1
|
Lecomte J, de Beeck IO, Mamouris P, Mathieu C, Goderis G. Knowledge and prescribing behaviour of Flemish general practitioners regarding novel glucose-lowering medications: Online cross-sectional survey. Prim Care Diabetes 2024:S1751-9918(24)00115-3. [PMID: 38862313 DOI: 10.1016/j.pcd.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 04/25/2024] [Accepted: 06/02/2024] [Indexed: 06/13/2024]
Abstract
AIMS To determine the knowledge and prescribing behaviour regarding new type 2 diabetes medication in general practice. Physicians in Belgium are bound by the prescription criteria which do not always correspond to the international guidelines. DESIGN & METHOD A mixed methods study with an online questionnaire was conducted in Flanders to collect data on demographic characteristics, theoretical knowledge, and prescribing behaviour, using ten theoretical questions and six clinical cases, based on the American Diabetes Association/European Association for the Study of Diabetes (ADA/EASD) guidelines and the Belgian reimbursement criteria. RESULTS 201 GPs and GPs in training were included in this study with a median age of 30 years and 68 % female participants. On the knowledge questionnaire, the mean test result was 7.15/15 (= 48 %) with a median of 8. Further analysis showed that 90 % of the respondents correctly recommended a sodium-glucose cotransporter 2 (sglt2) inhibitor when the clinical case showed a comorbidity of heart failure, whereas only 42 % suggested correctly a glucagon-like peptide 1 (GLP-1) agonist if presence of cardiovascular disease. Subgroup analysis showed no statistically significant demographic differences in obtained test results. Regarding prescription behaviour, 23 % of the respondents would prescribe medication that did not match the reimbursement criteria in at least one of the 6 proposed clinical cases. CONCLUSION This study highlights the need for enhanced knowledge and updated prescribing practices among Flemish GPs and Trainee GPs to effectively manage patients with T2DM.
Collapse
Affiliation(s)
- Julie Lecomte
- Academic Center for General Practice, Department of Public Health and Primary Care, Kapucijnenvoer 7 blok h - box 7001, Leuven 3000, Belgium
| | - Isabelle Op de Beeck
- Academic Center for General Practice, Department of Public Health and Primary Care, Kapucijnenvoer 7 blok h - box 7001, Leuven 3000, Belgium
| | - Pavlos Mamouris
- Academic Center for General Practice, Department of Public Health and Primary Care, Kapucijnenvoer 7 blok h - box 7001, Leuven 3000, Belgium
| | - Chantal Mathieu
- Clinical and Experimental Endocrinology, UZ Herestraat 49 - box 902, Leuven 3000, Belgium
| | - Geert Goderis
- Academic Center for General Practice, Department of Public Health and Primary Care, Kapucijnenvoer 7 blok h - box 7001, Leuven 3000, Belgium.
| |
Collapse
|
2
|
Thepwongsa I, Muthukumar R, Sripa P, Piterman L. Uptake and effectiveness of online diabetes continuing education: The perspectives of Thai general practitioner trainees. Heliyon 2023; 9:e13355. [PMID: 36755621 PMCID: PMC9900372 DOI: 10.1016/j.heliyon.2023.e13355] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 01/23/2023] [Accepted: 01/26/2023] [Indexed: 02/01/2023] Open
Abstract
Background Despite continuing medical education (CME) programmes on evidence-based diabetes care, evidence-based best practice and actual GP practice remain scant. Online CME offers numerous benefits to general practitioners (GPs), particularly during the coronavirus disease 2019 (COVID-19) pandemic. In Thailand, CME is a voluntary process and is yet to be established as a mandatory requirement. This study examined GP uptake of online diabetes CME and the changes in GPs' attitudes to and knowledge of Type 2 diabetes management. Methods A cross-sectional study and a before-and-after study were employed with 279 GP trainees who voluntarily undertook a newly-developed online diabetes programme. A follow-up survey was conducted six months after the GP trainees completed their training. Results One hundred and twelve out of 279 GP trainees (40.1%) participated in the study, of whom 37 (13.3%) enrolled in the online diabetes programme, and 20 (7.2%) completed the programme. Before enrolling in the programme, the participants' mean diabetes knowledge score was 61.5%. The participants' confidence in effective insulin treatment increased significantly after the programme (95% Confidence interval [CI], -0.51-0.00; P = 0.05), but their knowledge scores before and after the programme were not statistically different (95% CI, -3.93-0.59; P = 0.14). Conclusion Uptake of the online diabetes CME was poor, although appropriate recruitment strategies were employed, and the online educational option was attractive and accessible during the COVID-19 pandemic. This study emphasises the gap between evidence-based practice and actual GP practice and the need for mandatory CME.
