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The Chronic Care Model and the Transformation of Primary Care. LIFESTYLE MEDICINE 2016. [DOI: 10.1007/978-3-319-24687-1_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Anderson J, Malone L. Chronic care undergraduate nursing education in Australia. NURSE EDUCATION TODAY 2015; 35:1135-1138. [PMID: 26321375 DOI: 10.1016/j.nedt.2015.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 08/05/2015] [Accepted: 08/12/2015] [Indexed: 06/04/2023]
Abstract
The Chronic Care Model developed by Wagner is recognised to provide a systematic approach to managing chronic care. It has been adapted by the World Health Organization to become the Innovative Care for Chronic Conditions Framework. Together these have been demonstrated to provide an effective framework for chronic care management in a variety of settings. In order to prepare Australian nursing graduates for a changing health system it is important to recognise global issues and to prepare them to work within well recognised models. This paper examines the publically available documentation of pre-registration nursing degrees in Australia for their alignment with the Chronic Care Model and the Innovative Care for Chronic Conditions Framework. Those aspects of each which are well addressed are identified along with those which could be improved.
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Affiliation(s)
- Judith Anderson
- Charles Sturt University, School of Nursing, Midwifery and Indigenous Health, Panorama Ave, Bathurst, NSW 2795, Australia.
| | - Linda Malone
- Charles Sturt University, School of Nursing, Midwifery and Indigenous Health, Panorama Ave, Bathurst, NSW 2795, Australia.
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The Chronic Care for Wet Age Related Macular Degeneration (CHARMED) Study: A Randomized Controlled Trial. PLoS One 2015; 10:e0143085. [PMID: 26569501 PMCID: PMC4646575 DOI: 10.1371/journal.pone.0143085] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 10/21/2015] [Indexed: 12/15/2022] Open
Abstract
Background In real life, outcomes in wet age related macular degeneration (W-AMD) continue to fall behind the results from randomized controlled trials. The aim of this trial was to assess if outcomes can be improved by an intervention in healthcare organization following recommendations of the Chronic Care Model (CCM). Methods Multi-centered randomized controlled clinical trial. The multifaceted intervention consisted in reorganization of care (delivery by trained chronic care coaches, using reminder systems, performing structured follow-up, empowering patients in self-monitoring and giving decision-support). In the control usual care was continued. Main outcome measures were changes in ETDRS visual acuity, optical coherence tomography (OCT) macular retinal thickness and quality of life (NEI VFQ-25 questionnaire). Results 169 consecutive patients in Swiss ophthalmology centers were included. Mean ETDRS baseline visual acuity of eyes with W-AMD was 57.8 (± 18.7). After 12 months, the between-group difference in mean change of ETDRS visual acuity was -4.8 (95%CI: -10.8 to +1.2, p = 0.15); difference in mean change of OCT was +14.0 (95% CI -39.6 to 67.6, p = 0.60); difference in mean change of NEI VFQ-25 composite score mean change was +2.1(95%CI: -1.3 to +5.5, p = 0.19). Conclusions The intervention aiming at improving chronic care was not associated with favorable outcomes within 12 months. Other approaches need to be tested to close the evidence-performance gap in W-AMD. Trial Registration Controlled-Trials.com ISRCTN32507927
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Measured outcomes of chronic care programs for older adults: a systematic review. BMC Geriatr 2015; 15:139. [PMID: 26503159 PMCID: PMC4621859 DOI: 10.1186/s12877-015-0136-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 10/19/2015] [Indexed: 11/10/2022] Open
Abstract
Background Wagner’s Chronic Care Model (CCM), as well as the expanded version (ECCM) developed by Barr and colleagues, have been widely adopted as frameworks for prevention and management of chronic disease. Given the high prevalence of chronic illness in older persons, these frameworks can play a valuable role in reorienting the health care system to better serve the needs of seniors. We aimed to identify and assess the measured goals of E/CCM interventions in older populations. In particular, our objective was to determine the extent to which published E/CCM initiatives were evaluated based on population, community, system and individual-level outcomes (including clinical, functional and quality of life measures). Methods We conducted a systematic search of the Science Citation Index Web of Knowledge search tool to gather articles published between January 2003 and July 2014. We included published CCM interventions that cited at least one of the fundamental papers that introduced and described the CCM and ECCM. Studies retained for review reported evaluations of senior-focused E/CCM initiatives in community-based settings, with the topic of “older adults” OR senior* OR elder* OR geriatric OR aged. The resulting 619 published articles were independently reviewed for inclusion by two researchers. We excluded the following: systematic reviews, meta-analyses, descriptions of proposed programs, and studies whose populations did not focus on seniors. Results We identified 14 articles that met inclusion criteria. Studies used a wide range of measures, with little consensus between studies. All of the included studies used the original CCM. While a range of system-level and individual patient outcomes have been used to evaluate CCM interventions, no studies employed measures of population or community health outcomes. Conclusions Future efforts to test E/CCM interventions with seniors would be aided by more consistent outcome measures, greater attention to outcomes for the caregivers of older persons with chronic illness, and a greater focus on population and community impacts.
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Haw JS, Venkat Narayan KM, Ali MK. Quality improvement in diabetes-successful in achieving better care with hopes for prevention. Ann N Y Acad Sci 2015; 1353:138-51. [DOI: 10.1111/nyas.12950] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
| | - K. M. Venkat Narayan
- School of Medicine
- Rollins School of Public Health; Emory University; Atlanta Georgia
| | - Mohammed K. Ali
- Rollins School of Public Health; Emory University; Atlanta Georgia
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Kuo YF, Goodwin JS, Chen NW, Lwin KK, Baillargeon J, Raji MA. Diabetes Mellitus Care Provided by Nurse Practitioners vs Primary Care Physicians. J Am Geriatr Soc 2015; 63:1980-8. [PMID: 26480967 PMCID: PMC4743647 DOI: 10.1111/jgs.13662] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare processes and cost of care of older adults with diabetes mellitus cared for by nurse practitioners (NPs) with processes and cost of those cared for by primary care physicians (PCPs). DESIGN Retrospective cohort study. SETTING Primary care in communities. PARTICIPANTS Individuals with a diagnosis of diabetes mellitus in 2009 who received all their primary care from NPs or PCPs were selected from a national sample of Medicare beneficiaries (N = 64,354). MEASUREMENTS Propensity score matching within each state was used to compare these two cohorts with regard to rate of eye examinations, low-density lipoprotein cholesterol (LDL-C) and glycosylated hemoglobin (HbA1C) testing, nephropathy monitoring, specialist consultation, and Medicare costs. The two groups were also compared regarding medication adherence and use of statins, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (for individuals with a diagnosis of hypertension), and potentially inappropriate medications (PIMs). RESULTS Nurse practitioners and PCPs had similar rates of LDL-C testing (odds ratio (OR) = 1.01, 95% confidence interval (CI) = 0.94-1.09) and nephropathy monitoring (OR = 1.05, 95% CI = 0.98-1.03), but NPs had lower rates of eye examinations (OR = 0.89, 95% CI = 0.84-0.93) and HbA1C testing (OR = 0.88, 95% CI = 0.79-0.98). NPs were more likely to have consulted cardiologists (OR = 1.29, 95% CI = 1.21-1.37), endocrinologists (OR = 1.64, 95% CI = 1.48-1.82), and nephrologists (OR = 1.90, 95% CI = 1.67-2.17) and more likely to have prescribed PIMs (OR = 1.07, 95% CI = 1.01-1.12). There was no statistically significant difference in adjusted Medicare spending between the two groups (P = .56). CONCLUSION Nurse practitioners were similar to PCPs or slightly lower in their rates of diabetes mellitus guideline-concordant care. NPs used specialist consultations more often but had similar overall costs of care to PCPs.
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Affiliation(s)
- Yong-Fang Kuo
- Departments of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas
- Institute for Translational Science, University of Texas Medical Branch, Galveston, Texas
| | - James S. Goodwin
- Departments of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas
- Institute for Translational Science, University of Texas Medical Branch, Galveston, Texas
| | - Nai-Wei Chen
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
| | - Kyaw K. Lwin
- Departments of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas
| | - Jacques Baillargeon
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
| | - Mukaila A. Raji
- Departments of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas
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Mira JJ, Nuño-Solinís R, Fernández-Cano P, Contel JC, Guilabert-Mora M, Solas-Gaspar O. Readiness to tackle chronicity in Spanish health care organisations: a two-year experience with the Instrumento de Evaluación de Modelos de Atención ante la Cronicidad/Assessment of Readiness for Chronicity in Health Care Organisations instrument. Int J Integr Care 2015; 15:e041. [PMID: 27118958 PMCID: PMC4843180 DOI: 10.5334/ijic.1849] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 10/13/2015] [Accepted: 10/14/2015] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The Instrumento de Evaluación de Modelos de Atención ante la Cronicidad/Assessment of Readiness for Chronicity in Health Care Organisations instrument was developed to implement the conceptual framework of the Chronic Care Model in the Spanish national health system. It has been used to assess readiness to tackle chronicity in health care organisations. In this study, we use self-assessments at macro-, meso- and micro-management levels to (a) describe the two-year experience with the Instrumento de Evaluación de Modelos de Atención ante la Cronicidad/Assessment of Readiness for Chronicity in Health Care Organisations tool in Spain and (b) assess the validity and reliability of this instrument. METHODS The results from 55 organisational self-assessments were included and described. In addition to that, the internal consistency, reliability and construct validity of Instrumento de Evaluación de Modelos de Atención ante la Cronicidad/Assessment of Readiness for Chronicity in Health Care Organisations were examined using Cronbach's alpha, the Spearman-Brown coefficient and factorial analysis. RESULTS The obtained scores reflect opportunities for improvement in all dimensions of the instrument. Cronbach's alpha ranged between 0.90 and 0.95 and the Spearman-Brown coefficient ranged between 0.77 and 0.94. All 27 components converged in a second-order factorial solution that explained 53.8% of the total variance, with factorial saturations for the components of between 0.57 and 0.94. CONCLUSIONS Instrumento de Evaluación de Modelos de Atención ante la Cronicidad/Assessment of Readiness for Chronicity in Health Care Organisations is an instrument that allows health care organisations to perform self-assessments regarding their readiness to tackle chronicity and to identify areas for improvement in chronic care.
