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Tlili NE, Robert L, Gerard E, Lemaitre M, Vambergue A, Beuscart JB, Quindroit P. A systematic review of the value of clinical decision support systems in the prescription of antidiabetic drugs. Int J Med Inform 2024; 191:105581. [PMID: 39106772 DOI: 10.1016/j.ijmedinf.2024.105581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 07/23/2024] [Accepted: 07/28/2024] [Indexed: 08/09/2024]
Abstract
INTRODUCTION The management of chronic diabetes mellitus and its complications demands customized glycaemia control strategies. Polypharmacy is prevalent among people with diabetes and comorbidities, which increases the risk of adverse drug reactions. Clinical decision support systems (CDSSs) may constitute an innovative solution to these problems. The aim of our study was to conduct a systematic review assessing the value of CDSSs for the management of antidiabetic drugs (AD). MATERIALS AND METHODS We systematically searched the scientific literature published between January 2010 and October 2023. The retrieved studies were categorized as non-specific or AD-specific. The studies' quality was assessed using the Mixed Methods Appraisal Tool. The review's results were reported in accordance with the PRISMA guidelines. RESULTS Twenty studies met our inclusion criteria. The majority of AD-specific studies were conducted more recently (2020-2023) compared to non-specific studies (2010-2015). This trend hints at growing interest in more specialized CDSSs tailored for prescriptions of ADs. The nine AD-specific studies focused on metformin and insulin and demonstrated positive impacts of the CDSSs on different outcomes, including the reduction in the proportion of inappropriate prescriptions of ADs and in hypoglycaemia events. The 11 nonspecific studies showed similar trends for metformin and insulin prescriptions, although the CDSSs' impacts were not significant. There was a predominance of metformin and insulin in the studied CDSSs and a lack of studies on ADs such as sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists. CONCLUSION The limited number of studies, especially randomized clinical trials, interested in evaluating the application of CDSS in the management of ADs underscores the need for further investigations. Our findings suggest the potential benefit of applying CDSSs to the prescription of ADs particularly in primary care settings and when targeting clinical pharmacists. Finally, establishing core outcome sets is crucial for ensuring consistent and standardized evaluation of these CDSSs.
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Affiliation(s)
- Nour Elhouda Tlili
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France.
| | - Laurine Robert
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France; Institut de Pharmacie, CHU Lille, F-59000 Lille, France
| | - Erwin Gerard
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France; Institut de Pharmacie, CHU Lille, F-59000 Lille, France
| | - Madleen Lemaitre
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France; CHU Lille, Department of Diabetology, Endocrinology, Metabolism and Nutrition, Lille University Hospital, F-59000, Lille, France
| | - Anne Vambergue
- CHU Lille, Department of Diabetology, Endocrinology, Metabolism and Nutrition, Lille University Hospital, F-59000, Lille, France; European Genomic Institute for Diabetes, Lille University School of Medicine, F-59000 Lille, France
| | - Jean-Baptiste Beuscart
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France
| | - Paul Quindroit
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France
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El-Deyarbi M, Ahmed LA, King J, Al Nuaimi H, Al Juboori A, Mansour NA, Jarab AS, Abdel-Qader DH, Aburuz S. Effect of structured diet with exercise education on anthropometry and lifestyle modification in patients with type 2 diabetes: A 12-month randomized clinical trial. Diabetes Res Clin Pract 2024; 213:111754. [PMID: 38906331 DOI: 10.1016/j.diabres.2024.111754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 06/12/2024] [Accepted: 06/17/2024] [Indexed: 06/23/2024]
Abstract
AIMS Lifestyle modification involving active engagement of specialised dietitian with diet and exercise education, can be effective as first-line treatment for diabetes. METHODS 192 patients were enrolled with diabetes in a randomised controlled trial and followed up for one year. Ninety-four patients in the intervention group participated in a comprehensive structured diet and exercise education conducted by a specialised dietitian at ambulatory centre in the United Arab Emirates. RESULTS The mean difference in the change in body mass index between study groups at study exit and baseline was statistically significant (BMI difference = -1.86, 95 % CI -2.68 - -1.04, P < 0.01). The intervention group reported significant decrease in total carbohydrate and daily energy intake compared to baseline (173.7 g vs 221.1 g and 1828.5 kcal vs 2177.9 kcal, respectively). Moreover, the mean metabolic equivalents (METs) in the intervention group increased significantly at study exit from baseline compared to control group METs, with mean difference between all between-group differences after baseline of 0.63 (95 % 0.29 - 0.97, P < 0.01). CONCLUSIONS Structured diet and exercise counselling by specialised dietitian in ambulatory settings significantly reduced carbohydrate and daily energy intake, with improved anthropometric measurements and physical activity.
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Affiliation(s)
- Marwan El-Deyarbi
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates; Department of Pharmacy, Oud Al-Touba Diagnostic and Screening Clinic, Ambulatory Health Services, Abu Dhabi Health Services Co. (SEHA), Al Ain, United Arab Emirates
| | - Luai A Ahmed
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Jeffrey King
- David Geffen School of Medicine at the University of California, Los Angeles, CA USA; Department of Veterans Affairs, Greater Los Angeles, Department of Geriatrics and Extended Care, Los Angeles, CA USA
| | - Huda Al Nuaimi
- Clinical Nutrition and Dietary Department, Oud Al-Touba Diagnostic and Screening Clinic, Ambulatory Health Services, Abu Dhabi Health Services Co. (SEHA), Al Ain, United Arab Emirates
| | - Ahmed Al Juboori
- Division of Endocrinology, Oud Al-Touba Diagnostic and Screening Clinic, Ambulatory Health Services, Abu Dhabi Health Services Co. (SEHA), Al Ain, United Arab Emirates
| | - Nirmin A Mansour
- Division of Endocrinology, Oud Al-Touba Diagnostic and Screening Clinic, Ambulatory Health Services, Abu Dhabi Health Services Co. (SEHA), Al Ain, United Arab Emirates
| | - Anan S Jarab
- College of Pharmacy, Al Ain University, Abu Dhabi, United Arab Emirates; Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | | | - Salahdein Aburuz
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
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Sharan R, Wiens K, Ronksley PE, Hwang SW, Booth GL, Austin PC, Spackman E, Bai L, Campbell DJT. The Association of Homelessness With Rates of Diabetes Complications: A Population-Based Cohort Study. Diabetes Care 2023; 46:1469-1476. [PMID: 37276538 DOI: 10.2337/dc23-0211] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/01/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To estimate the rates of diabetes complications and revascularization procedures among people with diabetes who have experienced homelessness compared with a matched cohort of nonhomeless control subjects. RESEARCH DESIGN AND METHODS A propensity-matched cohort study was conducted using administrative health data from Ontario, Canada. Inclusion criteria included a diagnosis of diabetes and at least one hospital encounter between April 2006 and March 2019. Homeless status was identified using a validated administrative data algorithm. Eligible people with a history of homelessness were matched to nonhomeless control subjects with similar sociodemographic and clinical characteristics. Rate ratios (RRs) for macrovascular complications, revascularization procedures, acute glycemic emergencies, skin/soft tissue infections, and amputation were calculated using generalized linear models with negative binomial distribution and robust SEs. RESULTS Of 1,076,437 people who were eligible for inclusion in the study, 6,944 were identified as homeless. A suitable nonhomeless match was found for 5,219 individuals. The rate of macrovascular complications was higher for people with a history of homelessness compared with nonhomeless control subjects (RR 1.85, 95% CI 1.64-2.07), as were rates of hospitalization for glycemia (RR 5.64, 95% CI 4.07-7.81) and skin/soft tissue infections (RR 3.78, 95% CI 3.31-4.32). By contrast, the rates of coronary revascularization procedures were lower for people with a history of homelessness (RR 0.76, 95% CI 0.62-0.94). CONCLUSIONS These findings contribute to our understanding of the impact of homelessness on long-term diabetes outcomes. The higher rates of complications among people with a history of homelessness present an opportunity for tailored interventions to mitigate these disparities.
