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Yapi SM, Boudrias M, Tremblay A, Belanger G, Sourial N, Boivin A, Sasseville M, Côté A, Gartner JB, Taleb N, Lavoie ME, Trépanier E, Vachon B, Labelle M, Layani G. Intersectoral health interventions to improve the well-being of people living with type 2 diabetes: a scoping review protocol. BMJ Open 2024; 14:e080659. [PMID: 38772897 PMCID: PMC11110582 DOI: 10.1136/bmjopen-2023-080659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 05/07/2024] [Indexed: 05/23/2024] Open
Abstract
INTRODUCTION Intersectoral collaboration is a collaborative approach between the health sectors and other sectors to address the interdependent nature of the social determinants of health associated with chronic diseases such as diabetes. This scoping review aims to identify intersectoral health interventions implemented in primary care and community settings to improve the well-being and health of people living with type 2 diabetes. METHODS AND ANALYSIS This protocol is developed by the Arksey and O'Malley (2005) framework for scoping reviews and the Levac et al methodological enhancement. MEDLINE, Embase, CINAHL, grey literature and the reference list of key studies will be searched to identify any study, published between 2000 and 2023, related to the concepts of intersectorality, diabetes and primary/community care. Two reviewers will independently screen all titles/abstracts, full-text studies and grey literature for inclusion and extract data. Eligible interventions will be classified by sector of action proposed by the Social Determinants of Health Map and the conceptual framework for people-centred and integrated health services and further sorted according to the actors involved. This work started in September 2023 and will take approximately 10 months to be completed. ETHICS AND DISSEMINATION This review does not require ethical approval. The results will be disseminated through a peer-reviewed publication and presentations to stakeholders.
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Affiliation(s)
- Sopie Marielle Yapi
- Centre de Recherche du Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
| | - Marguerite Boudrias
- Centre de Recherche du Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
| | - Alexandre Tremblay
- Centre de Recherche du Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
| | - Gabrielle Belanger
- Centre de Recherche du Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
| | - Nadia Sourial
- Centre de Recherche du Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
- Department of Health Management, Evaluation & Policy, Université de Montréal, Montreal, Quebec, Canada
| | - Antoine Boivin
- Centre de Recherche du Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Maxime Sasseville
- Université Laval, Quebec, Quebec, Canada
- VITAM Centre de Recherche en Santé Durable, Quebec, Quebec, Canada
| | - André Côté
- VITAM Centre de Recherche en Santé Durable, Quebec, Quebec, Canada
- Département de management, Université Laval, Quebec, Quebec, Canada
- Centre de recherche en gestion des services de santé, Université Laval, Quebec, Quebec, Canada
| | - Jean-Baptiste Gartner
- VITAM Centre de Recherche en Santé Durable, Quebec, Quebec, Canada
- Département de management, Université Laval, Quebec, Quebec, Canada
- Centre de recherche en gestion des services de santé, Université Laval, Quebec City, Quebec, Canada
| | - Nadine Taleb
- Institut de recherches cliniques de Montreal, Montreal, Quebec, Canada
- Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
- Universite de Montreal, Montreal, Quebec, Canada
| | - Marie-Eve Lavoie
- Centre de Recherche du Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
| | - Emmanuelle Trépanier
- Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | | | - Marcel Labelle
- Centre de Recherche du Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
| | - Géraldine Layani
- Centre de Recherche du Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
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Leung CW, Patel MR, Miller M, Spring E, Wang Z, Wolfson JA, Cohen AJ, Heisler M, Hao W. Food Insecurity Prevalence and Risk Factors at a Large Academic Medical Center in Michigan. JAMA Netw Open 2024; 7:e243723. [PMID: 38530312 PMCID: PMC10966414 DOI: 10.1001/jamanetworkopen.2024.3723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 01/30/2024] [Indexed: 03/27/2024] Open
Abstract
Importance Health care systems are increasingly adopting methods to screen for and integrate food insecurity and other social risk factors into electronic health records. However, there remain knowledge gaps regarding the cumulative burden of food insecurity in large clinical settings, which patients are most at risk, and the extent to which patients are interested in social assistance through their health care system. Objective To evaluate the 5-year prevalence and associated risk factors of food insecurity among adult primary care patients, and to examine factors associated with patients' interest in social assistance among those with food insecurity. Design, Setting, and Participants This cross-sectional analysis of a retrospective cohort study took place at a tertiary care academic medical center (encompassing 