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Affiliation(s)
- José Joaquín Mira
- Alicante-Sant Joan d'Alacant Health District, Consellería de Sanidad, Alicante and Professor, Miguel Hernández University, Elche, Alicante, Spain
| | | | | | - Joan Carlos Contel
- Chronic Prevention and Care Programme, Department of Health, Servicio Catalán de la Salud (CatSalut), Barcelona, Spain
| | | | - Olga Solas-Gaspar
- International Consultant on Health Policies and Management Organizations and Associated Researcher in New Health Foundation, Spain
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Vachon B, Désorcy B, Gaboury I, Camirand M, Rodrigue J, Quesnel L, Guimond C, Labelle M, Huynh AT, Grimshaw J. Combining administrative data feedback, reflection and action planning to engage primary care professionals in quality improvement: qualitative assessment of short term program outcomes. BMC Health Serv Res 2015; 15:391. [PMID: 26384648 PMCID: PMC4574571 DOI: 10.1186/s12913-015-1056-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 09/11/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improving primary care for chronic disease management requires a coherent, integrated approach to quality improvement. Evidence in the continuing professional development (CPD) field suggests the importance of using strategies such as feedback delivery, reflective practice and action planning to facilitate recognition of gaps and service improvement needs. Our study explored the outcomes of a CPD intervention, named the COMPAS Project, which consists of a three-hour workshop composed of three main activities: feedback, critical reflection and action planning. The feedback intervention is delivered face-to-face and presents performance indicators extracted from clinical-administrative databases. This aim of this study was to assess the short term outcomes of this intervention to engage primary care professional in continuous quality improvement (QI). METHODS In order to develop an understanding of our intervention and of its short term outcomes, a program evaluation approach was used. Ten COMPAS workshops on diabetes management were directly observed and qualitative data was collected to assess the intervention short term outcomes. Data from both sources were combined to describe the characteristics of action plans developed by professionals. Two independent coders analysed the content of these plans to assess if they promoted engagement in QI and interprofessional collaboration. RESULTS During the ten workshops held, 26 interprofessional work teams were formed. Twenty-two of them developed a QI project they could implement themselves and that targeted aspects of their own practice they perceived in need of change. Most frequently prioritized strategies for change were improvement of systematic clientele follow-up, medication compliance, care pathway and support to improve adoption of healthier life habits. Twenty-one out of 22 action plans were found to target some level of improvement of interprofessional collaboration in primary care. DISCUSSION Our study results demonstrate that the COMPAS intervention enabled professionals to target priorities for practice improvements and to develop action plans that promote interprofessional collaboration. The COMPAS intervention aims to increase capability for continuous QI, readiness to implement process of care changes and team shared goals but available resources, climate and culture for change and leadership, are also important required conditions to successfully implement these practice changes. CONCLUSION We think that the proposed approach can be very useful to support and engage primary care professionals in the planning stage of quality improvement projects since it combines key successful ingredients: feedback, reflection and planning of action.
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Affiliation(s)
- Brigitte Vachon
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, 7077 Park Avenue, Montreal, Quebec, H3N 1X7, Canada.
| | - Bruno Désorcy
- Agence de la santé et des services sociaux de la Montérégie, 1255 Beauregard Street, Longueuil, Quebec, J4K 2M3, Canada.
| | - Isabelle Gaboury
- Faculty of medicine, Université de Sherbrooke, Pavillon Gérald-La Salle, 3001, 12e avenue Nord, Sherbrooke, Quebec, J1H 5N4, Canada.
| | - Michel Camirand
- Centre de santé Sutton, 33 Principale St South, Sutton, Quebec, J0E 2K0, Canada.
| | - Jean Rodrigue
- Agence de la santé et des services sociaux de la Montérégie, 1255 Beauregard Street, Longueuil, Quebec, J4K 2M3, Canada.
| | - Louise Quesnel
- Collège des médecins du Québec, 2170, boulevard René-Lévesque Ouest, Montreal, Quebec, H3H 2T8, Canada.
| | - Claude Guimond
- Fédération des médecins omnipraticiens du Québec, 3500 boul. de Maisonneuve Ouest, bureau 2000, Westmount, Quebec, H3Z 3C1, Canada.
| | - Martin Labelle
- Fédération des médecins omnipraticiens du Québec, 3500 boul. de Maisonneuve Ouest, bureau 2000, Westmount, Quebec, H3Z 3C1, Canada.
| | - Ai-Thuy Huynh
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, 7331, rue Hochelaga, Montreal, Quebec, H1N 3V2, Canada.
| | - Jeremy Grimshaw
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Box 711, Ottawa, Ontario, K1H 8L6, Canada.
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Laxy M, Stark R, Meisinger C, Kirchberger I, Heier M, von Scheidt W, Holle R. The effectiveness of German disease management programs (DMPs) in patients with type 2 diabetes mellitus and coronary heart disease: results from an observational longitudinal study. Diabetol Metab Syndr 2015; 7:77. [PMID: 26388948 PMCID: PMC4574141 DOI: 10.1186/s13098-015-0065-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 08/11/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although the population-based German disease management programs (DMPs) for diabetes mellitus (DM) and coronary heart disease (CHD) are among the biggest worldwide, evidence on the effectiveness of these programs is still inconclusive or missing, particularly for high risk patients with comorbidities. The objective of this study was therefore to analyze the impact of DMPs on process and outcome parameters in patients with both, type 2 DM and CHD. METHODS Analyses are based on two postal surveys of patients from the KORA myocardial infarction registry (southern Germany) with type 2 DM and on two postal validation studies with patients' general physicians (2006, n = 312 and 2011, n = 212). The association between DMP enrollment (being enrolled in either DMP-DM or DMP-CHD) and guideline care (defined by several process indicators) at baseline (2006) and its development until follow-up (2011) was analyzed using logistic regression models accounting for the repeated measurements structure. The impact of DMP enrollment/guideline care on cumulated (quality-adjusted) life years ((QA)LYs) over a 4-year time horizon (2006-2010) was assessed using multiple linear regression methods. Logistic regression models were applied to analyze the association between DMP status and patient self-management at follow-up. RESULTS Being enrolled in a DMP was associated with better guideline care at baseline [OR = 2.3 (95 % CI 1.27-4.03)], but not at follow-up [OR = 0.80 (95 % CI 0.40-1.58); p value for time-interaction <0.01]. DMP enrollment was not significantly [+0.15 LYs (95 % CI -0.07, 0.37); +0.06 QALYs (95 % CI -0.15, 0.26)], but treatment according to guideline care significantly [+0.40 LYs (95 % CI 0.21-0.60); +0.28 QALYs (95 % CI 0.10-0.45)] associated with higher (quality-adjusted) survival over the 4-year follow-up period. DMP enrollees further reported a somewhat better self-management than patients not being enrolled into a DMP. CONCLUSIONS The results of this study concerning the effectiveness of DMPs in patients with DM and CHD are mixed, but are weakly in favor of DMPs. However, we found a clear positive impact of guideline care on quality adjusted survival in this patient group. The development of the association between DMP enrollment and guideline care over the follow-up time indicates some external effects, which should be the subject of further investigations.
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Affiliation(s)
- Michael Laxy
- />Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
- />German Center for Diabetes Research, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
| | - Renée Stark
- />Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
| | - Christa Meisinger
- />Helmholtz Zentrum München, Institute of Epidemiology II, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
- />MONICA/KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany
| | - Inge Kirchberger
- />Helmholtz Zentrum München, Institute of Epidemiology II, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
- />MONICA/KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany
| | - Margit Heier
- />Helmholtz Zentrum München, Institute of Epidemiology II, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
- />MONICA/KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany
| | - Wolfgang von Scheidt
- />Department of Internal Medicine I-Cardiology, Central Hospital of Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany
| | - Rolf Holle
- />Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
- />German Center for Diabetes Research, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
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Penn ML, Kennedy AP, Vassilev II, Chew-Graham CA, Protheroe J, Rogers A, Monks T. Modelling self-management pathways for people with diabetes in primary care. BMC FAMILY PRACTICE 2015; 16:112. [PMID: 26330096 PMCID: PMC4557856 DOI: 10.1186/s12875-015-0325-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 08/17/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND Self-management support to facilitate people with type 2 diabetes to effectively manage their condition is complex to implement. Organisational and system elements operating in relation to providing optimal self-management support in primary care are poorly understood. We have applied operational research techniques to model pathways in primary care to explore and illuminate the processes and points where people struggle to find self-management support. METHODS Primary care clinicians and support staff in 21 NHS general practices created maps to represent their experience of patients' progress through the system following diagnosis. These were collated into a combined pathway. Following consideration of how patients reduce dependency on the system to become enhanced self-managers, a model was created to show the influences on patients' pathways to self-management. RESULTS Following establishment of diagnosis and treatment, appointment frequency decreases and patient self-management is expected to increase. However, capacity to consistently assess self-management capabilities; provide self-management support; or enhance patient-led self-care activities is missing from the pathways. Appointment frequencies are orientated to bio-medical monitoring rather than increasing the ability to mobilise resources or undertake self-management activities. CONCLUSIONS The model provides a clear visual picture of the complexities implicated in achieving optimal self-management support. Self-management is quickly hidden from view in a system orientated to treatment delivery rather than to enhancing patient self-management. The model created highlights the limited self-management support currently provided and illuminates points where service change might impact on providing support for self-management. Ensuring professionals are aware of locally available support and people's existing network support has potential to provide appropriate and timely direction to community facilities and the mobilisation of resources.
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Affiliation(s)
- Marion L Penn
- Southampton General Hospital, Mailpoint 11, AA72, South Academic Block, Tremona Road, Southampton, SO16 6YD, UK.
| | - Anne P Kennedy
- NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Wessex, Faculty of Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, UK.
| | - Ivaylo I Vassilev
- NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Wessex, Faculty of Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, UK.
| | - Carolyn A Chew-Graham
- Research Institute, Primary Care & Health Sciences, and NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) West Midlands, Keele University, Keele, Staffordshire, ST5 5BG, UK.
| | - Joanne Protheroe
- Research Institute, Primary Care & Health Sciences, and NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) West Midlands, Keele University, Keele, Staffordshire, ST5 5BG, UK.
| | - Anne Rogers
- NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Wessex, Faculty of Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, UK.
| | - Tom Monks
- Southampton General Hospital, Mailpoint 11, AA72, South Academic Block, Tremona Road, Southampton, SO16 6YD, UK.
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Clark NM, Quinn M, Dodge JA, Nelson BW. Alliance system and policy change: necessary ingredients for improvement in diabetes care and reduction of disparities. Health Promot Pract 2015; 15:11S-22S. [PMID: 25359245 DOI: 10.1177/1524839914543829] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Reducing diabetes inequities requires system and policy changes based on real-life experiences of vulnerable individuals living with the condition. While introducing innovative interventions for African American, Native American, and Latino low-income people, the five community-based sites of the Alliance to Reduce Disparities in Diabetes recognized that policy changes were essential to sustain their efforts. Data regarding change efforts were collected from site leaders and examined against documents provided routinely to the National Program Office at the University of Michigan. A policy expert refined the original lists to include only confirmed policy changes, scope of change (organizational to national), and stage of accomplishment (1, beginning; 2, adoption; 3, implementation; and 4, full maintenance). Changes were again verified through site visits and telephone interviews. In 3 years, Alliance teams achieved 53 system and policy change accomplishments. Efforts were implemented at the organizational (33), citywide (13), state (5), and national (2) levels, and forces helping and hindering success were identified. Three types of changes were deemed especially significant for diabetes control: data sharing across care-providing organizations, embedding community health workers into the clinical care team, and linking clinic services with community assets and resources in support of self-management.
