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Carrigan A, Meulenbroeks I, Sarkies M, Dammery G, Halim N, Singh N, Lake R, Davis E, Jones TW, Braithwaite J, Zurynski Y. Benefits, implementation and sustainability of innovative paediatric models of care for children with type 1 diabetes: a systematic review. BMC Pediatr 2024; 24:502. [PMID: 39103837 DOI: 10.1186/s12887-024-04945-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 07/15/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND AND AIM The evidence about the acceptability and effectiveness of innovative paediatric models of care for Type 1 diabetes is limited. To address this gap, we synthesised literature on implemented models of care, model components, outcomes, and determinants of implementation and sustainability. METHODS A systematic review was conducted and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Database searches of Medline, CINAHL, EMBASE and Scopus were conducted. Empirical studies focused on Type 1 diabetes paediatric models of care, published from 2010 to 2022 in English were included. RESULTS Nineteen extant studies reported on models and their associations with health and psychosocial outcomes, patient engagement with healthcare, and healthcare costs. Thirteen studies described multidisciplinary teamwork, education and capacity building that supported self-care. Four studies involved shared decision making between providers and patients, and two discussed outreach support where technology was an enabler. Fourteen studies reported improvements in health outcomes (e.g. glycaemic control), mostly for models that included multidisciplinary teams, education, and capacity building (11 studies), outreach support or shared care (3 studies). Four studies reported improvements in quality of life, three reported increased satisfaction for patients and carers and, and one reported improved communication. Four of five studies describing shared care and decision-making reported improvements in quality of life, support and motivation. Outreach models reported no negative outcomes, however, accessing some models was limited by technological and cost barriers. Eight studies reported on model sustainability, but only half reported implementation determinants; none reported applying a theoretical framework to guide their research. CONCLUSION Some health and psychosocial benefits were associated with newer models. To address knowledge gaps about implementation determinants and model sustainability, longitudinal studies are needed to inform future adoption of innovative models of care for children with Type 1 diabetes.
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Affiliation(s)
- Ann Carrigan
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, Sydney, Australia
| | - Isabelle Meulenbroeks
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Mitchell Sarkies
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, Sydney, Australia
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Genevieve Dammery
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, Sydney, Australia
| | - Nicole Halim
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, Sydney, Australia
| | - Nehal Singh
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, Sydney, Australia
| | - Rebecca Lake
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, Sydney, Australia
| | - Elizabeth Davis
- Telethon Kids Institute, Perth Children's Hospital, Western, Australia
- Perth Children's Hospital, Perth, Western, Australia
| | - Timothy W Jones
- Telethon Kids Institute, Perth Children's Hospital, Western, Australia
- Perth Children's Hospital, Perth, Western, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, Sydney, Australia
| | - Yvonne Zurynski
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, Sydney, Australia.
- Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
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Çimke S, Yıldırım Gürkan D, Polat S. Research on Family-Centered Care in pediatric patients: A Bibliometric Analysis. J Pediatr Nurs 2024; 76:199-206. [PMID: 38479074 DOI: 10.1016/j.pedn.2024.02.017] [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: 12/11/2023] [Revised: 02/01/2024] [Accepted: 02/19/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE This study is conducted as a bibliometric analysis to determine the trends in studies related to family-centered care in children. MATERIALS AND METHODS The Web of Science database was used to collect study data. A search was conducted on Web of Science using the keywords "family-centered care", "family centered care", "family-centred care", "family centred care", "family-integrated care", "family integrated care", "patient and family centered care", "patient- and family-centered care" and "child" or "pediatric" or "pediatrics" or "child" or "newborn" or "neonatal" or "adolescent" together. The VOSviewer program was used for data analysis and visualization. The analysis included the number of publications by year, distribution by journals, most cited studies, countries with the highest publication output, most frequently used keywords, and co-authorship dimensions, presented with visual maps. RESULTS A total of 2525 studies conducted from 1980 onwards were analyzed. The analysis revealed that the initial publications related to the subject emerged in 1980, and the United States was identified as the country with the highest number of publications, based on the Web of Science database. The Journal of Pediatric Nursing: Nursing Care of Children and Families (JPN) was determined as the journal with the highest number of publications, while the journal receiving the most citations was PEDIATRICS. CONCLUSION The study found an increasing importance given to the Family-Centered Care Approach since the 1980s, with a majority of studies being descriptive in nature. It was determined that the studies were concentrated in the USA indicating a lack of global interest in the Family-Centered. PRACTICAL IMPLICATIONS Nursing researchers can build upon this study in the field of family-centered care by conducting more specific and in-depth investigations. This contributes to adding new information to the nursing literature and filling gaps in this area.
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Affiliation(s)
- Sevim Çimke
- Faculty of Health Sciences, Yozgat Bozok University, Turkey.
| | | | - Sevinç Polat
- Faculty of Health Sciences, Yozgat Bozok University, Turkey
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Nouira S, Ach T, Ammar A, Ach M, Sabbagh G, Ezzi O, Benabdelkrim A. Prevalence and factors associated with school failure in children with type 1 diabetes. Pediatr Endocrinol Diabetes Metab 2024; 30:3-7. [PMID: 39026473 PMCID: PMC11037087 DOI: 10.5114/pedm.2023.133124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 10/22/2023] [Indexed: 07/20/2024]
Abstract
INTRODUCTION Type 1 diabetes mellitus (T1DM) is a health problem that can be difficult for young people to accept. The aim of this study is to determine the prevalence and characteristics of school failure in children with T1DM and to identify the associated factors. MATERIAL AND METHODS This is a retrospective study conducted in the endocrinology department of the Farhat Hached Hospital in Sousse, regarding T1DM patients, by analysing their school and career paths according to their clinicobiological and social data. School failure was defined in our study by the presence of at least one year's repetition and/or exclusion from school. RESULTS Our study included 70 patients. School failure was recorded in 71.4% of cases. School drop-out was observed in 47.1% of patients. The reasons for school drop-out were iterative hospitalizations in 31.4% of cases and glycaemic instability with hyper/hypoglycaemic fluctuations in 17.1%. Multivariate analysis showed that the risk factors significantly associated with school failure were, respectively, number of hospitalizations for ketosis ≥ 5 (p = 0.037) and higher mean HbA1c at the last consultations (p = 0.001). Use of functional insulin therapy (p = 0.031) and use of insulin analogue (p = 0.004) were significantly protective factors. CONCLUSIONS The risk of school failure in T1DM is real and should not be underestimated. Socioeconomic factors such as lack of financial resources, limited family support, and an unfavourable social environment can contribute to school avoidance.
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Affiliation(s)
- Sawsen Nouira
- Department of Endocrinology, University Hospital of Farhat Hached Sousse, Tunisia
| | - Taieb Ach
- Department of Endocrinology, University Hospital of Farhat Hached Sousse, Tunisia
- Laboratory of Exercise Physiology and Pathophysiology, University of Sousse, Faculty of Medicine of Sousse, Tunisia
| | - Asma Ammar
- Department of Hospital Hygiene, University of Sousse, Faculty of Medicine of Sousse, Tunisia
| | - Meriem Ach
- Family Medicine, University of Sousse, Faculty of Medicine of Sousse, Tunisia
| | - Ghada Sabbagh
- Department of Endocrinology, University Hospital of Farhat Hached Sousse, Tunisia
| | - Olfa Ezzi
- Department of Hospital Hygiene, University of Sousse, Faculty of Medicine of Sousse, Tunisia
| | - Asma Benabdelkrim
- Department of Endocrinology, University Hospital of Farhat Hached Sousse, Tunisia
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Thomas S, Byrne LK, Ryan NP, Hendrieckx C, White V. Unmet supportive care needs in families of children with chronic health conditions: an Australian cross-sectional study. World J Pediatr 2023; 19:1181-1191. [PMID: 37246167 PMCID: PMC10225288 DOI: 10.1007/s12519-023-00730-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/01/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND The aim of this study was to identify similarities and differences in the unmet supportive care needs (USCN) of families of children with major chronic health conditions (CHCs) using a universal need assessment tool. METHODS A cross-sectional online survey involving parents of children with congenital heart disease (CHD), type 1 diabetes mellitus (T1D), cancer, and asthma diagnosed within the last 5 years recruited via social media and support organizations. Thirty-four items assessing the USCN across six domains (care needs, physical and social needs, informational needs, support needs, financial needs, child-related emotional needs) were responded to on a 4-point Likert scale [no need (1) to high need (4)]. Descriptive statistics identified the level of need, and linear regressions identified factors associated with higher need domain scores. Due to small numbers, the asthma group was excluded from comparisons across CHCs. RESULTS One hundred and ninety-four parents completed the survey (CHD: n = 97, T1D: n = 50, cancer: n = 39, and asthma: n = 8). Parents of children with cancer were most likely to report at least one USCN (92%), followed by parents of children with T1D (62%). The five most commonly reported USCN across CHCs were drawn from four domains: child-related emotional, support, care, and financial. Three need items were included in the top five needs for all conditions. A higher USCN was associated with a greater frequency of hospital visits and the absence of parental support. CONCLUSIONS Using a universal need assessment tool, this is one of the first studies to characterize USCN in families of children diagnosed with common CHCs. While proportions endorsing different needs varied across conditions, the most endorsed needs were similar across the illness groups. This suggests that support programs or services could be shared across different CHCs. Video Abstract.
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Affiliation(s)
- Sangeetha Thomas
- School of Psychology, Faculty of Health, Deakin University, Melbourne, VIC, 3125, Australia.
| | - Linda K Byrne
- School of Psychology, Faculty of Health, Deakin University, Melbourne, VIC, 3125, Australia
| | - Nicholas P Ryan
- School of Psychology, Faculty of Health, Deakin University, Melbourne, VIC, 3125, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Christel Hendrieckx
- School of Psychology, Faculty of Health, Deakin University, Melbourne, VIC, 3125, Australia
- Australian Centre for Behavioural Research in Diabetes, Melbourne, VIC, Australia
- Institute of Health Transformation, Deakin University, Melbourne, VIC, Australia
| | - Victoria White
- School of Psychology, Faculty of Health, Deakin University, Melbourne, VIC, 3125, Australia.
- Cancer Council Victoria, Melbourne, VIC, Australia.
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Gauche L, Laporte R, Bernoux D, Marquant E, Vergier J, Bonnet L, Aouchiche K, Bresson V, Zanini D, Fabre-Brue C, Reynaud R, Castets S. Assessment of a new home-based care pathway for children newly diagnosed with type 1 diabetes. Prim Care Diabetes 2023; 17:518-523. [PMID: 37391315 DOI: 10.1016/j.pcd.2023.06.007] [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: 09/20/2022] [Revised: 06/09/2023] [Accepted: 06/18/2023] [Indexed: 07/02/2023]
Abstract
AIM To compare the outcomes of home-based and conventional hospital-based care for children newly diagnosed with type 1 diabetes mellitus. METHODS A descriptive study was conducted of all children newly diagnosed with diabetes mellitus at the Timone Hospital in Marseille, France, between November 2017 and July 2019. The patients received either home-based or in-patient hospital care. The primary outcome was the length of initial hospital stay. The secondary outcome measures were glycemic control in the first year of treatment, families' diabetes knowledge, the effect of diabetes on quality of life, and overall quality of care. RESULTS A total of 85 patients were included, 37 in the home-based care group and 48 in the in-patient care group. The initial length of hospital stay was 6 days in the home-based care group versus 9 days in the in-patient care group. Levels of glycemic control, diabetes knowledge and quality of care were comparable in the two groups despite a higher rate of socioeconomic deprivation in the home-based care group. CONCLUSION Home-based care for children with diabetes is safe and effective. This new healthcare pathway provides good overall social care, especially for socioeconomically deprived families.