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Affiliation(s)
- Ruchi Sharan
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kathryn Wiens
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Paul E Ronksley
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Stephen W Hwang
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Gillian L Booth
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Peter C Austin
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Eldon Spackman
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Li Bai
- ICES, Toronto, Ontario, Canada
| | - David J T Campbell
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
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Mendonça TS, Oliveira WN, Belo VS, Silva ES, Pereira ML, Obreli-Neto PR, Baldoni AO. Clinical and humanistic impact of pharmacotherapeutic follow-up in patients with type 1 diabetes mellitus treated judicially. Diabetol Metab Syndr 2022; 14:61. [PMID: 35501843 PMCID: PMC9061226 DOI: 10.1186/s13098-022-00835-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/13/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is a lack of studies that assess the effectiveness of pharmacotherapeutic follow-up in the context of the judicialization of insulin analogues. AIMS To evaluate the clinical and humanistic impact of pharmacotherapeutic follow-up in patients with type 1 diabetes mellitus who receive insulin analogues by judicial decision in a Brazilian municipality. METHODS A quasi-experimental study of the before-and-after type was carried out through pharmacotherapeutic follow-up. Patients who accepted to participate in the study underwent laboratory tests of glycemic and lipid profile before and after the intervention, and underwent five pharmaceutical consultations. In addition, quality of life and health, knowledge, and skills related to insulin application techniques were analyzed. RESULTS 28 patients participated in all stages. Of these, most were female (53.6%), with a mean age of 32.8 ± 11.6 years. After the intervention, there was a reduction in blood glucose levels, blood pressure, and increased body mass index. In addition, there was greater knowledge and skills regarding insulin application techniques, improved quality of life, health, greater number of medications used, reduction of pharmacotherapeutic problems, and improvement in eating habits. CONCLUSION The pharmacotherapeutic follow-up promoted clinical and humanistic benefits, with improvement in quality of life and health.
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Affiliation(s)
- Thays S. Mendonça
- Programa de Pós-Graduação em Ciências da Saúde, Federal University of São João Del-Rei (UFSJ)–Campus Centro-Oeste Dona Lindu (CCO), Rua Sebastião Gonçalves Coelho, 400–Bairro Chanadour, Divinópolis, MG CEP:35501-296 Brazil
| | - William N. Oliveira
- Programa de Pós-Graduação em Ciências da Saúde, Federal University of São João Del-Rei (UFSJ)–Campus Centro-Oeste Dona Lindu (CCO), Rua Sebastião Gonçalves Coelho, 400–Bairro Chanadour, Divinópolis, MG CEP:35501-296 Brazil
| | - Vinícius S. Belo
- Programa de Pós-Graduação em Ciências da Saúde, Federal University of São João Del-Rei (UFSJ)–Campus Centro-Oeste Dona Lindu (CCO), Rua Sebastião Gonçalves Coelho, 400–Bairro Chanadour, Divinópolis, MG CEP:35501-296 Brazil
| | - Eduardo S. Silva
- Programa de Pós-Graduação em Ciências da Saúde, Federal University of São João Del-Rei (UFSJ)–Campus Centro-Oeste Dona Lindu (CCO), Rua Sebastião Gonçalves Coelho, 400–Bairro Chanadour, Divinópolis, MG CEP:35501-296 Brazil
| | - Mariana L. Pereira
- Programa de Pós-Graduação em Ciências da Saúde, Federal University of São João Del-Rei (UFSJ)–Campus Centro-Oeste Dona Lindu (CCO), Rua Sebastião Gonçalves Coelho, 400–Bairro Chanadour, Divinópolis, MG CEP:35501-296 Brazil
| | - Paulo R. Obreli-Neto
- Departamento de Farmácia, Centro Universitário das Faculdades Integradas de Ourinhos (UniFIO), Rodovia BR-153, Km 338 S/N Água do Cateto, Ourinhos, SP 19909-100 Brazil
| | - André O. Baldoni
- Núcleo de Ensino e Pesquisa em Farmácia Clínica (NEPeFaC), Federal University of São João Del-Rei (UFSJ), Rua Sebastião Gonçalves Coelho, 400 – Bairro Chanadour, Divinópolis, MG CEP:35501-296 Brazil
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Neudorf H, Mindrum M, Mindrum C, Durrer C, Little JP. A Low-Carbohydrate, High-Fat Ketogenic Diet Program Implemented by an Interdisciplinary Primary Care Team Improves Markers of Cardiometabolic Health in Adults With Type 2 Diabetes: A Retrospective Secondary Analysis. Can J Diabetes 2021; 46:302-306.e4. [PMID: 35120790 DOI: 10.1016/j.jcjd.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/30/2021] [Accepted: 09/01/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Helena Neudorf
- University of British Columbia, Okanagan Campus, School of Health and Exercise Sciences, Kelowna, British Columbia, Canada
| | - Michael Mindrum
- Department of Internal Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Christa Mindrum
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Cody Durrer
- University of British Columbia, Okanagan Campus, School of Health and Exercise Sciences, Kelowna, British Columbia, Canada
| | - Jonathan P Little
- University of British Columbia, Okanagan Campus, School of Health and Exercise Sciences, Kelowna, British Columbia, Canada.
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Alharbi TJ, Tourkmani AM, Rsheed AB, Al Abood AF, Alotaibi YK. Sociodemographic and clinical predictors of refractory type 2 diabetes patients: Findings from a case-control study. Saudi Med J 2021; 42:181-188. [PMID: 33563737 PMCID: PMC7989287 DOI: 10.15537/smj.2021.2.25694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 12/30/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To identify the sociodemographic and clinical predictors of uncontrolled diabetic patients, to identify high-risk and people with impaired glycemic control, to establish more effective strategies for reducing morbidity and mortality. METHODS This case-control study of 8209 enrolled patients were included from the diabetes registry by Chronic Illness Center (CIC), Family and Community Medicin, Prince Sultan Military Medical City, Riyadh Saudi Arabia between February 2019 and February 2020. Cases are defined as patients with type II refractory diabetes having persistent HbA1c >9, not reach adequate glycemic control despite intensified therapy under specialist care (CIC) for at least 6 months. Controls were defined as patients with Hba1c ≤9. Multivariable regression analysis was used to identify predictors for patients with the persistent outcome of HbA1c >9%. RESULTS Overall, a total of 1152 cases and 4555 controls were included. Patients with refractory diabetes were younger (mean: 58.5, standard deviation [SD]: 11.7) and females (63.4%). Duration of diabetes (13.3, SD: 7.4, p<0.001) and the mean value of low-density lipoprotein (LDL) (2.7, SD: 0.91, p<0.001) were significantly higher in the refractory group. The findings from the final model revealed that with every unit increase in age (odds ratio [OR]: 0.97, [95% confidence interval [CI]: 0.96-0.98]) and body mass index the odds of having refractory diabetes significantly reduced by 0.97 times (OR: 0.97, [95% CI: 0.95-0.99]). While with every unit increase in the duration of diabetes (OR: 1.03, [95% CI: 1.01-1.05]), systolic blood pressure (OR: 1.01, [95% CI: 1.00-1.02]) and LDL (OR: 1.42, [95% CI: 1.23-.62]) the odds of having refractory diabetes significantly increased by 1.03 and 1.42 times respectively compared to controls when adjusted for gender, albumin creatinine, diastolic blood pressure. CONCLUSION The findings from this study helped classify the predictors of refractory patients with diabetes. Understanding refractory patients' predictors may help to develop new therapeutic strategies to boost their glycemic status safely.
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Affiliation(s)
- Turki J. Alharbi
- From the Family and Community Medicine Department (Alharbi, Tourkmani, Bin Rsheed, Al Abood), Chronic Illness Center, Prince Sultan Military Medical City; and from the Department of Quality and Patient Safety (Alotaibi), Armed Forces Medical Services Directorate, Riyadh, Kingdom of Saudi Arabia.