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Implementing Effective Substance Abuse Treatments in General Medical Settings: Mapping the Research Terrain. J Subst Abuse Treat 2015; 60:110-8. [PMID: 26233697 DOI: 10.1016/j.jsat.2015.06.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 06/22/2015] [Accepted: 06/22/2015] [Indexed: 11/20/2022]
Abstract
The National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institute on Drug Abuse (NIDA), and Veterans Health Administration (VHA) share an interest in promoting high quality, rigorous health services research to improve the availability and utilization of evidence-based treatment for substance use disorders (SUD). Recent and continuing changes in the healthcare policy and funding environments prioritize the integration of evidence-based substance abuse treatments into primary care and general medical settings. This area is a prime candidate for implementation research. Recent and ongoing implementation projects funded by these agencies are reviewed. Research in five areas is highlighted: screening and brief intervention for risky drinking; screening and brief intervention for tobacco use; uptake of FDA-approved addiction pharmacotherapies; safe opioid prescribing; and disease management. Gaps in the portfolios, and priorities for future research, are described.
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263
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Pinto MB. Social media's contribution to customer satisfaction with services. SERVICE INDUSTRIES JOURNAL 2015. [DOI: 10.1080/02642069.2015.1062881] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Designing and implementing effective lifestyle modification strategies remains one of the great challenges in diabetes care. Historically, programs have focused on individual behavior change with little or no attempt to integrate change within the broader social framework or community context. However, these contextual factors have been shown to be associated with poor diabetes outcomes, particularly in low-income minority populations. Recent evidence suggests that one way to address these disparities is to match patient needs to existing community resources. Not only does this position patients to more quickly adapt behavior in a practical way, but this also refers patients back to their local communities where a support mechanism is in place to sustain healthy behavior. Technology offers a new and promising platform for connecting patients to meaningful resources (also referred to as "assets"). This paper summarizes several noteworthy innovations that use technology as a practical bridge between healthcare and community-based resources that promote diabetes self-care.
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Affiliation(s)
- Elizabeth L. Tung
- Section of General Internal Medicine, Chicago Center of Diabetes Translation Research, University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637, USA
| | - Monica E. Peek
- Section of General Internal Medicine, Chicago Center of Diabetes Translation Research, University of Chicago, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637, USA
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Siple J, Harris EA, Morey JM, Skaperdas E, Weinberg KL, Tuepker A. Experiences of Veterans With Diabetes From Shared Medical Appointments. Fed Pract 2015; 32:40-45. [PMID: 30766063 PMCID: PMC6363302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Camaraderie and shared narratives, coupled with clinical guidance, may help motivate veterans to better manage their diabetes.
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Affiliation(s)
- Jolene Siple
- is a clinical pharmacist; is a Graduate Healthcare Administrative Training Program resident and at the time of the study was a dietician; is a clinical pharmacist; is a doctoral student in sociology at the University of California, Los Angeles, and at the time of the study was a research associate; is a community nurse liaison and at the time of the study was a nurse case manager; is an investigator with the VA Health Services Research and Development Center to Improve Veteran Involvement in Care, all at the VA Portland Health Care System in Oregon
| | - Elizabeth A Harris
- is a clinical pharmacist; is a Graduate Healthcare Administrative Training Program resident and at the time of the study was a dietician; is a clinical pharmacist; is a doctoral student in sociology at the University of California, Los Angeles, and at the time of the study was a research associate; is a community nurse liaison and at the time of the study was a nurse case manager; is an investigator with the VA Health Services Research and Development Center to Improve Veteran Involvement in Care, all at the VA Portland Health Care System in Oregon
| | - Jessica M Morey
- is a clinical pharmacist; is a Graduate Healthcare Administrative Training Program resident and at the time of the study was a dietician; is a clinical pharmacist; is a doctoral student in sociology at the University of California, Los Angeles, and at the time of the study was a research associate; is a community nurse liaison and at the time of the study was a nurse case manager; is an investigator with the VA Health Services Research and Development Center to Improve Veteran Involvement in Care, all at the VA Portland Health Care System in Oregon
| | - Eleni Skaperdas
- is a clinical pharmacist; is a Graduate Healthcare Administrative Training Program resident and at the time of the study was a dietician; is a clinical pharmacist; is a doctoral student in sociology at the University of California, Los Angeles, and at the time of the study was a research associate; is a community nurse liaison and at the time of the study was a nurse case manager; is an investigator with the VA Health Services Research and Development Center to Improve Veteran Involvement in Care, all at the VA Portland Health Care System in Oregon
| | - Kathy L Weinberg
- is a clinical pharmacist; is a Graduate Healthcare Administrative Training Program resident and at the time of the study was a dietician; is a clinical pharmacist; is a doctoral student in sociology at the University of California, Los Angeles, and at the time of the study was a research associate; is a community nurse liaison and at the time of the study was a nurse case manager; is an investigator with the VA Health Services Research and Development Center to Improve Veteran Involvement in Care, all at the VA Portland Health Care System in Oregon
| | - Anais Tuepker
- is a clinical pharmacist; is a Graduate Healthcare Administrative Training Program resident and at the time of the study was a dietician; is a clinical pharmacist; is a doctoral student in sociology at the University of California, Los Angeles, and at the time of the study was a research associate; is a community nurse liaison and at the time of the study was a nurse case manager; is an investigator with the VA Health Services Research and Development Center to Improve Veteran Involvement in Care, all at the VA Portland Health Care System in Oregon
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Chronic care model as a framework to improve diabetes care at an academic internal medicine faculty-resident practice. J Ambul Care Manage 2015; 37:42-50. [PMID: 24309394 DOI: 10.1097/jac.0000000000000007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
We implemented a quality improvement project for diabetes care in a faculty-resident internal medicine practice, using the Chronic Care Model framework. We created a planned visit clinic, used a stepwise medication algorithm, and self-management support. The intervention was effective for patients with glycohemoglobin A1c levels 10 or above (P = .0075) when compared with usual care after adjusting for all significant predictors. Compliance with foot examinations increased by 72% (P < .0001) and pneumococcal vaccinations by 25% (P = .0115). We believe that the Chronic Care Model can be successfully integrated into faculty-resident practices and provides a model for further exploration into disease management education in academic settings.
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Dickinson LM, Dickinson WP, Nutting PA, Fisher L, Harbrecht M, Crabtree BF, Glasgow RE, West DR. Practice context affects efforts to improve diabetes care for primary care patients: a pragmatic cluster randomized trial. J Gen Intern Med 2015; 30:476-82. [PMID: 25472509 PMCID: PMC4370994 DOI: 10.1007/s11606-014-3131-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 10/23/2014] [Accepted: 11/12/2014] [Indexed: 01/10/2023]
Abstract
BACKGROUND Efforts to improve primary care diabetes management have assessed strategies across heterogeneous groups of patients and practices. However, there is substantial variability in how well practices implement interventions and achieve desired outcomes. OBJECTIVE To examine practice contextual features that moderate intervention effectiveness. DESIGN Secondary analysis of data from a cluster randomized trial of three approaches for implementing the Chronic Care Model to improve diabetes care. PARTICIPANTS Forty small to mid-sized primary care practices participated, with 522 clinician and staff member surveys. Outcomes were assessed for 822 established patients with a diagnosis of type 2 diabetes who had at least one visit to the practice in the 18 months following enrollment. MAIN MEASURES The primary outcome was a composite measure of diabetes process of care, ascertained by chart audit, regarding nine quality measures from the American Diabetes Association Physician Recognition Program: HgA1c, foot exam, blood pressure, dilated eye exam, cholesterol, nephropathy screen, flu shot, nutrition counseling, and self-management support. Data from practices included structural and demographic characteristics and Practice Culture Assessment survey subscales (Change Culture, Work Culture, Chaos). KEY RESULTS Across the three implementation approaches, demographic/structural characteristics (rural vs. urban + .70(p = .006), +2.44(p < .001), -.75(p = .004)); Medicaid: < 20 % vs. ≥ 20 % (-.20(p = .48), +.75 (p = .08), +.60(p = .02)); practice size: < 4 clinicians vs. ≥ 4 clinicians (+.56(p = .02), +1.96(p < .001), +.02(p = .91)); practice Change Culture (high vs. low: -.86(p = .048), +1.71(p = .005), +.34(p = .22)), Work Culture (high vs. low: -.67(p = .18), +2.41(p < .001), +.67(p = .005)) and variability in practice Change Culture (high vs. low: -.24(p = .006), -.20(p = .0771), -.44(p = .0019) and Work Culture (high vs. low: +.56(p = .3160), -1.0(p = .008), -.25 (p = .0216) were associated with trajectories of change in diabetes process of care, either directly or differentially by study arm. CONCLUSIONS This study supports the need for broader use of methodological approaches to better examine contextual effects on implementation and effectiveness of quality improvement interventions in primary care settings.
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Affiliation(s)
- L Miriam Dickinson
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA,
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Gee PM, Greenwood DA, Paterniti DA, Ward D, Miller LMS. The eHealth Enhanced Chronic Care Model: a theory derivation approach. J Med Internet Res 2015; 17:e86. [PMID: 25842005 PMCID: PMC4398883 DOI: 10.2196/jmir.4067] [Citation(s) in RCA: 152] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 01/21/2015] [Accepted: 02/07/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Chronic illnesses are significant to individuals and costly to society. When systematically implemented, the well-established and tested Chronic Care Model (CCM) is shown to improve health outcomes for people with chronic conditions. Since the development of the original CCM, tremendous information management, communication, and technology advancements have been established. An opportunity exists to improve the time-honored CCM with clinically efficacious eHealth tools. OBJECTIVE The first goal of this paper was to review research on eHealth tools that support self-management of chronic disease using the CCM. The second goal was to present a revised model, the eHealth Enhanced Chronic Care Model (eCCM), to show how eHealth tools can be used to increase efficiency of how patients manage their own chronic illnesses. METHODS Using Theory Derivation processes, we identified a "parent theory", the Chronic Care Model, and conducted a thorough review of the literature using CINAHL, Medline, OVID, EMBASE PsychINFO, Science Direct, as well as government reports, industry reports, legislation using search terms "CCM or Chronic Care Model" AND "eHealth" or the specific identified components of eHealth. Additionally, "Chronic Illness Self-management support" AND "Technology" AND several identified eHealth tools were also used as search terms. We then used a review of the literature and specific components of the CCM to create the eCCM. RESULTS We identified 260 papers at the intersection of technology, chronic disease self-management support, the CCM, and eHealth and organized a high-quality subset (n=95) using the components of CCM, self-management support, delivery system design, clinical decision support, and clinical information systems. In general, results showed that eHealth tools make important contributions to chronic care and the CCM but that the model requires modification in several key areas. Specifically, (1) eHealth education is critical for self-care, (2) eHealth support needs to be placed within the context of community and enhanced with the benefits of the eCommunity or virtual communities, and (3) a complete feedback loop is needed to assure productive technology-based interactions between the patient and provider. CONCLUSIONS The revised model, eCCM, offers insight into the role of eHealth tools in self-management support for people with chronic conditions. Additional research and testing of the eCCM are the logical next steps.
