Adult Patient Perspectives on Care for Type 1 and Type 2 Diabetes Across the Institute of Medicine's 6 Domains of Quality

Patient Perspectives on Virtual Care for Diabetes Management in the Era of COVID-19

OBJECTIVE

The aim of this study was to characterize patient perspectives on the quality of diabetes care at The Ottawa Hospital Endocrinology and Metabolism multidisciplinary clinic delivered virtually during the COVID-19 pandemic.

METHODS

An online survey was developed to collect quantitative and qualitative data on patients' experiences with virtual diabetes clinic visits between March 2020 and April 2021.

RESULTS

A total of 333 patients were included in this study; 45% were female and had a mean age of 60 years. Seventy-nine percent were born in Canada and 87% identified as Caucasian. Thirty-six percent were treated for type 1 diabetes and 62% for type 2 diabetes. Eighty-seven percent of virtual visits occurred by phone, with 12% of these on Zoom. Overall, 83% were "very satisfied" or "satisfied" with their virtual care experience. Most respondents perceived all treatment-related factors to be equally well addressed virtually as in person, except for physical examination. Auxiliary factors like travel, cost, and time spent were rated more favourably with virtual care. Qualitative findings provided further contextualization and identified gaps in virtual care delivery. For future visits, 44% wanted in-person visits only as needed, 36% wanted a hybrid of in-person and virtual appointments, and 11% preferred in-person appointments only.

CONCLUSIONS

Patients perceive that virtual care provides high-fidelity diabetes management while reducing their pandemic risks as well as minimizing travel and time associated with in-person care. Virtual care is an important medium for diabetes care delivery that should be used according to patient preference and intermixed with in-person appointments.

Quality of care of patients with type 2 diabetes mellitus at a public sector district hospital

BACKGROUND

 Globally, diabetes mellitus (DM) remains one of the leading causes of mortality, with approximately 2 million deaths in 2019, the condition also contributes significantly to adverse health conditions and costs. The study aimed to describe the quality of care (QOC) rendered to patients with type 2 DM (T2DM) seeking care at Wentworth Hospital (WWH), a district hospital in KwaZulu-Natal province, South Africa.

METHODS

 A descriptive cross-sectional design was used, and all patients living with T2DM on treatment who had accessed care for at least 1 year were included. Data were collected through structured exit interviews, and their clinical data were extracted from their medical records. Their knowledge, attitudes and practices were assessed using a 5-point Likert scale.

RESULTS

 The mean age (standard deviation [s.d.]) was 59 (13.0) years and most (65.3%) were female, of African (30.0%) and Indian (38.6%) descent, with two-thirds (69.4%) obtaining a secondary school education. Their mean glycated haemoglobin (HbA1c) (s.d.) was 8.6 (2.4%). Over 82% had one or more comorbidity, while 30% had at least one DM-related complication. Generally, participants were pleased with the care received, but their knowledge and practices related to their T2DM was suboptimal.

CONCLUSION

 This study indicates that the QOC was suboptimal due to poor efficacy indicators, poor knowledge and lack of adequate lifestyle measures, despite the frequency of medical practitioner reviews.Contributions: This study identified gaps in QOC and will aid South African public sector policy-makers in devising quality improvement initiatives.

Feasibility and acceptability of e-learning to upskill diabetes educators in supporting people experiencing diabetes distress: a pilot randomised controlled trial

BACKGROUND

Diabetes distress is a commonly experienced negative emotional response to the ongoing burden of diabetes. Holistic diabetes care, including attention to diabetes distress, is recommended in clinical guidelines, yet not routinely implemented. Diabetes health professionals have highlighted lack of training as a barrier to implementation of psychological care. Therefore, we developed an e-learning: 'Diabetes distress e-learning: A course for diabetes educators' to address this need. This pilot study aimed to examine the feasibility of evaluating the e-learning in a randomised controlled trial study, the acceptability of the e-learning to credentialled diabetes educators (CDEs); and preliminary evidence of its effect upon CDEs' diabetes distress-related knowledge, motivation, confidence, behavioural skills, and barriers to implementation.

METHODS

A pilot, unblinded, 2-armed, parallel group randomised controlled trial. Participants were recruited during a 4-month timeframe. Eligible participants were CDEs for ≥ 1 year providing care to ≥ 10 adults with type 1 or type 2 diabetes per week. Participants were randomly allocated (1:1 computer automated) to 1 of 2 learning activities: diabetes distress e-learning (intervention) or diabetes distress chapter (active control). They had 4 weeks to access the activity. They completed online surveys at baseline, 2-week and 12-week follow-up.