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Affiliation(s)
- Laetitia Gauche
- Multidisciplinary Pediatrics Department, Timone Enfants Hospital, APHM, Marseille, France
| | - Rémi Laporte
- APHM, Hôpital Nord, Permanence d'Accès aux Soins de Santé Mère-Enfant, Marseille, France, Aix Marseille Univ, Equipe de Recherche EA 3279 "Santé Publique, Maladies Chroniques et Qualité de Vie", Faculté de Médecine, Marseille, France
| | - Delphine Bernoux
- Multidisciplinary Pediatrics Department, Timone Enfants Hospital, APHM, Marseille, France
| | - Emeline Marquant
- Multidisciplinary Pediatrics Department, Timone Enfants Hospital, APHM, Marseille, France
| | - Julia Vergier
- Multidisciplinary Pediatrics Department, Timone Enfants Hospital, APHM, Marseille, France
| | - Laura Bonnet
- Multidisciplinary Pediatrics Department, Timone Enfants Hospital, APHM, Marseille, France
| | - Karine Aouchiche
- Multidisciplinary Pediatrics Department, Timone Enfants Hospital, APHM, Marseille, France
| | - Violaine Bresson
- Pediatric Home-based Care, Timone enfant Hospital, Marseille, France
| | - Didier Zanini
- Pediatric Home-based Care, Timone enfant Hospital, Marseille, France
| | - Catherine Fabre-Brue
- Multidisciplinary Pediatrics Department, Timone Enfants Hospital, APHM, Marseille, France
| | - Rachel Reynaud
- Multidisciplinary Pediatrics Department, Timone Enfants Hospital, APHM, Marseille, France
| | - Sarah Castets
- Multidisciplinary Pediatrics Department, Timone Enfants Hospital, APHM, Marseille, France.
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Narm KE, Wen J, Sung L, Dar S, Kim P, Olson B, Schrager A, Tsay A, Himmelstein DU, Woolhandler S, Shure N, McCormick D, Gaffney A. Chronic Illness in Children and Foregone Care Among Household Adults in the United States: A National Study. Med Care 2023; 61:185-191. [PMID: 36730827 DOI: 10.1097/mlr.0000000000001791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Childhood chronic illness imposes financial burdens that may affect the entire family. OBJECTIVE The aim was to assess whether adults living with children with 2 childhood chronic illnesses-asthma and diabetes-are more likely to forego their own medical care, and experience financial strain, relative to those living with children without these illnesses. RESEARCH DESIGN 2009-2018 National Health Interview Survey. SUBJECTS Adult-child dyads, consisting of one randomly sampled child and adult in each family. MEASURES The main exposure was a diagnosis of asthma or diabetes in the child. The outcomes were delayed/foregone medical care for the adult as well as family financial strain; the authors evaluated their association with the child's illness using multivariable logistic regressions adjusted for potential confounders. RESULTS The authors identified 93,264 adult-child dyads; 8499 included a child with asthma, and 179 a child with diabetes. Families with children with either illness had more medical bill problems, food insecurity, and medical expenses. Adults living with children with each illness reported more health care access problems. For instance, relative to other adults, those living with a child with asthma were more likely to forego/delay care (14.7% vs. 10.2%, adjusted odds ratio: 1.27; 95% CI: 1.16-1.39) and were more likely to forego medications, specialist, mental health, and dental care. Adults living with a child with diabetes were also more likely to forego/delay care (adjusted odds ratio: 1.76; 95% CI: 1.18-2.64). CONCLUSIONS Adults living with children with chronic illnesses may sacrifice their own care because of cost concerns. Reducing out-of-pocket health care costs, improving health coverage, and expanding social supports for families with children with chronic conditions might mitigate such impacts.
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Affiliation(s)
- Koh Eun Narm
- Cambridge Health Alliance, Cambridge
- Harvard Medical School, Boston, MA
| | - Jenny Wen
- Cambridge Health Alliance, Cambridge
- Harvard Medical School, Boston, MA
| | - Lily Sung
- Cambridge Health Alliance, Cambridge
- Harvard Medical School, Boston, MA
| | - Sofia Dar
- Cambridge Health Alliance, Cambridge
- Harvard Medical School, Boston, MA
| | - Paul Kim
- Cambridge Health Alliance, Cambridge
- Harvard Medical School, Boston, MA
| | - Brady Olson
- Cambridge Health Alliance, Cambridge
- Harvard Medical School, Boston, MA
| | - Alix Schrager
- Cambridge Health Alliance, Cambridge
- Harvard Medical School, Boston, MA
| | - Annie Tsay
- Cambridge Health Alliance, Cambridge
- Harvard Medical School, Boston, MA
| | - David U Himmelstein
- Cambridge Health Alliance, Cambridge
- Harvard Medical School, Boston, MA
- City University of New York at Hunter College, New York, NY
| | - Steffie Woolhandler
- Cambridge Health Alliance, Cambridge
- Harvard Medical School, Boston, MA
- City University of New York at Hunter College, New York, NY
| | | | - Danny McCormick
- Cambridge Health Alliance, Cambridge
- Harvard Medical School, Boston, MA
| | - Adam Gaffney
- Cambridge Health Alliance, Cambridge
- Harvard Medical School, Boston, MA
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Kimbell B, Rankin D, Hart RI, Allen JM, Boughton CK, Campbell F, Fröhlich‐Reiterer E, Hofer SE, Kapellen TM, Rami‐Merhar B, Schierloh U, Thankamony A, Ware J, Hovorka R, Lawton J. Parents' views about healthcare professionals having real-time remote access to their young child's diabetes data: Qualitative study. Pediatr Diabetes 2022; 23:799-808. [PMID: 35561092 PMCID: PMC9544441 DOI: 10.1111/pedi.13363] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 04/02/2022] [Accepted: 05/04/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES We explored parents' views about healthcare professionals having remote access to their young child's insulin and glucose data during a clinical trial to inform use of data sharing in routine pediatric diabetes care. RESEARCH DESIGN AND METHODS Interviews with 33 parents of 30 children (aged 1-7 years) with type 1 diabetes participating in a randomized trial (KidsAP02) comparing hybrid closed-loop system use with sensor-augmented pump therapy. Data were analyzed using a qualitative descriptive approach. RESULTS Parents reported multiple benefits to healthcare professionals being able to remotely access their child's glucose and insulin data during the trial, despite some initial concerns regarding the insights offered into everyday family life. Key benefits included: less work uploading/sharing data; improved consultations; and, better clinical input and support from healthcare professionals between consultations. Parents noted how healthcare professionals' real-time data access facilitated remote delivery of consultations during the COVID-19 pandemic, and how these were more suitable for young children than face-to-face appointments. Parents endorsed use of real-time data sharing in routine clinical care, subject to caveats regarding data access, security, and privacy. They also proposed that, if data sharing were used, consultations for closed-loop system users in routine clinical care could be replaced with needs-driven, ad-hoc contact. CONCLUSIONS Real-time data sharing can offer clinical, logistical, and quality-of-life benefits and enhance opportunities for remote consultations, which may be more appropriate for young children. Wider rollout would require consideration of ethical and cybersecurity issues and, given the heightened intrusion on families' privacy, a non-judgmental, collaborative approach by healthcare professionals.
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Affiliation(s)
| | - David Rankin
- Usher InstituteUniversity of EdinburghEdinburghUK
| | - Ruth I. Hart
- Usher InstituteUniversity of EdinburghEdinburghUK
| | - Janet M. Allen
- Wellcome Trust‐MRC Institute of Metabolic ScienceUniversity of CambridgeCambridgeUK,Department of PaediatricsUniversity of CambridgeCambridgeUK
| | | | - Fiona Campbell
- Department of Paediatric DiabetesLeeds Children's HospitalLeedsUK
| | | | - Sabine E. Hofer
- Department of Pediatrics IMedical University of InnsbruckInnsbruckAustria
| | - Thomas M. Kapellen
- Hospital for Children and AdolescentsUniversity of Leipzig, Leipzig, Germany/Hospital for Children and Adolescents am Nicolausholz Bad KösenLeipzigGermany
| | - Birgit Rami‐Merhar
- Department of Pediatric and Adolescent Medicine, Comprehensive Center for PediatricsMedical University of ViennaViennaAustria
| | - Ulrike Schierloh
- Department of Pediatric Diabetes and EndocrinologyClinique Pédiatrique, Centre HospitalierLuxembourg CityLuxembourg
| | - Ajay Thankamony
- Department of PaediatricsUniversity of CambridgeCambridgeUK,Children's Services, Cambridge University Hospitals NHS Foundation TrustAddenbrooke's HospitalCambridgeUK
| | - Julia Ware
- Wellcome Trust‐MRC Institute of Metabolic ScienceUniversity of CambridgeCambridgeUK,Department of PaediatricsUniversity of CambridgeCambridgeUK
| | - Roman Hovorka
- Wellcome Trust‐MRC Institute of Metabolic ScienceUniversity of CambridgeCambridgeUK,Department of PaediatricsUniversity of CambridgeCambridgeUK
| | - Julia Lawton
- Usher InstituteUniversity of EdinburghEdinburghUK
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Swann-Thomsen HE, Lindsay R, Rourk S, Hofacer R, Nguyen E. National Survey Data to Evaluate Case Management Services: A Systematic Review on Care Coordination Using the National Survey of Children With Special Health Care Needs. Prof Case Manag 2022; 27:124-140. [PMID: 35363658 DOI: 10.1097/ncm.0000000000000551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Hillary E Swann-Thomsen
- Hillary E. Swann-Thomsen, PhD, was a postdoctoral fellow in the Idaho Center for Health Research at Idaho State University during the time of this work. She is currently an applied research scientist at St. Luke's Health System. Her research focuses on improving quality of care in vulnerable patient populations
- Ryan Lindsay, PhD, MPH, is an associate professor in the Department of Community and Public Health at Idaho State University with interests in the household production of health, healthcare access, and the interaction between substance use and infectious diseases. His research highlights the health of addicted, deaf, homeless, immigrant, and sex worker populations
- Seth Rourk, PharmD, was a student pharmacist at Idaho State University College of Pharmacy during the time of this work. He is currently an instructor and affiliate faculty in the Department of Pharmacy Practice at Idaho State University
- Rylon Hofacer, PhD, was a postdoctoral fellow in the Idaho Center for Health Research at Idaho State University during the time of this work. He is currently a healthcare economics analyst at Blue Cross of Idaho
- Elaine Nguyen, PharmD, MPH, is an assistant professor in the Department of Pharmacy Practice at Idaho State University. She is interested in chronic disease management, health services-related research, and the use of technology in patient care
| | - Ryan Lindsay
- Hillary E. Swann-Thomsen, PhD, was a postdoctoral fellow in the Idaho Center for Health Research at Idaho State University during the time of this work. She is currently an applied research scientist at St. Luke's Health System. Her research focuses on improving quality of care in vulnerable patient populations
- Ryan Lindsay, PhD, MPH, is an associate professor in the Department of Community and Public Health at Idaho State University with interests in the household production of health, healthcare access, and the interaction between substance use and infectious diseases. His research highlights the health of addicted, deaf, homeless, immigrant, and sex worker populations
- Seth Rourk, PharmD, was a student pharmacist at Idaho State University College of Pharmacy during the time of this work. He is currently an instructor and affiliate faculty in the Department of Pharmacy Practice at Idaho State University
- Rylon Hofacer, PhD, was a postdoctoral fellow in the Idaho Center for Health Research at Idaho State University during the time of this work. He is currently a healthcare economics analyst at Blue Cross of Idaho