Collapse
Affiliation(s)
- Isaraporn Thepwongsa
- Family Medicine Unit, Department of Community Medicine, Faculty of Medicine, Khon Kaen University, Thailand,Corresponding author. Family Medicine Unit, Department of Community Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen province, 40002, Thailand.
| | | | - Poompong Sripa
- Medicine for the Elderly Department, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Leon Piterman
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Australia
| |
Collapse
|
3
|
Pretorius D, Couper ID, Mlambo MG. Sexual history taking: Doctors' clinical decision-making in primary care in the North West province, South Africa. Afr J Prim Health Care Fam Med 2021; 13:e1-e9. [PMID: 34636612 PMCID: PMC8517797 DOI: 10.4102/phcfm.v13i1.2985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/02/2021] [Accepted: 07/08/2021] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Clinical reasoning is an important aspect of making a diagnosis for providing patient care. Sexual dysfunction can be as a result of cardiovascular or neurological complications of patients with chronic illness, and if a patient does not raise a sexual challenge, then the doctor should know that there is a possibility that one exists and enquire. AIM The aim of this research study was to assess doctors' clinical decision-making process with regards to the risk of sexual dysfunction and management of patients with chronic illness in primary care facilities of the North West province based on two hypothetical patient scenarios. SETTING This research study was carried out in 10 primary care facilities in Dr Kenneth Kaunda health district, North West province, a rural health district. METHODS This vignette study using two hypothetical patient scenarios formed part of a broader grounded theory study to determine whether sexual dysfunction as comorbidity formed part of the doctors' clinical reasoning and decision-making. After coding the answers, quantitative content analysis was performed. The questions and answers were then compared with standard answers of a reference group. RESULTS One of the doctors (5%) considered sexual dysfunction, but failed to follow through without considering further exploration, investigations or management. For the scenario of a female patient with diabetes, the reference group considered cervical health questions (p = 0.001) and compliance questions (p = 0.004) as standard enquiries, which the doctors from the North West province failed to consider. For the scenario of a male patient with hypertension and an ex-smoker, the reference group differed significantly by expecting screening for mental health and vision (both p = 0.001), as well as for HIV (p 0.001). The participating doctors did not meet the expectations of the reference group. CONCLUSION Good clinical reasoning and decision-making are not only based on knowledge, intuition and experience but also based on an awareness of human well-being as complex and multidimensional, to include sexual well-being.
Collapse
Affiliation(s)
- Deidré Pretorius
- Division of Family Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg.
| | | | | |
Collapse
|
4
|
Sanchez-Ramirez DC, Singer A, Kosowan L, Polimeni C. Exploring Clinical Care Among Adults With Diabetes Mellitus: Alignment With Recommended Statin and Sulfonylureas Treatment. Can J Diabetes 2019; 43:498-503. [PMID: 31307912 DOI: 10.1016/j.jcjd.2019.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/19/2019] [Accepted: 04/12/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The care of patients with diabetes mellitus (DM), compiled in the 2008 Canadian Diabetes Association clinical practice guidelines and in recommendations from the Choosing Wisely Canada program, is informed by a large body of evidence. This study sought to assess to what extent primary care providers (PCPs) incorporate recommended statin and sulfonylureas treatment in their care of patients with DM, and to identify the association between use of recommended care and PCP characteristics. METHODS This retrospective cohort study (2007-2017) used electronic medical records of 21,149 patients with DM receiving care from 240 PCPs participating in the Manitoba Primary Care Research Network. RESULTS PCPs prescribed statins to patients newly diagnosed with DM who were ≥40 years of age 41% of the time, with 45% of the prescriptions occurring ≤180 days after a new diagnosis (early treatment). PCPs least likely to prescribe recommended statin treatment had higher odds of being older (adjusted odds ratio [aOR], 1.05; 95% confidence interval [CI], 1.01 to 1.09) and fee-for-service funded (aOR, 4.36; 95% CI, 1.47 to 12.91). In addition, older PCPs (aOR, 1.06; 95% CI, 1.02 to 1.10) and women (aOR, 2.42; 95% CI, 1.11 to 5.28) were less likely to prescribe statin treatment early. Seventy-four percent of PCPs prescribed sulfonylureas to adults ≥65 years of age. No PCP characteristics were associated with prescription of sulfonylureas in the lower implementation quartile in the fully adjusted model. CONCLUSIONS Results suggest that PCPs' practice does not always align with current evidence-based clinical guidelines or Choosing Wisely Canada recommendations for patients with DM. Some PCP's characteristics were associated with lower implementation of recommended evidence-based care. This information can help guide future targeted medical education.
