A prospective examination of disease management program use by complex cardiac outpatients

Assessment of the effects of rehabilitation after cerebrovascular accident in patients with diabetes mellitus and hypertension as risk factors

Aim:

The aim of this study is to evaluate the results of rehabilitation, to determine the prevalence of major risk factors in cerebrovascular accident and their consequences, as well as to propose measures and procedures that will affect the better rehabilitation.

Methods:

The survey analyzed: age, sex, duration of rehabilitation, activities in daily life through the Barthel index at admission and at discharge, presence of risk factors HTA and DM. The study included a total of 116 patients, the majority of patients are older than 61 years. We had 49% of male patients and 51% of female patients and they spent 31-40 days at the rehabilitation.

Results:

The most common risk factor is HTA (83%) and diabetes (33%). Most of the patients at admission had a BI from 0 to 4 (32.7%), and at discharge BI in the range 17-20 (36.2%). Statistical analysis shows that there is a statistically significant correlation between the BI at admission, BI at discharge and risk factors of HTA and diabetes mellitus.

Conclusions:

the rehabilitation results in most patients is good results of rehabilitation. The most important risk factors in patients are HTA, DM and directly affect on results of rehabilitation. For the better results we should have energetic fight against risk factors for HTA and DM through primary and secondary prevention and patient education about early detection and treatment of these risk factors.

Adherence to international follow-up guidelines in type 2 diabetes: a longitudinal cohort study in Luxembourg

Introduction

Type 2 diabetes is associated with severe micro- and macro-vascular complications. Physicians’ and patients’ adherence to follow-up guidelines permits postponing or reducing these complications. The objectives were to assess the level of adherence to fundamental follow-up guidelines and determine patients’ characteristics associated with this level of adherence in the context of Luxembourg, where no guidelines were implemented.

Study population

The exhaustive residing population treated for type 2 diabetes in Luxembourg during the 2000-2006 period (N = 21,068).

Methods

Seven fundamental criteria were extracted from international guidelines (consultation with the treating physician, HbA1c tests, electrocardiogram, retinal, dental, lipid and renal check-ups). The factors associated with the level of adherence to those criteria were identified using a partial proportional odds model.

Results

In 2006, despite 90% of the patients consulted at least 4 times their treating physician, only 0.6% completed all criteria; 55.0% had no HbA1c test (−8.6 points since 2000) and 31.1% had a renal check-up (+21.6 points). The sex (OR_male: 0.87 [95%CI, 0.83−0.92]), the nationality (OR_NonEU: 0.64 [0.52−0.78]), the type of antidiabetic treatment (OR_oral: 1.48 [1.35−1.63], OR_mixed: 1.35 [1.20−1.52]) and the type of treating physician (OR_G-ID: 0.47 [0.42−0.53]) were the main factors associated with the level of adherence in 2006 (3 or more criteria).

Conclusion

A large percentage of patients were not provided with a systematic annual follow-up between 2000 and 2006. This study highlighted the necessity to promote guidelines in Luxembourg, education for physicians and to launch a national discussion on a disease management program for diabetic patients.