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Affiliation(s)
- Perry M Gee
- School of Nursing, Division of Health Sciences, Idaho State University, Pocatello, ID, United States.
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Aung E, Donald M, Coll JR, Williams GM, Doi SAR. Association between patient activation and patient-assessed quality of care in type 2 diabetes: results of a longitudinal study. Health Expect 2015; 19:356-66. [PMID: 25773785 DOI: 10.1111/hex.12359] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Previous research using cross-sectional data has shown a positive relationship between patient activation and quality of care. The quantitative relationships in the same patients over time, however, remain undefined. OBJECTIVE To examine the relationship between changes in activation over time and patient-assessed quality of chronic illness care. DESIGN Prospective cohort study. PARTICIPANTS The study used data reported annually from 2008 (N = 3761) to 2010 (N = 3040), using self-report survey questionnaires, completed by patients with type 2 diabetes in a population-based cohort in Queensland, Australia. MAIN MEASURES Principal measures were the 13-item Patient Activation Measure (PAM), and the 20-item Patient Assessment of Chronic Illness Care (PACIC) instrument. METHODS Nonparametric anova was used to determine the association between patient activation and patient-assessed quality of care in low and high patient activation groups at baseline (2008), and in 2009 and 2010, when patients had changed group membership. The Wilcoxon signed ranks test was used to compare the PACIC scores between baseline and each follow-up survey for the same patient activation level. RESULTS Patient activation was positively associated with the median PACIC score within each survey year and within each of the groups defined at baseline (high- and low-activation groups; P < 0.001). CONCLUSIONS Patient activation and the PACIC change in the same direction and should be considered together in the interpretation of patient care assessment. This can be carried out by interpreting PACIC scores within strata of PAM.
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Affiliation(s)
- Eindra Aung
- School of Population Health, University of Queensland, Brisbane, Qld, Australia
| | - Maria Donald
- School of Medicine, University of Queensland, Brisbane, Qld, Australia
| | - Joseph R Coll
- School of Population Health, University of Queensland, Brisbane, Qld, Australia
| | - Gail M Williams
- School of Population Health, University of Queensland, Brisbane, Qld, Australia
| | - Suhail A R Doi
- School of Population Health, University of Queensland, Brisbane, Qld, Australia
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Coulter A, Entwistle VA, Eccles A, Ryan S, Shepperd S, Perera R. Personalised care planning for adults with chronic or long-term health conditions. Cochrane Database Syst Rev 2015; 2015:CD010523. [PMID: 25733495 PMCID: PMC6486144 DOI: 10.1002/14651858.cd010523.pub2] [Citation(s) in RCA: 275] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Personalised care planning is a collaborative process used in chronic condition management in which patients and clinicians identify and discuss problems caused by or related to the patient's condition, and develop a plan for tackling these. In essence it is a conversation, or series of conversations, in which they jointly agree goals and actions for managing the patient's condition. OBJECTIVES To assess the effects of personalised care planning for adults with long-term health conditions compared to usual care (i.e. forms of care in which active involvement of patients in treatment and management decisions is not explicitly attempted or achieved). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, ProQuest, clinicaltrials.gov and WHO International Clinical Trials Registry Platform to July 2013. SELECTION CRITERIA We included randomised controlled trials and cluster-randomised trials involving adults with long-term conditions where the intervention included collaborative (between individual patients and clinicians) goal setting and action planning. We excluded studies where there was little or no opportunity for the patient to have meaningful influence on goal selection, choice of treatment or support package, or both. DATA COLLECTION AND ANALYSIS Two of three review authors independently screened citations for inclusion, extracted data, and assessed risk of bias. The primary outcomes were effects on physical health, psychological health, subjective health status, and capabilities for self management. Secondary outcomes included effects on health-related behaviours, resource use and costs, and type of intervention. A patient advisory group of people with experience of living with long-term conditions advised on various aspects of the review, including the protocol, selection of outcome measures and emerging findings. MAIN RESULTS We included 19 studies involving a total of 10,856 participants. Twelve of these studies focused on diabetes, three on mental health, one on heart failure, one on end-stage renal disease, one on asthma, and one on various chronic conditions. All 19 studies included components that were intended to support behaviour change among patients, involving either face-to-face or telephone support. All but three of the personalised care planning interventions took place in primary care or community settings; the remaining three were located in hospital clinics. There was some concern about risk of bias for each of the included studies in respect of one or more criteria, usually due to inadequate or unclear descriptions of research methods. Physical healthNine studies measured glycated haemoglobin (HbA1c), giving a combined mean difference (MD) between intervention and control of -0.24% (95% confidence interval (CI) -0.35 to -0.14), a small positive effect in favour of personalised care planning compared to usual care (moderate quality evidence).Six studies measured systolic blood pressure, a combined mean difference of -2.64 mm/Hg (95% CI -4.47 to -0.82) favouring personalised care (moderate quality evidence). The pooled results from four studies showed no significant effect on diastolic blood pressure, MD -0.71 mm/Hg (95% CI -2.26 to 0.84).We found no evidence of an effect on cholesterol (LDL-C), standardised mean difference (SMD) 0.01 (95% CI -0.09 to 0.11) (five studies) or body mass index, MD -0.11 (95% CI -0.35 to 0.13) (four studies).A single study of people with asthma reported that personalised care planning led to improvements in lung function and asthma control. Psychological healthSix studies measured depression. We were able to pool results from five of these, giving an SMD of -0.36 (95% CI -0.52 to -0.20), a small effect in favour of personalised care (moderate quality evidence). The remaining study found greater improvement in the control group than the intervention group.Four other studies used a variety of psychological measures that were conceptually different so could not be pooled. Of these, three found greater improvement for the personalised care group than the usual care group and one was too small to detect differences in outcomes. Subjective health statusTen studies used various patient-reported measures of health status (or health-related quality of life), including both generic health status measures and condition-specific ones. We were able to pool data from three studies that used the SF-36 or SF-12, but found no effect on the physical component summary score SMD 0.16 (95% CI -0.05 to 0.38) or the mental component summary score SMD 0.07 (95% CI -0.15 to 0.28) (moderate quality evidence). Of the three other studies that measured generic health status, two found improvements related to personalised care and one did not.Four studies measured condition-specific health status. The combined results showed no difference between the intervention and control groups, SMD -0.01 (95% CI -0.11 to 0.10) (moderate quality evidence). Self-management capabilitiesNine studies looked at the effect of personalised care on self-management capabilities using a variety of outcome measures, but they focused primarily on self efficacy. We were able to pool results from five studies that measured self efficacy, giving a small positive result in favour of personalised care planning: SMD 0.25 (95% CI 0.07 to 0.43) (moderate quality evidence).A further five studies measured other attributes that contribute to self-management capabilities. The results from these were mixed: two studies found evidence of an effect on patient activation, one found an effect on empowerment, and one found improvements in perceived interpersonal support. Other outcomesPooled data from five studies on exercise levels showed no effect due to personalised care planning, but there was a positive effect on people's self-reported ability to carry out self-care activities: SMD 0.35 (95% CI 0.17 to 0.52).We found no evidence of adverse effects due to personalised care planning.The effects of personalised care planning were greater when more stages of the care planning cycle were completed, when contacts between patients and health professionals were more frequent, and when the patient's usual clinician was involved in the process. AUTHORS' CONCLUSIONS Personalised care planning leads to improvements in certain indicators of physical and psychological health status, and people's capability to self-manage their condition when compared to usual care. The effects are not large, but they appear greater when the intervention is more comprehensive, more intensive, and better integrated into routine care.
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Affiliation(s)
- Angela Coulter
- University of OxfordHealth Services Research Unit, Nuffield Department of Population HealthOld Road Campus, HeadingtonOxfordUKOX3 7LF
| | - Vikki A Entwistle
- University of AberdeenHealth Services Research UnitHealth Services Building Level 3ForesterhillAberdeenUKAB25 2ZD
| | - Abi Eccles
- University of OxfordDepartment of Primary Care Health Sciences23‐28 Hythe Bridge StreetOxfordUKOX1 2ET
| | - Sara Ryan
- University of OxfordQuality and Outcomes Research Unit and Health Experiences Research Group23‐28 Hythe Bridge StreetOxfordUKOX1 2ET
| | - Sasha Shepperd
- University of OxfordNuffield Department of Population HealthRosemary Rue Building, Old Road CampusHeadingtonOxfordUKOX3 7LF
| | - Rafael Perera
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
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Zeytinoglu M, Huang ES. Diabetes and Aging: Meeting the Needs of a Burgeoning Epidemic in the United States. Health Syst Reform 2015; 1:128-141. [PMID: 31546311 DOI: 10.1080/23288604.2015.1037042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Abstract-In the United States, one out of every four adults over the age of 65 has diabetes and one half of all adults in this age group are prediabetic, placing them at high risk for developing the disease. Beyond the United States, many other countries are also facing aging populations and high obesity rates that contribute to a staggering global diabetes epidemic. The care of the older patient with diabetes is frequently challenging, due to the accumulation of diabetic complications, extensive comorbidities, and functional impairments. Compounding this challenge is the lack of directly available evidence to guide management and care in this population. Though the global community shares in the epidemiologic burden of diabetes, there are large disparities across health systems and nations in the allocation of resources to the prevention, diagnosis, and treatment of the disease. Yet there is a consistency across many countries in the sub-optimal glycemic control and health outcomes for a majority of diabetics. This article reviews the context in which health systems provide diabetes care for the elderly and provides a framework for policy makers to support comprehensive diabetes care in the older adult. Nearly half of global diabetes expenditures occur in the United States, where only 6% of the world's diabetics reside. This article focuses on how to improve diabetes care in the United States, given its disproportionate contribution to global diabetes expenditures. Many of the recommendations presented, however, may be adapted and applied to other health systems.