Collapse
Affiliation(s)
- Diana C Sanchez-Ramirez
- Office of Continuing Competency and Assessment, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Alexander Singer
- Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Leanne Kosowan
- Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Christine Polimeni
- Office of Continuing Competency and Assessment, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
5
|
Gardiner FW, Nwose EU, Bwititi PT, Crockett J, Wang L. Blood glucose and pressure controls in diabetic kidney disease: Narrative review of adherence, barriers and evidence of achievement. J Diabetes Complications 2018; 32:104-112. [PMID: 29102249 DOI: 10.1016/j.jdiacomp.2017.09.008] [Citation(s) in RCA: 6] [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: 07/26/2017] [Revised: 09/07/2017] [Accepted: 09/10/2017] [Indexed: 11/17/2022]
Abstract
AIMS To review the epidemiology and the clinical evidence regarding achieving blood pressure (BP) and blood glucose control in patients with chronic kidney disease (CKD) and diabetes mellitus (DM), with emphasis on adherence and barriers within the context of Australian clinical guidelines. This article then considers Australian services aimed at BP, DM, and CKD, guideline adherence and control. METHODS Evidence from PubMed-listed articles published between 1994 and 2016 is considered, including original research, focusing on randomised controlled trials and prospective studies, review articles, meta- analyses, expert and professional bodies' guidelines as well as our experience. RESULTS There have been no Australian studies that consider adherence to BP control in DM and CKD patients. This is a major limitation in preventing DM and renal disease progression. It is possible that Australian clinicians are not adhering to DM, hypertension (HT), and glucose recommendations, thus resulting in reduced patient outcomes. CONCLUSIONS It is hoped that future studies ascertain the extent to which the required BP and glucose control in patients is achieved, and the potential barriers to adherence. The significance of this is immense since the impact of failure to control blood glucose levels and BP leads to renal damage.
Collapse
Affiliation(s)
- Fergus William Gardiner
- School of Community Health, Charles Sturt University, Australia; Calvary Hospital, ACT, Australia; School of Biomedical Sciences, Charles Sturt University, Australia.
| | | | | | - Judith Crockett
- School of Community Health, Charles Sturt University, Australia
| | - Lexin Wang
- School of Biomedical Sciences, Charles Sturt University, Australia
| |
Collapse
|
6
|
Ramchandani N, Johnson K, Cullen K, Hamm T, Bisordi J, Sullivan-Bolyai S. CDE Perspectives of Providing New-Onset Type 1 Diabetes Education Using Formal Vignettes and Simulation. DIABETES EDUCATOR 2016; 43:97-104. [DOI: 10.1177/0145721716676893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Purpose The purpose of this article is to describe the 4 Parent Education Through Simulation-Diabetes (PETS-D) nurse certified diabetes educators’ (CDEs) perspectives of teaching parents of children with newly diagnosed type 1 diabetes mellitus (T1DM) early diabetes management skills using formal vignettes and a human patient simulator/human patient simulation (HPS) to augment/enhance the teaching–learning process. Methods A qualitative descriptive approach was used. Four CDEs were interviewed by phone about their teaching experiences. Meticulous notes were taken. Data were analyzed using qualitative content analysis. Results The vignettes (and use of HPS) provided structure, especially for parents who were struggling to learn. Certified diabetes educators described a short learning curve to master the use of the HPS manikin. Human patient simulation-enhanced education was described as helpful for teaching multiple caregivers about diabetes. Certified diabetes educators also described factors that affect parent learning, mechanical issues with the HPS, and additional space requirements for HPS-enhanced education. Conclusion Vignettes and HPS-enhanced education can successfully be used to educate parents of children with new-onset T1DM and were preferred by the CDEs when compared with previous teaching strategies. The results of this study support the use of both vignette-based and HPS-enhanced education when a child is newly diagnosed with T1DM. Further studies need to be done to see if these effects persist with different populations, during different stages of the disease, and for individuals with other chronic illnesses.