- Elaine Nguyen, PharmD, MPH, is an assistant professor in the Department of Pharmacy Practice at Idaho State University. She is interested in chronic disease management, health services-related research, and the use of technology in patient care
| | - Seth Rourk
- Hillary E. Swann-Thomsen, PhD, was a postdoctoral fellow in the Idaho Center for Health Research at Idaho State University during the time of this work. She is currently an applied research scientist at St. Luke's Health System. Her research focuses on improving quality of care in vulnerable patient populations
- Ryan Lindsay, PhD, MPH, is an associate professor in the Department of Community and Public Health at Idaho State University with interests in the household production of health, healthcare access, and the interaction between substance use and infectious diseases. His research highlights the health of addicted, deaf, homeless, immigrant, and sex worker populations
- Seth Rourk, PharmD, was a student pharmacist at Idaho State University College of Pharmacy during the time of this work. He is currently an instructor and affiliate faculty in the Department of Pharmacy Practice at Idaho State University
- Rylon Hofacer, PhD, was a postdoctoral fellow in the Idaho Center for Health Research at Idaho State University during the time of this work. He is currently a healthcare economics analyst at Blue Cross of Idaho
- Elaine Nguyen, PharmD, MPH, is an assistant professor in the Department of Pharmacy Practice at Idaho State University. She is interested in chronic disease management, health services-related research, and the use of technology in patient care
| | - Rylon Hofacer
- Hillary E. Swann-Thomsen, PhD, was a postdoctoral fellow in the Idaho Center for Health Research at Idaho State University during the time of this work. She is currently an applied research scientist at St. Luke's Health System. Her research focuses on improving quality of care in vulnerable patient populations
- Ryan Lindsay, PhD, MPH, is an associate professor in the Department of Community and Public Health at Idaho State University with interests in the household production of health, healthcare access, and the interaction between substance use and infectious diseases. His research highlights the health of addicted, deaf, homeless, immigrant, and sex worker populations
- Seth Rourk, PharmD, was a student pharmacist at Idaho State University College of Pharmacy during the time of this work. He is currently an instructor and affiliate faculty in the Department of Pharmacy Practice at Idaho State University
- Rylon Hofacer, PhD, was a postdoctoral fellow in the Idaho Center for Health Research at Idaho State University during the time of this work. He is currently a healthcare economics analyst at Blue Cross of Idaho
- Elaine Nguyen, PharmD, MPH, is an assistant professor in the Department of Pharmacy Practice at Idaho State University. She is interested in chronic disease management, health services-related research, and the use of technology in patient care
| | - Elaine Nguyen
- Hillary E. Swann-Thomsen, PhD, was a postdoctoral fellow in the Idaho Center for Health Research at Idaho State University during the time of this work. She is currently an applied research scientist at St. Luke's Health System. Her research focuses on improving quality of care in vulnerable patient populations
- Ryan Lindsay, PhD, MPH, is an associate professor in the Department of Community and Public Health at Idaho State University with interests in the household production of health, healthcare access, and the interaction between substance use and infectious diseases. His research highlights the health of addicted, deaf, homeless, immigrant, and sex worker populations
- Seth Rourk, PharmD, was a student pharmacist at Idaho State University College of Pharmacy during the time of this work. He is currently an instructor and affiliate faculty in the Department of Pharmacy Practice at Idaho State University
- Rylon Hofacer, PhD, was a postdoctoral fellow in the Idaho Center for Health Research at Idaho State University during the time of this work. He is currently a healthcare economics analyst at Blue Cross of Idaho
- Elaine Nguyen, PharmD, MPH, is an assistant professor in the Department of Pharmacy Practice at Idaho State University. She is interested in chronic disease management, health services-related research, and the use of technology in patient care
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9
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Huang MX, Wang MC, Wu BY. Telehealth Education via WeChat Improves the Quality of Life of Parents of Children with Type-1 Diabetes Mellitus. Appl Clin Inform 2022; 13:263-269. [PMID: 35235993 PMCID: PMC8890918 DOI: 10.1055/s-0042-1743239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE The purpose of this study was to explore the effect of telehealth education and care guidance via WeChat (Tencent Ltd., Shenzhen, China; a popular smartphone-based social media application) on improving the quality of life of parents of children with type-1 diabetes mellitus. METHODS A prospective randomized controlled study was conducted in our hospital from March 2019 to September 2020 to compare the quality of life of parents of children with type-1 diabetes mellitus in the intervention group and the control group. RESULTS Six months after discharge, the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) scores of parents in the intervention group were significantly lower than those in the control group (p < 0.05). Compared with the SAS and SDS scores at discharge time, those scores of parents at 6 months after discharge time in intervention group were significantly lower (p < 0.05), while those scores of parents at 6 months after discharge time in control was similar (p > 0.05). Six months after discharge, the scores of the physiological field, psychological field, social relationship field, and environmental field in the intervention group were significantly higher than those of the control group according to the result of the World Health Organization Quality of Life Brief Scale (WHOQOL-BREF; p < 0.05). CONCLUSION Using WeChat to provide telehealth education and home care guidance to the parents of children with type-1 diabetes mellitus can effectively relieve the anxiety and depression of the parents and improve their quality of life.
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Affiliation(s)
- Mei-Xia Huang
- Department of Pediatrics, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian Province, China
| | - Mei-Chun Wang
- Department of Pediatrics, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian Province, China
| | - Bi-Yu Wu
- Department of Pediatrics, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian Province, China,Address for correspondence Bi-Yu Wu, BM Department of Pediatrics, Quanzhou First Hospital Affiliated to Fujian Medical UniversityQuanzhou, Fujian Province 362000China
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10
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Rajan R, Kshatriya M, Banfield L, Athale U, Thabane L, Samaan MC. Impact of virtual care on health-related quality of life in children with diabetes mellitus: a systematic review protocol. BMJ Open 2022; 12:e053642. [PMID: 35173001 PMCID: PMC8852758 DOI: 10.1136/bmjopen-2021-053642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 01/24/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Diabetes mellitus is the most common endocrine disorder in children, and the prevalence of paediatric type 1 and type 2 diabetes continue to rise globally. Diabetes clinical care programs pivoted to virtual care with the COVID-19 pandemic-driven social distancing measures. Yet, the impact of virtual care on health-related quality of life in children living with diabetes remains unclear. This protocol reports on the methods that will be implemented to conduct a systematic review to assess the health-related quality of life and metabolic health impacts of virtual diabetes care. METHODS AND ANALYSIS We will search MEDLINE, Embase, EMCare, PsycInfo, Web of Science, and the grey literature for eligible studies. We will screen title, abstract, and full-text papers for potential inclusion and assess the risk of bias and the overall confidence in the evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. A meta-analysis will be conducted if two studies report similar populations, study designs, methods, and outcomes.This systematic review will summarise the health-related quality of life outcomes for virtual diabetes care delivery models. ETHICS AND DISSEMINATION No ethics approval is required for this systematic review protocol as it does not include patient data. The systematic review will be published in a peer-reviewed journal and presented at international conferences. PROSPERO REGISTRATION NUMBER CRD42021235646.
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Affiliation(s)
- Raeesha Rajan
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Maya Kshatriya
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Global Health Program, McMaster University, Hamilton, Ontario, Canada
| | - Laura Banfield
- Health Sciences Library, McMaster University, Hamilton, Ontario, Canada
| | - Uma Athale
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Hematology Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - M Constantine Samaan
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Global Health Program, McMaster University, Hamilton, Ontario, Canada
- Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
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11
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Kimbell B, Lawton J, Boughton C, Hovorka R, Rankin D. Parents' experiences of caring for a young child with type 1 diabetes: a systematic review and synthesis of qualitative evidence. BMC Pediatr 2021; 21:160. [PMID: 33814007 PMCID: PMC8019496 DOI: 10.1186/s12887-021-02569-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/24/2021] [Indexed: 01/16/2023] Open
Abstract
AIMS To synthesise the qualitative evidence on parents' experiences of caring for a child aged ≤8 years with type 1 diabetes to identify: the challenges they encounter; their views about support received; ways in which support could be improved; and, directions for future research. METHODS We searched Medline, EMBASE, CINAHL, PsycINFO and Web of Science databases to identify qualitative studies reporting parents' views and experiences of caring for a child with type 1 diabetes aged ≤8 years. Key analytical themes were identified using thematic synthesis. RESULTS Fourteen studies were included. The synthesis resulted in the generation of two overarching themes. Monopolisation of life describes the all-encompassing impact diabetes could have on parents due to the constant worry they experienced and the perceived need for vigilance. It describes how parents' caring responsibilities could affect their wellbeing, relationships and finances, and how a lack of trusted sources of childcare and a desire to enable a 'normal' childhood constrained personal choices and activities. However, use of diabetes technologies could lessen some of these burdens. Experiences of professional and informal support describes how encounters with healthcare professionals, while generally perceived as helpful, could lead to frustration and anxiety, and how connecting with other parents caring for a child with type 1 diabetes provided valued emotional and practical support. CONCLUSIONS This synthesis outlines the challenges parents encounter, their views about support received and ways in which support might be improved. It also highlights significant limitations in the current literature and points to important areas for future research, including how sociodemographic factors and use of newer diabetes technologies influence parents' diabetes management practices and experiences. PROSPERO: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019128710.