20 primary care clinics) in Michigan. Participants included adult patients who completed screening for social risk factors between August 1, 2017, and August 1, 2022. Data analysis was performed from November 2022 to June 2023. Exposure Food insecurity was assessed using the Hunger Vital Sign. Main Outcomes and Measures The primary outcome was patients' interest in social assistance, and associated factors were examined using multivariate logistic regression models, adjusting for patients' demographic and health characteristics. Results Over the 5-year period, 106 087 adult primary care patients (mean [SD] age, 52.9 [17.9] years; 61 343 women [57.8%]) completed the standardized social risk factors questionnaire and were included in the analysis. The overall prevalence of food insecurity was 4.2% (4498 patients), with monthly trends ranging from 1.5% (70 positive screens) in August 2018 to 5.0% (193 positive screens) in June 2022. Food insecurity was significantly higher among patients who were younger, female, non-Hispanic Black or Hispanic, unmarried or unpartnered, and with public health insurance. Food insecurity was significantly associated with a higher cumulative burden of social needs, including social isolation, medical care insecurity, medication nonadherence, housing instability, and lack of transportation. Only 20.6% of patients with food insecurity (927 patients) expressed interest in social assistance. Factors associated with interest in social assistance including being non-Hispanic Black, unmarried or unpartnered, a current smoker, and having a higher burden of other social needs. Conclusions and Relevance In this retrospective cohort study, the overall prevalence of food insecurity was 4.2%, of whom approximately 1 in 5 patients with food insecurity expressed interest in assistance. This study highlights ongoing challenges in ensuring all patients complete routine social determinants of health screening and gaps in patients' interest in assistance for food insecurity and other social needs through their health care system.
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Affiliation(s)
- Cindy W. Leung
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Minal R. Patel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor
| | | | | | - Zixi Wang
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor
| | - Julia A. Wolfson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Alicia J. Cohen
- Center for Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, Rhode Island
- Department of Family Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Health Services, Policy, and Practice, Brown University School of Public Health Providence, Rhode Island
| | - Michele Heisler
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Wei Hao
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor
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Roth SE, Gronowski B, Jones KG, Smith RA, Smith SK, Vartanian KB, Wright BJ. Evaluation of an Integrated Intervention to Address Clinical Care and Social Needs Among Patients with Type 2 Diabetes. J Gen Intern Med 2023; 38:38-44. [PMID: 36864267 PMCID: PMC9980858 DOI: 10.1007/s11606-022-07920-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/31/2022] [Indexed: 03/04/2023]
Abstract
BACKGROUND The Providence Diabetes Collective Impact Initiative (DCII) was designed to address the clinical challenges of type 2 diabetes and the social determinants of health (SDoH) challenges that exacerbate disease impact. OBJECTIVE We assessed the impact of the DCII, a multifaceted intervention approach to diabetes treatment that employed both clinical and SDoH strategies, on access to medical and social services. DESIGN The evaluation employed a cohort design and used an adjusted difference-in-difference model to compare treatment and control groups. PARTICIPANTS Our study population consisted of 1220 people (740 treatment, 480 control), aged 18-65 years old with a pre-existing type 2 diabetes diagnosis who visited one of the seven Providence clinics (three treatment and four control) in the tri-county area of Portland, Oregon, between August 2019 and November 2020. INTERVENTIONS The DCII threaded together clinical approaches such as outreach, standardized protocols, and diabetes self-management education and SDoH strategies including social needs screening, referral to a community resource desk, and social needs support (e.g., transportation) to create a comprehensive, multi-sector intervention. MAIN MEASURES Outcome measures included SDoH screens, diabetes education participation, HbA1c, blood pressure, and virtual and in-person primary care utilization, as well as inpatient and emergency department hospitalization. KEY RESULTS Compared to patients at the control clinics, patients at DCII clinics saw an increase in diabetes education (15.5%, p<0.001), were modestly more likely to receive SDoH screening (4.4%, p<0.087), and had an increase in the average number of virtual primary care visits of 0.35 per member, per year (p<0.001). No differences in HbA1c, blood pressure, or hospitalization were observed. CONCLUSIONS DCII participation was associated with improvements in diabetes education use, SDoH screening, and some measures of care utilization.