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Affiliation(s)
- Meltem Zeytinoglu
- Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism; Department of Medicine; University of Chicago ; Chicago , IL , USA
| | - Elbert S Huang
- Section of General Internal Medicine; Department of Medicine; University of Chicago ; Chicago , IL , USA
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Markun S, Brändle E, Dishy A, Rosemann T, Frei A. The concordance of care for age related macular degeneration with the chronic care model: a multi-centered cross-sectional study. PLoS One 2014; 9:e108536. [PMID: 25290915 PMCID: PMC4188520 DOI: 10.1371/journal.pone.0108536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 08/26/2014] [Indexed: 11/18/2022] Open
Abstract
Aims The aim of the study was to assess the concordance of care for age related macular degeneration with the evidence-based framework for care for chronic medical conditions known as the chronic care model. Furthermore we aimed to identify factors associated with the concordance of care with the chronic care model. Methods Multi-centered cross-sectional study. 169 patients beginning medical treatment for age related macular degeneration were recruited and analyzed. Patients completed the Patient Assessment of Chronic Illness Care (PACIC) questionnaire, reflecting accordance to the chronic care model from a patient’s perspective, the National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ-25) and Patient Health Questionnaire (PHQ-9). Visual acuity and chronic medical conditions were assessed. Nonparametric tests and correlation analyses were performed, also multivariable regression analysis. Results The median PACIC summary score was 2.4 (interquartile range 1.75 to 3.25), the lowest PACIC subscale score was “follow-up/coordination” with a median of 1.8 (interquartile range 1.00 to 2.60). In multivariable regression analysis the presence of diabetes type 2 was strongly associated with low PACIC scores (coefficient = −0.85, p = 0.007). Conclusion Generally, care for patients with age related macular degeneration by ophthalmologists is in moderate concordance with the chronic care model. Concerning follow-up and coordination of health service, large improvements are possible. Future research should answer the question how healthcare delivery can be improved effecting relevant benefits to patients with AMD.
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Affiliation(s)
- Stefan Markun
- Institute of General Practice and Health Service Research, University of Zurich, University Hospital of Zurich, Zurich, Switzerland
| | - Elisabeth Brändle
- Institute of General Practice and Health Service Research, University of Zurich, University Hospital of Zurich, Zurich, Switzerland
| | - Avraham Dishy
- Department of Ophthalmology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Thomas Rosemann
- Institute of General Practice and Health Service Research, University of Zurich, University Hospital of Zurich, Zurich, Switzerland
| | - Anja Frei
- Institute of General Practice and Health Service Research, University of Zurich, University Hospital of Zurich, Zurich, Switzerland; Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland
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Busetto L, Luijkx KG, Vrijhoef HJM. Implementation of integrated care for type 2 diabetes: a protocol for mixed methods research. Int J Integr Care 2014; 14:e033. [PMID: 25550689 PMCID: PMC4272241 DOI: 10.5334/ijic.1516] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 10/30/2014] [Accepted: 10/30/2014] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION While integrated care for diabetes mellitus type 2 has achieved good results in terms of intermediate clinical and process outcomes, the evidence-based knowledge on its implementation is scarce, and insights generalisable to other settings therefore remain limited. OBJECTIVE This study protocol provides a description of the design and methodology of a mixed methods study on the implementation of integrated care for type 2 diabetes. The aim of the proposed research is to investigate the mechanisms by which and the context in which integrated care for type 2 diabetes has been implemented, which outcomes have been achieved and how the context and mechanisms have affected the outcomes. METHODS This article describes a convergent parallel mixed methods research design, including a systematic literature review on the implementation of integrated care for type 2 diabetes as well as a case study on two Dutch best practices on integrated care for type 2 diabetes. DISCUSSION The implementation of integrated care for diabetes type 2 is an under-researched area. Insights from this study could be applied to other settings as well as other chronic conditions to strengthen the evidence on the implementation of integrated care.
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Affiliation(s)
- Loraine Busetto
- Department of TRANZO, Faculty of Social and Behavioural Sciences, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
| | - Katrien Ger Luijkx
- Elderly Care, Department of TRANZO, Faculty of Social and Behavioural Sciences, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
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Ramli AS, Lakshmanan S, Haniff J, Selvarajah S, Tong SF, Bujang MA, Abdul-Razak S, Shafie AA, Lee VKM, Abdul-Rahman TH, Daud MH, Ng KK, Ariffin F, Abdul-Hamid H, Mazapuspavina MY, Mat-Nasir N, Miskan M, Stanley-Ponniah JP, Ismail M, Chan CW, Abdul-Rahman YR, Chew BH, Low WHH. Study protocol of EMPOWER participatory action research (EMPOWER-PAR): a pragmatic cluster randomised controlled trial of multifaceted chronic disease management strategies to improve diabetes and hypertension outcomes in primary care. BMC FAMILY PRACTICE 2014; 15:151. [PMID: 25218689 PMCID: PMC4174665 DOI: 10.1186/1471-2296-15-151] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 08/20/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Chronic disease management presents enormous challenges to the primary care workforce because of the rising epidemic of cardiovascular risk factors. The chronic care model was proven effective in improving chronic disease outcomes in developed countries, but there is little evidence of its effectiveness in developing countries. The aim of this study was to evaluate the effectiveness of the EMPOWER-PAR intervention (multifaceted chronic disease management strategies based on the chronic care model) in improving outcomes for type 2 diabetes mellitus and hypertension using readily available resources in the Malaysian public primary care setting. This paper presents the study protocol. METHODS/DESIGN A pragmatic cluster randomised controlled trial using participatory action research is underway in 10 public primary care clinics in Selangor and Kuala Lumpur, Malaysia. Five clinics were randomly selected to provide the EMPOWER-PAR intervention for 1 year and another five clinics continued with usual care. Each clinic consecutively recruits type 2 diabetes mellitus and hypertension patients fulfilling the inclusion and exclusion criteria over a 2-week period. The EMPOWER-PAR intervention consists of creating/strengthening a multidisciplinary chronic disease management team, training the team to use the Global Cardiovascular Risks Self-Management Booklet to support patient care and reinforcing the use of relevant clinical practice guidelines for management and prescribing. For type 2 diabetes mellitus, the primary outcome is the change in the proportion of patients achieving HbA1c < 6.5%. For hypertension without type 2 diabetes mellitus, the primary outcome is the change in the proportion of patients achieving blood pressure < 140/90 mmHg. Secondary outcomes include the proportion of patients achieving targets for serum lipid profile, body mass index and waist circumference. Other outcome measures include medication adherence levels, process of care and prescribing patterns. Patients' assessment of their chronic disease care and providers' perceptions, attitudes and perceived barriers in care delivery and cost-effectiveness of the intervention are also evaluated. DISCUSSION Results from this study will provide objective evidence of the effectiveness and cost-effectiveness of a multifaceted intervention based on the chronic care model in resource-constrained public primary care settings. The evidence should instigate crucial primary care system change in Malaysia. TRIAL REGISTRATION ClinicalTrials.gov NCT01545401.
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Affiliation(s)
- Anis S Ramli
- Primary Care Medicine Discipline, Faculty of Medicine, Universiti Teknologi MARA, Selayang Campus, 68100 Batu Caves, Selangor Malaysia
| | - Sharmila Lakshmanan
- Clinical Epidemiology Unit, National Clinical Research Centre, Ministry of Health, Kuala Lumpur, Malaysia
| | - Jamaiyah Haniff
- Clinical Epidemiology Unit, National Clinical Research Centre, Ministry of Health, Kuala Lumpur, Malaysia
| | - Sharmini Selvarajah
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Seng F Tong
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Mohamad-Adam Bujang
- Clinical Epidemiology Unit, National Clinical Research Centre, Ministry of Health, Kuala Lumpur, Malaysia
| | - Suraya Abdul-Razak
- Primary Care Medicine Discipline, Faculty of Medicine, Universiti Teknologi MARA, Selayang Campus, 68100 Batu Caves, Selangor Malaysia
| | - Asrul A Shafie
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Kragujevac, Penang Malaysia
| | - Verna KM Lee
- Department of Family Medicine, Faculty of Medicine, International Medical University, Bukit Jalil, Kuala Lumpur, Malaysia
| | - Thuhairah H Abdul-Rahman
- Centre for Pathology and Diagnostic Research Laboratory, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor Malaysia
| | - Maryam H Daud
- Primary Care Medicine Discipline, Faculty of Medicine, Universiti Teknologi MARA, Selayang Campus, 68100 Batu Caves, Selangor Malaysia
| | - Kien K Ng
- Primary Care Medicine Discipline, Faculty of Medicine, Universiti Teknologi MARA, Selayang Campus, 68100 Batu Caves, Selangor Malaysia
| | - Farnaza Ariffin
- Primary Care Medicine Discipline, Faculty of Medicine, Universiti Teknologi MARA, Selayang Campus, 68100 Batu Caves, Selangor Malaysia
| | - Hasidah Abdul-Hamid
- Primary Care Medicine Discipline, Faculty of Medicine, Universiti Teknologi MARA, Selayang Campus, 68100 Batu Caves, Selangor Malaysia
| | - Md-Yasin Mazapuspavina
- Primary Care Medicine Discipline, Faculty of Medicine, Universiti Teknologi MARA, Selayang Campus, 68100 Batu Caves, Selangor Malaysia
| | - Nafiza Mat-Nasir
- Primary Care Medicine Discipline, Faculty of Medicine, Universiti Teknologi MARA, Selayang Campus, 68100 Batu Caves, Selangor Malaysia
| | - Maizatullifah Miskan
- Primary Care Medicine Discipline, Faculty of Medicine, Universiti Teknologi MARA, Selayang Campus, 68100 Batu Caves, Selangor Malaysia
| | - Jaya P Stanley-Ponniah
- Clinical Epidemiology Unit, National Clinical Research Centre, Ministry of Health, Kuala Lumpur, Malaysia
| | - Mastura Ismail
- Klinik Kesihatan Seremban 2, Kragujevac, Negeri Sembilan Malaysia
| | - Chun W Chan
- Department of Family Medicine, Faculty of Medicine, International Medical University, Bukit Jalil, Kuala Lumpur, Malaysia
| | - Yong R Abdul-Rahman
- Family Medicine Discipline, Faculty of Medicine, Cyberjaya University College of Medical Sciences, Cyberjaya, Selangor Malaysia
| | - Boon-How Chew
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor Malaysia
| | - Wilson HH Low
- Azmi Burhani Consulting Sdn. Bhd, Petaling Jaya, Selangor Malaysia
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Stock S, Pitcavage JM, Simic D, Altin S, Graf C, Feng W, Graf TR. Chronic Care Model Strategies In The United States And Germany Deliver Patient-Centered, High-Quality Diabetes Care. Health Aff (Millwood) 2014; 33:1540-8. [DOI: 10.1377/hlthaff.2014.0428] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Stephanie Stock
- Stephanie Stock ( ) is a professor at the Institute of Health Economics and Clinical Epidemiology, University Hospital of Cologne, in Germany
| | - James M. Pitcavage
- James M. Pitcavage is a project manager at the Center for Health Research, Geisinger Health System, in Danville, Pennsylvania, and a PhD candidate in the Department of Health Policy and Administration at the Pennsylvania State University, in University Park
| | - Dusan Simic
- Dusan Simic is a scientific associate at the Institute of Health Economics and Clinical Epidemiology, University Hospital of Cologne
| | - Sibel Altin
- Sibel Altin is a scientific associate at the Institute of Health Economics and Clinical Epidemiology, University Hospital of Cologne
| | - Christian Graf
- Christian Graf is head of the Department of Product Development, Health Care Management, and Prevention at Barmer, in Wuppertal, Germany
| | - Wen Feng
- Wen Feng is a biostatistical analyst at the Center for Health Research, Geisinger Health System
| | - Thomas R. Graf
- Thomas R. Graf is chief medical officer for population health and longitudinal care service lines, Geisinger Health System
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278
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van Doorn-Klomberg AL, Braspenning JCC, Wolters RJ, Bouma M, de Grauw WJC, Wensing M. Organizational determinants of high-quality routine diabetes care. Scand J Prim Health Care 2014; 32:124-31. [PMID: 25264939 PMCID: PMC4206557 DOI: 10.3109/02813432.2014.960252] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Randomized trials showed that changes in healthcare organization improved diabetes care. This study aimed to identify which organizational determinants were associated with patient outcomes in routine diabetes care. DESIGN Observational study, in which multilevel regression analyses were applied to examine the impact of 12 organizational determinants on diabetes care as separate measures and as a composite score. SETTING Primary care practices in the Netherlands. SUBJECTS 11,751 patients with diabetes in 354 practices. MAIN OUTCOME MEASURES Patients' recorded glycated hemoglobin (HbA1c), systolic blood pressure, and serum cholesterol levels. RESULTS A higher score on the composite measure of organizational determinants was associated with better control of systolic blood pressure (p = 0.017). No effects on HbA1C or cholesterol levels were found. Exploration of specific organizational factors found significant impact of use of an electronic patient registry on HbA1c (OR = 1.80, 95% CI 1.12-2.88), availability of patient leaflets on systolic blood pressure control (OR = 2.59, 95% CI 1.06-6.35), and number of hours' nurse education on cholesterol control (OR = 2.51, 95% CI 1.02-6.15). CONCLUSION In routine primary care, it was found that favorable healthcare organization was associated with a number of intermediate outcomes in diabetes care. This finding lends support to the findings of trials on organizational changes in diabetes care. Notably, the composite measure of organizational determinants had most impact.