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Affiliation(s)
- B Kimbell
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK.
| | - J Lawton
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - C Boughton
- Wellcome Trust - MRC Medical Research Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - R Hovorka
- Wellcome Trust - MRC Medical Research Institute of Metabolic Science, University of Cambridge, Cambridge, UK.,Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - D Rankin
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
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12
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Cox ED, Palta M, Lasarev M, Binder AT, Connolly JR, Flynn KE. Influences of health and environmental deprivation on family relationships among children with chronic disease. Qual Life Res 2021; 30:1337-1346. [PMID: 33496901 DOI: 10.1007/s11136-020-02737-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Families play a key role in managing chronic illness. Among chronically ill children, we describe the Patient-Reported Outcomes Measurement Information System (PROMIS) Family Relationships measure over time and its associations with sociodemographics, environmental deprivation, and health. METHODS Parents of children aged 8-18 years with asthma (n = 171), type 1 diabetes (n = 199), or sickle cell disease (n = 135), recruited in pediatric clinics and emergency departments (ED), completed demographic surveys. Every six months for up to three years, children completed PROMIS Family Relationships, Anxiety, and Depressive Symptoms short forms (T-scores; mean 50, SD = 10), and a 5-level health status item. Linear mixed models were fit to estimate associations. RESULTS Older baseline age was associated with weaker family relationships. For example, for each 3-year higher baseline age, relationships were 3 points weaker for males (- 3.0; 95%CI - 5.7 to - .0.2) and females (- 3.1; 95%CI - 6.0 to - 0.3) with asthma recruited in the ED. For each 1-unit higher mean overall health, relationships were 4.6 points (95%CI 3.2-6.1) stronger for children with diabetes and about 2 points stronger for children with asthma (2.3; 0.7-3.9) and sickle cell disease (2.1; 0.3-3.9). Family relationships were 0.3-0.5 points weaker for each 1-unit increment in mean anxiety or depressive symptoms across all three diseases. Relationships were not significantly associated with environmental deprivation and generally stable over time. CONCLUSIONS Family relationships were weaker among older children and generally stable over time, yet fluctuated with physical and mental health. Monitoring PROMIS Family Relationships scores may facilitate referrals for chronically ill children who need support.
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Affiliation(s)
- Elizabeth D Cox
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, H6/558 Clinical Science Center, 600 Highland Avenue, Madison, WI, 53792-4108, USA.
| | - Mari Palta
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, USA.,Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, USA
| | - Michael Lasarev
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, USA
| | - Alex T Binder
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, H6/558 Clinical Science Center, 600 Highland Avenue, Madison, WI, 53792-4108, USA
| | - Jenny R Connolly
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, H6/558 Clinical Science Center, 600 Highland Avenue, Madison, WI, 53792-4108, USA
| | - Kathryn E Flynn
- Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, USA
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13
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Sanjari M, Peyrovi H, Mehrdad N. The Process of Managing the Children with Type 1 Diabetes in the Family: A Grounded Theory Study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2021; 26:25-33. [PMID: 33954095 PMCID: PMC8074732 DOI: 10.4103/ijnmr.ijnmr_5_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 08/02/2020] [Accepted: 08/23/2020] [Indexed: 11/04/2022]
Abstract
Background: Diabetes is a disease that affects all family members. Parents of children with type 1 diabetes are always concerned about all aspects of children's life. The aim of this study was to elucidate the process of managing children with diabetes in the family. Materials and Methods: This is a qualitative grounded theory of a doctoral dissertation, which was done on 2016. The 18 participants were selected through purposive and theoretical sampling until data saturation. The main participants in this study included parents, siblings, and children with type 1 diabetes. The data was gathered by semi-structured interviews as well as field notes and memos. Data analysis was done concurrently with data collection in four levels, including data analysis for concept and contex, bringing the process into the analysis, and integration of categories according to Corbin and Struss (2008). Core category appeared at the end of integrated categories. Results: “The family with diabetes in the child's diabetes orbit” as a core category contains the process of managing children with diabetes within the family, which included three main subcategories, including “entering into the diabetes orbit”, “movement into the diabetes orbit”, and “living into the diabetes orbit”. Conclusions: The family through the concept of “The family with diabetes in the child's diabetes orbit “as a main concern of families with diabetes suffering diabetes attempt to select and practicing appropriate strategies and manage diabetes and children with diabetes.
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Affiliation(s)
- Mahnaz Sanjari
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Peyrovi
- Department of Critical Care Nursing, Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Neda Mehrdad
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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14
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La Banca RO, Laffel LMB, Volkening LK, C Sparapani V, de Carvalho EC, Nascimento LC. Therapeutic play to teach children with type 1 diabetes insulin self-injection: A pilot trial in a developing country. J SPEC PEDIATR NURS 2021; 26:e12309. [PMID: 32945620 PMCID: PMC7871331 DOI: 10.1111/jspn.12309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/09/2020] [Accepted: 09/03/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE Child participation in type 1 diabetes (T1D) self-care is needed in developing countries due to a lack of resources, especially during the school day. This pilot study evaluated the feasibility of a therapeutic play intervention (ITP) versus standard education (SE) on the ability of children with T1D to correctly perform insulin injection technique. DESIGN AND METHODS Children with T1D (7-12 years) were recruited at two diabetes clinics in Brazil and randomized to ITP or SE. Registered nurses received protocol training to deliver the intervention and perform data collection. ITP group received an education that included a story about a child with T1D who self-injects insulin at school; SE group received routine clinic-based education. Preintervention, children were video-recorded giving insulin injections to a doll; postintervention, children were rerecorded giving the doll an injection. The research team reviewed the videos and assessed the injection technique using validated checklists. Parents reported children's self-injection practices at baseline and 30 days. RESULTS Children (N = 20, 40% male) were 9.6 ± 1.3 years old and had T1D for 3.6 ± 2.3 years; HbA1c was 9.1 ± 2.0%; 20% of ITP and 50% of SE children used syringes (vs. pens) for injections. At baseline, 80% of both groups knew how to self-inject; most were taught by a parent/relative. Injection technique scores were low in both groups; ITP group increased their scores significantly postintervention. Practices of self-injection did not change in either group after 30 days. PRACTICE IMPLICATIONS The play-based intervention appeared to improve the injection technique in the short-term. Pilot findings support the development of a larger trial to evaluate the effectiveness of ITP on educating children on insulin injections.
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Affiliation(s)
- Rebecca O La Banca
- Section on Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA.,Ribeirao Preto College of Nursing, PAHO/WHO Collaborating Center for Nursing Research Development, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Lori M B Laffel
- Section on Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Lisa K Volkening
- Section on Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Valéria C Sparapani
- Nursing Department of Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Emilia C de Carvalho
- Ribeirao Preto College of Nursing, PAHO/WHO Collaborating Center for Nursing Research Development, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Lucila C Nascimento
- Ribeirao Preto College of Nursing, PAHO/WHO Collaborating Center for Nursing Research Development, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
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15
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Oluma A, Mosisa G, Abadiga M, Tsegaye R, Habte A, Abdissa E. Predictors of Adherence to Self-Care Behavior Among Patients with Diabetes at Public Hospitals in West Ethiopia. Diabetes Metab Syndr Obes 2020; 13:3277-3288. [PMID: 33061490 PMCID: PMC7520154 DOI: 10.2147/dmso.s266589] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/20/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Diabetes is a typical chronic disease that needs integrated and multifaceted approaches. Self-care practices are fundamental to achieve good blood glucose control and prevent long-term complications. Therefore, the aim of the study was to determine the level and predictors of adherence to self-care behavior among patients with diabetes on follow-up at public hospitals of western Ethiopia. PATIENTS AND METHODS The cross-sectional study design was employed on a sample of 423 diabetic patients on follow-up at public hospitals of western Ethiopia. A systematic random sampling method was employed. The data were entered into Epi data version 3.1 and exported into Statistical Package for the Social Sciences window version 24 for analysis. All variables significant at p-value <0.05 in the bivariable were entered in multivariate regression analysis. Backward stepwise goodness of fit was used to ascertain the suitable variables in multiple linear regression analysis. Finally, multivariate linear regression analysis with adjusted B, CI at 95%, and the significance level was set at p <0.05. All predictive variables were reported in terms of adjusted R2. RESULTS The overall mean and standard deviation of adherence to self-care behavior was 23.09 ±6.55. Among the study participants, 42.70% had good self-care behavior. Self-efficacy (B=0.106, p<0.001), home blood glucose test (B=0.075, p<0.001), exercise per week (0.035, P<0.002), meal planning (B=0.039, P<0.001), dietary restriction (B=0.077, P<0.001), duration of diabetes<4 years (B=0.030, P<0.013), non-pharmacological intervention (B=0.055, P<0.011), and good appetite (B=0.039, P<0.045) were significant variables associated with adherence to self-care behaviors. CONCLUSION The overall level of adherence to self-care behavior was low. Therefore, we recommended that it is better if the national health policymaker focused on dietary management modality that engages patients' behavior change to develop self-care practices and closely monitoring of glucose level. Also, we recommended an additional longitudinal study incorporating a qualitative study that focused on behavioral changes.
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Affiliation(s)
- Adugna Oluma
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Getu Mosisa
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Muktar Abadiga
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Reta Tsegaye
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Ashenafi Habte
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Eba Abdissa
- School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
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16
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How do parents of children with type 1 diabetes mellitus cope and how does this condition affect caregivers' mental health? Arch Pediatr 2020; 27:265-269. [PMID: 32418643 DOI: 10.1016/j.arcped.2020.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 03/25/2020] [Accepted: 05/02/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the impact that type 1 diabetes mellitus (T1DM) in children has on parents' mental health and parents' coping with this condition. METHODS A cross-sectional study involving, at the outpatient examination, 41 caregivers of T1DM patients who had been diagnosed for at least 6 months. We evaluated the parents' coping strategies with the Brief COPE and their depressive and anxiety symptoms with the Hospital Anxiety and Depression Scale (HADS). Glycemic control of patients was assessed using the last glycated hemoglobin (HbA1c) values. RESULTS The average total score at HADS was 17.62 (SD=6.98). Half of the parents had an anxious score over the cut-off. The more parents were depressed or anxious, the more they used emotion-focused coping (P=0.002 and P=0.00, respectively). The more parents were anxious or depressed, the more they used maladaptive coping strategies such as avoidance and distraction. CONCLUSION These findings emphasise the key role of healthcare providers in assessing parents' difficulties and taking special care of those who have the most problems.
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McNally Keehn R, Enneking B, Ramaker M, Goings M, Yang Z, Carroll A, Ciccarelli M. Family-Centered Care Coordination in an Interdisciplinary Neurodevelopmental Evaluation Clinic: Outcomes From Care Coordinator and Caregiver Reports. Front Pediatr 2020; 8:538633. [PMID: 33194884 PMCID: PMC7661956 DOI: 10.3389/fped.2020.538633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 09/28/2020] [Indexed: 11/13/2022] Open
Abstract
Children with neurodevelopmental disabilities experience many unmet healthcare needs. Care coordination is one critical solution to addressing the substantial strain on families, local communities, and the larger healthcare system. The purpose of this study was to implement a care coordination program in an interdisciplinary pediatric neurodevelopmental evaluation clinic and examine care coordinator and caregiver outcomes. Following neurodevelopmental diagnosis, children were provided with either care coordination (CC) or care as usual (CAU). For those receiving CC, the care coordinator documented family goals and care coordination activities, outcomes, and time spent. Caregivers in both groups completed a survey measuring access to needed services and caregiver stress and empowerment following their child's evaluation (T1) and 4-6 months post-evaluation (T2). Care coordinator findings demonstrated that over 85% of family goals focused on understanding the child's diagnosis, getting needed interventions and educational support, and accessing healthcare financing programs. More than half of care coordination activities were spent on engaging and educating the family; similarly, the most time-consuming care coordination efforts were in helping families understand their child's diagnosis and meeting family's basic needs. For those children referred to needed services, 54% were enrolled in one or more service at T2. Caregivers in both the CC and CAU groups reported an increase in stress related to interactions with their child as well as increased empowerment from T1 to T2. Contrary to our hypotheses, there were no significant group-by-time interactions across caregiver-report measures. While these findings further our understanding of care coordination delivery, they diverge from previous evidence demonstrating care coordination efficacy. This study paves the way for future opportunities to evaluate what kinds of care coordination supports family need at varying times in their child's healthcare journey and how the outcomes important to all stakeholders are measured to reflect true evaluation of efficacy.