- Address correspondence and reprint request to: Dr. Turki J. Alharbi, Family and Community Medicine Department, Chronic Illness Center, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia. E-mail: ORCID ID: https://orcid.org/0000-0003-0942-3301
| | - Ayla M. Tourkmani
- From the Family and Community Medicine Department (Alharbi, Tourkmani, Bin Rsheed, Al Abood), Chronic Illness Center, Prince Sultan Military Medical City; and from the Department of Quality and Patient Safety (Alotaibi), Armed Forces Medical Services Directorate, Riyadh, Kingdom of Saudi Arabia.
| | - Abdulaziz Bin Rsheed
- From the Family and Community Medicine Department (Alharbi, Tourkmani, Bin Rsheed, Al Abood), Chronic Illness Center, Prince Sultan Military Medical City; and from the Department of Quality and Patient Safety (Alotaibi), Armed Forces Medical Services Directorate, Riyadh, Kingdom of Saudi Arabia.
| | - Abood F. Al Abood
- From the Family and Community Medicine Department (Alharbi, Tourkmani, Bin Rsheed, Al Abood), Chronic Illness Center, Prince Sultan Military Medical City; and from the Department of Quality and Patient Safety (Alotaibi), Armed Forces Medical Services Directorate, Riyadh, Kingdom of Saudi Arabia.
| | - Yasser K. Alotaibi
- From the Family and Community Medicine Department (Alharbi, Tourkmani, Bin Rsheed, Al Abood), Chronic Illness Center, Prince Sultan Military Medical City; and from the Department of Quality and Patient Safety (Alotaibi), Armed Forces Medical Services Directorate, Riyadh, Kingdom of Saudi Arabia.
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Facilitating Adherence to Evidence-Based Practices for Adults With Type 2 Diabetes Mellitus. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2020.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Wozniak LA, Soprovich AL, Johnson JA, Eurich DT. Adopting and implementing an innovative model to organize diabetes care within First Nations communities: A qualitative assessment. BMC Health Serv Res 2021; 21:415. [PMID: 33941176 PMCID: PMC8094479 DOI: 10.1186/s12913-021-06424-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/16/2021] [Indexed: 11/15/2022] Open
Abstract
Background Diabetes care remains suboptimal in First Nations populations. Innovative and culturally relevant approaches are needed to promote systematic and proactive organization of diabetes care for people living with diabetes on-reserve in Canada. The RADAR model is one strategy to improve care: an integrated disease registry paired with an electronic health record for local community healthcare providers with remote care coordination. We qualitatively assessed adoption and implementation of RADAR in First Nations communities in Alberta to inform its potential spread in the province. Methods We used the RE-AIM framework to evaluate adoption and implementation of RADAR in 6 First Nations communities. Using purposeful sampling, we recruited local healthcare providers and remote care coordinators involved in delivering RADAR to participate in telephone or in-person interviews at 6- and 24-months post-implementation. Interviews were digitally recorded, transcribed, and verified for accuracy. Data was analyzed using content analysis and managed using ATLAS.ti 8. Results In total, we conducted 21 semi-structured interviews (6 at 6-months; 15 at 24-months) with 11 participants. Participants included 3 care coordinators and 8 local healthcare providers, including registered nurses, licensed practical nurses, and registered dietitians. We found that adoption of RADAR was influenced by leadership as well as appropriateness, acceptability, and perceived value of the model. In addition, we found that implementation of RADAR was variable across communities regardless of implementation supports and appropriate community-specific adaptations. Conclusions The variable adoption and implementation of RADAR has implications for how likely it will achieve its anticipated outcomes. RADAR is well positioned for spread through continued appropriate community-based adaptations and by expanding the existing implementation supports, including dedicated human resources to support the delivery of RADAR and the provision of levels of RADAR based on existing or developed capacity among local HCPs. Trial registration Not applicable to this qualitative assessment. ISRCTN14359671. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06424-1.
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Affiliation(s)
- Lisa A Wozniak
- Alliance for Canadian Health Outcomes Research in Diabetes, School of Public Health, 2-040 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, T6G 2E1, Canada
| | - Allison L Soprovich
- Alliance for Canadian Health Outcomes Research in Diabetes, School of Public Health, 2-040 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, T6G 2E1, Canada
| | - Jeffrey A Johnson
- Alliance for Canadian Health Outcomes Research in Diabetes, School of Public Health, 2-040 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, T6G 2E1, Canada
| | - Dean T Eurich
- Alliance for Canadian Health Outcomes Research in Diabetes, School of Public Health, 2-040 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, T6G 2E1, Canada.
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Abstract
Diabetic foot disease is the leading cause of lower-extremity amputation globally and imposes a significant burden for healthcare services and patients alike. The main pathology is ulceration, due to neuropathy or peripheral arterial disease. The most frequent sign is ulceration on the foot. Ulceration needs to be referred to the multidisciplinary diabetic foot team promptly for a comprehensive management plan to be developed. Delay in referral is associated with poor outcomes. Management of diabetic foot ulceration is multifaceted, including offloading, revascularisation, infection control, debridement, glycaemic control and wound care. Management plans need to be patient focused and developed collaboratively across primary and secondary care settings.
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Affiliation(s)
- Pauline Wilson
- Clinical Specialist Podiatrist in Diabetes, St James's Hospital, Dublin; PhD Scholar, Royal College of Surgeons in Ireland
| | - Declan Patton
- Director of Nursing and Midwifery Research, Deputy Director of SWaT, Royal College of Surgeons in Ireland
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Marani H, Halperin IJ, Jamieson T, Mukerji G. Quality Gaps of Electronic Health Records in Diabetes Care. Can J Diabetes 2020; 44:350-355. [DOI: 10.1016/j.jcjd.2019.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 11/24/2022]
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Wozniak LA, Johnson JA, Eurich DT. Working towards a better understanding of type 2 diabetes care organization with First Nations communities: a qualitative assessment. ACTA ACUST UNITED AC 2020; 78:7. [PMID: 32025300 PMCID: PMC6998233 DOI: 10.1186/s13690-020-0391-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 01/14/2020] [Indexed: 01/01/2023]
Abstract
Background Diabetes care is suboptimal in First Nations populations. Innovative and culturally-relevant approaches are needed to promote proactive organization of diabetes care for diabetes patients on-reserve in Canada. The Reorganizing the Approach to Diabetes care through the Application of Registries (RADAR) model is one strategy to improve care: an integrated disease registry and electronic health record for community healthcare workers with centralized care coordination. The aim of this study was to qualitatively assess the organization of type 2 diabetes care in participating communities in Alberta, Canada, at baseline prior to implementing RADAR. Methods Using qualitative description, we purposefully sampled healthcare workers involved in diabetes care at each health center. We used the 5Rs framework (i.e., Recognize, Register, Resource, Relay, Recall) to inform the baseline assessment and conducted group interviews in 6 communities with 16 healthcare workers. Detailed notes were taken and validated by participants. Data was managed using ATLAS.ti 8 and analyzed using content analysis. Results We found strong commitment and effort by local healthcare workers to support people living with type 2 diabetes in their communities. However, healthcare workers were limited in their ability to identify (i.e., recognize), track (i.e., register and relay) and manage (i.e., resource and recall) people with type 2 diabetes as proposed by the 5Rs framework. The organization of diabetes care was often reactive and dependent on patients’ abilities to navigate the health system. Interestingly, participants talked about the 5Rs in relationship to one another, not in a linear or isolated manner. Conclusions Overall, the organization of diabetes care in participating communities did not align with the recommended approach of the 5Rs framework. In addition, we propose “reimagining” the 5Rs to reflect the interdependence and mediation of components situated within human and financial resources. This will better equip healthcare workers to assess, plan and execute organized and proactive diabetes care. However, the onus on people living with type 2 diabetes to engage with healthcare services remains a concern. Trial registration ISRCTN.com, ISRCTN14359671.
