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Krall JS, Childs B, Mehrotra N. Mobile Applications to Support Diabetes Self-Management Education: Patient Experiences and Provider Perspectives. J Diabetes Sci Technol 2023; 17:1206-1211. [PMID: 37162000 PMCID: PMC10563538 DOI: 10.1177/19322968231174037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND Diabetes self-management education and support (DSMES) is a critical component of diabetes care, but time for it is often limited. Digital tools, such as mobile applications (apps), show promise in extending efforts and supporting self-management education, but have not been fully used. Objectives of this multi-phase study were to (1) evaluate an app designed to support patients with insulin therapy and (2) examine provider perspectives on DSMES apps. METHODS Phase 1: Thirty-two adult patients with type 2 diabetes new to or having difficulties with insulin therapy were introduced to the BDTM Diabetes Care App. Three-month app use and satisfaction and changes in hemoglobin A1c (HbA1c) and diabetes distress were assessed. Phase 2: Sixty diabetes providers completed a survey about their experiences with and perspectives on DSMES apps. RESULTS Phase 1: Patients reported satisfaction with the app, and significant improvements in HbA1c and diabetes distress were observed. Phase 2: Most providers viewed apps as adjuncts to diabetes education. Only 33% had previous app experience; however, 100% would consider recommending apps to their patients. Most would spend 5-15 minutes introducing apps to patients. All respondents agreed that the following DSMES app features-evidence-based educational content, data logging and tracking features, customizable user experience, digital coaching via goal setting or reminders, and ability to share data with providers-are key components to consider. CONCLUSIONS Findings suggest DSMES apps can play a role in self-management support and provide guidance on factors to consider when introducing digital tools into clinical practice. TRIAL REGISTRATION Clinicaltrials.gov, #NCT03999268.
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Affiliation(s)
- Jodi S. Krall
- University of Pittsburgh Medical
Center, Pittsburgh, PA, USA
- Division of Endocrinology and
Metabolism, Department of Medicine, University of Pittsburgh, Pittsburgh, PA,
USA
| | | | - Neha Mehrotra
- University of Pittsburgh Medical
Center, Pittsburgh, PA, USA
- Division of Endocrinology and
Metabolism, Department of Medicine, University of Pittsburgh, Pittsburgh, PA,
USA
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Ramallo-Fariña Y, Rivero-Santana A, García-Pérez L, García-Bello MA, Wägner AM, Gonzalez-Pacheco H, Rodríguez-Rodríguez L, Kaiser-Girardot S, Monzón-Monzón G, Guerra-Marrero C, Daranas-Aguilar C, Roldán-Ruano M, Carmona M, Serrano-Aguilar PG. Patient-reported outcome measures for knowledge transfer and behaviour modification interventions in type 2 diabetes-the INDICA study: a multiarm cluster randomised controlled trial. BMJ Open 2021; 11:e050804. [PMID: 34911711 PMCID: PMC8679133 DOI: 10.1136/bmjopen-2021-050804] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 11/03/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE This study assesses the effectiveness of different interventions of knowledge transfer and behaviour modification to improve type 2 diabetes mellitus patients' (T2DM) reported outcomes measures (PROMs) in the long-term. Design: open, community-based pragmatic, multicentre, controlled trial with random allocation by clusters to usual care (UC) or to one of the three interventions. PARTICIPANTS A total of 2334 patients with uncomplicated T2DM and 211 healthcare professionals were included of 32 primary care centres. SETTING Primary Care Centers in Canary Islands (Spain). INTERVENTION The intervention for patients (PTI) included an educational group programme, logs and a web-based platform for monitoring and automated short message service (SMS). The intervention for professionals (PFI) included an educational programme, a decision support tool embedded into the electronic clinical record and periodic feedback about patients' results. A third group received both PTI and PFI (combined intervention, CBI). OUTCOME MEASURE Cognitive-attitudinal, behavioural, affective and health-related quality of life (HQoL) variables. RESULTS Compared with UC at 24 months, the PTI group significantly improved knowledge (p=0.005), self-empowerment (p=0.002), adherence to dietary recommendations (p<0.001) and distress (p=0.01). The PFI group improved at 24 months in distress (p=0.03) and at 12 months there were improvements in depression (p=0.003), anxiety (p=0.05), HQoL (p=0.005) and self-empowerment (p<0.001). The CBI group improved at 24 months in self-empowerment (p=0.008) and adherence to dietary recommendations (p=0.004) and at 12 months in knowledge (p=0.008), depression (p=0.006), anxiety (p=0.003), distress (p=0.01), HQoL (p<0.001) and neuropathic symptoms (p=0.02). Statistically significant improvements were also observed at 24 months in the proportion of patients who quit smoking for PTI and CBI (41.5% in PTI and 42.3% in CBI vs 21.2% in the UC group). CONCLUSIONS Assessed interventions to improve PROMs in T2DM attain effectiveness for knowledge, self-empowerment, distress, diet adherence and tobacco cessation. PTI produced the most lasting benefits. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT01657227 (6 August 2012) https://clinicaltrials.gov/ct2/show/NCT01657227.
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Affiliation(s)
- Yolanda Ramallo-Fariña
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain
| | - Amado Rivero-Santana
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain
| | - Lidia García-Pérez
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain
| | | | - Ana Maria Wägner
- Department of Endocrinology and Nutrition, Insular University Hospital of Gran Canaria, Las Palmas de Gran Canaria, Spain
- University Institute for Biomedical and Health Research (IUIBS), University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | | | | | | | | | | | | | | | - Montserrat Carmona
- Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain
- Health Technology Assesment Agency, Instituto de Salud Carlos III, Madrid, Spain
| | - Pedro G Serrano-Aguilar
- Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Services (SCS), Tenerife, Spain
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Catapan SDC, Nair U, Gray L, Cristina Marino Calvo M, Bird D, Janda M, Fatehi F, Menon A, Russell A. Same goals, different challenges: A systematic review of perspectives of people with diabetes and healthcare professionals on Type 2 diabetes care. Diabet Med 2021; 38:e14625. [PMID: 34154035 DOI: 10.1111/dme.14625] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 06/06/2021] [Indexed: 01/14/2023]
Abstract
AIMS To identify the views of people with Type 2 diabetes (PWD) and healthcare professionals (HCP) about diabetes care. METHODS A systematic review of qualitative studies reporting both groups' views using thematic synthesis frameworked by the eHealth Enhanced Chronic Care Model was conducted. RESULTS We searched six electronic databases between 2010 and 2020, identified 6999 studies and included 21. Thirty themes were identified with in general complementary views between PWD and HCP. PWD and HCP find lifestyle changes challenging and get frustrated when PWD struggle to achieve it. Good self-management requires a trustful PWD-HCP relationship. Diabetes causes distress and often HCP focus on clinical aspects. They value diabetes education. PWD require broader, tailored, consistent and ongoing information, but HCPs do not have enough time for providing it. There is need for diabetes training for primary HCP. Shared decision making can mitigate PWD's fears. Different sources of social support can influence PWD's ability to self-manage and PWD/HCP suggest online peer groups. PWD/HCP indicate lack of communication and collaboration between HCP. PWD's and HCP's views about quality in diabetes care differ. They believe that comprehensive, multidisciplinary and locally provided care can help to achieve better outcomes. They recognise digital health benefits, with room for personal interaction (PWD) and eHealth literacy improvements (HCP). Evidence-based guidelines are important but can detract from personalised care. CONCLUSION We hypothesise that including PWD's and HCP's complementary views, multidisciplinary teams and digital tools in the redesign of Type 2 diabetes care can help with overcoming some of the challenges and achieving common goals.
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Affiliation(s)
- Soraia de Camargo Catapan
- Public Health Department, Federal University of Santa Catarina, Florianopolis, Brazil
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Uthara Nair
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Len Gray
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | | | - Dominique Bird
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Monika Janda
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Farhad Fatehi
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Anish Menon
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Metro South Health, Brisbane, Australia
| | - Anthony Russell
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Metro South Health, Brisbane, Australia
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Chen CC, Li TC, Huang CY, Chang MP. Validation of the Chinese version of the insulin treatment appraisal scale. Diabetes Res Clin Pract 2020; 170:108485. [PMID: 33035596 DOI: 10.1016/j.diabres.2020.108485] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 08/26/2020] [Accepted: 09/25/2020] [Indexed: 11/25/2022]
Abstract
AIMS To test the reliability and validity of the Chinese version of the Insulin Treatment Appraisal Scale (ITAS) questionnaire in patients with type 2 diabetes mellitus (T2DM). METHODS A total of 200 patients with T2DM were consecutively recruited from the outpatient clinic in Taiwan. The World Health Organization guideline was followed to translate the questionnaire. The internal consistency was assessed by Cronbach's α coefficient and item-total correlations. The construct validity was evaluated by using confirmatory factor analysis, convergent validity, and discriminate validity. RESULTS The Cronbach's α coefficient for estimates of internal consistency of the total scale was 0.72, and ranged from 0.76 to 0.77 for the subscales. A value of ≥0.40 was considered being substantial. The item-total correlation values were 14 out of 20 items having substantial correlations (4 out of 4 items on the positive appraisal scale and 10 out of 16 items on the negative appraisal scale). The confirmatory factor analysis confirmed both positive and negative factors with total explained variance 33.9% (12.2% for positive subscale and 21.7% for negative subscale). The success rate, calculated from the item-total correlation values, was 70% for the convergent validity (100% for positive subscale and 63% for negative subscale) and 90% for discriminate validity (100% for positive subscale and 88% for negative subscale), respectively. Both the ceiling effect and floor effect were 0%. CONCLUSIONS The Chinese version of the ITAS questionnaire is a valid and reliable instrument for measuring the perceptions of insulin injection in patients with T2DM.
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Affiliation(s)
- Ching-Chu Chen
- Division of Endocrinology and Metabolism, Department of Medicine, China Medical University Hospital, Taichung 40447, Taiwan; School of Chinese Medicine, China Medical University, Taichung 40447, Taiwan
| | - Tsai-Chung Li
- Department of Public Health, College of Public Health, China Medical University, Taichung 40402, Taiwan; Department of Healthcare Administration, College of Health Science, Asia University, Taichung 41354, Taiwan
| | - Chi-Yu Huang
- Division of Endocrinology and Metabolism, Department of Medicine, China Medical University Hospital, Taichung 40447, Taiwan
| | - Man-Ping Chang
- Department of Nursing, National Taichung University of Science and Technology, Taichung 40354, Taiwan.