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Affiliation(s)
- Rebecca McNally Keehn
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Brett Enneking
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Margo Ramaker
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Michael Goings
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Ziyi Yang
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Aaron Carroll
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Mary Ciccarelli
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
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Crossen SS, Marcin JP, Qi L, Sauers-Ford HS, Reggiardo AM, Chen ST, Tran VA, Glaser NS. Home Visits for Children and Adolescents with Uncontrolled Type 1 Diabetes. Diabetes Technol Ther 2020; 22:34-41. [PMID: 31448952 PMCID: PMC6945797 DOI: 10.1089/dia.2019.0214] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: Home-based video visits were provided over one year as a supplement to in-person care for pediatric type 1 diabetes (T1D) patients with suboptimal glycemic control. We hypothesized that the intervention would be feasible and satisfactory for the target population and would significantly improve hemoglobin A1c (HbA1c) levels and completion of recommended quarterly diabetes clinic visits. Methods: This was a nonrandomized clinical trial. Fifty-seven patients aged 3-17 years with known T1D and HbA1c ≥8% (64 mmol/mol) were recruited to receive the intervention. The study population was 49% adolescent (13-17 years old) and 58% publicly insured patients. Video visits were scheduled every 4, 6, or 8 weeks depending on the HbA1c level. HbA1c levels as well as frequencies of clinic visits and of diabetes-related emergency department (ED) and hospital encounters were compared before and after the study. Results: Thirty participants completed 12 months of video visits. The study cohort demonstrated significant improvement in mean HbA1c in both intention-to-treat (N = 57) analysis (10.8% [95 mmol/mol] to 10.0% [86 mmol/mol], P = 0.01) and per-protocol (N = 30) analysis (10.8% [95 mmol/mol] to 9.6% [81 mmol/mol], P = 0.004). Completion of ≥4 annual diabetes clinic visits improved significantly from 21% at baseline to 83% during the study period for the entire cohort, P < 0.0001. The frequency of diabetes-related ED and hospital encounters did not change significantly. Conclusions: Home-based video visits are a feasible supplement to in-person care for children and adolescents with T1D and suboptimal glycemic control and can successfully improve HbA1c levels and adherence to recommended frequency of care in this high-risk clinical population.
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Affiliation(s)
- Stephanie S. Crossen
- Department of Pediatrics, University of California, Davis Health System, Sacramento, California
- Address correspondence to: Stephanie S. Crossen, MD, MPH, Department of Pediatrics, UC Davis Health, 2516 Stockton Boulevard, Sacramento, CA 95817
| | - James P. Marcin
- Department of Pediatrics, University of California, Davis Health System, Sacramento, California
| | - Lihong Qi
- Department of Public Health Sciences, University of California, Davis, Davis, California
| | - Hadley S. Sauers-Ford
- Department of Pediatrics, University of California, Davis Health System, Sacramento, California
| | - Allison M. Reggiardo
- Department of Pediatrics, University of California, Davis Health System, Sacramento, California
| | - Shelby T. Chen
- Department of Pediatrics, University of California, Davis Health System, Sacramento, California
| | - Victoria A. Tran
- Department of Pediatrics, University of California, Davis Health System, Sacramento, California
| | - Nicole S. Glaser
- Department of Pediatrics, University of California, Davis Health System, Sacramento, California
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19
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Watson D, Nickel A. Analysis of longitudinal adherence data: Hitting the target with consistency. Stat Med 2019; 38:5259-5267. [PMID: 31578737 DOI: 10.1002/sim.8369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/02/2019] [Accepted: 08/20/2019] [Indexed: 11/11/2022]
Abstract
Typical descriptions of partial adherence summarize to what extent a patient follows a prescribed treatment plan. Another aspect of adherence relates to how consistently a patient behaves. We distinguish these two notions as "adherence target" and "adherence consistency." Most research on adherence focuses on the former concept, but the latter can be a useful idea in assessing patients' compliance. Quantifying these two notions goes beyond typical summaries of center and spread, because they may be related to each other. That is, the mean is often related to the standard deviation via the variance function. Our approach defines a parameter that measures consistency separate from the adherence target. For exponential dispersion or quasi-likelihood families, the parameter corresponds to the dispersion parameter. Assessing adherence consistency to medical treatment requires longitudinal data, which can be collected with new technology. Two examples from pediatric medicine demonstrate that detangling the notion of consistency from the adherence target is useful.
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Affiliation(s)
- David Watson
- Design and Analytics, Children's Minnesota Research Institute, Minneapolis, Minnesota
| | - Amanda Nickel
- Design and Analytics, Children's Minnesota Research Institute, Minneapolis, Minnesota
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Thomas DM, Lipsky LM, Liu A, Nansel TR. Income Relates to Adherence in Youth with Type 1 Diabetes Through Parenting Constructs. J Dev Behav Pediatr 2019; 39:508-515. [PMID: 29782387 PMCID: PMC6059984 DOI: 10.1097/dbp.0000000000000579] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Informed by the family stress and family investment models, this study investigated whether income is indirectly related to adherence and glycemic control through parenting constructs among youth with type 1 diabetes (TID). METHODS Youth and their families (n = 390) from 4 geographically dispersed pediatric endocrinology clinics in the United States were participants in a multisite clinical trial from 2006 to 2009 examining the efficacy of a clinic-integrated behavioral intervention targeting family disease management for youth with TID. Baseline data were collected from youth aged 9 to 14 years and their parents. Parents reported family income and completed a semistructured interview assessing diabetes management adherence. Parents and children reported diabetes-specific parent-child conflict. Children completed measures of collaborative parent involvement and authoritative parenting. Hemoglobin A1c (HbA1c), a biomarker of glycemic control, was analyzed centrally at a reference laboratory. The relations of income, parenting variables, regimen, adherence, and HbA1c were examined using structural equation modeling. RESULTS Lower family income was associated with greater parent-child conflict and a less authoritative parenting style. Authoritative parenting was associated with more collaborative parent involvement and less parent-child conflict, both of which were associated with greater adherence, which was associated with more optimal glycemic control (p < 0.05 all associations). Indirect effects of family income on adherence and glycemic control through parenting constructs were significant (p < 0.001). CONCLUSION Findings lend support for the family stress and family investment models, suggesting that lower family income may negatively impact parent-child constructs, with adverse effects on diabetes management.
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Affiliation(s)
- Dexter M. Thomas
- Division of Intramural Population Health Research, Health Behavior Branch (DMT, LML, TRN), Biostatistics and Bioinformatics Branch (AL), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Leah M. Lipsky
- Division of Intramural Population Health Research, Health Behavior Branch (DMT, LML, TRN), Biostatistics and Bioinformatics Branch (AL), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Aiyi Liu
- Division of Intramural Population Health Research, Health Behavior Branch (DMT, LML, TRN), Biostatistics and Bioinformatics Branch (AL), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Tonja R. Nansel
- Division of Intramural Population Health Research, Health Behavior Branch (DMT, LML, TRN), Biostatistics and Bioinformatics Branch (AL), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
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Bergloff A, Stratton E, Briggs Early K. A Cross-Sectional Pilot Survey of Rural Clinic Attitudes and Proficiency with Insulin Pumps and Continuous Glucose Monitoring Devices. Diabetes Technol Ther 2019; 21:665-670. [PMID: 31339738 DOI: 10.1089/dia.2019.0161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Purpose: To examine the perceptions, proficiencies, and barriers of diabetes device use among rural clinic providers. Methods: A total of 210 surveys were sent through e-mail and/or U.S. Postal Service to rural clinics throughout Alaska, Idaho, Montana, Oregon, Washington, and Utah based on discussions with rural clinic network leadership in the states. Responses were included if the participant was 18 years of age and older, and worked at a rural clinic as a physician, physician assistant, nurse, nurse practitioner, allied health worker, or clinic manager. Results: Respondents included clinic management (13%), midlevel providers (physician assistants and nurse practitioners) and allied health workers (pharmacists, dietitians, and social workers, 30.8%), nurses (30.8%), and physicians (23.1%). We had a low response rate (20%; n = 41), but of those who said they work with patients who have diabetes, only 47.4% indicated that they use diabetes devices as part of their patients' treatment. The most common barrier reported among respondents suggested that additional medical team expertise is needed in their community or clinic to adopt insulin pumps and/or continuous glucose monitoring for qualified patients (75.9% and 80.8%, respectively). Conclusion: Lack of provider experience and having patients managed by out-of-area experts were the biggest reasons for providers not seeing or managing patients using these devices. Lack of provider access, patient satisfaction with current diabetes regimens, unsupportive health care team, patient literacy, and patient fear showed limited to negligible endorsements from survey respondents. A variety of potential solutions to this problem of limited provider experience and training are also offered.
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Affiliation(s)
- Andrew Bergloff
- College of Osteopathic Medicine, Pacific Northwest University of Health Sciences (PNWU), Yakima, Washington
| | - Emily Stratton
- Emergency Medicine, SUNY Upstate Medical University, Syracuse, New York
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Hospital-based home care for young children newly diagnosed with type 1 diabetes: Assessing expectations and obstacles in families and general practitioners. Arch Pediatr 2019; 26:324-329. [PMID: 31500922 DOI: 10.1016/j.arcped.2019.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/19/2019] [Accepted: 08/02/2019] [Indexed: 11/21/2022]
Abstract
AIMS This study aimed to evaluate whether hospital-based home care was desired by the parents of children diagnosed with type 1 diabetes (T1D) under the age of 5 years and their general practitioners, and to identify the main expectations and obstacles to its implementation. METHODS This descriptive bicentric study in France was performed between November 2016 and November 2017. Data were collected by interviewing 57 families of children diagnosed with diabetes before the age of 5 years and the corresponding 30 general practitioners. The primary endpoint was the families' or general practitioners' acceptance of home-based care after diagnosis. RESULTS A high proportion of families and physicians (86% and 93%, respectively) expressed a wish for hospital-based home care, most of whom considered it essential (79% and 87%, respectively). Low-income families were less likely to accept this care pathway (P<0.001). The families' expectations regarding home care were help with social care, the management of emergencies, and return to school. The physicians' main request was improved interprofessional collaboration. CONCLUSION Hospital-based home care seems to be an acceptable transition after conventional care for children just diagnosed with T1D. Multidisciplinary support, personalized social care, and access to welfare benefits may improve acceptance rates, especially among low-income families.