Collapse
Affiliation(s)
- Neesha Ramchandani
- New York University Rory Meyers College of Nursing, New York, New York (Ms Ramchandani, Dr Sullivan-Bolyai)
- Division of Pediatric Endocrinology, University of Massachusetts, Worcester, Worcester, Massachusetts (Ms Johnson, Ms Cullen)
- Division of Pediatric Endocrinology, Rhode Island Hospital, Providence, Rhode Island (Mrs Hamm, Mrs Bisordi)
| | - Kim Johnson
- New York University Rory Meyers College of Nursing, New York, New York (Ms Ramchandani, Dr Sullivan-Bolyai)
- Division of Pediatric Endocrinology, University of Massachusetts, Worcester, Worcester, Massachusetts (Ms Johnson, Ms Cullen)
- Division of Pediatric Endocrinology, Rhode Island Hospital, Providence, Rhode Island (Mrs Hamm, Mrs Bisordi)
| | - Karen Cullen
- New York University Rory Meyers College of Nursing, New York, New York (Ms Ramchandani, Dr Sullivan-Bolyai)
- Division of Pediatric Endocrinology, University of Massachusetts, Worcester, Worcester, Massachusetts (Ms Johnson, Ms Cullen)
- Division of Pediatric Endocrinology, Rhode Island Hospital, Providence, Rhode Island (Mrs Hamm, Mrs Bisordi)
| | - Terri Hamm
- New York University Rory Meyers College of Nursing, New York, New York (Ms Ramchandani, Dr Sullivan-Bolyai)
- Division of Pediatric Endocrinology, University of Massachusetts, Worcester, Worcester, Massachusetts (Ms Johnson, Ms Cullen)
- Division of Pediatric Endocrinology, Rhode Island Hospital, Providence, Rhode Island (Mrs Hamm, Mrs Bisordi)
| | - Jean Bisordi
- New York University Rory Meyers College of Nursing, New York, New York (Ms Ramchandani, Dr Sullivan-Bolyai)
- Division of Pediatric Endocrinology, University of Massachusetts, Worcester, Worcester, Massachusetts (Ms Johnson, Ms Cullen)
- Division of Pediatric Endocrinology, Rhode Island Hospital, Providence, Rhode Island (Mrs Hamm, Mrs Bisordi)
| | - Susan Sullivan-Bolyai
- New York University Rory Meyers College of Nursing, New York, New York (Ms Ramchandani, Dr Sullivan-Bolyai)
- Division of Pediatric Endocrinology, University of Massachusetts, Worcester, Worcester, Massachusetts (Ms Johnson, Ms Cullen)
- Division of Pediatric Endocrinology, Rhode Island Hospital, Providence, Rhode Island (Mrs Hamm, Mrs Bisordi)
| |
Collapse
|
7
|
Gupta R, Lodha S, Sharma KK, Sharma SK, Gupta S, Asirvatham AJ, Mahanta BN, Maheshwari A, Sharma DC, Meenawat AS, Khedar RS. Evaluation of statin prescriptions in type 2 diabetes: India Heart Watch-2. BMJ Open Diabetes Res Care 2016; 4:e000275. [PMID: 27648292 PMCID: PMC5013346 DOI: 10.1136/bmjdrc-2016-000275] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 07/20/2016] [Accepted: 07/27/2016] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Contemporary treatment guidelines advise statin use in all patients with diabetes for reducing coronary risk. Use of statins in patients with type 2 diabetes has not been reported from India. METHODS We performed a multisite (n=9) registry-based study among internists (n=3), diabetologists (n=3), and endocrinologists (n=3) across India to determine prescriptions of statins in patients with type 2 diabetes. Demographic and clinical details were obtained and prescriptions were audited for various medications with a focus on statins. Details of type of statin and dosage form (low, moderate, and high) were obtained. Patients were divided into categories based on presence of cardiovascular risk into low (no risk factors, n=1506), medium (≥1 risk factor, n=5425), and high (with vascular disease, n=1769). Descriptive statistics are presented. RESULTS Prescription details were available in 8699 (men 5292, women 3407). Statins were prescribed in 55.2% and fibrates in 9.2%. Statin prescription was significantly greater among diabetologists (64.4%) compared with internists (n=53.3%) and endocrinologists (46.8%; p<0.001). Atorvastatin was prescribed in 74.1%, rosuvastatin in 29.2%, and others in 3.0%. Statin