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Affiliation(s)
- Sarah E Roth
- Center for Outcomes Research & Education (CORE), Providence St. Joseph Health, 5251 NE Glisan Street, Portland, OR, 97213, USA.
| | - Ben Gronowski
- Center for Outcomes Research & Education (CORE), Providence St. Joseph Health, 5251 NE Glisan Street, Portland, OR, 97213, USA
| | - Kyle G Jones
- Center for Outcomes Research & Education (CORE), Providence St. Joseph Health, 5251 NE Glisan Street, Portland, OR, 97213, USA
| | - Rachel A Smith
- Community Health Division, Providence Health and Services, Portland, OR, USA
| | | | - Keri B Vartanian
- Center for Outcomes Research & Education (CORE), Providence St. Joseph Health, 5251 NE Glisan Street, Portland, OR, 97213, USA
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Leung CW, Heisler M, Patel MR. Multiple social risk factors are adversely associated with diabetes management and psychosocial outcomes among adults with diabetes. Prev Med Rep 2022; 29:101957. [PMID: 36161137 PMCID: PMC9502323 DOI: 10.1016/j.pmedr.2022.101957] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/21/2022] [Accepted: 08/14/2022] [Indexed: 11/24/2022] Open
Abstract
Adults from structurally marginalized populations have disproportionately higher rates of diabetes, highlighting the importance of addressing social risk factors in diabetes prevention and management. This study examined the correlations among multiple social risk factors and their respective burden on diabetes management and psychosocial health outcomes among adults with diabetes. Data came from the baseline assessment of an ongoing randomized controlled trial evaluating approaches to addressing unmet social needs among 579 adults with diabetes. Four social risks (food insecurity, financial insecurity, housing insecurity, and utility insecurity) were assessed, dichotomized and summed to create a score of cumulative social risk factors. The outcomes of interest were: hemoglobin A1c, cost-related non-adherence for diabetes, diabetes distress, and anxiety or depression. Multivariate regression models were used to examine the associations between cumulative social risk factors and health outcomes, adjusting for sociodemographic characteristics and diabetes duration. Approximately 18% of study participants reported one social risk, 18% reported two social risks, and 23% reported three or four social risks. After multivariate adjustment, adults with three or four social risk factors had a greater likelihood of cost-related non-adherence (OR 2.81, 95% CI 1.95, 4.06), diabetes distress (OR 3.03, 95% CI 2.13, 4.31), and anxiety or depression (OR 5.36, 95% CI 3.39, 8.47), compared to adults with no social risk factors. Significant dose-response relationships were observed with greater social risk factors and poorer diabetes-related outcomes. These findings support efforts to address systemic contributors to diabetes management and care to better promote individual and population health.
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Affiliation(s)
- Cindy W. Leung
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, United States
| | - Michele Heisler
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, United States
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, United States
| | - Minal R. Patel
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, United States
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Association of Social Determinants of Health and Their Cumulative Impact on Hospitalization Among a National Sample of Community-Dwelling US Adults. J Gen Intern Med 2022; 37:1935-1942. [PMID: 34355346 PMCID: PMC9198163 DOI: 10.1007/s11606-021-07067-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/21/2021] [Indexed: 10/29/2022]
Abstract
IMPORTANCE While the association between Social Determinants of Health (SDOH) and health outcomes is well known, few studies have explored the impact of SDOH on hospitalization. OBJECTIVE Examine the independent association and cumulative effect of six SDOH domains on hospitalization. DESIGN Using cross-sectional data from the 2016-2018 National Health Interview Surveys (NHIS), we used multivariable logistical regression models controlling for sociodemographics and comorbid conditions to assess the association of each SDOH and SDOH burden (i.e., cumulative number of SDOH) with hospitalization. SETTING National survey of community-dwelling individuals in the US PARTICIPANTS: Adults ≥18 years who responded to the NHIS survey EXPOSURE: Six SDOH domains (economic instability, lack of community, educational deficits, food insecurity, social isolation, and inadequate access to medical care) MEASURES: Hospitalization within 1 year RESULTS: Among all 55,186 respondents, most were ≤50 years old (54.2%), female (51.7%, 95% CI 51.1-52.3), non-Hispanic (83.9%, 95% CI 82.4-84.5), identified as White (77.9%, 95% CI 76.8-79.1), and had health insurance (90%, 95% CI 88.9-91.9). Hospitalized individuals (n=5506; 8.7%) were more likely to be ≥50 years old (61.2%), female (60.7%, 95% CI 58.9-62.4), non-Hispanic (87%, 95% CI 86.2-88.4), and identify as White (78.5%, 95% CI 76.7-80.3), compared to those who were not hospitalized. Hospitalized individuals described poorer overall health, reporting higher incidence of having ≥5 comorbid conditions (38.9%, 95% CI 37.1-40.1) compared to those who did not report a hospitalization (15.9%, 95% CI 15.4-16.5). Hospitalized respondents reported higher rates of economic instability (33%), lack of community (14%), educational deficits (67%), food insecurity (14%), social isolation (34%), and less access to health care (6%) compared to non-hospitalized individuals. In adjusted analysis, food insecurity (OR: 1.36, 95% CI 1.22-1.52), social isolation (OR: 1.17, 95% CI 1.08-1.26), and lower educational attainment (OR: 1.12, 95% CI 1.02-1.25) were associated with hospitalization, while a higher SDOH burden was associated with increased odds of hospitalization (3-4 SDOH [OR: 1.25, 95% CI 1.06-1.49] and ≥5 SDOH [OR: 1.72, 95% CI 1.40-2.06]) compared to those who reported no SDOH. CONCLUSIONS Among community-dwelling US adults, three SDOH domains: food insecurity, social isolation, and low educational attainment increase an individual's risk of hospitalization. Additionally, risk of hospitalization increases as SDOH burden increases.