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Affiliation(s)
- Arna L. van Doorn-Klomberg
- Radboud University Medical Center, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands
| | - Jozé C. C. Braspenning
- Radboud University Medical Center, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands
| | - René J. Wolters
- Radboud University Medical Center, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands
| | - Margriet Bouma
- Dutch College of General Practitioners (NHG), The Netherlands
| | - Wim J. C. de Grauw
- Radboud University Medical Center, Department of Primary and Community Care, Nijmegen, The Netherlands
| | - Michel Wensing
- Radboud University Medical Center, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands
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279
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Sands DZ, Wald JS. Transforming health care delivery through consumer engagement, health data transparency, and patient-generated health information. Yearb Med Inform 2014; 9:170-6. [PMID: 25123739 DOI: 10.15265/iy-2014-0017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Address current topics in consumer health informatics. METHODS Literature review. RESULTS Current health care delivery systems need to be more effective in the management of chronic conditions as the population turns older and experiences escalating chronic illness that threatens to consume more health care resources than countries can afford. Most health care systems are positioned poorly to accommodate this. Meanwhile, the availability of ever more powerful and cheaper information and communication technology, both for professionals and consumers, has raised the capacity to gather and process information, communicate more effectively, and monitor the quality of care processes. CONCLUSION Adapting health care systems to serve current and future needs requires new streams of data to enable better self-management, improve shared decision making, and provide more virtual care. Changes in reimbursement for health care services, increased adoption of relevant technologies, patient engagement, and calls for data transparency raise the importance of patient-generated health information, remote monitoring, non-visit based care, and other innovative care approaches that foster more frequent contact with patients and better management of chronic conditions.
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Affiliation(s)
- D Z Sands
- Daniel Z. Sands, MD, MPH, 56 Solon St., Suite 200, Newton, MA 02461, USA, Tel: +1 617 256 4775, Fax: +1 617 663 6321, E-mail:
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280
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Tai B, Hu L, Ghitza UE, Sparenborg S, VanVeldhuisen P, Lindblad R. Patient registries for substance use disorders. Subst Abuse Rehabil 2014; 5:81-6. [PMID: 25114612 PMCID: PMC4114906 DOI: 10.2147/sar.s64977] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This commentary discusses the need for developing patient registries of substance use disorders (SUD) in general medical settings. A patient registry is a tool that documents the natural history of target diseases. Clinicians and researchers use registries to monitor patient comorbidities, care procedures and processes, and treatment effectiveness for the purpose of improving care quality. Enactments of the Affordable Care Act 2010 and the Mental Health Parity and Addiction Equity Act 2008 open opportunities for many substance users to receive treatment services in general medical settings. An increased number of patients with a wide spectrum of SUD will initially receive services with a chronic disease management approach in primary care. The establishment of computer-based SUD patient registries can be assisted by wide adoption of electronic health record systems. The linkage of SUD patient registries with electronic health record systems can facilitate the advancement of SUD treatment research efforts and improve patient care.
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Affiliation(s)
- Betty Tai
- Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
| | - Lian Hu
- The EMMES Corporation, Rockville, MD, USA
| | - Udi E Ghitza
- Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
| | - Steven Sparenborg
- Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA
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281
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Des Jardins TR. The keys to governance and stakeholder engagement: the southeast michigan beacon community case study. EGEMS 2014; 2:1068. [PMID: 25848612 PMCID: PMC4371470 DOI: 10.13063/2327-9214.1068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Community-based health information exchanges (HIEs) and efforts to consolidate and house data are growing, given the advent of Accountable Care Organizations (ACOs) under the Affordable Care Act and other similar population health focused initiatives. The Southeast Michigan Beacon Community (SEMBC) can be looked to as one case study that offers lessons learned, insights on challenges faced and accompanying workarounds related to governance and stakeholder engagement. The SEMBC case study employs an established Data Warehouse Governance Framework to identify and explain the necessary governance and stakeholder engagement components, particularly as they relate to community-wide data sharing and data warehouses or repositories. Perhaps the biggest lesson learned through the SEMBC experience is that community-based work is hard. It requires a great deal of community leadership, collaboration and resources. SEMBC found that organizational structure and guiding principles needed to be continually revisited and nurtured in order to build the relationships and trust needed among stakeholder organizations. SEMBC also found that risks and risk mitigation tactics presented challenges and opportunities at the outset and through the duration of the three year pilot period. Other communities across the country embarking on similar efforts need to consider realistic expectations about community data sharing infrastructures and the accompanying and necessary governance and stakeholder engagement fundamentals.
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282
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Pfaar O, Demoly P, Gerth van Wijk R, Bonini S, Bousquet J, Canonica GW, Durham SR, Jacobsen L, Malling HJ, Mösges R, Papadopoulos NG, Rak S, Rodriguez del Rio P, Valovirta E, Wahn U, Calderon MA. Recommendations for the standardization of clinical outcomes used in allergen immunotherapy trials for allergic rhinoconjunctivitis: an EAACI Position Paper. Allergy 2014; 69:854-67. [PMID: 24761804 DOI: 10.1111/all.12383] [Citation(s) in RCA: 311] [Impact Index Per Article: 31.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2014] [Indexed: 01/17/2023]
Abstract
BACKGROUND Allergen immunotherapy (AIT) has been thoroughly documented in randomized controlled trials (RCTs). It is the only immune-modifying and causal treatment available for patients suffering from IgE-mediated diseases such as allergic rhinoconjunctivitis, allergic asthma and insect sting allergy. However, there is a high degree of clinical and methodological heterogeneity among the endpoints in clinical studies on AIT, for both subcutaneous and sublingual immunotherapy (SCIT and SLIT). At present, there are no commonly accepted standards for defining the optimal outcome parameters to be used for both primary and secondary endpoints. METHODS As elaborated by a Task Force (TF) of the European Academy of Allergy and Clinical Immunology (EAACI) Immunotherapy Interest Group, this Position Paper evaluates the currently used outcome parameters in different RCTs and also aims to provide recommendations for the optimal endpoints in future AIT trials for allergic rhinoconjunctivitis. RESULTS Based on a thorough literature review, the TF members have outlined recommendations for nine domains of clinical outcome measures. As the primary outcome, the TF recommends a homogeneous combined symptom and medication score (CSMS) as a simple and standardized method that balances both symptoms and the need for antiallergic medication in an equally weighted manner. All outcomes, grouped into nine domains, are reviewed. CONCLUSION A standardized and globally harmonized method for analysing the clinical efficacy of AIT products in RCTs is required. The EAACI TF highlights the CSMS as the primary endpoint for future RCTs in AIT for allergic rhinoconjunctivitis.