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Puhl RM, Himmelstein MS, Hateley-Browne JL, Speight J. Weight stigma and diabetes stigma in U.S. adults with type 2 diabetes: Associations with diabetes self-care behaviors and perceptions of health care. Diabetes Res Clin Pract 2020; 168:108387. [PMID: 32858100 DOI: 10.1016/j.diabres.2020.108387] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/17/2020] [Accepted: 08/19/2020] [Indexed: 01/18/2023]
Abstract
AIMS Diabetes stigma and weight stigma have been identified as important but neglected issues that warrant attention among people with type 2 diabetes. This study assessed associations of diabetes stigma and weight stigma with diabetes self-care behaviors and health care in adults with type 2 diabetes. METHODS U.S. adults with type 2 diabetes (N = 1,227) completed self-report questionnaires to assess their experiences of weight stigma, diabetes stigma, diabetes self-management, diabetes-specific distress, healthcare utilization, perceptions of diabetes-specific health care. They also provided sociodemographic information. Linear regressions examined relationships among stigma and diabetes self-care and related health care, controlling for participants' age, education, income, gender, race/ethnicity, and body mass index. RESULTS Internalized weight stigma and diabetes self-stigma were both significantly associated with higher diabetes-specific distress. Adults who expressed self-stigma for their diabetes reported less diabetes self-management and lower self-efficacy, and those who reported being judged about their weight by a doctor exhibited greater diabetes-specific distress. While a history of experienced weight stigma (in general) did not reduce frequency of seeking health care, lower quality interactions with health care professionals were reported by adults who expressed diabetes self-stigma and those who experienced weight stigma from a doctor. CONCLUSIONS Self-stigma for diabetes and body weight, as well as experiencing judgment about weight from doctors, may have negative implications for diabetes-specific self-care behaviors and perceived quality of health care. Efforts to promote wellbeing in individuals with type 2 diabetes need to consider reducing both diabetes and weight stigma and their potentially harmful consequences.
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Affiliation(s)
- Rebecca M Puhl
- Department of Human Development & Family Sciences, University of Connecticut, Storrs, CT, United States; Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford, CT, United States.
| | - Mary S Himmelstein
- Department of Psychological Sciences, Kent State University, Kent, OH, United States
| | | | - Jane Speight
- Deakin University, School of Psychology, Geelong, Victoria, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
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The Role of Nurses and the Facilitators and Barriers in Diabetes Care: A Mixed Methods Systematic Literature Review. Behav Sci (Basel) 2019; 9:bs9060061. [PMID: 31197121 PMCID: PMC6616628 DOI: 10.3390/bs9060061] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 12/31/2022] Open
Abstract
Background: The aim of this review is to identify the roles and activities of nurses working with people with diabetes and to examine the facilitators and barriers in caring for such people. Methods: A systematic review was conducted. From 531 abstracts reviewed, 29 studies were included (18 studies comprised questionnaire surveys, one was an intervention study, two used both questionnaires and interviews, and eight of them used interviews). Barriers and facilitators were extracted and combined using qualitative synthesis. Results: The literature review revealed three major roles and a number of barriers. A model for achieving enhanced nursing care of patients with diabetes has been developed according to the findings of this literature. Specifically, a stepladder suggesting that through better nursing training and education and by providing adequate resources, time, and synergies to diabetes specialists, nurses will be able to correctly perform their diabetes care roles, which include patient education, advanced care, and psychological support. Conclusions: Taking into serious consideration that a large number of hospital users are people with diabetes and that there is an inconsistency among countries about the work settings of Diabetes Specialist Nurses (DSNs), it is important to give greater focus to inpatient care and perhaps to enhance nurses’ roles by eliminating any barriers that prevent them from providing adequate quality care. Furthermore, integrated care involving the role of DSNs within the inpatient care would have been more beneficial for patients.
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Misra A, Sattar N, Tandon N, Shrivastava U, Vikram NK, Khunti K, Hills AP. Clinical management of type 2 diabetes in south Asia. Lancet Diabetes Endocrinol 2018; 6:979-991. [PMID: 30287103 DOI: 10.1016/s2213-8587(18)30199-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 06/19/2018] [Accepted: 06/19/2018] [Indexed: 02/07/2023]
Abstract
Compared with other ethnic groups, south Asian people with type 2 diabetes tend to develop the disease at a younger age and manifest with higher glycaemia, dyslipidaemia, nephropathy, and cardiovascular diseases. Additionally, specific issues that can affect treatment of type 2 diabetes in south Asia include poor awareness of the disease, delay in diagnosis, inadequate treatment, the use of ineffective and often harmful alternative medicines, and frequent non-compliance with lifestyle recommendations and drug treatment. Disease development at younger ages, delayed diagnosis, and inadequate management result in early development of severe complications and premature mortality. In this Series paper, we describe the challenges associated with the increasing burden of type 2 diabetes in south Asia and discuss ways to improve clinical care of people with the disorder in the region (defined to include Bangladesh, Bhutan, India, Nepal, Pakistan, and Sri Lanka). Treatment of diabetes in south Asia needs to be individualised on the basis of diverse and heterogeneous lifestyle, phenotype, environmental, social, cultural, and economic factors. Aggressive management of risk factors from diagnosis is necessary to reduce the risk of microvascular and macrovascular complications, focusing on provision of basic treatments (eg, metformin, low-cost statins, and blood pressure-lowering drugs) and other interventions such as smoking cessation. Strengthening of the primary care model of care, better referral linkages, and implementation of rehabilitation services to care for patients with chronic complications will be important. Finally, improvement of physicians' skills, provision of relevant training to non-physician health-care workers, and the development and regular updating of national clinical management guidelines will also be crucial to improve diabetes care in the region.
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Affiliation(s)
- Anoop Misra
- Fortis C-DOC Centre of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, New Delhi, India; National Diabetes, Obesity, and Cholesterol Foundation, New Delhi, India; Diabetes Foundation (India), New Delhi, India.
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Nikhil Tandon
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Usha Shrivastava
- National Diabetes, Obesity, and Cholesterol Foundation, New Delhi, India
| | - Naval K Vikram
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Andrew P Hills
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia
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Risk factors and quality of life of patients with high diabetes-related distress in primary care: a cross-sectional, multicenter study. Qual Life Res 2018; 28:491-501. [PMID: 30194625 DOI: 10.1007/s11136-018-1994-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE This study aimed to examine risk factors and quality of life of patients with high diabetes-related distress (DRD) in primary care. METHODS A cross-sectional, multicenter study was conducted in four primary healthcare institutions. Patients aged ≥ 21 years with T2DM were included; patients who were pregnant or unable to communicate independently were excluded from this study. The problem area in diabetes (PAID) measuring DRD, European quality of life-5 dimensions (EQ-5D), and audit of diabetes-dependent quality of life (ADDQoL) measuring quality of life were administered by trained research assistants. RESULTS A total of 525 patients were eligible for this study. The mean PAID score was 26.90 ± 20.23, with 27.8% of patients reporting having high DRD (PAID score ≥ 40). Patients who were younger than 50 years (OR 4.577, 95% CI 1.977-10.600) and patients with HbA1c greater than 9% (OR 1.720, 95% CI 1.064-2.779) were at higher risk of having high DRD (p < 0.05). Patients with high DRD have a lower EQ-5D index value (B = - 0.141) and ADDQoL AWI (B = - 1.276) than patients with little/no DRD (p < 0.001). CONCLUSION High DRD was more common among younger patients and patients with poorer glycemic control. High DRD was associated with poorer quality of life and early screening and management of DRD is recommended.
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Aweko J, De Man J, Absetz P, Östenson CG, Swartling Peterson S, Mölsted Alvesson H, Daivadanam M. Patient and Provider Dilemmas of Type 2 Diabetes Self-Management: A Qualitative Study in Socioeconomically Disadvantaged Communities in Stockholm. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1810. [PMID: 30135373 PMCID: PMC6164476 DOI: 10.3390/ijerph15091810] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/09/2018] [Accepted: 08/16/2018] [Indexed: 12/27/2022]
Abstract
Studies comparing provider and patient views and experiences of self-management within primary healthcare are particularly scarce in disadvantaged settings. In this qualitative study, patient and provider perceptions of self-management were investigated in five socio-economically disadvantaged communities in Stockholm. Twelve individual interviews and four group interviews were conducted. Semi-structured interview guides included questions on perceptions of diabetes diagnosis, diabetes care services available at primary health care centers, patient and provider interactions, and self-management support. Data was analyzed using thematic analysis. Two overarching themes were identified: adopting and maintaining new routines through practical and appropriate lifestyle choices (patients), and balancing expectations and pre-conceptions of self-management (providers). The themes were characterized by inherent dilemmas representing confusions and conflicts that patients and providers experienced in their daily life or practice. Patients found it difficult to tailor information and lifestyle advice to fit their daily life. Healthcare providers recognized that patients needed support to change behavior, but saw themselves as inadequately equipped to deal with the different cultural and social aspects of self-management. This study highlights patient and provider dilemmas that influence the interaction and collaboration between patients and providers and hinder uptake of self-management advice.
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Affiliation(s)
- Juliet Aweko
- Department of Public Health Sciences, Karolinska Institutet, SE-171 76 Stockholm, Sweden.
| | - Jeroen De Man
- Department of Public Health, Institute of Tropical Medicine, 43, 2000 Antwerp, Belgium.
| | - Pilvikki Absetz
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 111, FI-80101 Joensuu, Finland.
| | - Claes-Göran Östenson
- Department of Molecular Medicine and Surgery, Karolinska University Hospital, SE-171 77 Stockholm, Sweden.
| | - Stefan Swartling Peterson
- Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, 751 85 Uppsala, Sweden.
| | - Helle Mölsted Alvesson
- Department of Public Health Sciences, Karolinska Institutet, SE-171 76 Stockholm, Sweden.
| | - Meena Daivadanam
- Department of Public Health Sciences, Karolinska Institutet, SE-171 76 Stockholm, Sweden.
- Department of Food, Nutrition and Dietetics, Uppsala University, P.O. Box 560, 751 22 Uppsala, Sweden.
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Perceptions of insulin use in type 2 diabetes in primary care: a thematic synthesis. BMC FAMILY PRACTICE 2018; 19:70. [PMID: 29788908 PMCID: PMC5964885 DOI: 10.1186/s12875-018-0753-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 05/01/2018] [Indexed: 01/29/2023]
Abstract
Background Increasing numbers of patients with type 2 diabetes mellitus are progressing to insulin therapy, and despite its potency many such individuals still have suboptimal glycaemic control. Insulin initiation and intensification is now often conducted by Practice Nurses and General Practitioners in many parts of the UK. Therefore, gaining insight into perspectives of patients and primary care clinicians is important in determining self-management and engagement with insulin. A thematic synthesis of studies was conducted exploring the views and experiences of people with type 2 diabetes and of healthcare professionals on insulin use and management in the context of primary care. Methods Protocol based systematic searches of electronic databases (CINAHL, Cochrane Library, EMBASE, MEDLINE, PsycINFO, and Web of Science) were performed on 1 October 2014 and updated on 31 March 2015, to identify studies that identified the views and experiences of adults with type 2 diabetes or primary care clinicians on the use of insulin in the management of type 2 diabetes. Studies meeting the review inclusion criteria were critically appraised using the CASP qualitative research checklist or Barley’s checklist for survey designs. A thematic synthesis was then conducted of the collected studies. Results Thirty-four studies were selected. Of these, 12 used qualitative interviews (nine with patients and three with healthcare professionals) and 22 were survey based (14 with patients, three with healthcare professionals, and five with both). Twelve key themes were identified and formed three domains, patient perceptions, healthcare professional perceptions, and health professional-patient relationships. The patient-centred themes were: insulin-related beliefs, social influences, psychological factors, hypoglycaemia, and therapy barriers. The clinician-related themes were: insulin skills of general practitioners, healthcare integration, healthcare professional-perceived barriers, hypoglycaemia, and explanations for adherence. Healthcare professional-patient relationship themes were drawn from the perspectives of patients and from clinicians. Conclusions This review reveals multiple barriers to optimal insulin use in primary care at both the patient and healthcare professional levels. These barriers indicate the need for multimodal interventions to: improve the knowledge and competencies of primary care professionals in insulin use; provide more effective patient education and self-management support; and introduce integrated insulin support systems. Electronic supplementary material The online version of this article (10.1186/s12875-018-0753-2) contains supplementary material, which is available to authorized users.