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Gandrud L, Altan A, Buzinec P, Hemphill J, Chatterton J, Kelley T, Vojta D. Intensive remote monitoring versus conventional care in type 1 diabetes: A randomized controlled trial. Pediatr Diabetes 2018; 19:1086-1093. [PMID: 29464831 DOI: 10.1111/pedi.12654] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 12/22/2017] [Accepted: 01/24/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE While frequent contact with diabetes care providers may improve glycemic control among patients with type 1 diabetes (T1D), in-person visits are labor-intensive and costly. This study was conducted to assess the impact of an intensive remote therapy (IRT) intervention for pediatric patients with T1D. METHODS Pediatric patients with T1D were randomized to IRT or conventional care (CC) for 6 months. Both cohorts continued routine quarterly clinic visits and uploaded device data; for the IRT cohort, data were reviewed and patients were contacted if regimen adjustments were indicated. Glycated hemoglobin (HbA1c) change from baseline was assessed at 6 and 9 months. Diabetes-related quality of life (QoL), healthcare services utilization, and hypoglycemic events were also tracked. RESULTS Among 117 enrollees (60 IRT, 57 CC), mean (SD) 6-month %HbA1c change for IRT vs CC was -0.34 (0.85) (-3.7 mmol/mol) vs -0.05 (0.74) (-0.5 mmol/mol) overall (P = .071); -0.15 (0.67) (1.6 mmol/mol) vs -0.02 (0.66) (0.2 mmol/mol) for ages 8 to 12 (P = .541); and -0.50 (0.95) (-5.5 mmol/mol) vs -0.06 (0.80) (-0.7 mmol/mol) for ages 13 to 17 (P = .056). Diabetes-related QoL increased by 6.5 and 1.3 points for IRT and CC, respectively (P = .062). Three months after intervention cessation, %HbA1c changed minimally among treated children aged 8 to 12 but increased by 0.22 (0.89) (2.4 mmol/mol) among those aged 13 to 17. CONCLUSIONS IRT substantially affected diabetes metrics and improved QoL among pediatric patients with T1D. Adolescents experienced a stronger treatment effect, but had difficulty in sustaining improved control after intervention cessation.
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Affiliation(s)
| | | | | | | | | | - Tina Kelley
- UnitedHealth Group Research & Development, Minnetonka, Minnesota
| | - Deneen Vojta
- UnitedHealth Group Research & Development, Minnetonka, Minnesota
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Barry SA, Teplitsky L, Wagner DV, Shah A, Rogers BT, Harris MA. Partnering with Insurers in Caring for the Most Vulnerable Youth with Diabetes: NICH as an Integrator. Curr Diab Rep 2017; 17:26. [PMID: 28321766 DOI: 10.1007/s11892-017-0849-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE OF REVIEW In this review, we outline barriers to appropriately caring for high-risk youth with diabetes and discuss efforts in partnering with insurers through Alternative Payment Models to achieve the Triple Aim (improved health, improved care, and reduced costs) for this population. RECENT FINDINGS Current approaches in caring for youth with diabetes who evidence a high degree of social complexity are woefully ineffective. These youth are vulnerable to repeat diabetic ketoacidosis episodes, poor glycemic control, and excessive utilization of healthcare resources. To effectively pursue the Triple Aim, an "integrator" (i.e., an entity that accepts responsibility for all components of the Triple Aim for a specified population) must be identified; however, this does not fit into current fee-for-service models. Integrators for youth with diabetes are limited, but early examples of integrator efforts are promising. We present one successful "integrator," Novel Interventions in Children's Healthcare (NICH), and detail this program's efforts in partnering with insurers to serve high-risk youth with diabetes.
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Affiliation(s)
- Samantha A Barry
- University of Massachusetts Medical Center, Diabetes Center of Excellence, UMass Medical School, 368 Plantation St., Worcester, MA, 01605, USA
| | - Lena Teplitsky
- Oregon Health & Science University OHSU, 707 SW Gaines Street, Portland, OR, 97239, USA
| | - David V Wagner
- Oregon Health & Science University OHSU, 707 SW Gaines Street, Portland, OR, 97239, USA
| | - Amit Shah
- CareOregon, 315 SW 5th Ave, Portland, OR, 97204, USA
| | - Brian T Rogers
- Oregon Health & Science University OHSU, 707 SW Gaines Street, Portland, OR, 97239, USA
| | - Michael A Harris
- Oregon Health & Science University OHSU, 707 SW Gaines Street, Portland, OR, 97239, USA.
- Harold Schnitzer Diabetes Health Center, Portland, OR, 97239, USA.
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Ye CY, Jeppson TC, Kleinmaus EM, Kliems HM, Schopp JM, Cox ED. Outcomes That Matter to Teens With Type 1 Diabetes. DIABETES EDUCATOR 2017; 43:251-259. [PMID: 28520550 DOI: 10.1177/0145721717699891] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Purpose The purpose of the study was to describe outcomes that matter to teens with type 1 diabetes. Understanding outcomes that matter to teens could support successful interventions to improve diabetes self-management. Methods Fifty publicly available posts published in the "teen" sections of 2 major diabetes online forums between 2011 and 2013 were analyzed using qualitative research methods. From each post, content and descriptive data (eg, duration of diabetes and age) were collected. Two members of the research team independently used open coding techniques to identify outcomes (defined as impacts or consequences of type 1 diabetes) and organized them into themes and subthemes. A codebook was jointly developed to facilitate the identification of meaningful outcomes from the posts. Results Teens' average age was 15.7 years, and the average time since diabetes diagnosis was 6.3 years. The 3 most commonly mentioned outcomes were (1) interactions with peers ("I want to talk to someone who understands"), (2) emotional well-being ("Diabetes makes me want to cry"), and (3) blood glucose management ("My blood sugar never goes down"). Other identified outcomes included (4) physical well-being, (5) education and motivation of others, (6) family interactions, (7) academic achievement, and (8) interactions with important others such as teachers. Conclusions While teens are concerned about control of their blood glucose, there are many other outcomes that matter to them. Health care providers and diabetes educators may want to consider these other outcomes when motivating teens with type 1 diabetes to improve blood glucose control.
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Affiliation(s)
- Clara Y Ye
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (Ms Ye, Mr Jeppson, Ms Kleinmaus, Mr Kliems, Ms Schopp, Dr Cox)
| | - Thor C Jeppson
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (Ms Ye, Mr Jeppson, Ms Kleinmaus, Mr Kliems, Ms Schopp, Dr Cox)
| | - Ellen M Kleinmaus
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (Ms Ye, Mr Jeppson, Ms Kleinmaus, Mr Kliems, Ms Schopp, Dr Cox)
| | - Harald M Kliems
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (Ms Ye, Mr Jeppson, Ms Kleinmaus, Mr Kliems, Ms Schopp, Dr Cox)
| | - Jennifer M Schopp
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (Ms Ye, Mr Jeppson, Ms Kleinmaus, Mr Kliems, Ms Schopp, Dr Cox)
| | - Elizabeth D Cox
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (Ms Ye, Mr Jeppson, Ms Kleinmaus, Mr Kliems, Ms Schopp, Dr Cox)
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Raphael JL, Cooley WC, Vega A, Kowalkowski MA, Tran X, Treadwell J, Giardino AP, Giordano TP. Outcomes for Children with Chronic Conditions Associated with Parent- and Provider-reported Measures of the Medical Home. J Health Care Poor Underserved 2016; 26:358-76. [PMID: 25913335 DOI: 10.1353/hpu.2015.0051] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE Assess relationships between having a patient-centered medical home (PCMH) and health care utilization among low-income children with chronic conditions using parent and practice perspectives. METHODS We analyzed data from 240 publicly insured children with chronic conditions. Parents completed surveys assessing PCMH access and their child's primary care practice completed the Medical Home Index (MHI) self-assessment. Multivariate negative binomial analyses were conducted to investigate relationships between PCMH and service use. RESULTS Parent-report of a usual source of care was associated with lower rates of emergency care (ED) encounters and hospitalizations. Practice report of higher organizational capacity (e.g., communication, staff education) was associated with lower rates of ED visits and hospitalizations. Parent report of a PCMH was positively associated with practice MHI score. CONCLUSIONS Among low-income children with chronic conditions, having a usual source of care and higher quality organizational capacity were associated with lower rates of ED visits and hospitalizations.
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Blake H, Quirk H, Leighton P, Randell T, Greening J, Guo B, Glazebrook C. Feasibility of an online intervention (STAK-D) to promote physical activity in children with type 1 diabetes: protocol for a randomised controlled trial. Trials 2016; 17:583. [PMID: 27931254 PMCID: PMC5146845 DOI: 10.1186/s13063-016-1719-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 11/22/2016] [Indexed: 01/02/2023] Open
Abstract
Background Regular physical activity has important health benefits for children with type 1 diabetes mellitus (T1DM), yet children and their parents face barriers to participation such as lack of self-efficacy or concerns around hypoglycaemia. Multimedia interventions are useful for educating children about their health and demonstrate potential to improve children’s health-related self-efficacy, but few paediatric clinics offer web-based resources as part of routine care. The Steps to Active Kids with Diabetes (STAK-D) programme is an online intervention grounded in psychological theory (social cognitive theory) and informed by extensive preliminary research. The aim of the programme is to encourage and support safe engagement with physical activity for children with T1DM. The aim of this research is to explore the feasibility of delivering the STAK-D programme to children aged 9–12 years with T1DM, and to assess the feasibility of further research to demonstrate its clinical and cost-effectiveness. Methods Up to 50 children aged 9–12 years with T1DM and their parents will be recruited from two paediatric diabetes clinics in the UK. Child-parent dyads randomised to the intervention group will have access to the intervention website (STAK-D) and a wrist-worn activity monitor for 6 months. The feasibility of intervention and further research will be assessed by rate of recruitment, adherence, retention, data completion and adverse events. Qualitative interviews will be undertaken with a subsample of children and parents (up to 25 dyads) and health care professionals (up to 10). Health outcomes and the feasibility of outcome measurement tools will be assessed. These include self-efficacy (CSAPPA), objective physical activity, self-reported physical activity (PAQ), fear of hypoglycaemia (CHFS; PHFS), glycaemic control (HbA1c), insulin dose, Body Mass Index (BMI), health-related quality of life (CHU9D; CHQ-PF28), health service use and patient-clinician communication. Assessments will be taken at baseline (T0), 8 weeks (T1) and at 6-month follow-up (T2). Discussion The goal of this feasibility trial is to assess the delivery of STAK-D to promote physical activity among children with T1DM, and to assess the potential for further, definitive research to demonstrate its effectiveness. Results will provide the information necessary to design a larger randomised controlled trial and maximise the recruitment rate, intervention delivery and trial retention. Trial registration ISRCTN, ISRCTN48994721. Registered on 28 October 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1719-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Holly Blake
- University of Nottingham School of Health Sciences, A Floor, Queen's Medical Centre, Nottingham, NG7 2HA, UK.