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Affiliation(s)
- O. Pfaar
- Center for Rhinology and Allergology Wiesbaden; Department of Otorhinolaryngology, Head and Neck Surgery; University Hospital Mannheim; Mannheim Germany
| | - P. Demoly
- Département de Pneumologie et Addictologie; Hôpital Arnaud de Villeneuve; University Hospital of Montpellier; Montpellier France
- Sorbonne Universités; UPMC Paris 06, UMR-S 1136, IPLESP; Equipe EPAR; Paris France
| | - R. Gerth van Wijk
- Section of Allergology; Department of Internal Medicine; Erasmus MC; Rotterdam the Netherlands
| | - S. Bonini
- Second University of Naples and Institute of Translational Pharmacology; Italian National Research Council (IFT-CNR); Rome Italy
| | - J. Bousquet
- Département de Pneumologie et Addictologie; Hôpital Arnaud de Villeneuve; University Hospital of Montpellier; Montpellier France
- 1018, Respiratory and Environmental Epidemiology Team; INSERM; CESP Centre for research in Epidemiology and Population Health; Villejuif France
| | - G. W. Canonica
- Respiratory Diseases & Allergy Clinic; University of Genova; IRCCS AOU San Martino; Genova Italy
| | - S. R. Durham
- Section of Allergy and Clinical Immunology; National Heart and Lung Institute; Imperial College; London UK
| | - L. Jacobsen
- ALC, Allergy Learning and Consulting; Copenhagen Denmark
| | - H. J. Malling
- Allergy Clinic; University Hospital Gentofte; Copenhagen Denmark
| | - R. Mösges
- Institute of Medical Statistics; Informatics and Epidemiology (IMSIE); University of Cologne; Cologne Germany
| | - N. G. Papadopoulos
- Allergy Department; 2nd Pediatric Clinic; University of Athens; Athens Greece
- Centre for Paediatrics and Child Health; Institute of Human Development; University of Manchester; Manchester UK
| | - S. Rak
- Department of Respiratory Medicine and Allergology; Sahlgrenska University Hospital; Goteborg Sweden
| | | | - E. Valovirta
- Department of Clinical Allergology and Pulmonary Diseases; University of Turku; Finland
- Suomen Terveystalo Allergy Clinic; Turku Finland
| | - U. Wahn
- Department for Pediatric Pneumology and Immunology; Charité Medical University; Berlin Germany
| | - M. A. Calderon
- Section of Allergy and Clinical Immunology; National Heart and Lung Institute; Imperial College; London UK
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283
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Lall D, Prabhakaran D. Organization of primary health care for diabetes and hypertension in high, low and middle income countries. Expert Rev Cardiovasc Ther 2014; 12:987-95. [DOI: 10.1586/14779072.2014.928591] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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284
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Bottino CJ, Cox JE, Kahlon PS, Samuels RC. Improving immunization rates in a hospital-based primary care practice. Pediatrics 2014; 133:e1047-54. [PMID: 24664096 DOI: 10.1542/peds.2013-2494] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We implemented a quality improvement initiative aimed at reaching a 95% immunization rate for patients aged 24 months. The setting was a hospital-based pediatric primary care practice in Boston, Massachusetts. We defined immunization as full receipt of the vaccine series as recommended by the Centers for Disease Control and Prevention. METHODS The initiative was team-based and structured around 3 core interventions: systematic identification and capture of target patients, use of a patient-tracking registry, and patient outreach and care coordination. We measured monthly overall and modified immunization rates for patients aged 24 months. The modified rate excluded vaccine refusals and practice transfers. We plotted monthly overall and modified immunization rates on statistical process control charts to monitor progress and evaluate impact. RESULTS We measured immunization rates for 3298 patients aged 24 months between January 2009 and December 2012. Patients were 48% (n = 1576) female, 77.3% (n = 2548) were African American or Hispanic, and 70.2% (n = 2015) were publicly insured. Using control charts, we established mean overall and modified immunization rates of 90% and 93%, respectively. After implementation, we observed an increase in the mean modified immunization rate to 95%. CONCLUSIONS A quality improvement initiative enabled our pediatric practice to increase its modified immunization rate to 95% for children aged 24 months. We attribute the improvement to the incorporation of medical home elements including a multidisciplinary team, patient registry, and care coordination.
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285
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Frei A, Senn O, Chmiel C, Reissner J, Held U, Rosemann T. Implementation of the chronic care model in small medical practices improves cardiovascular risk but not glycemic control. Diabetes Care 2014; 37:1039-47. [PMID: 24513589 DOI: 10.2337/dc13-1429] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To test whether the implementation of elements of the Chronic Care Model (CCM) via a specially trained practice nurse leads to an improved cardiovascular risk profile among type 2 diabetes patients. RESEARCH DESIGN AND METHODS This cluster randomized controlled trial with primary care physicians as the unit of randomization was conducted in the German part of Switzerland. Three hundred twenty-six type 2 diabetes patients (age >18 years; at least one glycosylated hemoglobin [HbA1c] level of ≥7.0% [53 mmol/mol] in the preceding year) from 30 primary care practices participated. The intervention included implementation of CCM elements and involvement of practice nurses in the care of type 2 diabetes patients. Primary outcome was HbA1c levels. The secondary outcomes were blood pressure (BP), LDL cholesterol, accordance with CCM (assessed by Patient Assessment of Chronic Illness Care [PACIC] questionnaire), and quality of life (assessed by the 36-item short-form health survey [SF-36]). RESULTS After 1 year, HbA1c levels decreased significantly in both groups with no significant difference between groups (-0.05% [-0.60 mmol/mol]; P = 0.708). Among intervention group patients, systolic BP (-3.63; P = 0.050), diastolic BP (-4.01; P < 0.001), LDL cholesterol (-0.21; P = 0.033), and PACIC subscores (P < 0.001 to 0.048) significantly improved compared with control group patients. No differences between groups were shown in the SF-36 subscales. CONCLUSIONS A chronic care approach according to the CCM and involving practice nurses in diabetes care improved the cardiovascular risk profile and is experienced by patients as a better structured care. Our study showed that care according to the CCM can be implemented even in small primary care practices, which still represent the usual structure in most European health care systems.
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Abstract
The patient-centered medical home (PCMH) is an innovative care model for the provision of primary care that is being rapidly adopted in the U.S. with the support of federal agencies and professional organizations. Its goal is to provide comprehensive, patient-centered care with increased access, quality, and efficiency. Diabetes, as a common, costly, chronic disease that requires ongoing management by patients and providers, is a condition that is frequently monitored as a test case in PCMH implementations. While in theory a PCMH care model that supports patient engagement and between-visit care may help improve diabetes care delivery and outcomes, the success of this approach may depend largely upon the specific strategies used and implementation approach. The cost-effectiveness of diabetes care in the PCMH model is not yet clear. Interventions have been most effective and most cost-effective for those with the poorest diabetes management at baseline.
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Affiliation(s)
- Sarah A. Ackroyd
- University of Rochester School of Medicine and Dentistry Rochester, NY 14642
| | - Deborah J. Wexler
- Corresponding Author: Massachusetts General Hospital Diabetes Center and Harvard Medical School, 50 Staniford Street, Boston MA 02114, 617-726-8767 (phone); 617.726.6781 (fax),
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287
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Philis-Tsimikas A, Gallo LC. Implementing community-based diabetes programs: the scripps whittier diabetes institute experience. Curr Diab Rep 2014; 14:462. [PMID: 24390404 PMCID: PMC3946451 DOI: 10.1007/s11892-013-0462-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Diabetes affects a large and growing segment of the US population. Ethnic and racial minorities are at disproportionate risk for diabetes, with Hispanics and non-Hispanic Blacks showing a near doubling of risk relative to non-Hispanic Whites. There is an urgent need to identify low cost, effective, and easily implementable primary and secondary prevention approaches, as well as tertiary strategies that delay disease progression, complications, and associated deterioration in function in patients with diabetes. The Chronic Care Model provides a well-accepted framework for improving diabetes and chronic disease care in the community and primary care medical home. A number of community-based diabetes programs have incorporated this model into their infrastructure. Diabetes programs must offer accessible information and support throughout the community and must be delivered in a format that is understood, regardless of literacy and socioeconomic status. This article will discuss several successful, culturally competent community-based programs and the key elements needed to implement the programs at a community or health system level. Health systems together with local communities can integrate the elements of community-based programs that are effective across the continuum of the care to enhance patient-centered outcomes, enable patient acceptability and ultimately lead to improved patient engagement and satisfaction.
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Affiliation(s)
- Athena Philis-Tsimikas
- Scripps Whittier Diabetes Institute, 9894 Genesee Ave, Suite 316, La Jolla, CA 92037, Telephone : 858-626-5628, Fax : 858-626-5680
| | - Linda C. Gallo
- San Diego State University, Department of Psychology, 9245 Sky Park Court Suite 115, San Diego, CA 92123, Telephone: (619) 594-4833, Fax: (619) 594-6780
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288
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Weeks DL, Polello JM, Hansen DT, Keeney BJ, Conrad DA. Measuring primary care organizational capacity for diabetes care coordination: the Diabetes Care Coordination Readiness Assessment. J Gen Intern Med 2014; 29:98-103. [PMID: 23897130 PMCID: PMC3889951 DOI: 10.1007/s11606-013-2566-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 06/21/2013] [Accepted: 07/12/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Not all primary care clinics are prepared to implement care coordination services for chronic conditions, such as diabetes. Understanding true capacity to coordinate care is an important first-step toward establishing effective and efficient care coordination. Yet, we could identify no diabetes-specific instruments to systematically assess readiness and/or status of primary care clinics to engage in diabetes care coordination. OBJECTIVE This report describes the development and initial validation of the Diabetes Care Coordination Readiness Assessment (DCCRA), which is intended to measure primary care clinic readiness to coordinate care for adult patients with diabetes. DESIGN The instrument was developed through iterative item generation within a framework of five domains of care coordination: Organizational Capacity, Care Coordination, Clinical Management, Quality Improvement, and Technical Infrastructure. PARTICIPANTS Validation data was collected on 39 primary care clinics. MAIN MEASURES Content validity, inter-rater reliability, internal consistency, and construct validity of the 49-item instrument were assessed. KEY RESULTS Inter-rater agreement indices per item ranged from 0.50 to 1.0. Cronbach's alpha of the entire instrument was 0.964, and for the five domain scales ranged from 0.688 to 0.961. Clinics with existing care coordinators were rated as more ready to support care coordination than clinics without care coordinators for the entire DCCRA and for each domain, supporting construct validity. CONCLUSIONS As providers increasingly attempt to adopt patient-centered approaches, introduction of the DCCRA is timely and appropriate for assisting clinics with identifying gaps in provision of care coordination services. The DCCRA's strengths include promising psychometric properties. A valid measure of diabetes care coordination readiness should be useful in diabetes program evaluation, assistance with quality improvement initiatives, and measurement of patient-centered care in research.