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Paduch A, Kuske S, Schiereck T, Droste S, Loerbroks A, Sørensen M, Maggini M, Icks A. Psychosocial barriers to healthcare use among individuals with diabetes mellitus: A systematic review. Prim Care Diabetes 2017; 11:495-514. [PMID: 28918199 DOI: 10.1016/j.pcd.2017.07.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 06/26/2017] [Accepted: 07/31/2017] [Indexed: 01/20/2023]
Abstract
PURPOSE To conduct a systematic review regarding psychosocial barriers to healthcare use in individuals with diabetes mellitus, using a well-established model of health-service use as a theoretical framework. METHODS We used database-specific controlled vocabularies and additional free text terms, and conducted searches via MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science, OVID Journals. Included studies were rated according to the UK National Institute for Health and Care Excellence (NICE) criteria. A narrative data synthesis was conducted, using the Andersen model and developing categories from the included studies. PRINCIPAL RESULTS In total, 2923 studies were identified, and 15 finally included. We identified barriers according to the main categories "population characteristics", "norms and values", and "healthcare services" on a contextual and individual level, as well as "health status". Frequently reported barriers were "socioeconomic status", and "physician characteristics". Ethnic minorities were frequently analysed and may have specific barriers, e.g. "cultural beliefs" and "language". MAJOR CONCLUSIONS We identified a broad range of barriers to healthcare use in individuals with diabetes mellitus. However, the number of studies is low. Further research is needed to analyse barriers in more detail considering special subgroups.
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Affiliation(s)
- Andrea Paduch
- Heinrich Heine University Düsseldorf, Faculty of Medicine, Institute for Health Services Research and Health Economics, Centre for Health and Society, Moorenstraße 5, 40225 Düsseldorf, Germany.
| | - Silke Kuske
- Heinrich Heine University Düsseldorf, Faculty of Medicine, Institute for Health Services Research and Health Economics, Centre for Health and Society, Moorenstraße 5, 40225 Düsseldorf, Germany; German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Institute for Health Services Research and Health Economics, Auf'm Hennekamp 65, 40225 Düsseldorf, Germany.
| | - Tim Schiereck
- Heinrich Heine University Düsseldorf, Faculty of Medicine, Institute for Health Services Research and Health Economics, Centre for Health and Society, Moorenstraße 5, 40225 Düsseldorf, Germany.
| | - Sigrid Droste
- Heinrich Heine University Düsseldorf, Faculty of Medicine, Institute for Health Services Research and Health Economics, Centre for Health and Society, Moorenstraße 5, 40225 Düsseldorf, Germany.
| | - Adrian Loerbroks
- Heinrich Heine University Düsseldorf, Faculty of Medicine, Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Moorenstraße 5, 40225 Düsseldorf, Germany.
| | - Monica Sørensen
- The Norwegian Directorate of Health, Pb 7000 St. Olavs plass, 0130 Oslo, Norway.
| | - Marina Maggini
- Centro Nazionale di Epidemiologia, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
| | - Andrea Icks
- Heinrich Heine University Düsseldorf, Faculty of Medicine, Institute for Health Services Research and Health Economics, Centre for Health and Society, Moorenstraße 5, 40225 Düsseldorf, Germany; German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Institute for Health Services Research and Health Economics, Auf'm Hennekamp 65, 40225 Düsseldorf, Germany; German Centre for Diabetes Research, Munich-Neuherberg, Germany.
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Borgermans L, Goderis G, Van Den Broeke C, Verbeke G, Carbonez A, Ivanova A, Mathieu C, Heyrman J. Patients' Experiences with Patient-Centred Care are Associated with Documented outcome of Care Indicators for Diabetes: Findings from the Leuven Diabetes Project. ACTA ACUST UNITED AC 2017. [DOI: 10.1258/jicp.2011.011m27] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Assessment of diabetes care quality increasingly integrates measurements of patient perceptions. With escalating demand for diabetic services, it is critical to evaluate patients' experiences with patient-centred care and their association with outcome of care indicators. Global satisfaction and experiences with patient-centred care were evaluated in patients with type 2 diabetes. Patients participated in a quality improvement programme set-up as a two-arm clustered randomized trial. The Usual Quality Improvement Programme (UQIP) targeted clinical inertia in primary care physicians. The Advanced Quality Improvement Programme (AQIP) aimed to reduce the rate of clinical inertia and improve the provision of patient-centred care. Objective measures of patient-centred care, including overall satisfaction with care and measures related to health promotion, were associated with mean levels of glycosylated haemoglobin (HbA1c), low-density lipoprotein cholesterol (LDLc) and systolic blood pressure (SBP), measured after 18 months of intervention. The patient response rate was 55.4%. Fifty-nine per cent of patients were very satisfied with quality of care. Overall satisfaction scores and patients' experiences with patient-centred care, did not significantly differ between AQIP and UQIP. The association between overall satisfaction with care and HbA1c levels significantly differed between AQIP and UQIP (P = 0.048). Overall satisfaction with care and LDLc levels did not significantly differ between AQIP and UQIP, or among all patients. The association between overall satisfaction with care and SBP levels, significantly differed between AQIP and UQIP (P = 0.004). Positive experiences with support in the use of oral antidiabetic agents were associated with significantly lower levels of HbA1c in all patients (P = 0.006). Positive experiences with information provision on diabetes mellitus were associated with significantly lower levels of LDLc and SBP (P = 0.036 and 0.010, respectively), as were experiences with information provision on medical treatment (LDLc, P = 0.005; SBP, P = 0.003). In conclusion, results show relatively good performance in both overall satisfaction with quality of care and in all patient-centredness measures examined. Overall satisfaction and measures of patient-centred care are associated with improved outcomes of care, although not consistently.
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Affiliation(s)
- Liesbeth Borgermans
- Department of General Practice, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Geert Goderis
- Department of General Practice, Katholieke Universiteit Leuven, Leuven, Belgium
| | | | - Geert Verbeke
- Biostatistical Centre, Katholieke Universiteit Leuven, Belgium
| | - An Carbonez
- Leuven Statistics Centre, Katholieke Universiteit Leuven, Belgium
| | - Anna Ivanova
- Leuven Statistics Centre, Katholieke Universiteit Leuven, Belgium
| | | | - Jan Heyrman
- Department of General Practice, Katholieke Universiteit Leuven, Leuven, Belgium
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Brod M, Pfeiffer KM, Barnett AH, Berntorp K, Vilsbøll T, Weissenberger B. Perceptions of diabetes control among physicians and people with type 2 diabetes uncontrolled on basal insulin in Sweden, Switzerland, and the United Kingdom. Curr Med Res Opin 2016; 32:981-9. [PMID: 26849483 DOI: 10.1185/03007995.2016.1150821] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective A large proportion of people with type 2 diabetes (T2D) remain uncontrolled on basal insulin. Yet, there is limited understanding of how people with uncontrolled type 2 diabetes (PWUD) perceive control and insulin intensification and whether their perceptions differ from those of physicians. The purpose of the study was to investigate perceptions of control and views on insulin intensification among physicians and PWUD. Research design and methods Web surveys of 1012 PWUD on basal insulin and 300 physicians were conducted in Sweden, Switzerland, and the United Kingdom. Results Analyses revealed significant differences between physicians and PWUD. Physicians were significantly more likely than PWUD to indicate that HbA1c (85.0% vs. 78.9%, p < 0.05), complications from diabetes (89.3% vs. 75.3%, p < 0.001), and frequency/severity of hypoglycemia (93.3% vs. 68.6%, p < 0.001) were very/extremely important for deciding whether or not diabetes is well controlled. In contrast PWUD were significantly more likely to place importance on a variety of factors, including energy levels (74.5% vs. 33.0%, p < 0.001), insulin units/day (77.6% vs. 29.0%, p < 0.001) and how predictable life is (72.1% vs. 29.3%, p < 0.001). PWUD also perceived significantly greater obstacles to control and viewed uncontrolled T2D as more interfering in their lives compared to physicians. Physicians were most reluctant to intensify insulin when there is a lack of patient agreement. Worries about weight gain and feelings of 'getting sicker' were the most frequently reported reasons why PWUD on basal insulin were reluctant to intensify insulin. Conclusions Results revealed a significant disconnect between physicians and PWUD in their perceptions of diabetes control. While physicians generally expressed a more focused and clinical view of diabetes control, patients had a broader view. Results also provide insights into PWUD and physicians' reluctance to intensify insulin. The findings suggest that physician and patient education on differing perceptions could benefit communication and improve diabetes management.
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Affiliation(s)
- Meryl Brod
- a The Brod Group , Mill Valley , CA , United States
| | | | - Anthony H Barnett
- b Heart of England NHS Foundation Trust and University of Birmingham , Birmingham , United Kingdom
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14
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Two Days With Diabetes. TOP CLIN NUTR 2016. [DOI: 10.1097/tin.0000000000000063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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15
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Roopnarinesingh N, Brennan N, Khan C, Ladenson PW, Hill-Briggs F, Kalyani RR. Barriers to optimal diabetes care in Trinidad and Tobago: a health care Professionals' perspective. BMC Health Serv Res 2015; 15:396. [PMID: 26386950 PMCID: PMC4575420 DOI: 10.1186/s12913-015-1066-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 09/12/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The republic of Trinidad and Tobago (T&T) is a middle income country with a comparatively high prevalence of diabetes mellitus (DM) compared to others in the Caribbean. To date, there have been no studies on health care professionals' (HCP) perspectives regarding the barriers to achieving optimal care of patients with DM in this country and few previous studies in the Caribbean, yet such perspectives are imperative to develop strategies that reduce the global burden of this disease. METHODS An electronic invitation was sent to prospective HCP in T&T inviting them to attend a symposium on DM and cardiovascular disease. A total of 198 HCP participants attended of whom approximately 100 participants completed an Audience Response Survey at the completion of the conference. The Audience Response Survey included questions regarding access to resources, need for prevention and education, and coordination of care for to diabetes care in T&T. Responses were analyzed in aggregate. RESULTS The 198 HCP participants attending the symposium included mostly nurses (40 %) and physicians (43 %). The most common specialty indicated by the 198 HCP participants was Internal and Family Medicine (28 %), followed by Anesthesiology (7 %), Emergency Medicine (6 %), Endocrinology and Diabetes (5 %) and Cardiology (3 %). Among the ~100 HCP who completed the Audience Response Survey, multiple barriers to achieving optimal care of patients with diabetes were reported such as: limited access to blood testing (75 %), ophthalmological evaluations (96 %), ECGs (69 %), and cardiac stress tests (92 %); inadequate time to screen and evaluate DM complications (95 %); poor access to consultants for referral of difficult cases (77 %); and lack of provider education regarding cardiovascular complications of DM (57 %). HCP agreed that nurses could potentially be considered to have a more active role in the care and prevention of cardiovascular disease and diabetes through leading patient education efforts (98 %), screening patients for complications (91 %), coordinating care efforts (99 %) and educating family members (98 %). CONCLUSIONS The HCP in our study reported significant barriers to achieving optimal diabetes care in T&T. In the future, such barriers to care will need to be addressed in order to respond to the projected growth of diabetes in developing countries both within the Caribbean and globally.