prescriptions were lower in women (52.1%) versus men (57.2%; p<0.001) and in patients aged <40 years (34.3%), versus those aged 40-49 (49.7%), 50-59 (60.1%), and ≥60 years (62.2%; p<0.001). Low-dose statins were prescribed in 1.9%, moderate dose in 85.4%, and high dose in 12.7%. Statin prescriptions were greater in the high-risk group (58.0%) compared with those in the medium-risk (53.8%) and low-risk (56.8%) groups (p <0.001). High-dose statin prescriptions were similar in the high-risk (14.5%), medium-risk (11.8%), and low-risk (13.5%) groups (p=0.31). CONCLUSIONS Statins are prescribed in only half of the clinic-based patients in India with type 2 diabetes. Prescription of high-dose statins is very low.
Collapse
Affiliation(s)
- Rajeev Gupta
- Departments of Preventive Cardiology, Internal Medicine and Endocrinology, Eternal Heart Care Centre and Research Institute, Mount Sinai New York Affiliate, Jaipur, Rajasthan, India
| | - Sailesh Lodha
- Departments of Preventive Cardiology, Internal Medicine and Endocrinology, Eternal Heart Care Centre and Research Institute, Mount Sinai New York Affiliate, Jaipur, Rajasthan, India
| | - Krishna K Sharma
- Research Unit, Fortis Escorts Hospital, Jaipur, Rajasthan, India
| | - Surendra K Sharma
- Department of Endocrinology, Galaxy Specialty Centre, Jaipur, Rajasthan,India
| | - Sunil Gupta
- Department of Diabetes, Diabetes Care and Research Centre, Nagpur, Maharashtra, India
| | | | | | - Anuj Maheshwari
- Department of Medicine, BBD College of Dental Sciences, Lucknow, Uttar Pradesh, India
| | - Dinesh C Sharma
- Department of Endocrinology, RNT Medical College, Udaipur, Rajasthan, India
| | - Anand S Meenawat
- Department of Medicine, Satyam Hospital, Jodhpur, Rajasthan, India
| | - Raghubir S Khedar
- Departments of Preventive Cardiology, Internal Medicine and Endocrinology, Eternal Heart Care Centre and Research Institute, Mount Sinai New York Affiliate, Jaipur, Rajasthan, India
| |
Collapse
|
8
|
Mor A, Berencsi K, Svensson E, Rungby J, Nielsen JS, Friborg S, Brandslund I, Christiansen JS, Vaag A, Beck-Nielsen H, Sørensen HT, Thomsen RW. Prescribing practices and clinical predictors of glucose-lowering therapy within the first year in people with newly diagnosed Type 2 diabetes. Diabet Med 2015; 32:1546-54. [PMID: 26032247 DOI: 10.1111/dme.12819] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2015] [Indexed: 11/26/2022]
Abstract
AIM To examine prescribing practices and predictors of glucose-lowering therapy within the first year following diagnosis of Type 2 diabetes mellitus in a clinical care setting. METHODS We followed people enrolled in the Danish Centre for Strategic Research in Type 2 Diabetes (DD2) cohort from outpatient hospital clinics and general practices throughout Denmark in 2010-2013. We used Poisson regression to compute age- and gender-adjusted risk ratios (RRs). RESULTS Among 1158 new Type 2 diabetes mellitus patients, 302 (26%) did not receive glucose-lowering therapy within the first year, 723 (62%) received monotherapy [685 (95%) with metformin], and 133 (12%) received more than one drug. Predictors of receiving any vs. no therapy and combination vs. monotherapy were: age < 40 years [RR: 1.29 (95% CI: 1.16-1.44) and 3.60 (95% CI: 2.36-5.50)]; high Charlson Comorbidity Index [RRs: 1.20 (95% CI: 1.05-1.38) and 2.08 (95% CI: 1.16-3.72)]; central obesity [RRs: 1.23 (95% CI: 1.04-1.44) and 1.93 (95% CI: 0.76-4.94)]; fasting blood glucose of ≥ 7.5 mmol/l [RRs: 1.25 (95% CI: 1.10-1.42) and 1.94 (95% CI: 1.02-3.71)]; and HbA1c ≥ 59 mmol/mol (≥ 7.5%) [RR: 1.26 (95% CI: 1.20-1.32) and 2.86 (95% CI: 1.97-4.14)]. Weight gain ≥ 30 kg since age 20, lack of physical exercise and C-peptide of < 300 pmol/l also predicted therapy. CONCLUSIONS Comorbidity, young age, central obesity and poor baseline glycaemic control are important predictors of therapy one year after Type 2 diabetes mellitus debut.