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Affiliation(s)
- Lisa A Wozniak
- 1School of Public Health, University of Alberta, Edmonton, Alberta T6G 2E1 Canada.,2Alliance for Canadian Health Outcomes Research in Diabetes, 2-040 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta T6G 2E1 Canada
| | - Jeffrey A Johnson
- 1School of Public Health, University of Alberta, Edmonton, Alberta T6G 2E1 Canada.,2Alliance for Canadian Health Outcomes Research in Diabetes, 2-040 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta T6G 2E1 Canada
| | - Dean T Eurich
- 1School of Public Health, University of Alberta, Edmonton, Alberta T6G 2E1 Canada.,2Alliance for Canadian Health Outcomes Research in Diabetes, 2-040 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta T6G 2E1 Canada
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Randhawa GK, Shachak A, Courtney KL, Kushniruk A. Evaluating a post-implementation electronic medical record training intervention for diabetes management in primary care. BMJ Health Care Inform 2019; 26:e100086. [PMID: 31570365 PMCID: PMC7062349 DOI: 10.1136/bmjhci-2019-100086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/05/2019] [Accepted: 09/10/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This study evaluated the potential for electronic medical record (EMR) video tutorials to improve diabetes (type 1 and 2) care processes by primary care physicians (PCP) using OSCAR EMR. DESIGN A QUAN(qual) mixed methods approach with an embedded design was used for the overall research study. EMR video tutorials were developed based on the chronic care model (CCM), value-adding EMR use, best practice guidelines for designing software video tutorials and clinician-led EMR training. RESULTS In total, 18 PCPs from British Columbia, Canada, participated in the study. The video EMR intervention elicited a statistically significant increase in EMR advanced feature use for diabetes care, with a large effect size (ie, F(1,51)=6.808, p<0.001, partial η2=0.286). CONCLUSION This small-scale efficacy study demonstrates the potential of CCM-based EMR video tutorials to improve EMR use for chronic diseases, such as diabetes. A larger-scale effectiveness study with a control group is needed to further validate the study findings and determine their generalisability. The demonstrated efficacy of the intervention suggests that EMR video tutorials may be a cost-effective, sustainable and scalable strategy for supporting EMR optimisation and the continuous learning and development of PCPs. Health informatics practitioners may develop video tutorials for their respective EMR/electronic health record software based on theory and best practices for video tutorial design. For patients, EMR video tutorials may lead to improved tracking of processes of care for diabetes, and potentially other chronic conditions.
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Affiliation(s)
- Gurprit Kaur Randhawa
- Learning and Performance Support, Island Health, Victoria, British Columbia, Canada
- Health Information Science, University of Victoria, Victoria, British Columbia, Canada
| | - Aviv Shachak
- Health Information Science, University of Victoria, Victoria, British Columbia, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Karen L Courtney
- Health Information Science, University of Victoria, Victoria, British Columbia, Canada
| | - Andre Kushniruk
- Health Information Science, University of Victoria, Victoria, British Columbia, Canada
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Lethebe BC, Williamson T, Garies S, McBrien K, Leduc C, Butalia S, Soos B, Shaw M, Drummond N. Developing a case definition for type 1 diabetes mellitus in a primary care electronic medical record database: an exploratory study. CMAJ Open 2019; 7:E246-E251. [PMID: 31061005 PMCID: PMC6504632 DOI: 10.9778/cmajo.20180142] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Identifying cases of disease in primary care electronic medical records (EMRs) is important for surveillance, research, quality improvement and clinical care. We aimed to develop and validate a case definition for type 1 diabetes mellitus using EMRs. METHODS For this exploratory study, we used EMR data from the Southern Alberta Primary Care Network within the Canadian Primary Care Sentinel Surveillance Network (CPCSSN), for the period 2008 to 2016. For patients identified as having diabetes mellitus according to the existing CPCSSN case definition, we asked family physicians to confirm the diabetes subtype, to create the reference standard. We used 3 decision-tree classification algorithms and least absolute shrinkage and selection operator logistic regression to identify variables that correctly distinguished between type 1 and type 2 diabetes cases. RESULTS We identified a total of 1309 people with type 1 or type 2 diabetes, 110 of whom were confirmed by their physicians as having type 1 diabetes. Two machine learning algorithms were useful in identifying these cases in the EMRs. The first algorithm used "type 1" text words or age less than 22 years at time of initial diabetes diagnosis; this algorithm had sensitivity 42.7% (95% confidence interval [CI] 33.5%-52.5%), specificity 99.3% (95% CI 98.6%-99.7%), positive predictive value 85.5% (95% CI 72.8%-93.1%) and negative predictive value 94.9% (95% CI 93.5%-96.1%). The second algorithm used a combination of free-text terms, insulin prescriptions and age; it had sensitivity 87.3% (95% CI 79.2%-92.6%), specificity 85.4% (95% CI 83.2%-87.3%), positive predictive value 35.6% (95% CI 29.9%-41.6%) and negative predictive value 98.6% (95% CI 97.7%-99.2%). INTERPRETATION We used machine learning to develop and validate 2 case definitions that achieve different goals in distinguishing between type 1 and type 2 diabetes in CPCSSN data. Further validation and testing with a larger and more diverse sample are recommended.
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Affiliation(s)
- B Cord Lethebe
- Department of Community Health Sciences (Lethebe, Williamson, Garies, McBrien, Soos, Shaw), Clinical Research Unit (Lethebe), Department of Family Medicine (Garies, McBrien, Leduc, Drummond) and Department of Medicine (Butalia), University of Calgary, Calgary, Alta.; Department of Family Medicine (Drummond), University of Alberta, Edmonton, Alta.
| | - Tyler Williamson
- Department of Community Health Sciences (Lethebe, Williamson, Garies, McBrien, Soos, Shaw), Clinical Research Unit (Lethebe), Department of Family Medicine (Garies, McBrien, Leduc, Drummond) and Department of Medicine (Butalia), University of Calgary, Calgary, Alta.; Department of Family Medicine (Drummond), University of Alberta, Edmonton, Alta
| | - Stephanie Garies
- Department of Community Health Sciences (Lethebe, Williamson, Garies, McBrien, Soos, Shaw), Clinical Research Unit (Lethebe), Department of Family Medicine (Garies, McBrien, Leduc, Drummond) and Department of Medicine (Butalia), University of Calgary, Calgary, Alta.; Department of Family Medicine (Drummond), University of Alberta, Edmonton, Alta
| | - Kerry McBrien
- Department of Community Health Sciences (Lethebe, Williamson, Garies, McBrien, Soos, Shaw), Clinical Research Unit (Lethebe), Department of Family Medicine (Garies, McBrien, Leduc, Drummond) and Department of Medicine (Butalia), University of Calgary, Calgary, Alta.; Department of Family Medicine (Drummond), University of Alberta, Edmonton, Alta
| | - Charles Leduc
- Department of Community Health Sciences (Lethebe, Williamson, Garies, McBrien, Soos, Shaw), Clinical Research Unit (Lethebe), Department of Family Medicine (Garies, McBrien, Leduc, Drummond) and Department of Medicine (Butalia), University of Calgary, Calgary, Alta.; Department of Family Medicine (Drummond), University of Alberta, Edmonton, Alta
| | - Sonia Butalia
- Department of Community Health Sciences (Lethebe, Williamson, Garies, McBrien, Soos, Shaw), Clinical Research Unit (Lethebe), Department of Family Medicine (Garies, McBrien, Leduc, Drummond) and Department of Medicine (Butalia), University of Calgary, Calgary, Alta.; Department of Family Medicine (Drummond), University of Alberta, Edmonton, Alta
| | - Boglarka Soos
- Department of Community Health Sciences (Lethebe, Williamson, Garies, McBrien, Soos, Shaw), Clinical Research Unit (Lethebe), Department of Family Medicine (Garies, McBrien, Leduc, Drummond) and Department of Medicine (Butalia), University of Calgary, Calgary, Alta.; Department of Family Medicine (Drummond), University of Alberta, Edmonton, Alta
| | - Marta Shaw
- Department of Community Health Sciences (Lethebe, Williamson, Garies, McBrien, Soos, Shaw), Clinical Research Unit (Lethebe), Department of Family Medicine (Garies, McBrien, Leduc, Drummond) and Department of Medicine (Butalia), University of Calgary, Calgary, Alta.; Department of Family Medicine (Drummond), University of Alberta, Edmonton, Alta
| | - Neil Drummond
- Department of Community Health Sciences (Lethebe, Williamson, Garies, McBrien, Soos, Shaw), Clinical Research Unit (Lethebe), Department of Family Medicine (Garies, McBrien, Leduc, Drummond) and Department of Medicine (Butalia), University of Calgary, Calgary, Alta.; Department of Family Medicine (Drummond), University of Alberta, Edmonton, Alta
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Quinn AE, Edwards A, Senior P, McBrien KA, Hemmelgarn BR, Tonelli M, Au F, Ma Z, Weaver RG, Manns BJ. The association between payment model and specialist physicians' selection of patients with diabetes: a descriptive study. CMAJ Open 2019; 7:E109-E116. [PMID: 30782774 PMCID: PMC6380900 DOI: 10.9778/cmajo.20180171] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND As the number of people with chronic diseases increases, understanding the impact of payment model on the types of patients seen by specialists has implications for improving the quality and value of care. We sought to determine if there is an association between specialist physician payment model and the types of patients seen. METHODS In this descriptive study, we used administrative data to compare demographic characteristics, illness severity and visit indication of patients with diabetes seen by fee-for-service and salary-based internal medicine and diabetes specialists in Calgary and Edmonton between April 2011 and September 2014. The study cohort included all newly referred adults with diabetes (no appointment with a specialist in prior 4 yr). Diabetes was identified using a validated algorithm that excludes gestational diabetes. RESULTS Patients managed by salary-based physicians (n = 2736) were sicker than those managed by fee-for-service physicians (n = 21 218). Patients managed by salary-based specialists were more likely to have 5 or more comorbidities (23.0% [n = 628] v. 18.1% [n = 3843]) and to have been admitted to hospital or seen in an emergency department for an ambulatory care sensitive condition in the year before their index visit, probably reflecting poorer disease control or barriers to optimal outpatient care. A higher proportion of visits to salary-based physicians were for appropriate indications (65.2% [n = 744] v. 55.6% [n = 5553]; risk ratio 1.17, 95% confidence interval 1.09-1.27). INTERPRETATION Salary-based specialists were more likely to see patients with a clear indication for a specialist visit, while fee-for-service specialists were more likely to see healthier patients. Future research is needed to determine if the differences in types of patients are attributable to payment model or other provider- or system-level factors.