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Affiliation(s)
- Nira Roopnarinesingh
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
| | - Nancyellen Brennan
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
| | - Claude Khan
- Southwest Regional Health Authority, San Fernando, Trinidad and Tobago.
| | - Paul W Ladenson
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
| | - Felicia Hill-Briggs
- Division of General Internal Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
| | - Rita Rastogi Kalyani
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins Medical Institutions, Baltimore, MD, USA. .,Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 333, Baltimore, MD, 21287, USA.
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Schroeder EB, Desai J, Schmittdiel JA, Paolino AR, Schneider JL, Goodrich GK, Lawrence JM, Newton KM, Nichols GA, O'Connor PJ, Fitz-Randolph M, Steiner JF. An Innovative Approach to Informing Research: Gathering Perspectives on Diabetes Care Challenges From an Online Patient Community. Interact J Med Res 2015; 4:e13. [PMID: 26126421 PMCID: PMC4526969 DOI: 10.2196/ijmr.3856] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 03/30/2015] [Accepted: 04/27/2015] [Indexed: 11/26/2022] Open
Abstract
Background Funding agencies and researchers increasingly recognize the importance of patient stakeholder engagement in research. Despite calls for greater patient engagement, few studies have engaged a broad-based online community of patient stakeholders in the early stages of the research development process. Objective The objective of our study was to inform a research priority-setting agenda by using a Web-based survey to gather perceptions of important and difficult aspects of diabetes care from patient members of a social networking site-based community. Methods Invitations to participate in a Web-based survey were sent by email to members of the PatientsLikeMe online diabetes community. The survey asked both quantitative and qualitative questions addressing individuals’ level of difficulty with diabetes care, provider communication, medication management, diet and exercise, and relationships with others. Qualitative responses were analyzed using content analysis. Results Of 6219 PatientsLikeMe members with diabetes who were sent survey invitations, 1044 (16.79%) opened the invitation and 320 (5.15% of 6219; 30.65% of 1044) completed the survey within 23 days. Of the 320 respondents, 33 (10.3%) reported having Type 1 diabetes; 107 (33.4%), Type 2 diabetes and taking insulin; and 180 (56.3%), Type 2 diabetes and taking oral agents or controlling their diabetes with lifestyle modifications. Compared to 2005-2010 National Health and Nutrition Examination Survey data for individuals with diabetes, our respondents were younger (mean age 55.8 years, SD 9.9 vs 59.4 years, SE 0.5); less likely to be male (111/320, 34.6% vs 48.4%); and less likely to be a racial or ethnic minority (40/312, 12.8% vs 37.5%). Of 29 potential challenges in diabetes care, 19 were categorized as difficult by 20% or more of respondents. Both quantitative and qualitative results indicated that top patient challenges were lifestyle concerns (diet, physical activity, weight, and stress) and interpersonal concerns (trying not to be a burden to others, getting support from family/friends). In our quantitative analysis, similar concerns were expressed across patient subgroups. Conclusions Lifestyle and interpersonal factors were particularly challenging for our online sample of adults with Type 1 or Type 2 diabetes. Our study demonstrates the innovative use of social networking sites and online communities to gather rapid, meaningful, and relevant patient perspectives that can be used to inform the development of research agendas.
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Affiliation(s)
- Emily B Schroeder
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, United States.
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Kapur K, McAleer S, Persson F, Bjerre-Christensen U. Improving the effectiveness of short-term courses for multidisciplinary health care professionals. PRACTICAL DIABETES 2015. [DOI: 10.1002/pdi.1953] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Kavita Kapur
- Steno Diabetes Center A/S; Niels Steensens Vej 6 DK-2820 Gentofte Denmark
| | - Sean McAleer
- Centre for Medical Education; University of Dundee; Dundee UK
| | - Frederik Persson
- Steno Diabetes Center A/S; Niels Steensens Vej 6 DK-2820 Gentofte Denmark
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18
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Diabetesbezogene Belastungen, Wohlbefinden und Einstellung von Menschen mit Diabetes. DIABETOLOGE 2015. [DOI: 10.1007/s11428-015-1335-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Solvang MM, Norekvål TM, Tell GS, Berge LI, Iversen MM. Attempts to improve and confidence in improving health behaviour in 40-49 year olds with and without coronary heart disease: The Hordaland Health Study. Eur J Cardiovasc Nurs 2015; 15:e60-9. [PMID: 25888607 DOI: 10.1177/1474515115583399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 03/30/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND While the overall incidence of acute myocardial infarction in Norway decreased in 2001-2009, this was not observed for younger adults. Smoking cessation, physical activity and healthy diet are associated with reduced risk of recurrent cardiovascular events and mortality among individuals with established coronary heart disease (CHD). AIMS We investigated whether adults in their 40s with or without CHD had 1) attempted to improve their health behaviour during the previous year, and 2) had confidence in their ability to improve their health behaviour over the next five years. METHODS Study participants were 22,019 40-49 year olds from the Hordaland Health Study. Associations between improvements and intentions regarding health behaviours and prevalent CHD were assessed with logistic regression analyses. RESULTS One hundred and seventy-five (0.8%) participants reported to have CHD. After controlling for demographic, lifestyle and psychosocial variables, attempts to improve health behaviour during the prior year were associated with a threefold increased odds of prevalent CHD (odds ratio 3.07; 95% confidence interval, 1.91-4.95). Confidence in improving health behaviour during the subsequent five years was not associated with increased odds of prevalent CHD. CONCLUSIONS Adults in their 40s with CHD were more likely to have attempted to improve their health behaviour during the past year compared with those without CHD. Healthcare providers should take advantage of these positive attitudes to encourage further positive improvements.
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Affiliation(s)
- Marte M Solvang
- Faculty of Health and Social Sciences, Bergen University College, Norway
| | - Tone M Norekvål
- Faculty of Health and Social Sciences, Bergen University College, Norway Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Line I Berge
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Marjolein M Iversen
- Faculty of Health and Social Sciences, Bergen University College, Norway Department of Endocrinology, Stavanger University Hospital, Norway
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Boström E, Isaksson U, Lundman B, Sjölander AE, Hörnsten Å. Diabetes specialist nurses’ perceptions of their multifaceted role. ACTA ACUST UNITED AC 2015. [DOI: 10.1002/edn.204] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Nafees B, Lloyd A, Kennedy-Martin T, Hynd S. How diabetes and insulin therapy affects the lives of people with type 1 diabetes. ACTA ACUST UNITED AC 2015. [DOI: 10.1002/edn.50] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Lauvergeon S, Mettler D, Burnand B, Peytremann‐Bridevaux I. Convergences and divergences of diabetic patients' and healthcare professionals' opinions of care: a qualitative study. Health Expect 2015; 18:111-23. [PMID: 23121596 PMCID: PMC5060754 DOI: 10.1111/hex.12013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2012] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To investigate opinions' convergences and divergences of diabetic patients and health-care professionals on diabetes care and the development of a regional diabetes programme. BACKGROUND Development and implementation of a regional diabetes programme. RESEARCH DESIGN Qualitative study using focus groups to elicit diabetic patients' and health-care professionals' opinions, followed by content analysis. SETTING AND PARTICIPANTS Eight focus groups: four focus groups with diabetic patients (n = 39) and four focus groups with various health-care professionals (n = 34) residing or practicing in the canton of Vaud, Switzerland, respectively. RESULTS Perceived quality of diabetes care varied between individuals and types of participants. To improve quality, patients favoured a comprehensive follow-up while professionals suggested considering existing structures and trained professionals. All participants mentioned communication difficulties between professionals and were favouring teamwork. In addition, they described the role that patients should have in care and self-management. Financial difficulties were also mentioned by both groups of participants. Finally, they were in favour of the development of a regional diabetes programme adapted to actors' needs. For patients indeed, such a programme would represent an opportunity to improve information and to have access to comprehensive care. For professionals, it would help the development of local networks and the reinforcement of existing tools and structures. DISCUSSION AND CONCLUSIONS Acknowledging convergences and divergences of opinions of both diabetic patients and health-care professionals should help the further development of a programme adapted to users' needs, taking all stakeholders interests and priorities into consideration.
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Affiliation(s)
- Stéphanie Lauvergeon
- Institute of Social and Preventive Medicine (IUMSP)Lausanne University HospitalLausanneSwitzerland
| | - Désirée Mettler
- Institute of Social and Preventive Medicine (IUMSP)Lausanne University HospitalLausanneSwitzerland
| | - Bernard Burnand
- Institute of Social and Preventive Medicine (IUMSP)Lausanne University HospitalLausanneSwitzerland
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Perceptions of primary care doctors towards Type 2 Diabetes Mellitus and challenges for care at primary care level in India. Int J Diabetes Dev Ctries 2014. [DOI: 10.1007/s13410-014-0199-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Daly B, Arroll B, Sheridan N, Kenealy T, Scragg R. Diabetes knowledge of nurses providing community care for diabetes patients in Auckland, New Zealand. Prim Care Diabetes 2014; 8:215-223. [PMID: 24485171 DOI: 10.1016/j.pcd.2014.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 12/14/2013] [Accepted: 01/03/2014] [Indexed: 11/19/2022]
Abstract
AIMS To quantify and compare knowledge of diabetes including risk factors for diabetes-related complications among the three main groups of primary health care nurses. METHODS In a cross-sectional survey of practice, district and specialist nurses (n=1091) in Auckland, New Zealand, 31% were randomly sampled to complete a self-administered questionnaire and telephone interview, designed to ascertain nurses' knowledge of diabetes and best practice, in 2006-2008. RESULTS All 287 nurses (response rate 86%) completed the telephone interview and 284 the self-administered questionnaire. Major risk factors identified by nurses were excess body weight for type 2 diabetes (96%) and elevated plasma glucose levels or glycosylated haemoglobin (86%) for diabetes-related complications. In contrast, major cardiovascular risk factors were less well identified, particularly smoking, although by more specialist nurses (43%) than practice (14%) and district (12%) nurses (p=0.0005). Cardiovascular complications, particularly stroke, were less well known than microvascular complications, and by significantly fewer practice (13%) and district (8%) nurses than specialist nurses (36%, p=0.002). CONCLUSIONS In general, nurses had better knowledge of overweight as a risk factor for type 2 diabetes mellitus and elevated plasma glucose levels as a risk factor for diabetes-related complications compared with knowledge of cardiovascular risk factors, particularly smoking.
