficiency and care team compositions, as exemplified in this study, will help healthcare organizations make informed decisions in budgeting for and sustaining telehealth programmes to enhance diabetes management.
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Affiliation(s)
- Tzeyu L Michaud
- Center for Reducing Health Disparities, University of Nebraska Medical Center, USA.,Department of Health Promotion, University of Nebraska Medical Center, USA
| | - Jennie L Hill
- Department of Epidemiology, University of Nebraska Medical Center, USA
| | - Paul A Estabrooks
- Center for Reducing Health Disparities, University of Nebraska Medical Center, USA.,Department of Health Promotion, University of Nebraska Medical Center, USA
| | - Dejun Su
- Center for Reducing Health Disparities, University of Nebraska Medical Center, USA.,Department of Health Promotion, University of Nebraska Medical Center, USA
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97
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Aghili R, Valojerdi AE, Farshchi A, Khamseh ME. Type 2 diabetes: patient assessment of chronic illness care. J Diabetes Metab Disord 2021; 20:7-13. [PMID: 34178820 DOI: 10.1007/s40200-020-00540-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/06/2020] [Indexed: 12/21/2022]
Abstract
Objective We tried to assess perception of chronic illness care in people with type 2 diabetes and to determine whether demographic variables, self-care behavior, as well as affective variables were related with perception of chronic illness care. Methods We conducted a secondary analysis of the previously published cross-sectional study in 441 Iranian people with type 2 diabetes. Chronic illness care was assessed with the validated tool of patient assessment of chronic illness care (PACIC). Different aspects of care according to the chronic care model are measured on a scale of 1-5, with 5 being highest perception of care. The association between perception of chronic illness care and measured variables were tested using spearman correlation test as well as univariate and multiple linear regression analysis. Results Finally, 380 filled out the PACIC questionnaire, completely (53.4% female, mean age: 54.73 ± 8.0 years, mean PACIC score: 2.52 ± 0.87). In spearman correlation test, considering PACIC score as the dependent variable, chronic illness care was inversely associated with level of education and distress, whereas, insulin treatment, wellbeing, family-social support and self-management were positively associated with chronic care (All p value<0.05). In the multiple linear regression analysis, family-social support was positively related to chronic care while level of education, marital status, diabetes-related distress, and high density lipoprotein had significant negative relationship with PACIC score (All p value<0.05). Conclusions Family-social support, level of education, marital status, and diabetes-related distress are the major determinants of patient experience of chronic illness care in people with type 2 diabetes.
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Affiliation(s)
- Rokhsareh Aghili
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, No. 10, Firoozeh St., South Vali-asr Ave., Vali-asr Sq., Tehran, 15937-16615 Iran
| | - Ameneh Ebrahim Valojerdi
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, No. 10, Firoozeh St., South Vali-asr Ave., Vali-asr Sq., Tehran, 15937-16615 Iran
| | - Amir Farshchi
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, No. 10, Firoozeh St., South Vali-asr Ave., Vali-asr Sq., Tehran, 15937-16615 Iran.,Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ebrahim Khamseh
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, No. 10, Firoozeh St., South Vali-asr Ave., Vali-asr Sq., Tehran, 15937-16615 Iran
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98
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc21-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc21-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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99
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4. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Medical Care in Diabetes-2021. Diabetes Care 2021; 44:S40-S52. [PMID: 33298415 DOI: 10.2337/dc21-s004] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc21-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc21-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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100
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Fortmann AL, Walker C, Barger K, Robacker M, Morrisey R, Ortwine K, Loupasi I, Lee I, Hogrefe L, Strohmeyer C, Philis-Tsimikas A. Care Team Integration in Primary Care Improves One-Year Clinical and Financial Outcomes in Diabetes: A Case for Value-Based Care. Popul Health Manag 2020; 23:467-475. [PMID: 31944895 PMCID: PMC7864113 DOI: 10.1089/pop.2019.0103] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Despite significant treatment advances, diabetes outcomes remain suboptimal and health care costs continue to rise. There are limited data on the feasibility and financial implications of integrating a diabetes-specific care team in the primary care setting (ie, where the majority of diabetes is treated). This pragmatic quality improvement project investigated whether a cardiometabolic care team intervention (CMC-TI) could achieve greater improvements in clinical, behavioral, and cost outcomes compared to usual diabetes care in a large primary care group in Southern California. Over 12 months, n = 236 CMC-TI and n = 239 usual care patients with type 1 or 2 diabetes were identified using the electronic medical record. In the CMC-TI group, a registered nurse (RN)/certified diabetes educator care manager, medical assistant health coach, and RN depression care manager utilized electronic medical record-based risk stratification reports, standardized decision-support tools, live and remote tailored treatments, and coaching to manage care. Results indicated that the CMC-TI group achieved greater improvements in glycemic and lipid control, diabetes self-management behaviors, and emotional distress over 1 year compared with the usual care group (all P < .05). The CMC-TI group also had a significant 12.6% reduction in total health care costs compared to a 51.7% increase in the usual care group during the same period and inclusive of CMC-TI program costs. Patients and providers reported high satisfaction with CMC-TI. These findings highlight that team-based care management interventions that utilize nurses, medical assistant health coaches, and behavioral specialists to support diabetes patients can help primary care practices achieve value-based targets of improved health, cost, and patient experience.
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Affiliation(s)
| | - Chris Walker
- Scripps Whittier Diabetes Institute, San Diego, California, USA
| | - Kelly Barger
- Scripps Whittier Diabetes Institute, San Diego, California, USA
| | - Maire Robacker
- Scripps Whittier Diabetes Institute, San Diego, California, USA
| | - Robin Morrisey
- Scripps Whittier Diabetes Institute, San Diego, California, USA
| | | | - Ioanna Loupasi
- Scripps Whittier Diabetes Institute, San Diego, California, USA
| | - Ina Lee
- Scripps Health, San Diego, California, USA
| | - Lou Hogrefe
- Scripps Coastal Medical Group, San Diego, California, USA
- Regional Health, Rapid City, South Dakota, USA
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