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Affiliation(s)
- Amity E Quinn
- Departments of Community Health Sciences (Quinn, McBrien, Hemmelgarn, Manns), Medicine (Edwards, Hemmelgarn, Tonelli, Au, Ma, Weaver, Manns) and Family Medicine (McBrien), University of Calgary, Calgary, Alta.; Department of Medicine (Senior), University of Alberta, Edmonton, Alta
| | - Alun Edwards
- Departments of Community Health Sciences (Quinn, McBrien, Hemmelgarn, Manns), Medicine (Edwards, Hemmelgarn, Tonelli, Au, Ma, Weaver, Manns) and Family Medicine (McBrien), University of Calgary, Calgary, Alta.; Department of Medicine (Senior), University of Alberta, Edmonton, Alta
| | - Peter Senior
- Departments of Community Health Sciences (Quinn, McBrien, Hemmelgarn, Manns), Medicine (Edwards, Hemmelgarn, Tonelli, Au, Ma, Weaver, Manns) and Family Medicine (McBrien), University of Calgary, Calgary, Alta.; Department of Medicine (Senior), University of Alberta, Edmonton, Alta
| | - Kerry A McBrien
- Departments of Community Health Sciences (Quinn, McBrien, Hemmelgarn, Manns), Medicine (Edwards, Hemmelgarn, Tonelli, Au, Ma, Weaver, Manns) and Family Medicine (McBrien), University of Calgary, Calgary, Alta.; Department of Medicine (Senior), University of Alberta, Edmonton, Alta
| | - Brenda R Hemmelgarn
- Departments of Community Health Sciences (Quinn, McBrien, Hemmelgarn, Manns), Medicine (Edwards, Hemmelgarn, Tonelli, Au, Ma, Weaver, Manns) and Family Medicine (McBrien), University of Calgary, Calgary, Alta.; Department of Medicine (Senior), University of Alberta, Edmonton, Alta
| | - Marcello Tonelli
- Departments of Community Health Sciences (Quinn, McBrien, Hemmelgarn, Manns), Medicine (Edwards, Hemmelgarn, Tonelli, Au, Ma, Weaver, Manns) and Family Medicine (McBrien), University of Calgary, Calgary, Alta.; Department of Medicine (Senior), University of Alberta, Edmonton, Alta
| | - Flora Au
- Departments of Community Health Sciences (Quinn, McBrien, Hemmelgarn, Manns), Medicine (Edwards, Hemmelgarn, Tonelli, Au, Ma, Weaver, Manns) and Family Medicine (McBrien), University of Calgary, Calgary, Alta.; Department of Medicine (Senior), University of Alberta, Edmonton, Alta
| | - Zhihai Ma
- Departments of Community Health Sciences (Quinn, McBrien, Hemmelgarn, Manns), Medicine (Edwards, Hemmelgarn, Tonelli, Au, Ma, Weaver, Manns) and Family Medicine (McBrien), University of Calgary, Calgary, Alta.; Department of Medicine (Senior), University of Alberta, Edmonton, Alta
| | - Robert G Weaver
- Departments of Community Health Sciences (Quinn, McBrien, Hemmelgarn, Manns), Medicine (Edwards, Hemmelgarn, Tonelli, Au, Ma, Weaver, Manns) and Family Medicine (McBrien), University of Calgary, Calgary, Alta.; Department of Medicine (Senior), University of Alberta, Edmonton, Alta
| | - Braden J Manns
- Departments of Community Health Sciences (Quinn, McBrien, Hemmelgarn, Manns), Medicine (Edwards, Hemmelgarn, Tonelli, Au, Ma, Weaver, Manns) and Family Medicine (McBrien), University of Calgary, Calgary, Alta.; Department of Medicine (Senior), University of Alberta, Edmonton, Alta.
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Wharton S, Raiber L, Serodio KJ, Lee J, Christensen RA. Medications that cause weight gain and alternatives in Canada: a narrative review. Diabetes Metab Syndr Obes 2018; 11:427-438. [PMID: 30174450 PMCID: PMC6109660 DOI: 10.2147/dmso.s171365] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The cause of the obesity epidemic is multifactorial, but may, in part, be related to medication-induced weight gain. While clinicians may strive to do their best to select pharmacotherapy(ies) that has the least negative impact on weight, the literature regarding the weight effects of medication is often limited and devoid of alternative therapies. RESULTS Antipsychotics, antidepressants, antihyperglycemics, antihypertensives and corticosteroids all contain medications that were associated with significant weight gain. However, there are several medication alternatives within the majority of these classes associated with weight neutral or even weight loss effects. Further, while not all of the classes of medication examined in this review have weight-favorable alternatives, there exist many other tools to mitigate weight gain associated with medication use, such as changes in dosing, medication delivery or the use of adjunctive therapies. CONCLUSION Medication-induced weight gain can be frustrating for both the patient and the clinician. As the use of pharmaceuticals continues to increase, it is pertinent for clinicians to consider the weight effects of medications prior to prescribing or in the course of treatment. In the case where it is not feasible to make changes to medication, adjunctive therapies should be considered.