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MESH Headings
- Adult
- Attitude of Health Personnel
- Clinical Competence
- Community Health Services
- Cross-Sectional Studies
- Diabetes Mellitus, Type 1/diagnosis
- Diabetes Mellitus, Type 1/epidemiology
- Diabetes Mellitus, Type 1/nursing
- Diabetes Mellitus, Type 2/diagnosis
- Diabetes Mellitus, Type 2/epidemiology
- Diabetes Mellitus, Type 2/nursing
- Female
- Health Care Surveys
- Health Knowledge, Attitudes, Practice
- Humans
- Interviews as Topic
- Male
- New Zealand/epidemiology
- Nurse's Role
- Nurses, Community Health/psychology
- Practice Patterns, Nurses'
- Primary Care Nursing
- Risk Factors
- Surveys and Questionnaires
- Telephone
- Workforce
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Affiliation(s)
- Barbara Daly
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Bruce Arroll
- School of Population Health, University of Auckland, New Zealand
| | - Nicolette Sheridan
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Timothy Kenealy
- School of Population Health, University of Auckland, New Zealand
| | - Robert Scragg
- School of Population Health, University of Auckland, New Zealand
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Siminerio L, Ruppert K, Huber K, Toledo FGS. Telemedicine for Reach, Education, Access, and Treatment (TREAT): linking telemedicine with diabetes self-management education to improve care in rural communities. DIABETES EDUCATOR 2014; 40:797-805. [PMID: 25253624 DOI: 10.1177/0145721714551993] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this study was to examine diabetes-related behavioral and psychosocial outcomes as well as patient satisfaction with the Telemedicine for Reach, Education, Access, and Treatment (TREAT) model. METHODS TREAT employs telemedicine services provided by an endocrinologist at an urban area in partnership with a diabetes educator in a rural area, working together with patients and primary care providers (PCPs). Thirty-five patients with type 2 diabetes were referred by PCPs and received glycemic management and education in the TREAT model. A diabetes educator operated the videoconferencing equipment, remained with the patient to receive and review plan communicated by the endocrinologist during the visit, coordinated services, administered surveys, and provided self-management education and support. Empowerment, self-care, diabetes distress, adherence to monitoring, and patient satisfaction were assessed by survey at baseline and follow-up. RESULTS There was significant improvement in empowerment, self-care (adherence to diet and monitoring), and reduction in diabetes distress. Patients reported high levels of satisfaction. CONCLUSIONS In rural areas, the TREAT model delivers improvements in behavioral and psychosocial outcomes and high patient satisfaction. The TREAT model may be a viable option for rural communities that suffer from a shortage of team-based diabetes specialist and self-management support services.
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Affiliation(s)
- Linda Siminerio
- Department of Medicine, Division of Endocrinology and Metabolism, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Siminerio, Dr Toledo)
| | - Kristine Ruppert
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Ruppert)
| | - Kimberly Huber
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (Ms Huber)
| | - Fredrico G S Toledo
- Department of Medicine, Division of Endocrinology and Metabolism, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Siminerio, Dr Toledo)
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Lascar N, Kennedy A, Hancock B, Jenkins D, Andrews RC, Greenfield S, Narendran P. Attitudes and barriers to exercise in adults with type 1 diabetes (T1DM) and how best to address them: a qualitative study. PLoS One 2014; 9:e108019. [PMID: 25237905 PMCID: PMC4169586 DOI: 10.1371/journal.pone.0108019] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 08/25/2014] [Indexed: 01/10/2023] Open
Abstract
Background Regular physical activity has recognised health benefits for people with T1DM. However a significant proportion of them do not undertake the recommended levels of activity. Whilst questionnaire-based studies have examined barriers to exercise in people with T1DM, a formal qualitative analysis of these barriers has not been undertaken. Our aims were to explore attitudes, barriers and facilitators to exercise in patients with T1DM. Methodology A purposeful sample of long standing T1DM patients were invited to participate in this qualitative study. Twenty-six adults were interviewed using a semi-structured interview schedule to determine their level of exercise and barriers to initiation and maintenance of an exercise programme. Principal findings Six main barriers to exercise were identified: lack of time and work related factors; access to facilities; lack of motivation; embarrassment and body image; weather; and diabetes specific barriers (low levels of knowledge about managing diabetes and its complications around exercise). Four motivators to exercise were identified: physical benefits from exercise; improvements in body image; enjoyment and the social interaction of exercising at gym or in groups. Three facilitators to exercise were identified: free or reduced admission to gyms and pools, help with time management, and advice and encouragement around managing diabetes for exercise. Significance Many of the barriers to exercise in people with T1DM are shared with the non-diabetic population. The primary difference is the requirement for education about the effect of exercise on diabetes control and its complications. There was a preference for support to be given on a one to one basis rather than in a group environment. This suggests that with the addition of the above educational requirements, one to one techniques that have been successful in increasing activity in patients with other chronic disease and the general public should be successful in increasing activity in patients with T1DM.
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Affiliation(s)
- Nadia Lascar
- School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- Department of Diabetes, Nuffield House, The Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom
| | - Amy Kennedy
- School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- Department of Diabetes, Nuffield House, The Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom
| | - Beverley Hancock
- School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - David Jenkins
- Department of Diabetes, Nuffield House, The Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom
| | - Robert C. Andrews
- School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - Sheila Greenfield
- Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Parth Narendran
- School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- Department of Diabetes, Nuffield House, The Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom
- * E-mail:
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Mohammed K, Nolan MB, Rajjo T, Shah ND, Prokop LJ, Varkey P, Murad MH. Creating a Patient-Centered Health Care Delivery System: A Systematic Review of Health Care Quality From the Patient Perspective. Am J Med Qual 2014; 31:12-21. [PMID: 25082873 DOI: 10.1177/1062860614545124] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patient experience is one of key domains of value-based purchasing that can serve as a measure of quality and be used to improve the delivery of health services. The aims of this study are to explore patient perceptions of quality of health care and to understand how perceptions may differ by settings and condition. A systematic review of multiple databases was conducted for studies targeting patient perceptions of quality of care. Two reviewers screened and extracted data independently. Data synthesis was performed following a meta-narrative approach. A total of 36 studies were included that identified 10 quality dimensions perceived by patients: communication, access, shared decision making, provider knowledge and skills, physical environment, patient education, electronic medical record, pain control, discharge process, and preventive services. These dimensions can be used in planning and evaluating health care delivery. Future research should evaluate the effect of interventions targeting patient experience on patient outcomes.
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Affiliation(s)
| | | | - Tamim Rajjo
- Mercy Family Medicine Residency Program, Toledo, OH
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Papp R, Borbas I, Dobos E, Bredehorst M, Jaruseviciene L, Vehko T, Balogh S. Perceptions of quality in primary health care: perspectives of patients and professionals based on focus group discussions. BMC FAMILY PRACTICE 2014; 15:128. [PMID: 24974196 PMCID: PMC4083126 DOI: 10.1186/1471-2296-15-128] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 06/06/2014] [Indexed: 12/02/2022]
Abstract
Background The EUprimecare project-team assessed the perception of primary health care (PHC) professionals and patients on quality of organization of PHC systems in the participating countries: Estonia, Finland, Germany, Hungary, Italy, Lithuania and Spain. This article presents the aggregated opinions, expectations and priorities of patients and professionals along some main dimensions of quality in primary health care, such as access, equity, appropriateness and patient- centeredness. Methods The focus group technique was applied in the study as a qualitative research method for exploration of attitudes regarding the health care system and health service. Discussions were addressing the topics of: general aspects of quality in primary health care; possibilities to receive/provide PHC services based on both parties needs; determinant factors of accessibility to PHC services; patient centeredness. The data sets collected during the focus group discussions were evaluated using the method of thematic analysis. Results There were 14 focus groups in total: a professional and a patient group in each of the seven partner countries. Findings of the thematic analysis were summarized along the following dimensions: access and equity, appropriateness (coordination, continuity, competency and comprehensiveness) and patient centeredness. Conclusions This study shows perceptions and views of patients in interaction with PHC and opinion of professionals working in PHC. It serves as source of criteria with relevance to everyday practice and experience. The criteria mentioned by patients and by health care professionals which were considered determining factors of the quality in primary care were quite similar among the investigated countries. However, the perception and the level of tolerance regarding some of the criteria differed among EUprimecare countries. Among these dissimilar criteria we especially note the gate-keeping role of GPs, the importance of nurses' competency and the acceptance of waiting times. The impact of waiting time on patient satisfaction is obvious; the influence of equity and access to PHC services are more dependent on the equal distribution of settings and doctors in urban and rural area. Foreseen shortage of doctors is expected to have a substantial influence on patient satisfaction in the near future.
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Affiliation(s)
- Renata Papp
- National Institute of Primary Health Care, 84-88 Jász Str, Budapest 1135, Hungary.
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Lou Q, Chen Y, Guo X, Yuan L, Chen T, Wang C, Shen L, Sun Z, Zhao F, Dai X, Huang J, Yang H. Diabetes Attitude Scale: validation in type-2 diabetes patients in multiple centers in China. PLoS One 2014; 9:e96473. [PMID: 24802805 PMCID: PMC4011833 DOI: 10.1371/journal.pone.0096473] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 04/09/2014] [Indexed: 02/05/2023] Open
Abstract
Objective The aim of the paper is to report the development and psychometric testing of Diabetes Attitude Scale. Method A prospective study was performed. The cultural equivalency and content validity of the Diabetes Attitude Scale were determined by panels of endocrinologists, physiologists, nurses and dieticians. An accurate and usable translation was obtained for each of five subscales examining attitudes on need for special training, the seriousness of type-2 diabetes, the need for controlling the condition, its psychosocial impact and the degree of autonomy given to patients in decision making. The validation was derived from 5961 patients with type-2 diabetes, recruited from 50 centers in 29 provinces throughout China between March 1st and September 30th, 2010. Results The modified Diabetes Attitude Scale showed an acceptable level of internal consistency. The strength of the inter-correlations among the domains of five subscales suggests that the instrument measures related but separate domains of patients' attitudes toward diabetes. Moreover, the test-retest intraclass correlation coefficients were high enough to support the stability of the Chinese version of the third version of the scale. Conclusions The psychometric properties of the Chinese version of Diabetes Attitude Scale demonstrated satisfactory validity and reliability and appeared to effectively evaluate attitudes toward diabetes in patients with type-2 diabetes.
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Affiliation(s)
- Qingqing Lou
- Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, Jiangsu Province, China
- Sir Run Run Shaw Hospital, Zhejiang University Medical School, Hangzhou, Zhejiang Province, China
| | - Yufeng Chen
- School of Nursing, Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Xiaohui Guo
- Department of Endocrinology, Peking University First Hospital, Beijing, China
- * E-mail:
| | - Li Yuan
- Department of Endocrinology, West China Medical School, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Tao Chen
- Department of Endocrinology, West China Medical School, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Chun Wang
- Department of Endocrinology, West China Medical School, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Li Shen
- Peking University First Hospital, Beijing, China
| | - Zilin Sun
- Institute of Diabetes, Zhongda Hospital, Medical School, Southeast University, Nanjing, Jiangsu Province, China
| | - Fang Zhao
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China
| | - Xia Dai
- First Affiliated Hospital, Guangxi Medical University, Nanning, Jiangsu Province, China
| | - Jin Huang
- The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Huiying Yang
- The First Affiliated Hospital of Kunming Medical College, Kunming, Yunnan Province, China
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Manski-Nankervis JA, Furler J, Blackberry I, Young D, O’Neal D, Patterson E. Roles and relationships between health professionals involved in insulin initiation for people with type 2 diabetes in the general practice setting: a qualitative study drawing on relational coordination theory. BMC FAMILY PRACTICE 2014; 15:20. [PMID: 24479762 PMCID: PMC3909758 DOI: 10.1186/1471-2296-15-20] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 01/30/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND The majority of care for people with type 2 diabetes occurs in general practice, however when insulin initiation is required it often does not occur in this setting or in a timely manner and this may have implications for the development of complications. Increased insulin initiation in general practice is an important goal given the increasing prevalence of type 2 diabetes and a relative shortage of specialists. Coordination between primary and secondary care, and between medical and nursing personnel, may be important in achieving this. Relational coordination theory identifies key concepts that underpin effective interprofessional work: communication which is problem solving, timely, accurate and frequent and relationships between professional roles which are characterized by shared goals, shared knowledge and mutual respect. This study explores roles and relationships between health professionals involved in insulin initiation in order to gain an understanding of factors which may impact on this task being carried out in the general practice setting. METHOD 21 general practitioners, practice nurses, diabetes nurse educators and physicians were purposively sampled to participate in a semi-structured interview. Transcripts of the interviews were analysed using framework analysis. RESULTS There were four closely interlinked themes identified which impacted on how health professionals worked together to initiate people with type 2 diabetes on insulin: 1. Ambiguous roles; 2. Uncertain competency and capacity; 3. Varying relationships and communication; and 4. Developing trust and respect. CONCLUSIONS This study has shown that insulin initiation is generally recognised as acceptable in general practice. The role of the DNE and practice nurse in this space and improved communication and relationships between health professionals across organisations and levels of care are factors which need to be addressed to support this clinical work. Relational coordination provides a useful framework for exploring these issues.