| | - Helen Quirk
- University of Nottingham School of Health Sciences, A Floor, Queen's Medical Centre, Nottingham, NG7 2HA, UK
| | - Paul Leighton
- University of Nottingham School of Medicine, C Floor, South Block, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Tabitha Randell
- Department of Paediatric Endocrinology and Diabetes, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - James Greening
- Children's Hospital, Leicester Royal Infirmary, Children's Diabetes and Endocrinology, Infirmary Square, Leicester, LE1 5WW, UK
| | - Boliang Guo
- Institute of Mental Health, Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
| | - Cris Glazebrook
- Institute of Mental Health, B Floor, Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
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Jönsson L, Lundqvist P, Hallström I. Parents HRQOL, Their Satisfaction with Care, and Children Over the Age of Eight’s Experiences of Family Support Two Years Subsequent to the Child’s Diagnosis with Type 1 Diabetes. Compr Child Adolesc Nurs 2016. [DOI: 10.1080/24694193.2016.1241837] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Miller JE, Nugent CN, Russell LB. How Much Time Do Families Spend on the Health Care of Children with Diabetes? Diabetes Ther 2016; 7:497-509. [PMID: 27350546 PMCID: PMC5014787 DOI: 10.1007/s13300-016-0181-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Family time caring for children with diabetes is an overlooked component of the overall burden of the condition. We document and analyze risk factors for time family members spend providing health care at home and arranging/coordinating health care for children with diabetes. METHODS Data for 755 diabetic children and 16,161 non-diabetic children whose chronic conditions required only prescription (Rx) medication were from the 2009-2010 United States National Survey of Children with Special Health Care Needs (NS-CSHCN). We used generalized ordered logistic regressions to estimate adjusted odds ratios (AORs) of time burden by diabetes, insulin use, and stability of the child's health care needs, controlling for health and socioeconomic status. RESULTS Nearly one-quarter of diabetic children had family members who spent 11+ h/week providing health care at home, and 8% spent 11+ h/week arranging/coordinating care, compared with 3.3% and 1.9%, respectively, of non-diabetic Rx-only children. Time providing care at home for insulin-using children was concentrated in the higher time categories: AORs for insulin-using diabetic compared to non-diabetic Rx-only children were 4.4 for 1+ h/week compared with <1 h/week, 9.7 for 6+ vs. <6 h, and 12.4 for 11+ vs. <11 h (all P < 0.05); the pattern was less pronounced for non-insulin-using children. AORs for arranging/coordinating care did not vary by time contrast: AOR = 4.2 for insulin-using, 3.0 for non-insulin-using children. CONCLUSION Health care providers, school personnel, and policymakers need to work with family members to improve care coordination and identify other ways to reduce family time burdens caring for children with diabetes.
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Affiliation(s)
- Jane E Miller
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA
- Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ, USA
| | - Colleen N Nugent
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA.
| | - Louise B Russell
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA
- Department of Economics, Rutgers University, New Brunswick, NJ, USA
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Kassahun T, Gesesew H, Mwanri L, Eshetie T. Diabetes related knowledge, self-care behaviours and adherence to medications among diabetic patients in Southwest Ethiopia: a cross-sectional survey. BMC Endocr Disord 2016; 16:28. [PMID: 27381349 PMCID: PMC4933997 DOI: 10.1186/s12902-016-0114-x] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 05/26/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The provision of health education involving self-care and good adherence to medications has been acknowledged to be a cost effective strategy for improving quality of life of diabetes patients. We assessed levels of knowledge about type 2 diabetes mellitus (T2DM), self-care behaviours and adherence to medication among DM patients. METHODS A facility based cross-sectional survey of 325 adults with T2DM patients attending Jimma University Teaching Hospital, Southwest Ethiopia was conducted. We used diabetes Knowledge Test, Expanded Version of the Summary of Diabetes Self-Care Activities and Morisky 8-Item medication adherence as tools to measure diabetic knowledge, self-care behaviours and adherence to medications respectively. Multinomial logistic regression analyses were used to assess the independent predictors of diabetes knowledge and adherence to medications. The binary logistic regression was applied for self-care behaviours. RESULTS 309 respondents were included in the survey. Of all the respondents, 44.9 %, 20.1 % and 34.9 % had low, medium and high level diabetic knowledge respectively. High level of diabetic knowledge was the reference group. Being illiterate (AOR = 3.1, 95%CI: 1.03-9.3), having BMI <18 kg/m(2) (AOR = 6.4, 95%CI: 1.2-34.9) and duration of DM < 5 years (AOR = 4.2, 95%CI: 1.9-9.5) were significantly associated with low level of diabetic knowledge. T2DM patients who practiced good self-care (AOR = 0.5, 95%CI: 0.3-0.9) were less likely to have low knowledge. Duration of DM < 5 years (AOR = 9.8, 95%CI: 3.2-30.2) was significantly associated with medium level of diabetic knowledge. 157(50.8 %) patients had poor self-care behaviour and this was associated with level of education and adherence to medication. The proportions of patients with low, medium and high adherence to medication were 24.9 %, 37.9 % and 37.2 % respectively. Being a merchant, having medium level of diabetic knowledge and having good glycemic control level were associated with low adherence to medications. CONCLUSIONS Significant number of DM patients had low level of knowledge, poor self-care behaviours and low level of adherence to medications. These findings call for the need of integrated interventional management on diabetic knowledge, self-care behaviours and adherence to medications. To ensure effective T2DM management, a strategic approach that improves health literacy could be a cross cutting intervention.
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Affiliation(s)
| | - Hailay Gesesew
- Department of Epidemiology, College of Health Sciences, Jimma University, Jimma, Ethiopia.
- Discipline of Public Health, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, Australia.
| | - Lillian Mwanri
- Discipline of Public Health, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Tesfahun Eshetie
- Department of Clinical Pharmacy, College of Health Sciences, Jimma University, Jimma, Ethiopia
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Herbert LJ, Wall K, Monaghan M, Streisand R. Parent Employment and School/Daycare Decisions among Parents of Young Children with Type 1 Diabetes. CHILDRENS HEALTH CARE 2016; 46:170-180. [PMID: 30906103 DOI: 10.1080/02739615.2015.1124776] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study explored the employment and school/daycare experiences of parents of young children with type 1 diabetes (T1D). Parents (n=134) of young children with T1D (ages 1-6) responded to open-ended questions. Responses were systematically reviewed to identify themes. Four parent employment themes were identified: work cessation/reduction, employment flexibility, significant career impact, and financial pressure. Three school/daycare attendance themes were identified: school/daycare structure and setting, previous experience with T1D, and school/daycare importance. Insulin regimen, child age, and family income were related to parents' decisions. Parents may benefit from clinical programs that assist them with employment and school/daycare decisions.
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Affiliation(s)
- Linda J Herbert
- Division of Psychology and Behavioral Health, Center for Translational, Science, Children's National Health System, 111 Michigan Ave NW, Washington, DC 20010,
| | - Katheryne Wall
- Center for Translational Science, Children's National Health System, 111 Michigan Ave NW, Washington, DC 20010,
| | - Maureen Monaghan
- Division of Psychology and Behavioral Health, Center for Translational Science, Children's National Health System, 111 Michigan Ave NW, Washington, DC 20010,
| | - Randi Streisand
- Division of Psychology and Behavioral Health, Center for Translational Science, Children's National Health System, 111 Michigan Ave NW, Washington, DC 20010,
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Zajicek-Farber ML, Lotrecchiano GR, Long TM, Farber JM. Parental Perceptions of Family Centered Care in Medical Homes of Children with Neurodevelopmental Disabilities. Matern Child Health J 2016; 19:1744-55. [PMID: 25724538 DOI: 10.1007/s10995-015-1688-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Life course theory sets the framework for strong inclusion of family centered care (FCC) in quality medical homes of children with neurodevelopmental disabilities (CNDD). The purpose of this study was to explore the perceptions of families with their experiences of FCC in medical homes for CNDD. Using a structured questionnaire, the Family-Centered Care Self-Assessment Tool developed by Family Voices, this study surveyed 122 parents of CNDD in a large urban area during 2010-2012. Data collected information on FCC in the provision of primary health care services for CNDD and focused on family-provider partnerships, care setting practices and policies, and community services. Frequency analysis classified participants' responses as strengths in the "most of the time" range, and weaknesses in the "never" range. Only 31 % of parents were satisfied with the primary health care their CNDD received. Based on an accepted definition of medical home services, 16 % of parents reported their CNDD had most aspects of a medical home, 64 % had some, and 20 % had none. Strengths in FCC were primarily evident in the family-provider partnership and care settings when focused on meeting the medical care needs of the child. Weaknesses in FCC were noted in meeting the needs of families, coordination, follow-up, and support with community resources. Improvements in key pediatric health care strategies for CNDD are recommended. CNDD and their families have multifaceted needs that require strong partnerships among parents, providers, and communities. Quality medical homes must include FCC and valued partnerships with diverse families and community-based providers.
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Affiliation(s)
- Michaela L Zajicek-Farber
- National Catholic School of Social Service (NCSSS), The Catholic University of America (CUA), Shahan Hall #112, 620 Michigan Ave., NE, Washington, DC, 20064, USA,
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Sanjari M, Peyrovi H, Mehrdad N. Managing children with diabetes within the family: Entering into the Diabetes Orbit. J Diabetes Metab Disord 2016; 15:7. [PMID: 26998445 PMCID: PMC4797217 DOI: 10.1186/s40200-016-0228-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 03/06/2016] [Indexed: 02/07/2023]
Abstract
Background Diabetes is the disease of family and parents of children with diabetes face different problems which concerns meeting the developmental needs of children and daily control of children with diabetes. This article aims to explain how to manage diabetes around the child’s life within the family. Methods In this qualitative study, data was collected through semi-structured interview technique and was analyzed using Grounded Theory approach. The process of data collection was carried out by purposeful sampling. The participants included 13 individuals from nine families (11 parents and two children with diabetes). The research environment was health centers in Iran providing care to the families of children with diabetes. Data analysis was performed using Corbin and Strauss approach. Data was analyzed with using MAXQDA software (version 10). Results The core category of “Entering into the Orbit of Diabetes” addresses the story of how to keep track of managing children with diabetes within the family which included Main categories “bitter taste of sugar”, “drawing coordinates of diabetes”, and “taking control of diabetes”. Conclusion The outcome of “enter into the orbit of diabetes” results capturing the control of diabetes. The findings of the present study may play an integral part to help households with practicing appropriate strategies for the management of children with diabetes.
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Affiliation(s)
- Mahnaz Sanjari
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran ; Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Peyrovi
- Nursing Care Research Center, Department of Critical Care Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Neda Mehrdad
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran ; Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Katz ML, Volkening LK, Dougher CE, Laffel LMB. Validation of the Diabetes Family Impact Scale: a new measure of diabetes-specific family impact. Diabet Med 2015; 32:1227-31. [PMID: 25655562 PMCID: PMC4500735 DOI: 10.1111/dme.12689] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2015] [Indexed: 11/30/2022]
Abstract
AIMS To develop and validate the Diabetes Family Impact Scale, a scale to measure the impact of diabetes on families. METHODS The Diabetes Family Impact Scale was developed by an iterative process, with input from multidisciplinary diabetes providers and parents of children with Type 1 diabetes. The psychometric properties of the Diabetes Family Impact Scale were assessed in parents of children with Type 1 diabetes. This assessment included internal consistency, convergent validity and exploratory factor analysis. RESULTS Parents (n = 148) of children (mean ± sd age 12.9 ± 3.3 years) with Type 1 diabetes (mean ± sd duration 6.2 ± 3.6 years) completed the 15-item Diabetes Family Impact Scale. After eliminating one item, the 14-item measure demonstrated good internal consistency (Cronbach's α = 0.84). Correlations between the Diabetes Family Impact Scale and measures of parent diabetes burden (r = 0.48, P < 0.0001), stressful life events (r = 0.28, P = 0.0007), and child's quality of life (r = -0.52 and -0.54, P < 0.0001 for generic and diabetes-specific quality of life, respectively) supported the convergent validity of the instrument. Factor analysis identified four factors corresponding to the four survey domains (school, work, finances and family well-being). CONCLUSIONS The Diabetes Family Impact Scale measures diabetes-specific family impacts with good internal consistency and convergent validity and may be a useful tool in clinical and research settings.