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Affiliation(s)
- Sean Wharton
- The Wharton Medical Clinic, Toronto, Canada,
- School of Kinesiology and Health Science, York University, Toronto, Canada
| | | | | | - Jasmine Lee
- The Wharton Medical Clinic, Toronto, Canada,
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Payne JI, Dunbar MJ, Talbot P, Tan MH. Diabetes Care Program of Nova Scotia: Celebrating 25 Years of Improving Diabetes Care in Nova Scotia. Can J Diabetes 2018; 42:317-324. [DOI: 10.1016/j.jcjd.2017.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 06/14/2017] [Indexed: 11/16/2022]
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Team composition and chronic disease management within primary healthcare practices in eastern Ontario: an application of the Measuring Organizational Attributes of Primary Health Care Survey. Prim Health Care Res Dev 2018; 19:622-628. [PMID: 29655397 DOI: 10.1017/s1463423618000257] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Various organizational-level attributes are being implemented in primary healthcare to improve healthcare delivery. There is a need to describe the distribution and nature of these attributes and explore differences across practices.AimThe aim of this study was to better understand organizational attributes of primary care teams, focusing specifically on team composition, nursing roles, and strategies that support chronic disease management. METHODS We employed a cross-sectional survey design. Team composition, nursing roles, availability of health services, and chronic disease management activities were described using the 'Measuring Organizational Attributes of Primary Health Care Survey.'FindingsA total of 76% (n=26 out of 34) of practice locations completed the survey, including family health teams (FHT; n=21) and community health centers (CHC; n=4). Nurse practitioners (NPs) and registered nurses (RNs) were the most common non-physician providers, and CHCs had a greater proportion of non-physician providers than FHTs. There was overlap in roles performed by NPs and RNs, and registered practical nurses engaged in fewer roles compared with NPs and RNs. A greater proportion of FHTs had systematic chronic disease management services for hypertension, depression and Alzheimer's disease compared with CHC practices. The 'Measuring Organizational Attributes of Primary Health Care Survey' was a useful tool to highlight variability in organizational attributes across PHC practices. Nurses are prominent within PHC practices, engaging in a wide range of roles related to chronic disease management, suggesting a need to better understand their contributions to patient care to optimize their roles.
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Affiliation(s)
- Scot H Simpson
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada.
| | - Lori MacCallum
- Banting & Best Diabetes Centre, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Kerry Mansell
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Touati N, Rodríguez C, Paquette MA, Denis JL. Understanding the emergence and development of medical collaboration across organizational boundaries: A longitudinal case study. Health (London) 2017; 22:580-602. [PMID: 28795577 DOI: 10.1177/1363459317724852] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Our goal in this investigation was to help shed light on the very difficult process of collaboration between family physicians and specialists working at different levels of healthcare delivery. More precisely, and grounded on Giddens' structuration theory, our investigation aims to understand how medical collaboration emerges and develops around chronic patients. This was a longitudinal interpretive case study, the "case" being a continuum-of-care for patients suffering from diabetes, put in place in an urban health center in the Canadian province of Quebec. The study shows how the application of rules of signification and of legitimation, combined with domination resources, have supported the emergence of new forms of collaborative practices. Our analysis reveals, however, that new collaborative practices at the administrative level do not necessarily entail greater shared decision-making in patient management and the mobilization of knowledge across boundaries. The study also corroborates the mutual recursive influence of practices and structures. Our study's most important contribution concerns the impact of knowledge dynamics, that is, individual and collective learning, on the development of medical collaboration across levels of care.
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Roth-Albin I, Mai SHC, Ahmed Z, Cheng J, Choong K, Mayer PV. Outcomes Following Advanced Wound Care for Diabetic Foot Ulcers: A Canadian Study. Can J Diabetes 2016; 41:26-32. [PMID: 27634016 DOI: 10.1016/j.jcjd.2016.06.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 06/21/2016] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Data concerning outcomes of Canadian patients with diabetic foot ulcers (DFUs) are limited. The objectives of this study were to evaluate the healing rates and identify the predictors of poor outcomes following advanced wound care in patients presenting with DFUs. METHODS We conducted retrospective cohort study of adult patients who had DFUs and were referred to a single Canadian advanced diabetic foot and wound care centre between January 1, 2010, and December 31, 2010. The primary outcome was the healing rate at 52 weeks. The generalized estimating equation model was used to identify potential risk factors associated with delayed healing of DFUs. RESULTS Of the 40 patients for whom there were complete follow ups, 35 (87.5%) had healing of all DFUs by 52 weeks. Predictors of poor healing were the presence of chronic ulcers, ulcer sizes >1 cm2, peripheral vascular disease and multiple ulcers at first presentation. Of the patients, 7.1% required amputation, and 8.9% of patients receiving our treatment died before 52 weeks. At 52 weeks of follow up, 16 of 17 recurrent ulcers and 68 of 108 pre-existing ulcers had healed. Compared to the unadjusted healing rate of preexisting ulcers (63.0%), the unadjusted healing rate of recurrent ulcers (94.1%) was significantly higher (p=0.01). CONCLUSIONS Our findings demonstrate that patients with DFUs in Canada who receive early and continued care from specialized, outpatient, advanced wound care centres experience significantly improved rates of healing of recurrent DFUs compared to pre-existing DFUs.
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Affiliation(s)
| | - Safiah H C Mai
- Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada
| | - Zeeshan Ahmed
- Department of Internal Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ji Cheng
- Biostatistics Unit, St. Joseph's Healthcare Hamilton and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Karen Choong
- Department of Pediatrics, Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
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Carter R, Quesnel-Vallée A, Plante C, Gamache P, Lévesque JF. Effect of family medicine groups on visits to the emergency department among diabetic patients in Quebec between 2000 and 2011: a population-based segmented regression analysis. BMC FAMILY PRACTICE 2016; 17:23. [PMID: 26924443 PMCID: PMC4770695 DOI: 10.1186/s12875-016-0422-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 02/21/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Family Medicine Groups (FMG) were introduced in Quebec in 2002 to re-organize primary care practices and encourage inter-professional service delivery. We measured visits to the emergency department (ED) for acute complications related to diabetes as a proxy for access to and quality of primary care, before and after the reform using an open cohort of individuals diagnosed with type 1 and type 2 diabetes. METHODS The weekly rate of ED visits between April 1, 2000 and March 31, 2012 were derived from administrative databases. We performed an interrupted segmented regression analysis to obtain the estimated and predicted rates of visits in the years following the introduction of the reform. An outcome control series of diabetic patients visiting the ED to treat appendicitis was incorporated to strengthen the study's internal validity. RESULTS After 9 years of reform implementation, we observed a statistically significant absolute decrease of 2.12 and 2.25 ED visits per 10,000 diabetic patients per week to treat acute diabetes-related complications in urban and rural areas, respectively. However, the magnitude of the changes between the estimated and predicted rates did not differ significantly over time. No statistically significant change in the rate of ED visits for appendicitis was observed. CONCLUSION Our findings suggest that the introduction of the FMG model produced reductions in the weekly rate of avoidable visits to the ED. Our results also imply that despite a greater proportion of the diabetes population being enrolled with FMG physicians across the province over time, the added benefit may be minimal. More studies examining this issue are needed to inform future policy.
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Affiliation(s)
- Renee Carter
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, 1020 Pine Avenue West, Montreal, Quebec, Canada. .,Institut National de Santé Publique du Québec, 945 Avenue Wolfe, Ste-Foy, Québec, Canada.
| | - Amélie Quesnel-Vallée
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, 1020 Pine Avenue West, Montreal, Quebec, Canada. .,Department of Sociology, Faculty of Arts, McGill University, 855 Sherbrooke Street West, Montreal, Quebec, Canada.
| | - Céline Plante
- Institut National de Santé Publique du Québec, 945 Avenue Wolfe, Ste-Foy, Québec, Canada.
| | - Philippe Gamache
- Institut National de Santé Publique du Québec, 945 Avenue Wolfe, Ste-Foy, Québec, Canada.
| | - Jean-Frédéric Lévesque
- Bureau of Health Information, Level 11 Sage Building, 67 Albert Avenue, Chastwood, NSW, Australia. .,Centre for Primary Health Care and Equity, University of New South Wales, Level 3, AGSM Building, Botany Street Gate 11, Sydney, NSW, 2052, Australia.