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Cuddapah GV, Vallivedu Chennakesavulu P, Pentapurthy P, Vallakati M, Kongara A, Reddivari P, Singareddy S, Chandupatla KP, Swamy M. Complications in Diabetes Mellitus: Social Determinants and Trends. Cureus 2022; 14:e24415. [PMID: 35619856 PMCID: PMC9126423 DOI: 10.7759/cureus.24415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2022] [Indexed: 11/12/2022] Open
Abstract
Conditions that impact an individual's health are referred to as social determinants of health. Through a retrospective study (January 2017-February 2022) and statistical analysis, researchers looked at the relationship between social demands and type 2 diabetes mellitus (T2DM) diagnosis. All social demands, with the exception of childcare, were more typically documented in patients with T2DM. Prescription expense, conveyance, and health literacy were the domains with the greatest relationships. These results might help health systems and social service providers develop collaborations to help in certain areas.
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Parcha V, Heindl B, Kalra R, Li P, Gower B, Arora G, Arora P. Insulin Resistance and Cardiometabolic Risk Profile Among Nondiabetic American Young Adults: Insights From NHANES. J Clin Endocrinol Metab 2022; 107:e25-e37. [PMID: 34473288 PMCID: PMC8684535 DOI: 10.1210/clinem/dgab645] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND The burden of insulin resistance (IR) among young American adults has not been previously assessed. We evaluated (1) the prevalence and trends of IR and cardiometabolic risk factors and (2) the association between measures of adiposity and IR among adults 18 to 44 years of age without diabetes and preexisting cardiovascular disease. METHODS Cross-sectional survey data from six consecutive National Health and Nutrition Examination Survey (2007-2008 to 2017-2018) cycles were analyzed. IR was defined by the homeostatic model assessment for IR (HOMA-IR) of ≥2.5. The temporal trends of IR, cardiometabolic risk factors, and the relationship between IR and measures of adiposity were assessed using multivariable-adjusted regression models. RESULTS Among 6247 young adults 18 to 44 years of age, the prevalence of IR was 44.8% (95% CI: 42.0%-47.6%) in 2007-2010 and 40.3% (95% CI: 36.4%-44.2%) in 2015-2018 (P for trend = 0.07). There was a modest association of HOMA-IR with higher body mass index (BMI), waist circumference, total lean fat mass, and total and localized fat mass (all Ps < 0.001). Participants with IR had a higher prevalence of hypertension [31.3% (95% CI: 29.2%-33.5%) vs 14.7% (95% CI: 13.2%-16.2%)], hypercholesterolemia [16.0% (95% CI: 12.4%-19.5%) vs 7.0% (95% CI: 5.8%-8.5%)], obesity [56.6% (95% CI: 53.9%-59.3%) vs 14.7% (95% CI: 13.0%-16.5%)], and poor physical activity levels [18.3% (95% CI: 16.4%-20.2%) vs 11.7% (95%CI: 10.3-13.1%)] compared to participants without IR (all Ps < 0.05). CONCLUSIONS Four-in-10 young American adults have IR, which occurs in a cluster with cardiometabolic risk factors. Nearly half of young adults with IR are nonobese. Screening efforts for IR irrespective of BMI may be required.
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Affiliation(s)
- Vibhu Parcha
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brittain Heindl
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rajat Kalra
- Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA
| | - Peng Li
- School of Nursing, University of Alabama at Birmingham, AL, USA
| | - Barbara Gower
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Garima Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pankaj Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
- Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
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