Collapse
Affiliation(s)
- A Mor
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - K Berencsi
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - E Svensson
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - J Rungby
- Department of Biomedicine, Aarhus University Hospital, Aarhus, Denmark
- Center for Diabetes Research, Gentofte University Hospital, Copenhagen, Denmark
| | - J S Nielsen
- Diabetes Research Centre, Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - S Friborg
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - I Brandslund
- Department of Biochemistry, Lillebaelt Hospital, Vejle, Denmark
| | - J S Christiansen
- Department of Internal Medicine and Endocrinology, Aarhus University Hospital, Aarhus, Denmark
| | - A Vaag
- Department of Endocrinology, Rigshospitalet and Copenhagen University, Denmark
| | - H Beck-Nielsen
- Diabetes Research Centre, Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - H T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - R W Thomsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
9
|
Thepwongsa I, Kirby C, Schattner P, Shaw J, Piterman L. Type 2 diabetes continuing medical education for general practitioners: what works? A systematic review. Diabet Med 2014; 31:1488-97. [PMID: 25047877 DOI: 10.1111/dme.12552] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 04/24/2014] [Accepted: 07/17/2014] [Indexed: 10/25/2022]
Abstract
AIMS To perform a systematic review of studies that have assessed the effectiveness of interventions designed to improve healthcare professionals' care of patients with diabetes and to assess the effects of educational interventions targeted at general practitioners' diabetes management. METHODS A computer search was conducted using the Cochrane Library, PubMed, Ovid MEDLINE, Scopus, EMBASE, Informit, Google scholar and ERIC from the earliest date of each database up until 2013. A supplementary review of reference lists from each article obtained was also carried out. Measured changes in general practitioners' satisfaction, knowledge, practice behaviours and patient outcomes were recorded. RESULTS Thirteen out of 1255 studies met the eligibility criteria, but none was specifically conducted in rural or remote areas. Ten studies were randomized trials. Fewer than half of the studies (5/13, 38.5%) reported a significant improvement in at least one of the following outcome categories: satisfaction with the programme, knowledge and practice behaviour. There was little evidence of the impact of general practitioner educational interventions on patient outcomes. Of the five studies that examined patient outcomes, only one reported a positive impact: a reduction in patient HbA1c levels. CONCLUSIONS Few studies examined the effectiveness of general practitioner Type 2 diabetes education in improving general practitioner satisfaction, knowledge, practices and/or patient outcomes. Evidence to support the effectiveness of education is partial and weak. To determine effective strategies for general practitioner education related to Type 2 diabetes, further well designed studies, accompanied by valid and reliable evaluation methods, are needed.