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Aronson R, Orzech N, Ye C, Goldenberg R, Brown V. Specialist-led diabetes registries and predictors of poor glycemic control in type 2 diabetes: Insights into the functionally refractory patient from the LMC Diabetes Registry database. J Diabetes 2016; 8:76-85. [PMID: 25565383 DOI: 10.1111/1753-0407.12257] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 11/12/2014] [Accepted: 11/28/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The aim of the present study was to explore features associated with glycemic control in type 2 diabetes (T2D) patients undergoing care by specialist clinics. METHODS Literature searches identified diabetes registries whose databases recorded outcomes of specialist care. The LMC Diabetes Registry database (n = 58 280; LMC) was queried to identify patients with T2D who had been seen in a defined 14-month period. Logistic regression modeling was used to identify predictors of glycemic control in these patients. Poor glycemic control was defined as HbA1c ≥9.0% (75 mmol/mol) despite specialist care for ≥1 year. RESULTS Few published registry-based studies have discussed glycemic control and outcomes of specialist care for T2D. Among 10 590 LMC patients with T2D, mean HbA1c was 7.6% (60 mmol/mol), with 38% of patients meeting the Canadian Diabetes Association target of ≤7.0% (53 mmol/mol). Overall, 15% showed poor glycemic control with persistent HbA1c ≥9.0% (75 mmol/mol); among insulin-treated patients (n = 3856), 28% met this criterion. Patient characteristics independently associated with poor glycemic control included early age of onset, the number of diabetes education program visits, the number of oral therapies, and insulin use. CONCLUSIONS Type 2 diabetes patients with poor glycemic control are found disproportionately in referral specialist care clinics. These functionally refractory patients demonstrate features that may assist in predicting their potential outcome, and may represent a group with specific barriers to care. Specialist patient registries, such as the LMC Diabetes Registry, may provide critical information regarding this cohort.
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Affiliation(s)
- Ronnie Aronson
- LMC Diabetes & Endocrinology, University of Toronto, Toronto, Ontario, Canada
| | - Naomi Orzech
- LMC Diabetes & Endocrinology, University of Toronto, Toronto, Ontario, Canada
| | - Chenglin Ye
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Ronald Goldenberg
- LMC Diabetes & Endocrinology, University of Toronto, Toronto, Ontario, Canada
| | - Vivien Brown
- Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada
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Adams DJ, Remick RA, Davis JC, Vazirian S, Khan KM. Exercise as medicine-the use of group medical visits to promote physical activity and treat chronic moderate depression: a preliminary 14-week pre-post study. BMJ Open Sport Exerc Med 2015; 1:e000036. [PMID: 27900130 PMCID: PMC5117054 DOI: 10.1136/bmjsem-2015-000036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2015] [Indexed: 11/16/2022] Open
Abstract
Objective The evidence that regular physical activity can treat depressive disorders is increasingly robust. However, motivating patients with depression to engage in physical activity can be challenging. Interdisciplinary group medical visits (GMVs) with an integrated physical activity component may be a novel means to support patients in becoming more active. Methods We conducted a ‘pre–post’ pilot study within a primary care setting. Participants were adults (≥18 years) with a chronic major depressive disorder or a bipolar 2 disorder (depression; chronic). A psychiatrist and exercise therapist co-led a series of 14 weekly 2 h GMVs. Each group visit combined specific medical advice, physical activity, patient discussions and a targeted educational component. Participants also attended 11 weekly hatha yoga classes. Primary outcome was ‘steps’ as measured by accelerometer (SenseWear) as well as depression (Patient Health Questionnaire, PHQ-9) and anxiety (Generalised Anxiety Disorder, GAD-7) ratings. Results 14 of 15 participants (93.3%) completed the 14-week programme. After 3 months postintervention, median depression scales (PHQ-9) decreased 38% from 16 to 10 (p<0.01; IQR pre/post 8/12); and median anxiety scales (GAD-7) decreased 50% from 13 to 6.5 (p<0.05; IQR 8.5/9). Median daily ‘steps’ increased 71% from 3366 to 5746 (IQR 2610/6237), though this was not significant (p>0.10). Conclusions While other studies have examined the efficacy of GMVs in addressing chronic illnesses and the promotion of lifestyle changes, none to our knowledge have embedded physical activity within the actual patient visits. Interdisciplinary GMVs (eg, psychiatrist/exercise professional) may be a means to decrease depression and anxiety ratings within clinical care while improving physical activity.
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Affiliation(s)
- David J Adams
- Department of Family Practice (DFP) , University of British Columbia , Vancouver, British Columbia , Canada
| | - Ronald A Remick
- Mood Disorders Association of BC , Vancouver, British Columbia , Canada
| | - Jennifer C Davis
- UBC School of Population and Public Health/Centre for Hip Health & Mobility (CHHM)
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Vachon B, Désorcy B, Gaboury I, Camirand M, Rodrigue J, Quesnel L, Guimond C, Labelle M, Huynh AT, Grimshaw J. Combining administrative data feedback, reflection and action planning to engage primary care professionals in quality improvement: qualitative assessment of short term program outcomes. BMC Health Serv Res 2015; 15:391. [PMID: 26384648 PMCID: PMC4574571 DOI: 10.1186/s12913-015-1056-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 09/11/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improving primary care for chronic disease management requires a coherent, integrated approach to quality improvement. Evidence in the continuing professional development (CPD) field suggests the importance of using strategies such as feedback delivery, reflective practice and action planning to facilitate recognition of gaps and service improvement needs. Our study explored the outcomes of a CPD intervention, named the COMPAS Project, which consists of a three-hour workshop composed of three main activities: feedback, critical reflection and action planning. The feedback intervention is delivered face-to-face and presents performance indicators extracted from clinical-administrative databases. This aim of this study was to assess the short term outcomes of this intervention to engage primary care professional in continuous quality improvement (QI). METHODS In order to develop an understanding of our intervention and of its short term outcomes, a program evaluation approach was used. Ten COMPAS workshops on diabetes management were directly observed and qualitative data was collected to assess the intervention short term outcomes. Data from both sources were combined to describe the characteristics of action plans developed by professionals. Two independent coders analysed the content of these plans to assess if they promoted engagement in QI and interprofessional collaboration. RESULTS During the ten workshops held, 26 interprofessional work teams were formed. Twenty-two of them developed a QI project they could implement themselves and that targeted aspects of their own practice they perceived in need of change. Most frequently prioritized strategies for change were improvement of systematic clientele follow-up, medication compliance, care pathway and support to improve adoption of healthier life habits. Twenty-one out of 22 action plans were found to target some level of improvement of interprofessional collaboration in primary care. DISCUSSION Our study results demonstrate that the COMPAS intervention enabled professionals to target priorities for practice improvements and to develop action plans that promote interprofessional collaboration. The COMPAS intervention aims to increase capability for continuous QI, readiness to implement process of care changes and team shared goals but available resources, climate and culture for change and leadership, are also important required conditions to successfully implement these practice changes. CONCLUSION We think that the proposed approach can be very useful to support and engage primary care professionals in the planning stage of quality improvement projects since it combines key successful ingredients: feedback, reflection and planning of action.
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Affiliation(s)
- Brigitte Vachon
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, 7077 Park Avenue, Montreal, Quebec, H3N 1X7, Canada.
| | - Bruno Désorcy
- Agence de la santé et des services sociaux de la Montérégie, 1255 Beauregard Street, Longueuil, Quebec, J4K 2M3, Canada.
| | - Isabelle Gaboury
- Faculty of medicine, Université de Sherbrooke, Pavillon Gérald-La Salle, 3001, 12e avenue Nord, Sherbrooke, Quebec, J1H 5N4, Canada.
| | - Michel Camirand
- Centre de santé Sutton, 33 Principale St South, Sutton, Quebec, J0E 2K0, Canada.
| | - Jean Rodrigue
- Agence de la santé et des services sociaux de la Montérégie, 1255 Beauregard Street, Longueuil, Quebec, J4K 2M3, Canada.
| | - Louise Quesnel
- Collège des médecins du Québec, 2170, boulevard René-Lévesque Ouest, Montreal, Quebec, H3H 2T8, Canada.
| | - Claude Guimond
- Fédération des médecins omnipraticiens du Québec, 3500 boul. de Maisonneuve Ouest, bureau 2000, Westmount, Quebec, H3Z 3C1, Canada.
| | - Martin Labelle
- Fédération des médecins omnipraticiens du Québec, 3500 boul. de Maisonneuve Ouest, bureau 2000, Westmount, Quebec, H3Z 3C1, Canada.
| | - Ai-Thuy Huynh
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, 7331, rue Hochelaga, Montreal, Quebec, H1N 3V2, Canada.
| | - Jeremy Grimshaw
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Box 711, Ottawa, Ontario, K1H 8L6, Canada.