RESULTS

Seventy-four eligible CDEs (36 intervention, 38 active control) participated. At baseline, recognition of the clinical importance of diabetes distress was high but knowledge and confidence to provide support were low-to-moderate. Engagement with learning activities was high (intervention: 83%; active control: 92%). Fifty-five percent returned at least 1 follow-up survey. All 30 intervention participants who returned the 2-week follow-up survey deemed the e-learning high quality and relevant. Systemic barriers (e.g., financial limitations and access to mental health professionals) to supporting people with diabetes distress were common at baseline and follow-up.  CONCLUSIONS: The e-learning was acceptable to CDEs. The study design was feasible but needs modification to improve follow-up survey return. The e-learning showed potential for improving diabetes distress-related knowledge, confidence and asking behaviours, but systemic barriers to implementation remained. Systemic barriers need to be addressed to facilitate implementation of support for diabetes distress in clinical practice. Future larger-scale evaluation of the e-learning is warranted.

Barriers and Facilitators in Access to Diabetes, Hypertension, and Dyslipidemia Medicines: A Scoping Review

Objective: Identify barriers and facilitators in access to medicines for diabetes, hypertension, and dyslipidemia, considering patient, health provider, and health system perspectives.

Methods: Scoping review based on Joanna Briggs methodology. The search considered PubMed, Cochrane Library, CINAHL, Academic Search Ultimate, Web of Science, SciELO Citation Index, and grey literature. Two researchers conducted screening and eligibility phases. Data were thematically analyzed.

Results: The review included 219 documents. Diabetes was the most studied condition; most of the evidence comes from patients and the United States. Affordability and availability of medicines were the most reported dimension and specific barrier respectively, both cross-cutting concerns. Among high- and middle-income countries, identified barriers were cost of medicines, accompaniment by professionals, long distances to facilities, and cultural aspects; cost of transportation emerges in low-income settings. Facilitators reported were financial accessibility, trained health workers, medicines closer to communities, and patients’ education.

Conclusion: Barriers and facilitators are determined by socioeconomic and cultural conditions, highlighting the role of health systems in regulatory and policy context (assuring financial coverage and free medicines); providers’ role bringing medicines closer; and patients’ health education and disease management.

Cuidados de enfermería para la persona adulta, diabética con hipoglucemia: revisión integrativa

Introducción: La hipoglucemia es la complicación más frecuente del tratamiento con insulina en adultos. Los eventos de hipoglucemia severa se asocian con complicaciones a corto, mediano y largo plazo en  pacientes con diabetes ellmitus. Una de las estrategias para reducir  la frecuencia de hipoglucemia son las intervenciones de enfermería y  aunque hay pocos estudios que las enuncian de manera explícita, se ha publicado respecto a las necesidades de dichos pacientes, que permiten determinar características definitorias de  diagnósticos enfermeros y a partir de ellos establecer metas e intervenciones enfermeras, para el cuidado de dichos pacientes.  Objetivo: identificar los cuidados de enfermería para prevenir y controlar los eventos de hipoglucemia en pacientes adultos diagnosticados con diabetes mellitus. Metodología: revisión integrativa, se realizó en seis fases: planteamiento de la pregunta PICO; búsqueda en bases de datos y metabuscadores; lectura crítica; análisis, clasificación, validación por nivel de evidencia y grado de recomendación, y presentación de la información. Resultados: la revisión reportó cinco categorías: factores de riesgo y protectores, miedo a la hipoglucemia, atención brindada al paciente, disminución de la hipoglucemia y descripción del impacto de la hipoglucemia en los pacientes. Conclusiones: a partir de las necesidades reportadas en las 5 categorías de los resultados se determinaron características definitorias y factores relacionados que permitieron formular diagnósticos de enfermería y determinar como principales intervenciones: enseñanza del proceso de enfermedad, medicamentos prescritos, entrenamiento de asertividad, manejo de la hipoglicemia, nutricional y de la medicación, mejorar el afrontamiento, enseñanza individual, facilitar el aprendizaje y potenciación de la disposición de aprendizaje.

Patients' perspectives on how to improve diabetes care and self-management: qualitative study

OBJECTIVE

People living with diabetes need and deserve high-quality, individualised care. However, providing such care remains a challenge in many countries, including Canada. Patients' expertise, if acknowledged and adequately translated, could help foster patient-centred care. This study aimed to describe Expert Patients' knowledge, wisdom and advice to others with diabetes and to health professionals to improve diabetes self-management and care.

DESIGN AND METHODS

We recruited a convenience sample of 21 men and women. Participants were people of diverse backgrounds who are Patient Partners in a national research network (hereafter Expert Patients). We interviewed and video-recorded their knowledge, wisdom and advice for health professionals and for others with diabetes. Three researchers independently analysed videos using inductive framework analysis, identifying themes through discussion and consensus. Expert Patients were involved in all aspects of study design, conduct, analysis and knowledge translation.

RESULTS

Acknowledging and accepting the reality of diabetes, receiving support from family and care teams and not letting diabetes control one's life are essential to live well with diabetes. To improve diabetes care, health professionals should understand and acknowledge the impact of diabetes on patients and their families, and communicate with patients openly, respectfully, with empathy and cultural competency.

CONCLUSION

Expert Patients pointed to a number of areas of improvement in diabetes care that may be actionable individually by patients or health professionals, and also collectively through intergroup collaboration. Improving the quality of care in diabetes is crucial for improving health outcomes for people with diabetes.