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Affiliation(s)
- Douglas L Weeks
- Inland Northwest Health Services, 601 W. First Ave., Spokane, WA, 99201, USA,
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289
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Peterson LE, Blackburn B, Phillips RL, Puffer JC. Improving quality of care for diabetes through a maintenance of certification activity: family physicians' use of the chronic care model. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2014; 34:47-55. [PMID: 24648363 DOI: 10.1002/chp.21216] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Improving the care of patients with diabetes is a health care priority. Through Part 4 of Maintenance of Certification for Family Physicians (MC-FP), American Board of Family Medicine (ABFM) diplomates participate in quality improvement (QI) modules for diabetes. Our objective was to determine associations between physician characteristics and actions taken during Part 4 diabetes modules with quality of care outcomes. METHODS The study sample was all Part 4 modules completed by family physicians from 2005 to 2012. Descriptive statistics were used to characterize the physicians and their behavior in the module. We used linear regression to test for associations between choice of intervention, mode of intervention, and chronic care model domain with improvement in quality measures. RESULTS There were 7924 modules completed by family physicians, whose mean age was 48.2 years; 61.9% were male, and 76.9% lived in urban areas. All physician and patient quality measures improved over the course of the Part 4 module. Regression models found that only baseline performance was consistently associated with quality outcomes. No other consistent association was seen between intervention type, mode, or chronic care model domain and greater likelihood of improvements; however, every quality measure improved. DISCUSSION Through MC-FP, family physicians improved the quality of care they delivered to diabetic patients. Improvement of care across nearly all measures, despite no consistent associations between processes of care or physician characteristics with improvement, suggests that participation in QI itself may lead to higher quality health care and this may be achieved through MC-FP.
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290
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Noël PH, Romero RL, Robertson M, Parchman ML. Key activities used by community based primary care practices to improve the quality of diabetes care in response to practice facilitation. QUALITY IN PRIMARY CARE 2014; 22:211-219. [PMID: 25685075 PMCID: PMC4326068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND A recent systematic review suggests that practice facilitation (PF) is a robust intervention for implementing evidence-based preventive care guidelines in primary care, but the ability of PF to improve chronic illness care remains unclear. AIMS To examine the specific activities and Chronic Care model (CCM) components that primary care practices implemented and sustained in response to a 12-month PF intervention. METHODS The ABC trial tested the effectiveness of PF to improve care for diabetes in 40 small community-based primary care practices that were randomized to "initial" or "delayed" intervention arms. A trained facilitator met with each practice over 12-months. Facilitators used interactive consensus building to help practices implement one or more of quality improvement activities based on the CCM. Facilitators prospectively recorded implementation activities reported by practice teams during monthly meetings and confirmed which of these were sustained at the end of the intervention. RESULTS 37 practices implemented and sustained a total of 43 unique activities [range 1-15, average 6.5 (SD=2.9)]. The number (%) of practices that implemented 1 or more key activities in each CCM component varied: Patient Self-Management Support: 37 (100%); Clinical Information Systems: 24 (64.9%), Delivery System Design: 14 (37.8%), Decision Support: 13 (35.1%), Community Linkages: 2 (5.4%); Healthcare System Support: 2 (2.7%). The majority of practices (59%) only implemented activities from 1 or 2 CCM components. The number of sustained activities was associated with the number of PF visits, but not with practice characteristics. CONCLUSIONS In spite of the PF intervention, it was difficult for these small practices to implement comprehensive CCM changes. Although practices implemented and sustained a remarkable number and variety of key activities, the majority of these focused on patient self-management support, as opposed to other components of the CCM, such as clinical information systems, decision support, delivery system redesign, and community linkages.
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Shaya FT, Chirikov VV, Howard D, Foster C, Costas J, Snitker S, Frimpter J, Kucharski K. Effect of social networks intervention in type 2 diabetes: a partial randomised study. J Epidemiol Community Health 2013; 68:326-32. [DOI: 10.1136/jech-2013-203274] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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294
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King WM, McDermott MT, Trujillo JM. Initial management of severe hyperglycemia in patients with type 2 diabetes: an observational study. Diabetes Ther 2013; 4:375-84. [PMID: 23949906 PMCID: PMC3889332 DOI: 10.1007/s13300-013-0036-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Current guidelines recommend insulin for patients with type 2 diabetes (T2D) and severe hyperglycemia, but this recommendation lacks sufficient evidence and poses practical challenges. It is unclear whether non-insulin treatments are effective in this setting. The objective of this study was to describe treatment strategies of T2D patients with severe hyperglycemia and identify which initial treatments, interventions, or patient characteristics correlated with successful glucose lowering. METHODS This was a retrospective cohort study of 114 patients with T2D and a glycosylated hemoglobin (A1C) ≥12%. Changes in A1C were compared between patients started on non-insulin medications versus insulin-based regimens. Regression analysis was performed to assess predictors of success in achieving A1C ≤9% within 1 year. The main outcomes measures were change in A1C from baseline and predictors of success in achieving A1C ≤9% within 1 year. RESULTS At baseline, 43 patients (37.7%) started one or more non-insulin medications; 71 (62.3%) started insulin. Fifty-eight patients (50.8%) achieved an A1C ≤9%. Predictors of success were newly diagnosed T2D, certified diabetes educator (CDE) visits, and less time to follow-up A1C; insulin therapy was not. Change in A1C was significantly better in the non-insulin cohort compared to the insulin cohort (-4.5% vs. -2.8%, p = 0.001). Newly diagnosed patients were less likely to start insulin therapy (20.8% vs. 73.3%, p < 0.001), less likely to use insulin at any point (29.2% vs 81.1%, p < 0.001), and more likely to achieve an A1C ≤9% compared to patients with established T2D (87.5% vs 41.1%, p < 0.001). CONCLUSION Insulin therapy was used in roughly two-thirds of patients with severe hyperglycemia, but did not result in better glycemic control compared to non-insulin regimens. Rapid follow-up, more CDE visits, and a new diabetes diagnosis were predictors of successful glucose lowering. Patients with T2D and severe hyperglycemia, particularly those newly diagnosed, may be managed with non-insulin therapy.
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Affiliation(s)
- William M. King
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO USA
| | | | - Jennifer M. Trujillo
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO USA
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295
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Bergman M. Inadequacies of current approaches to prediabetes and diabetes prevention. Endocrine 2013; 44:623-33. [PMID: 23881341 DOI: 10.1007/s12020-013-0017-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 07/10/2013] [Indexed: 12/20/2022]
Abstract
In view of the global shift from communicable to chronic, non-communicable diseases including obesity, prediabetes, and type 2 diabetes mellitus, the increasing prevalence of the latter creates a considerable challenge to the clinician and public health infrastructure. Despite the substantial research efforts in the last 10-15 years highlighting the considerable benefit of lifestyle modification in thwarting the insidious progression to diabetes and its complications, many individuals will ineluctably progress even when initially responsive. Furthermore, the vast majority of individuals with prediabetes remain undiagnosed and untreated. Therefore, the responsibilities of the medical and public health communities involve identifying new methods for screening and identifying those at risk as well as refining therapeutic approaches availing as many high-risk individuals as possible to novel treatment modalities.
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Affiliation(s)
- Michael Bergman
- Division of Endocrinology and Metabolism, NYU Diabetes and Endocrine Associates, NYU School of Medicine, 530 First Avenue, Schwartz East, Suite 5E, New York, NY, 10016, USA,
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296
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Abstract
PURPOSE OF REVIEW Lifestyle medicine is a new discipline that has recently emerged as a systematized approach for management of chronic disease. The practice of lifestyle medicine requires skills and competency in addressing multiple health risk behaviours and improving self-management. Targets include diet, physical activity, behaviour change, body weight control, treatment plan adherence, stress and coping, spirituality, mind body techniques, tobacco and substance abuse. This review focuses on the impact of a healthy lifestyle on chronic disease, the rarity of good health and the challenges of implementing a lifestyle medicine programme. RECENT FINDINGS Unhealthy lifestyle behaviours are at the root of the global burden of noncommunicable diseases and account for about 63% of all deaths. Over the past several years, there has been an increased interest in evaluating the benefit of adhering to 'low-risk lifestyle' behaviours and ideal 'cardiovascular health metrics'. Although a healthy lifestyle has repeatedly been shown to improve mortality, the population prevalence of healthy living remains low. SUMMARY Lifestyle medicine presents a new and challenging approach to address the prevention and treatment of noncommunicable diseases, the most important and prevalent causes for increased morbidity and mortality worldwide.
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Affiliation(s)
- Robert F Kushner
- Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
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297
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Lounsbury DW, Hirsch GB, Vega C, Schwartz CE. Understanding social forces involved in diabetes outcomes: a systems science approach to quality-of-life research. Qual Life Res 2013; 23:959-69. [PMID: 24062243 DOI: 10.1007/s11136-013-0532-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE The field of quality-of-life (QOL) research would benefit from learning about and integrating systems science approaches that model how social forces interact dynamically with health and affect the course of chronic illnesses. Our purpose is to describe the systems science mindset and to illustrate the utility of a system dynamics approach to promoting QOL research in chronic disease, using diabetes as an example. METHODS We build a series of causal loop diagrams incrementally, introducing new variables and their dynamic relationships at each stage. RESULTS These causal loop diagrams demonstrate how a common set of relationships among these variables can generate different disease and QOL trajectories for people with diabetes and also lead to a consideration of non-clinical (psychosocial and behavioral) factors that can have implications for program design and policy formulation. CONCLUSIONS The policy implications of the causal loop diagrams are discussed, and empirical next steps to validate the diagrams and quantify the relationships are described.
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Affiliation(s)
- David W Lounsbury
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
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298
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Affiliation(s)
- Carine Franc
- CERMES3, UMR8211, Inserm U988, Villejuif, France
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299
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Chen S, Boyle LL, Conwell Y, Chiu H, Li L, Xiao S. Dementia care in rural China. MENTAL HEALTH IN FAMILY MEDICINE 2013; 10:133-141. [PMID: 24427180 PMCID: PMC3822660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 08/21/2013] [Indexed: 06/03/2023]
Abstract
Dementia is a major cause of disability and has immense cost implications for the individual suffering from the condition, family caregivers and society. Given the high prevalence of dementia in China with its enormous and rapidly expanding population of elderly adults, it is necessary to develop and test approaches to the care for patients with this disorder. The need is especially great in rural China where access to mental healthcare is limited, with the task made more complex by social and economic reforms over the last 30 years that have transformed the Chinese family support system, family values and health delivery systems. Evidence-based collaborative care models for dementia, depression and other chronic diseases that have been developed in some Western countries serve as a basis for discussion of innovative approaches in the management of dementia in rural China, with particular focus on its implementation in the primary care system.
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Affiliation(s)
- Shulin Chen
- Department of Psychology, Zhejiang University, Hangzhou, China
| | - Lisa L Boyle
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, USA
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, USA
| | - Helen Chiu
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong
| | - Lydia Li
- Department of Social Work, University of Michigan, Michigan, USA
| | - Shuiyuan Xiao
- Public Health School, Central South University, Changsha, China
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300
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Becker BN, Becker YT. Those Who Can Do, Teach. Am J Kidney Dis 2013; 62:1-2. [DOI: 10.1053/j.ajkd.2013.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 04/12/2013] [Indexed: 11/11/2022]
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