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Williams E, Curtis A. Implementation of a Diabetes Management Flow Sheet in a Long-Term Care Setting. Can J Diabetes 2015; 39:273-7. [DOI: 10.1016/j.jcjd.2014.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 11/25/2014] [Accepted: 12/01/2014] [Indexed: 10/23/2022]
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Diabetes Case Management in Primary Care: The New Brunswick Experience and Expanding the Practice of the Certified Diabetes Educator Nurse into Primary Care. Can J Diabetes 2015; 39:322-4. [DOI: 10.1016/j.jcjd.2014.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 12/07/2014] [Indexed: 11/20/2022]
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Werfalli M, Raubenheimer P, Engel M, Peer N, Kalula S, Kengne AP, Levitt NS. Effectiveness of community-based peer-led diabetes self-management programmes (COMP-DSMP) for improving clinical outcomes and quality of life of adults with diabetes in primary care settings in low and middle-income countries (LMIC): a systematic review and meta-analysis. BMJ Open 2015; 5:e007635. [PMID: 26179646 PMCID: PMC4513536 DOI: 10.1136/bmjopen-2015-007635] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Globally, an estimated 380 million people live with diabetes today--80% in low-income and middle-income countries. The Middle East, Western Pacific, Sub-Saharan Africa and South-East Asia remain the most affected regions where economic development has transformed lifestyles, people live longer and there is an increase in the adult population. Although peer support has been used in different conditions with varied results, yet there is limited evidence to date supporting its effectiveness, particularly for individuals with diabetes. In this review, we will focus on community-based peer-led diabetes self-management programmes (COMP-DSMP) and examine the implementation strategies and diabetes-related health outcomes associated with them in LMIC primary healthcare settings. METHODS AND ANALYSIS In accordance with reporting equity-focused systematic reviews PRISMA-P (preferred reporting items for systematic review and meta-analysis protocols 2015 checklist) guidelines, a systematic review with meta-analysis of randomised controlled trials (RCTs), non-randomised controlled trials, quasi-randomised controlled trials (CCTs) that involve contact with an individual or group of peers (paid or voluntary). Electronic searches will be performed in The Cochrane Library, MEDLINE, PubMed, SCOUPS, CINAHL and PsycINFO Database for the period January up to July 2000 along with manual searches in the reference lists of relevant papers. The analyses will be performed based on baseline data from RCTs, CCTs and preintervention and postintervention means or proportions will be reported for both intervention and control groups, and the absolute change from baseline will be calculated, together with 95% CIs. For dichotomous outcomes, the relative risk of the outcome will be presented compared to the control group. The risk difference will be calculated, which is the absolute difference in the proportions in each treatment group. ETHICS AND DISSEMINATION Ethics is not required for this study, given that this is a protocol for a systematic review, which utilises published data. The findings of this study will be widely disseminated through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER PROSPERO (2014:CRD42014007531).
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Affiliation(s)
- Mahmoud Werfalli
- Department of Medicine, Faculty of Health Science, University of Cape Town, Chronic Disease Initiative for Africa, Cape town, Western Cape, South Africa
| | - Peter Raubenheimer
- Department of Medicine, Faculty of Health Science, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Mark Engel
- Department of Medicine, Faculty of Health Science, University of Cape Town, Cape Town, Western Cape, South Africa
- Department of Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Nasheeta Peer
- Chronic Diseases of Lifestyle Research Unit, Durban, Durban, South Africa
| | - Sebastiana Kalula
- Department of Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
- Department of Geriatric Medicine, Faculty of Health Science, University of Cape Town, South Africa, Cape Town, Western Cape, South Africa
| | - Andre P Kengne
- South African Medical Research Council, Cape Town, South Africa
| | - Naomi S Levitt
- Department of Medicine, Faculty of Health Science, University of Cape Town, Chronic Disease Initiative for Africa, Cape town, Western Cape, South Africa
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Balogh RS, Lake JK, Lin E, Wilton A, Lunsky Y. Disparities in diabetes prevalence and preventable hospitalizations in people with intellectual and developmental disability: a population-based study. Diabet Med 2015; 32:235-42. [PMID: 25185567 DOI: 10.1111/dme.12573] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 06/26/2014] [Accepted: 08/22/2014] [Indexed: 01/01/2023]
Abstract
AIMS To describe and compare population-level aspects of diabetes and diabetes primary care among people with and without intellectual and developmental disabilities. METHODS Administrative health data accessed from the Institute for Clinical Evaluative Sciences was used to identify a cohort of Ontarians with and without intellectual and developmental disabilities between the ages of 30 and 69 years (n = 28 567). These people were compared with a random sample of people without intellectual and developmental disabilities (n = 2 261 919) according to diabetes prevalence, incidence, age, sex, rurality, neighbourhood income and morbidity. To measure diabetes primary care, we also studied hospitalizations for diabetes-related ambulatory care-sensitive conditions. RESULTS Adults with intellectual and developmental disabilities had a consistently higher prevalence and incidence of diabetes than those without intellectual and developmental disabilities. Disparities in prevalence between those with and without intellectual and developmental disabilities were most notable among women, younger adults and those residing in rural or high income neighbourhoods. In terms of hospitalizations for diabetes-related ambulatory care-sensitive conditions, people with intellectual and developmental disabilities were 2.6 times more likely to be hospitalized. CONCLUSIONS Adults with intellectual and developmental disabilities are at high risk of developing and being hospitalized for diabetes. The findings of the present study have a number of important implications related to the early detection, prevention and proper management of diabetes among adults with intellectual and developmental disabilities.
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Affiliation(s)
- R S Balogh
- University of Ontario Institute of Technology, Oshawa; Institute for Clinical Evaluative Sciences
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Dean HJ, MacDonald L, Alessi-Severini S, Halipchuk JA, Sellers EA, Grymonpre RE. Elements and Enablers for Interprofessional Education Clinical Placements in Diabetes Teams. Can J Diabetes 2014; 38:273-8. [DOI: 10.1016/j.jcjd.2014.02.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 02/19/2014] [Accepted: 02/21/2014] [Indexed: 11/28/2022]
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Rocchi A, Khoudigian S, Hopkins R, Goeree R. Surrogate outcomes: experiences at the Common Drug Review. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2013; 11:31. [PMID: 24341379 PMCID: PMC3866929 DOI: 10.1186/1478-7547-11-31] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 12/10/2013] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Surrogate outcomes are a significant challenge in drug evaluation for health technology assessment (HTA) agencies. The research objectives were to: identify factors associated with surrogate use and acceptability in Canada's Common Drug Review (CDR) recommendations, and compare the CDR with other HTA or regulatory agencies regarding surrogate concerns. METHODS Final recommendations were identified from CDR inception (September 2003) to December 31, 2010. Recommendations were classified by type of outcome (surrogate, final, other) and acceptability of surrogates (determined by the presence/absence of statements of concern regarding surrogates). Descriptive and statistical analyses examined factors related to surrogate use and acceptability. For thirteen surrogate-based submissions, recommendations from international HTA and regulatory agencies were reviewed for statements about surrogate acceptability. RESULTS Of 156 final recommendations, 68 (44%) involved surrogates. The overall 'do not list' (DNL) rate was 48%; the DNL rate for surrogates was 41% (p = 0.175). The DNL rate was 64% for non-accepted surrogates (n = 28) versus 25% for accepted surrogates (odds ratio 5.4, p = 0.002). Clinical uncertainty, use of economic evidence over price alone, and a premium price were significantly associated with non-accepted surrogates. Surrogates were used most commonly for HIV, diabetes, rare diseases, cardiovascular disease and cancer. For the subset of drugs studied, other HTA agencies did not express concerns for most recommendations, while regulatory agencies frequently stated surrogate acceptance. CONCLUSIONS The majority of surrogates were accepted at the CDR. Non-accepted surrogates were significantly associated with clinical uncertainty and a DNL recommendation. There was inconsistency of surrogate acceptability across several international agencies. Stakeholders should consider collaboratively establishing guidelines on the use, validation, and acceptability of surrogates.
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Affiliation(s)
- Angela Rocchi
- Axia Research, 2068 Waterbridge Drive, Burlington, ON L7M 3W2, Canada
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