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Affiliation(s)
- Jo-Anne Manski-Nankervis
- General Practice and Primary Health Care Academic Centre, University of Melbourne, Carlton, Victoria
| | - John Furler
- General Practice and Primary Health Care Academic Centre, University of Melbourne, Carlton, Victoria
| | - Irene Blackberry
- General Practice and Primary Health Care Academic Centre, University of Melbourne, Carlton, Victoria
| | - Doris Young
- General Practice and Primary Health Care Academic Centre, University of Melbourne, Carlton, Victoria
| | - David O’Neal
- Department of Medicine, St Vincent’s Hospital, Fitzroy, Victoria
| | - Elizabeth Patterson
- Department of Nursing, Melbourne School of Health Sciences, University of Melbourne, Carlton, Victoria
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Wiley J, Westbrook M, Long J, Greenfield JR, Day RO, Braithwaite J. Multidisciplinary diabetes team care: the experiences of young adults with Type 1 diabetes. Health Expect 2013; 18:1783-96. [PMID: 24345040 DOI: 10.1111/hex.12170] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2013] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND This research examined whether young adults with Type 1 diabetes engage with the multidisciplinary consultation process and if not, then why. METHODS We designed a web-based self-reported survey, available online from February to May 2011, for Australian adults 18-35 years with Type 1 diabetes. Respondents were asked about which clinicians they consulted to assist with self-management. To expand on the results of the survey, we interviewed 33 respondents. RESULTS SURVEY Respondents (n = 150) consulted with the following clinicians: endocrinologist and diabetes educators: 23.3%; endocrinologist only: 18.0%; endocrinologist, diabetes educators and dieticians: 14.6%; endocrinologist, diabetes educators, dietician and general practitioners (GP): 11.3%; endocrinologist and GP: 10.6%; GP only: 4.6%; all clinicians recommended to assist with self-management: 1.3%; 2.7% did not consult any clinician. Interview: Participants (n = 33) reported eight key disincentives to consultation with multidisciplinary clinicians. These were time constraints; provision of conflicting advice; inaccessibility of health services; variation in service standards; cost constraints; failure of clinicians to refer to other clinicians; lack of opportunity to build a therapeutic relationship; and failure of clinicians to engage in shared decision making. CONCLUSION Our results indicate that high attrition rates of young adults with Type 1 diabetes from recommended diabetes health services is linked to the failure of those services to meet the needs and preferences of their patients. The identified needs and preferences included joint consultation with multi-disciplinary team clinicians; flexible access to advice by email or telephone consultation; and shared decision making. Patient engagement in health-service re-design has implications for improved health-service delivery and enhanced treatment outcomes.
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Affiliation(s)
- Janice Wiley
- Centre for Clinical Governance Research in Health, Australian Institute of Health Innovation, University of New South Wales, Sydney, NSW, Australia
| | - Mary Westbrook
- Centre for Clinical Governance Research in Health, Australian Institute of Health Innovation, University of New South Wales, Sydney, NSW, Australia
| | - Janet Long
- Centre for Clinical Governance Research in Health, Australian Institute of Health Innovation, University of New South Wales, Sydney, NSW, Australia
| | - Jerry R Greenfield
- Department of Clinical Pharmacology, St Vincent's Hospital, University of New South Wales, Sydney, NSW, Australia
| | - Richard O Day
- Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - Jeffrey Braithwaite
- Centre for Clinical Governance Research in Health, Australian Institute of Health Innovation, University of New South Wales, Sydney, NSW, Australia
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Lauvergeon S, Burnand B, Peytremann-Bridevaux I. [Implementation of a diabetes disease management program in Switzerland: patients' and healthcare professionals' point of view]. Rev Epidemiol Sante Publique 2013; 61:475-84. [PMID: 24035386 DOI: 10.1016/j.respe.2013.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 09/18/2012] [Accepted: 05/10/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND A reorganization of healthcare systems is required to meet the challenge of the increasing prevalence of chronic diseases, e.g. diabetes. In North-America and Europe, several countries have thus developed national or regional chronic disease management programs. In Switzerland, such initiatives have only emerged recently. In 2010, the canton of Vaud set up the "Diabetes Cantonal Program", within the framework of which we conducted a study designed to ascertain the opinions of both diabetic patients and healthcare professionals on the elements that could be integrated into this program, the barriers and facilitators to its development, and the incentives that could motivate these actors to participate. METHODS We organized eight focus-groups: one with diabetic patients and one with healthcare professionals in the four sanitary areas of the canton of Vaud. The discussions were recorded, transcribed and submitted to a thematic content analysis. RESULTS Patients and healthcare professionals were rather in favour of the implementation of a cantonal program, although patients were more cautious concerning its necessity. All participants envisioned a set of elements that could be integrated to this program. They also considered that the program could be developed more easily if it were adapted to patients' and professionals' needs and if it used existing structures and professionals. The difficulty to motivate both patients and professionals to participate was mentioned as a barrier to the development of this program however. Quality or financial incentives could therefore be created to overcome this potential problem. CONCLUSION The identification of the elements to consider, barriers, facilitators and incentives to participate to a chronic disease management program, obtained by exploring the opinions of patients and healthcare professionals, should favour its further development and implementation.
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Affiliation(s)
- S Lauvergeon
- Institut universitaire de médecine sociale et préventive (IUMSP), centre hospitalier universitaire Vaudois et université de Lausanne, Biopôle 2, route de la Corniche 10, 1010 Lausanne, Suisse
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Holt RIG, Nicolucci A, Kovacs Burns K, Escalante M, Forbes A, Hermanns N, Kalra S, Massi-Benedetti M, Mayorov A, Menéndez-Torre E, Munro N, Skovlund SE, Tarkun I, Wens J, Peyrot M. Diabetes Attitudes, Wishes and Needs second study (DAWN2™): cross-national comparisons on barriers and resources for optimal care--healthcare professional perspective. Diabet Med 2013; 30:789-98. [PMID: 23710839 DOI: 10.1111/dme.12242] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/22/2013] [Indexed: 12/23/2022]
Abstract
AIMS The second Diabetes Attitudes, Wishes and Needs (DAWN2) study sought cross-national comparisons of perceptions on healthcare provision for benchmarking and sharing of clinical practices to improve diabetes care. METHODS In total, 4785 healthcare professionals caring for people with diabetes across 17 countries participated in an online survey designed to assess diabetes healthcare provision, self-management and training. RESULTS Between 61.4 and 92.9% of healthcare professionals felt that people with diabetes needed to improve various self-management activities; glucose monitoring (range, 29.3-92.1%) had the biggest country difference, with a between-country variance of 20%. The need for a major improvement in diabetes self-management education was reported by 60% (26.4-81.4%) of healthcare professionals, with a 12% between-country variance. Provision of diabetes services differed among countries, with many healthcare professionals indicating that major improvements were needed across a range of areas, including healthcare organization [30.6% (7.4-67.1%)], resources for diabetes prevention [78.8% (60.4-90.5%)], earlier diagnosis and treatment [67.9% (45.0-85.5%)], communication between team members and people with diabetes [56.1% (22.3-85.4%)], specialist nurse availability [63.8% (27.9-90.7%)] and psychological support [62.7% (40.6-79.6%)]. In some countries, up to one third of healthcare professionals reported not having received any formal diabetes training. Societal discrimination against people with diabetes was reported by 32.8% (11.4-79.6%) of participants. CONCLUSIONS This survey has highlighted concerns of healthcare professionals relating to diabetes healthcare provision, self-management and training. Identifying between-country differences in several areas will allow benchmarking and sharing of clinical practices.
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Affiliation(s)
- R I G Holt
- Faculty of Medicine, University of Southampton, Southampton, UK.
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de Figueiredo RC, Snoek FJ, Barreto SM. Do patients and physicians agree on diabetes management? A study conducted in public healthcare centres in Brazil. PATIENT EDUCATION AND COUNSELING 2013; 92:107-113. [PMID: 23478448 DOI: 10.1016/j.pec.2013.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 01/21/2013] [Accepted: 01/25/2013] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To explore to what extent patients with diabetes agree with their physicians on diabetes management and whether the agreement varies according to patients' socio-demographic characteristics. METHODS A cross-sectional study was conducted among patients with diabetes and their Family Health physicians in 108 healthcare centres in Belo Horizonte, Brazil. Patients and physicians were interviewed face-to-face using standard questionnaires. Physicians were unaware of which of their patients would be interviewed. Their responses were compared using descriptive statistics and Cohen's weighted kappa. RESULTS 282 patient-physician pairs were included. Kappa coefficients were often low, the highest was found for presence of diabetic foot and the lowest for kidney disease. Physicians tended to overestimate patients' risk of diabetes complications and underestimate patients' adherence to all diabetes self-management activities as well as diabetes control. Moreover, the agreement rate regarding adherence to diet, foot care and medicine prescriptions was significantly higher among male, younger and higher educated patients. CONCLUSION Results indicate that physicians' recommendations are generally poorly apprehended by their patients, especially by the lower educated, compromising the goal of patient-centred care. PRACTICE IMPLICATIONS Educational programmes need to incorporate strategies to improve the comprehension and effectiveness of physician-patient communication, especially with the most socially vulnerable groups.
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Rendle KAS, May SG, Uy V, Tietbohl CK, Mangione CM, Frosch DL. Persistent Barriers and Strategic Practices. DIABETES EDUCATOR 2013; 39:560-7. [DOI: 10.1177/0145721713492218] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose The purpose of this study was to explore the everyday barriers to and practices of low-income patients managing their diabetes. Methods The study team conducted semistructured qualitative interviews with 20 patients with type 2 diabetes who were receiving care at safety-net clinics in Southern California. Transcripts were analyzed using grounded theory to identify emergent themes across participants. Results Participants described managing diabetes with limited financial resources as often a game of balance and negotiation, whereby purchasing healthy foods is abandoned because of a more pressing concern in their life. Although participants described strategic attempts at incorporating healthy dietary practices for diabetes management into their daily decisions, these efforts were significantly impeded by the existence of persistent and seemingly insurmountable barriers. Conclusions Although the challenges that low-income patients face in managing their diabetes may seem insurmountable at times, there are several ways that health care providers can help reduce the burden of these challenges, including tailoring their recommendations to incorporate the everyday socioeconomic environment of patients and engaging in clear, open communication with patients.