Collapse
Affiliation(s)
- I Thepwongsa
- Department of General Practice, School of Primary Health Care, Monash University, Notting Hill
| | | | | | | | | |
Collapse
|
10
|
Widyahening IS, van der Graaf Y, Soewondo P, Glasziou P, van der Heijden GJMG. Awareness, agreement, adoption and adherence to type 2 diabetes mellitus guidelines: a survey of Indonesian primary care physicians. BMC FAMILY PRACTICE 2014; 15:72. [PMID: 24755412 PMCID: PMC4000317 DOI: 10.1186/1471-2296-15-72] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 04/16/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND To assess the degree of awareness, agreement, adoption and adherence of physicians in Indonesia to type 2 diabetes mellitus guidelines, and their association with characteristics of the responders. METHODS Questionnaire survey among General Practitioners (GPs) attending the Indonesian Association of Family Practitioners annual conference in November 2012. The proportion of GPs who were aware of, agreed with, adopted and adhered to the seven recommendations in the guidelines (screening for diabetes, diagnosis, lifestyle modification, use of sulfonylurea, target blood glucose, target blood pressure and use of statin) were calculated in the total number of responders. RESULTS Of the 399 GPs participating, 383 (89%) were aware of the existence of Indonesian type 2 diabetes guidelines. Awareness for each recommendation varied from 66 to 91%. The recommendation to use a random blood glucose test for diagnosing patients with classic diabetes symptoms had the least awareness (265/399, 66%) and least agreement (163/399, 41%). The recommendation on statin use was the least adopted (192/399, 48%), while the least adherence (7/399, 2%) was found for the recommendation on screening for diabetes for patients with risk factors. Years of practice experience and proportion of diabetes patients seen in their practice were independently related with adherence to statin prescription. CONCLUSIONS High awareness of the Indonesian type 2 diabetes guideline does not necessary lead to adoption or adherence to recommendations important for outcomes and quality of care. The awareness-to-adherence model helps in identifying barriers for the use of guidelines.
Collapse
Affiliation(s)
- Indah S Widyahening
- Community Medicine Department, Faculty of Medicine Universitas Indonesia, Jl. Pegangsaan Timur 16, Jakarta 10430, Indonesia
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Yolanda van der Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Pradana Soewondo
- Internal Medicine Department, Faculty of Medicine Universitas Indonesia – Cipto Mangunkusumo Hospital, Jl. Diponegoro 71, Jakarta 10430, Indonesia
| | - Paul Glasziou
- Centre for Research in Evidence-Based Practice (CREBP) Faculty of Health Sciences, Bond University, Gold Coast, Queensland 4229, Australia
| | - Geert JMG van der Heijden
- Department Social Dentistry, Academic Center for Dentistry Amsterdam (ACTA), Gustav Mahlerlaan 3004, 1081 LA Amsterdam, The Netherlands
| |
Collapse
|
11
|
Johnston KN, Young M, Grimmer KA, Antic R, Frith PA. Barriers to, and facilitators for, referral to pulmonary rehabilitation in COPD patients from the perspective of Australian general practitioners: a qualitative study. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2014; 22:319-24. [PMID: 23797679 PMCID: PMC6442818 DOI: 10.4104/pcrj.2013.00062] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background: Pulmonary rehabilitation (PR) is recommended in the management of people with chronic obstructive pulmonary disease (COPD), but referral to this service is low. Aims: To identify barriers to, and facilitators for, referral to PR programmes from the perspective of Australian general practitioners. Methods: Semi-structured interviews were conducted with general practitioners involved in the care of people with COPD. Interview questions were informed by a validated behavioural framework and asked about participants’ experience of referring people with COPD for PR, and barriers to, or facilitators of, this behaviour. Interviews were audiotaped, transcribed verbatim, and analysed using content analysis. Results: Twelve general practitioners participated in this study, 10 of whom had never referred a patient to a PR programme. Four major categories relating to barriers to referral were identified: low knowledge of PR for COPD; low knowledge of how to refer; actual or anticipated access difficulties for patients; and questioning the need to do more to promote exercise behaviour change. Awareness of benefit was the only current facilitator. Three major categories of potential facilitators were identified: making PR part of standard COPD care through financial incentive; improving information flow with regard to referrals and services; and informing patients and public. Conclusions: Significant barriers to referral exist, but opportunities to change the organisation of practice and information management were identified. Behaviour change strategies which directly target these barriers and incorporate facilitators should make up the key components of interventions to improve referral to PR by general practitioners who care for people with COPD.