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Affiliation(s)
- Katharine A. S. Rendle
- University of Michigan, Ann Arbor, Michigan (Ms Rendle)
- Palo Alto Medical Foundation Research Institute, Palo Alto, California (Ms Rendle, Dr May, Ms Tietbohl, Dr Frosch)
- University of California, Los Angeles, California (Mr Uy, Dr Mangione, Dr Frosch)
| | - Suepattra G. May
- University of Michigan, Ann Arbor, Michigan (Ms Rendle)
- Palo Alto Medical Foundation Research Institute, Palo Alto, California (Ms Rendle, Dr May, Ms Tietbohl, Dr Frosch)
- University of California, Los Angeles, California (Mr Uy, Dr Mangione, Dr Frosch)
| | - Visith Uy
- University of Michigan, Ann Arbor, Michigan (Ms Rendle)
- Palo Alto Medical Foundation Research Institute, Palo Alto, California (Ms Rendle, Dr May, Ms Tietbohl, Dr Frosch)
- University of California, Los Angeles, California (Mr Uy, Dr Mangione, Dr Frosch)
| | - Caroline K. Tietbohl
- University of Michigan, Ann Arbor, Michigan (Ms Rendle)
- Palo Alto Medical Foundation Research Institute, Palo Alto, California (Ms Rendle, Dr May, Ms Tietbohl, Dr Frosch)
- University of California, Los Angeles, California (Mr Uy, Dr Mangione, Dr Frosch)
| | - Carol M. Mangione
- University of Michigan, Ann Arbor, Michigan (Ms Rendle)
- Palo Alto Medical Foundation Research Institute, Palo Alto, California (Ms Rendle, Dr May, Ms Tietbohl, Dr Frosch)
- University of California, Los Angeles, California (Mr Uy, Dr Mangione, Dr Frosch)
| | - Dominick L. Frosch
- University of Michigan, Ann Arbor, Michigan (Ms Rendle)
- Palo Alto Medical Foundation Research Institute, Palo Alto, California (Ms Rendle, Dr May, Ms Tietbohl, Dr Frosch)
- University of California, Los Angeles, California (Mr Uy, Dr Mangione, Dr Frosch)
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Elissen A, Nolte E, Knai C, Brunn M, Chevreul K, Conklin A, Durand-Zaleski I, Erler A, Flamm M, Frølich A, Fullerton B, Jacobsen R, Saz-Parkinson Z, Sarria-Santamera A, Sönnichsen A, Vrijhoef H. Is Europe putting theory into practice? A qualitative study of the level of self-management support in chronic care management approaches. BMC Health Serv Res 2013; 13:117. [PMID: 23530744 PMCID: PMC3621080 DOI: 10.1186/1472-6963-13-117] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 03/20/2013] [Indexed: 11/26/2022] Open
Abstract
Background Self-management support is a key component of effective chronic care management, yet in practice appears to be the least implemented and most challenging. This study explores whether and how self-management support is integrated into chronic care approaches in 13 European countries. In addition, it investigates the level of and barriers to implementation of support strategies in health care practice. Methods We conducted a review among the 13 participating countries, based on a common data template informed by the Chronic Care Model. Key informants presented a sample of representative chronic care approaches and related self-management support strategies. The cross-country review was complemented by a Dutch case study of health professionals’ views on the implementation of self-management support in practice. Results Self-management support for chronically ill patients remains relatively underdeveloped in Europe. Similarities between countries exist mostly in involved providers (nurses) and settings (primary care). Differences prevail in mode and format of support, and materials used. Support activities focus primarily on patients’ medical and behavioral management, and less on emotional management. According to Dutch providers, self-management support is not (yet) an integral part of daily practice; implementation is hampered by barriers related to, among others, funding, IT and medical culture. Conclusions Although collaborative care for chronic conditions is becoming more important in European health systems, adequate self-management support for patients with chronic disease is far from accomplished in most countries. There is a need for better understanding of how we can encourage both patients and health care providers to engage in productive interactions in daily chronic care practice, which can improve health and social outcomes.
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Affiliation(s)
- Arianne Elissen
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Duboisdomein 30, PO Box 616, 6200 MD, Maastricht, The Netherlands.
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Nishigaki M, Shimizu Y, Kuroda K, Mori K, Ohara Y, Seto N, Yoneda A, Miyatake Y, Kazuma K, Masaki H. Development of a support skill scale in insulin therapy: a nationwide study in Japan. NURSE EDUCATION TODAY 2012; 32:892-896. [PMID: 22051101 DOI: 10.1016/j.nedt.2011.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 09/16/2011] [Accepted: 09/22/2011] [Indexed: 05/31/2023]
Abstract
The aim of this cross-sectional, nationwide study in Japan was to develop a support skill scale for insulin therapy (IT-SSS) and to evaluate its validity and reliability. The sample consisted of 1604 nurses at 123 hospitals throughout the country. The factor validity, known-group validity, convergent validity, discriminant validity and internal consistency of IT-SSS were assessed. IT-SSS consisted of 26 minimum and 25 standard support skills. They included 4 subscales for minimum skills: management strategy for hypoglycemia, education about insulin injection technique, individual assessment and support about insulin rejection, and collaboration with medical professionals and patient/family. Three subscales for standard skills: apprehensions concerning the will and emotion of the patient, management for blood glucose control, and coordination in insulin management. Cronbach's alpha coefficient was between 0.75 and 0.90, suggesting strong internal consistency. Multitrait analysis showed that convergent validity was complete, and discriminant validity was found to be almost complete in both minimum and standard skill scales (scaling success rates of 97.6% and 98.7% across all subgroups, respectively). Known group analysis clearly showed that specialist nurses have significantly higher skills than general nurses. These findings indicate that IT-SSS has a reasonable factor validity, convergent validity, discriminant validity, known group validity, and internal consistency.
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Peytremann-Bridevaux I, Lauvergeon S, Mettler D, Burnand B. Diabetes care: Opinions, needs and proposed solutions of Swiss patients and healthcare professionals: a qualitative study. Diabetes Res Clin Pract 2012; 97:242-50. [PMID: 22459986 DOI: 10.1016/j.diabres.2012.02.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 01/10/2012] [Accepted: 02/23/2012] [Indexed: 11/26/2022]
Abstract
AIMS To explore, both among patients with diabetes and healthcare professionals, opinions on current diabetes care and the development of the "Regional Diabetes Program". METHODS We employed qualitative methods (focus groups - FG) and used purposive sampling strategy to recruit patients with diabetes and healthcare professionals. We conducted one diabetic and one professional FG in each of the four health regions of the canton of Vaud/Switzerland. The eight FGs were audio-taped and transcribed verbatim. Thematic analysis was then undertaken. RESULTS Results showed variability in the perception of the quality of diabetes care, pointed to insufficient information regarding diabetes, and lack of collaboration. Participants also evoked patients' difficulties for self-management, as well as professionals' and patients' financial concerns. Proposed solutions included reinforcing existing structures, developing self-management education, and focusing on comprehensive and coordinated care, communication and teamwork. Patients and professionals were in favour of a "Regional Diabetes Program" tailored to the actors' needs, and viewed it as a means to reinforce existing care delivery. CONCLUSIONS Patients and professionals pointed out similar problems and solutions but explored them differently. Combined with coming quantitative data, these results should help to further develop, adapt and implement the "Regional Diabetes Program".
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Affiliation(s)
- I Peytremann-Bridevaux
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, 17 Rue du Bugnon, CH-1005 Lausanne, Switzerland.
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Kruger DF. Managing diabetes from first diagnosis: choosing well-tolerated therapies with durability. DIABETES EDUCATOR 2012; 38:4S-11S; quiz 12S. [PMID: 22713263 DOI: 10.1177/0145721712450619] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE A review of the pathophysiologic features of early type 2 diabetes mellitus, the benefits of early glycemic control, the concerns of patients that may influence treatment adherence, and how the use of newer treatment options are addressed. CONCLUSION Given the multifactorial nature of diabetes pathophysiology, early combination therapy incorporating agents with different mechanisms of action is advocated. Medication side effects and risks influence patients' treatment choices. These concerns include hypoglycemia, weight gain, and fears of treatment failure. With the increasing complexity of therapy regimens for diabetes, the role of diabetes educators includes recommending therapy, counseling about adverse effects, monitoring for contraindications, identifying therapeutic duplication, as well as discussion of new agents to optimize patient outcomes. A case study is used to describe the process of choosing well-tolerated therapies at first diagnosis.
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Affiliation(s)
- Davida F Kruger
- Henry Ford Health System, Divsion of Endocrinology, Diabetes, Bone and Mineral Disease, New Center One, 3031 West Grand Blvd, Suite 800, Detroit, MI 48202 3031, USA.
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Lapolla A, Di Cianni G, Di Benedetto A, Franzetti I, Napoli A, Sciacca L, Torlone E, Tonutti L, Vitacolonna E, Mannino D. Quality of Life, Wishes, and Needs in Women with Gestational Diabetes: Italian DAWN Pregnancy Study. Int J Endocrinol 2012; 2012:784726. [PMID: 22611394 PMCID: PMC3350953 DOI: 10.1155/2012/784726] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 02/01/2012] [Accepted: 02/01/2012] [Indexed: 11/18/2022] Open
Abstract
The DAWN (Diabetes Attitudes, Wishes and Needs) study is a survey promoted by the International Diabetes Federation to recognize the perceptions and attitudes of people suffering from diabetes mellitus. In this context, we evaluated the quality of life of Italian and immigrant women with gestational diabetes mellitus (GDM). Information was gathered using a structured questionnaire for patients' self-compilation. In a 3-month period, a 51-item questionnaire was submitted to 198 Italians and 88 immigrants (from 27 different foreign nationalities). Italian women were older and had higher education than the immigrants. 60% of the Italians and 38% of the immigrants had a family history of diabetes mellitus. In both groups, the diagnosis of GDM caused anxiety; one-third of women feared their child could contract diabetes at delivery and/or have congenital malformations. Some women had trouble in following treatment regimens: the major concern being dietary advice and blood glucose testing. Most women were satisfied (34%) or highly satisfied (60%) with the quality of care, although the degree of cooperation between diabetes specialists and gynaecologists was considered sometimes unsatisfactory. In order to optimize maternal and foetal outcomes, educational projects and improved communication between patients and the healthcare provider team are recommended.
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Affiliation(s)
- A. Lapolla
- Department of Medicine, University of Padova, Italy
| | - G. Di Cianni
- Department of Diabetes and Metabolic Diseases Livorno, ASl6, Livorno, Italy
- *G. Di Cianni:
| | | | | | - A. Napoli
- Department of Clinical and Molecular Medicine, S. Andrea Hospital, Sapienza University of Rome, Italy
| | - L. Sciacca
- Department of Clinical and Molecular Biomedicine Endocrinology Section, University of Catania, Italy
| | - E. Torlone
- Department of Internal Medicine, Endocrinology and Metabolism, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - L. Tonutti
- Department of Endocrinology and Metabolism, Udine University, Italy
| | - E. Vitacolonna
- Department of Medicine and Ageing, University of Chieti, Italy
| | - D. Mannino
- Department of Endocrinology and Diabetology, Hospital Bianchi Malacrino Morelli, Italy
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Bradley C, de Pablos-Velasco P, Parhofer KG, Eschwège E, Gönder-Frederick L, Simon D. PANORAMA: a European study to evaluate quality of life and treatment satisfaction in patients with type-2 diabetes mellitus--study design. Prim Care Diabetes 2011; 5:231-239. [PMID: 21752743 DOI: 10.1016/j.pcd.2011.04.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Revised: 04/20/2011] [Accepted: 04/26/2011] [Indexed: 12/18/2022]
Abstract
AIM Type-2 diabetes mellitus (T2DM) is a major cause of disability reaching epidemic proportions worldwide. The disease burden of T2DM is commonly characterised using health status measures, but few European-wide data are available concerning patients' views of their quality of life (QoL) and other patient-reported outcomes (PROs). Despite evidence supporting benefits of glycaemic control, many patients are currently not treated to recommended HbA(1c) targets (<7%). Consequently, the prevalence of T2DM-related chronic complications remains high, impacting negatively on patients' health status. Hypoglycaemia is a side effect associated with some antidiabetes medications that may also diminish QoL and treatment satisfaction. The aim of the PANORAMA study (NCT00916513) is to evaluate QoL and other PROs in patients with T2DM. It will investigate the association between these variables, the different diabetes treatment regimens used and levels of glycaemic control achieved across Europe. This report describes the rationale for conducting the PANORAMA study, and the study design. METHODS PANORAMA is an observational, multicentre, multinational, cross-sectional study. Approximately 5000 patients with T2DM currently treated with diet, oral antidiabetes agents and/or injectables (insulin and/or glucagon-like peptide-1 [GLP-1] analogues), ≥1-year follow up, will be randomly selected from a representative sample of mainly primary care practices across nine countries. Patient demographics; HbA(1c) level (standardised measurement); PROs, including QoL (ADDQoL), health status (EQ-5D), treatment satisfaction (DTSQ) and fear of hypoglycaemia (HFS-II); disease-related variables; health-economic variables; physician demographics and physician-reported outcomes will be collected. DISCUSSION The large-scale, European-wide PANORAMA study is designed to evaluate QoL and other PROs in patients with T2DM.
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Affiliation(s)
- Clare Bradley
- Department of Psychology, Royal Holloway, University of London, Egham, Surrey, UK.
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Hajos TRS, Polonsky WH, Twisk JWR, Dain MP, Snoek FJ. Do physicians understand Type 2 diabetes patients' perceptions of seriousness; the emotional impact and needs for care improvement? A cross-national survey. PATIENT EDUCATION AND COUNSELING 2011; 85:258-263. [PMID: 20932702 DOI: 10.1016/j.pec.2010.08.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 07/19/2010] [Accepted: 08/29/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To explore across countries the extent to which physicians understand Type 2 diabetes patients' perceptions of seriousness, worries about complications, emotional distress, and needs for care improvement. METHODS Cross-sectional data were collected in a multinational survey (SHARED). Type 2 diabetes patients (n=1609), general practitioners (n=818) and diabetes specialists (n=697) from eight countries were included. Data were gathered online and via telephone interviews. Responses from patients and professionals were compared using descriptive statistics and multilevel analyses. RESULTS Patients generally perceived diabetes as a serious condition and reported moderate distress. Physicians tended to underestimate patients' perceived seriousness, while overestimating their level of distress. Physicians had difficulty estimating which diabetes complications concerned patients most, and what they needed to feel more confident about their diabetes. Patients did not wish for more consultation time, but rather active involvement, information and easy access to their physician. CONCLUSION Results of this large survey highlight the importance of patient involvement and shared decision making. PRACTICE IMPLICATIONS Further improvement of patient-provider communication as a basis for shared responsibilities and achieving optimal treatment outcomes is needed. With the growing numbers of diabetes patients worldwide, task delegation should be considered, in the framework of a multidisciplinary diabetes care model.
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Affiliation(s)
- Tibor R S Hajos
- Department of Medical Psychology, VU University Medical Centre, Amsterdam, The Netherlands.
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Bhattacharyya OK, Estey EA, Rasooly IR, Harris S, Zwarenstein M, Barnsley J. Providers' perceptions of barriers to the management of type 2 diabetes in remote Aboriginal settings. Int J Circumpolar Health 2011; 70:552-63. [PMID: 22067097 DOI: 10.3402/ijch.v70i5.17848] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To examine providers' perspectives of the barriers to providing diabetes care in remote First Nation communities in the Sioux Lookout Zone (SLZ) of Northwestern Ontario, Canada. STUDY DESIGN A qualitative study involving key informant interviews and focus groups was conducted with health care providers working in remote First Nation communities in SLZ. METHODS Twenty-four nurses, doctors, diabetes educators and community health representatives (CHRs) participated in qualitative interviews and focus groups. Data collected from the interviews and focus groups was coded and thematically analysed using NVIVO software. RESULTS Barriers to diabetes care were grouped into patient, clinic and system factors. Providers' perceptions of patient factors were divided between those advocating for a patient-provider partnership and those advocating for greater patient responsibility. Clinic-related barriers such as short staffing, staff turnover and system fragmentation were discussed, but were often overshadowed by a focus on patient factors and a general sense of frustration among providers. Cultural awareness and issues with clinic management were not mentioned, though they are both within the providers' control. CONCLUSIONS This study characterizes a range of barriers to diabetes care and shows that patient-related factors are of primary concern for many providers. We conclude that patient-focused interventions and cultural competence training may help improve patient-provider partnerships. Funding and supporting quality improvement initiatives and clinic reorganization may increase the providers' knowledge of the potential for clinical strategies to improve patient outcomes and focus attention on those factors that providers can change. Future research into the factors driving quality of care and strategies that can improve care in Aboriginal communities should be a high priority in addressing the rising burden of diabetes and related complications.
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Affiliation(s)
- Onil K Bhattacharyya
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON M5B 1M8, Canada.
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Ose D, Freund T, Urban E, Kunz CU, Szecsenyi J, Miksch A. Comorbidity and patient-reported quality of care: an evaluation of the primary care based German disease management program for type 2 diabetes. J Public Health (Oxf) 2011. [DOI: 10.1007/s10389-011-0429-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Levit S, Toledano Y, Wainstein J. Improved glycaemic control with reduced hypoglycaemic episodes and without weight gain using long-term modern premixed insulins in type 2 diabetes. Int J Clin Pract 2011; 65:165-71. [PMID: 21166963 DOI: 10.1111/j.1742-1241.2010.02513.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The primary goal of the study was to evaluate retrospectively efficacy of long-term modern premixed insulin (MPI) administration. The secondary aims were to monitor weight gain, hypoglycaemia and compliance during MPI therapy. RESEARCH DESIGN AND METHODS One hundred and fifteen outpatients with type 2 diabetes (64 male patients, 51 female patients; mean age 62.4±12.2 years; mean duration of diabetes 10±8 years; mean weight 84.3±14.8 kg) were included in this study. Patients were prescribed one of three MPIs thrice-daily: biphasic insulin lispro 25, biphasic insulin lispro 50, or biphasic insulin aspart 30. Metformin was combined with MPI in 81 patients. Data prior to and during MPI treatment were retrieved from computerised patient medical files. RESULTS After a mean treatment period of 2.9±0.9 years, mean A1C levels and fasting blood glucose decreased from 8.7±1.4% and 193±59 mg/dl to 7.3±1.1% and 141±41 mg/dl (p<0.001 for both), respectively. Thirty-six per cent of the cohort achieved target A1C level of ≤7%. Serum triglycerides decreased from 183±109 mg/dl to 151±76 mg/dl (p<0.001). Weight did not change during MPI treatment. Frequency of minor hypoglycaemic episodes decreased significantly during MPI administration. No major hypoglycaemic event was reported. Number of incompliant patients decreased significantly from 39 to 25 (p=0.001) during MPI treatment. CONCLUSIONS Modern premixed insulins represent an effective and safe long-term therapy for patients with type 2 diabetes. Specifically, the regimen of thrice-daily injections combined with metformin is a viable treatment option.
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Affiliation(s)
- S Levit
- Institute of Endocrinology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
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Stuckey HL, Adelman AM, Gabbay RA. Improving care by delivering the Chronic Care Model for diabetes. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/dmt.10.9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ricci-Cabello I, Ruiz-Pérez I, Olry de Labry-Lima A, Márquez-Calderón S. Do social inequalities exist in terms of the prevention, diagnosis, treatment, control and monitoring of diabetes? A systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2010; 18:572-587. [PMID: 21040063 DOI: 10.1111/j.1365-2524.2010.00960.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The major increase in the prevalence of diabetes mellitus (DM) has led to the study of social inequalities in health-care. The aim of this study is to establish the possible existence of social inequalities in the prevention, diagnosis, treatment, control and monitoring of diabetes in Organisation for Economic Co-operation and Development (OECD) countries which have universal healthcare systems. We searched MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews for all relevant articles published up to 15 December 2007. We included observational studies carried out in OECD countries with universal healthcare systems in place that investigate social inequalities in the provision of health-care to diabetes patients. Two independent reviewers carried out the critical assessment using the STROBE tool items considered most adequate for the evaluation of the methodological quality. We selected 41 articles from which we critically assessed 25 (18 cross-sectional, 6 cohorts, 1 case-control). Consistency among the article results was found regarding the existence of ethnic inequalities in treatment, metabolic control and use of healthcare services. Socioeconomic inequalities were also found in the diagnosis and control of the disease, but no evidence of any gender inequalities was found. In general, the methodological quality of the articles was moderate with insufficient information in the majority of cases to rule out bias. This review shows that even in countries with a significant level of economic development and which have universal healthcare systems in place which endeavour to provide medical care to the entire population, socioeconomic and ethnic inequalities can be identified in the provision of health-care to DM sufferers. However, higher quality and follow-up articles are needed to confirm these results.
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Affiliation(s)
- I Ricci-Cabello
- Andalusian School of Public Health, Regional Health Ministry, Andalusia, Spain
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Corser W, Lein C, Holmes-Rovner M, Gossain V. Contemporary Adult Diabetes Mellitus Management Perceptions. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2010. [DOI: 10.2165/11318450-000000000-00000] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Anderson RM, Funnell MM. Patient empowerment: myths and misconceptions. PATIENT EDUCATION AND COUNSELING 2010; 79:277-82. [PMID: 19682830 PMCID: PMC2879465 DOI: 10.1016/j.pec.2009.07.025] [Citation(s) in RCA: 436] [Impact Index Per Article: 31.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Revised: 07/16/2009] [Accepted: 07/16/2009] [Indexed: 05/22/2023]
Abstract
OBJECTIVE The purpose of this article is to clarify the concept of empowerment and to correct common misconceptions about its use in diabetes care and education. METHODS The patient empowerment approach is well suited to helping patients make self-selected changes related to weight, nutrition, and physical activity. Although the concept of patient empowerment has become an integral part of diabetes education, an accurate understanding and authentic application of empowerment has not occurred as readily. The empowerment approach is clarified and common misconceptions have been corrected. RESULTS Embracing empowerment means making a paradigm shift that is often difficult because the traditional approach to care is embedded in the training and socialization of most health care professionals (HCPs). CONCLUSION Unlike the traditional approach, empowerment is not something one does to patients. Rather, empowerment begins when HCPs acknowledge that patient are in control of their daily diabetes care. Empowerment occurs when the HCPs goal is to increase the capacity of patients to think critically and make autonomous, informed decisions. Empowerment also occurs when patients are actually making autonomous, informed decisions about their diabetes self-management. PRACTICE IMPLICATIONS Clarity about all aspects of the empowerment approach is essential if it is to be used effectively.
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Affiliation(s)
- Robert M Anderson
- University of Michigan Medical School, Department of Medical Education, Ann Arbor, USA.
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Affiliation(s)
- Mark Peyrot
- Department of Sociology, Loyola University, Maryland, USA.
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