Collapse
Affiliation(s)
- Kylie N Johnston
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | | | | | | | | |
Collapse
|
12
|
Djalali S, Frei A, Tandjung R, Baltensperger A, Rosemann T. Swiss quality and outcomes framework: quality indicators for diabetes management in Swiss primary care based on electronic medical records. Gerontology 2014; 60:263-73. [PMID: 24603324 DOI: 10.1159/000357370] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 11/18/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Most industrialized countries are faced with a growing population of patients with chronic diseases and multimorbidity. Evidence performance gaps have been recognized in the treatment of this vulnerable patient group. In England, the Quality and Outcomes Framework (QOF) - based on incentivized quality indicators - has been established to narrow the gap. OBJECTIVE We evaluated to what extent clinical data, extracted from electronic medical records (EMRs) of Swiss general practitioners, can be used as quality indicators in terms of a Swiss Quality and Outcomes Framework (SQOF) for diabetes care adopted from the QOF of the UK National Health Service (NHS). METHODS We searched the FIRE database (Family Medicine ICPC Research Using Electronic Medical Records) for patients suffering from diabetes type 1 or type 2. Eligible data were matched with the diabetes indicator set of the NHS QOF and compared with the results in England. RESULTS A total of 11 out of 17 diabetes indicators could be adopted for the SQOF; 46 practices with 1,781 diabetes patients were included. The practices fulfilled the SQOF diabetes indicator set with 46.9% overall, with highest compliance for blood pressure measurements (97.8% of all practices) and lowest compliance for influenza immunization (45.7%). Our study practices showed higher variation across all indicators and between practices compared to England, but lacking structured data limited calculation of scores and comparability. CONCLUSIONS Our results show that it is technically feasible to establish a diabetes QOF in Swiss primary care based on EMRs. However, a high amount of missing data made it impossible to evaluate the actual quality of care. For a nationwide introduction, standards for electronic medical documentation and EMR use need to be set. It should also be acknowledged that important dimensions of suffering from one or more chronic diseases such as health-related quality of life are not reflected within a system focusing only on somatic aspects of a disease.
Collapse
Affiliation(s)
- S Djalali
- Institute of General Practice and Health Services Research, University of Zurich, Zurich, Switzerland
| | | | | | | | | |
Collapse
|
13
|
Halkett GKB, Jiwa M, Meng X, Leong E. Referring advanced cancer patients for palliative treatment: a national structured vignette survey of Australian GPs. Fam Pract 2014; 31:60-70. [PMID: 24277383 DOI: 10.1093/fampra/cmt068] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Although (general practitioners) GPs have a role in managing patients with advanced cancer, little is known about their referral decisions. AIM The aim of this study was to explore, using structured vignettes, how GPs might manage patients presenting with advanced cancer. DESIGN A self-administered survey consisting of structured vignettes was administered to GPs in Australia. Fifty-six vignettes describing patients who may benefit from palliative care and/or treatment were constructed encompassing seven advanced cancer diagnoses (cerebral metastasis, lung metastases, renal cancer, bone metastases, ulcerating skin metastases, spinal metastases and stridor) and three clinical variables (age, prognosis and mobility). Seven vignettes were presented to each respondent. Respondents were asked if they would refer the patient and the benefits of different treatment modalities. Participant responses were compared with responses provided by an expert panel. Logistic regression and parametric tests were used to estimate odds of referral. SETTING/PARTICIPANTS The respondents were GPs, currently registered and practicing in Australia. Participants were selected randomly from a national list of practitioners. RESULTS Four hundred and seven questionnaires were received. There was wide variation (31%-97%) in the proportion of respondents who agreed with the expert panel. The odds of referral for radiotherapy varied the most. Significant predictive variables included patient age, mobility and prognosis and respondent demographics. CONCLUSION GPs' referral decisions for patients with advanced cancer appear to deviate from expert opinion and can be predicted using respondent and patient characteristics. If these data were reflected in clinical practice some patients may not be offered helpful palliative treatment options.
Collapse
|
14
|
Benito Badorrey B. El problema de la inercia terapéutica en el tratamiento de la diabetes mellitus tipo 2 en España. HIPERTENSION Y RIESGO VASCULAR 2012. [DOI: 10.1016/s1889-1837(12)70011-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
15
|
Seidu S, Khunti K. Non-adherence to diabetes guidelines in primary care - the enemy of evidence-based practice. Diabetes Res Clin Pract 2012; 95:301-2. [PMID: 22293930 DOI: 10.1016/j.diabres.2012.01.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|