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Affiliation(s)
- M L Katz
- Genetics and Epidemiology Section, Joslin Diabetes Center, Boston, MA, USA
- Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Boston, MA, USA
| | - L K Volkening
- Genetics and Epidemiology Section, Joslin Diabetes Center, Boston, MA, USA
| | - C E Dougher
- Genetics and Epidemiology Section, Joslin Diabetes Center, Boston, MA, USA
| | - L M B Laffel
- Genetics and Epidemiology Section, Joslin Diabetes Center, Boston, MA, USA
- Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Boston, MA, USA
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Boogerd EA, Maas-van Schaaijk NM, Noordam C, Marks HJG, Verhaak CM. Parents' experiences, needs, and preferences in pediatric diabetes care: Suggestions for improvement of care and the possible role of the Internet. A qualitative study. J SPEC PEDIATR NURS 2015; 20:218-29. [PMID: 26076888 DOI: 10.1111/jspn.12118] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 02/28/2015] [Accepted: 04/20/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate the needs and preferences of parents of children with type 1 diabetes (T1D) concerning pediatric diabetes care and use of Internet in care. DESIGN AND METHODS Parents of 34 children, aged 2-12, with T1D participated in seven focus group interviews. RESULTS Analysis revealed provision of tailored care, disease information, peer support, and accessibility of healthcare professionals as major needs in parents. Internet could be used to satisfy these needs. PRACTICAL IMPLICATIONS According to parents, diabetes teams should focus on the impact of the disease, parents' experience, and the child's development, and provide online professional and peer support.
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Affiliation(s)
- Emiel A Boogerd
- Department of Medical Psychology, Radboud university medical center, Nijmegen, the Netherlands
| | | | - Cees Noordam
- Department of Pediatrics, Radboud university medical center, Nijmegen, the Netherlands.,Children's Diabetes Center Nijmegen, Nijmegen, the Netherlands
| | - Hans J G Marks
- Department of Cultural Anthropology and Development Studies, Radboud University, Nijmegen, the Netherlands
| | - Chris M Verhaak
- Department of Medical Psychology, Radboud university medical center, Nijmegen, the Netherlands
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The Effect of Family-centered Care on Management of Blood Glucose Levels in Adolescents with Diabetes. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2015; 3:177-86. [PMID: 26171406 PMCID: PMC4495325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 04/11/2015] [Accepted: 04/20/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND Responsibility for diabetes management tasks must shift from caregivers to adolescents as adolescents grow older. Also, family-centered care is a way to provide efficient care for them at home. This study aimed to identify the effect of family-centered care on management of blood glucose levels in adolescents with type 1 diabetes mellitus (T1DM). METHODS This is a Pre-experimental study with a pre- and post-test design. The participants consisted of forty adolescents with T1DM, aged between 10-14 years, with their caregivers who were selected through simple random sampling from Hamadan Diabetes Research Center in Iran in 2013. The sample was divided into four similar groups. Educational sessions were conducted for each group for 30 to 40 minutes. Data collection tools were "Supervisory Behaviors of Caregiver" (SBC), "Management Behaviors of adolescents" (MBA) questionnaires, and the "Blood Glucose Levels Record Sheet". Data were analyzed using SPSS 19 and based on descriptive statistics, Kolmogorov-Smirnov, paired t-test and Pearson coefficient. RESULTS There was a significant difference between the subjects' MBA and SBC mean scores before (110.17±26.6) and after (134.6±1.28) intervention in four domains: "blood glucose testing", "insulin therapy", "meal plan" and "physical activity" (P<0.001). There were significant differences between the mean levels of recorded blood glucose during a week before and after intervention and between the mean levels of Glycated Hemoglobin level (HbA1c) before (8.4±1.12) and three months after (7.78±1.2) it (P<0.001). Pearson coefficient showed a positive relationship between the supervisory behaviors of caregivers with management behaviors of adolescents before and after the intervention (P<0.001). CONCLUSION Empowering adolescents with T1DM and their caregivers in home-centered care could improve diabetic adolescents' management of blood glucose levels and reduce their HbA1Clevels. Therefore, Family-centered care could provide for better regime adherence at home.
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Looman WS, Antolick M, Cady RG, Lunos SA, Garwick AE, Finkelstein SM. Effects of a Telehealth Care Coordination Intervention on Perceptions of Health Care by Caregivers of Children With Medical Complexity: A Randomized Controlled Trial. J Pediatr Health Care 2015; 29:352-63. [PMID: 25747391 PMCID: PMC4478110 DOI: 10.1016/j.pedhc.2015.01.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 01/16/2015] [Accepted: 01/21/2015] [Indexed: 01/17/2023]
Abstract
INTRODUCTION The purpose of this study was to evaluate the effect of advanced practice registered nurse (APRN) telehealth care coordination for children with medical complexity (CMC) on family caregiver perceptions of health care. METHOD Families with CMC ages 2 to 15 years (N = 148) were enrolled in a three-armed, 30-month randomized controlled trial to test the effects of adding an APRN telehealth care coordination intervention to an existing specialized medical home for CMC. Satisfaction with health care was measured using items from the Consumer Assessment of Healthcare Providers and Systems survey at baseline and after 1 and 2 years. RESULTS The intervention was associated with higher ratings on measures of the child's provider, provider communication, overall health care, and care coordination adequacy, compared with control subjects. Higher levels of condition complexity were associated with higher ratings of overall health care in some analyses. DISCUSSION APRN telehealth care coordination for CMC was effective in improving ratings of caregiver experiences with health care and providers. Additional research with CMC is needed to determine which children benefit most from high-intensity care coordination.
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Miller JE, Nugent CN, Russell LB. Risk factors for family time burdens providing and arranging health care for children with special health care needs: Lessons from nonproportional odds models. SOCIAL SCIENCE RESEARCH 2015; 52:602-14. [PMID: 26004483 DOI: 10.1016/j.ssresearch.2015.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 02/17/2015] [Accepted: 04/03/2015] [Indexed: 05/26/2023]
Abstract
We identify need, enabling, and predisposing factors for high family time burdens associated with the health care of chronically-ill children, using data from the U.S. 2009-2010 National Survey of Children with Special Health Care Needs (NS-CSHCN), a population-based survey of 40,242 children with special health care needs (CSHCN). We estimate generalized ordered logistic multivariable regressions of time spent (1) providing health care for the child at home, (2) arranging/coordinating health care, and (3) combined time. Factors associated with higher time burdens included child's functional limitations, severe or unstable health conditions, public health insurance, lack of a medical home, low family income, low adult education, and non-white race. Nonproportional odds models revealed associations between risk factors and time burden that were obscured by binary and standard ordered logistic models. Clinicians and policymakers can use this information to design interventions to alleviate this important family stressor.
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Affiliation(s)
- Jane E Miller
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, 112 Paterson Street, New Brunswick, NJ 08901, USA; Bloustein School of Planning and Public Policy, Rutgers University, 33 Livingston Avenue, New Brunswick, NJ 08901, USA.
| | - Colleen N Nugent
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, 112 Paterson Street, New Brunswick, NJ 08901, USA
| | - Louise B Russell
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, 112 Paterson Street, New Brunswick, NJ 08901, USA; Department of Economics, Rutgers University, 75 Hamilton Street, New Brunswick, NJ 08901, USA
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Kobos E, Imiela J. Factors affecting the level of burden of caregivers of children with type 1 diabetes. Appl Nurs Res 2015; 28:142-9. [DOI: 10.1016/j.apnr.2014.09.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 09/11/2014] [Accepted: 09/19/2014] [Indexed: 11/26/2022]
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Miller JE, Nugent CN, Russell LB. Which components of medical homes reduce the time burden on families of children with special health care needs? Health Serv Res 2015; 50:440-61. [PMID: 25100200 PMCID: PMC4369217 DOI: 10.1111/1475-6773.12215] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To examine which components of medical homes affect time families spend arranging/coordinating health care for their children with special health care needs (CSHCNs) and providing health care at home. DATA SOURCES 2009-2010 National Survey of Children with Special Health Care Needs (NS-CSHCN), a population-based survey of 40,242 CSHCNs. STUDY DESIGN NS-CSHCN is a cross-sectional, observational study. We used generalized ordered logistic regression, testing for nonproportional odds in the associations between each of five medical home components and time burden, controlling for insurance, child health, and sociodemographics. DATA COLLECTION/EXTRACTION METHODS Medical home components were collected using Child and Adolescent Health Measurement Initiative definitions. PRINCIPAL FINDINGS Family-centered care, care coordination, and obtaining needed referrals were associated with 15-32 percent lower odds of time burdens arranging/coordinating and 16-19 percent lower odds providing health care. All five components together were associated with lower odds of time burdens, with greater reductions for higher burdens providing care. CONCLUSIONS Three of the five medical home components were associated with lower family time burdens arranging/coordinating and providing health care for children with chronic conditions. If the 55 percent of CSHCNs lacking medical homes had one, the share of families with time burdens arranging care could be reduced by 13 percent.
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Affiliation(s)
- Jane E Miller
- Address correspondence to Jane E. Miller, Ph.D., Institute for Health, Health Care Policy, and Aging Research, and the Bloustein School of Planning and Public Policy, Rutgers University, 112 Paterson Street, New Brunswick, NJ 08901; e-mail:
| | - Colleen N Nugent
- Jane E. Miller, Ph.D., is also with the Bloustein School of Planning and Public PolicyNew Brunswick, NJ
- Colleen N. Nugent, Ph.D., and Louise B. Russell, Ph.D., are with the Institute for Health, Health Care Policy, and Aging Research, Rutgers UniversityNew Brunswick, NJ
- Louise B. Russell, Ph.D., is also with the Department of Economics, Rutgers UniversityNew Brunswick, NJ
| | - Louise B Russell
- Jane E. Miller, Ph.D., is also with the Bloustein School of Planning and Public PolicyNew Brunswick, NJ
- Colleen N. Nugent, Ph.D., and Louise B. Russell, Ph.D., are with the Institute for Health, Health Care Policy, and Aging Research, Rutgers UniversityNew Brunswick, NJ
- Louise B. Russell, Ph.D., is also with the Department of Economics, Rutgers UniversityNew Brunswick, NJ
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Nansel T, Haynie D, Lipsky L, Mehta S, Laffel L. Little variation in diet cost across wide ranges of overall dietary quality among youth with type 1 diabetes. J Acad Nutr Diet 2015; 115:433-439.e1. [PMID: 25266245 PMCID: PMC4344866 DOI: 10.1016/j.jand.2014.07.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 07/24/2014] [Indexed: 11/22/2022]
Abstract
We examined the association of diet quality with diet cost in a sample of youth with type 1 diabetes, for whom diet is an important component of medical management. Differences in food group spending by diet quality were also examined to identify potential budgetary reallocation to improve overall diet quality. Families of 252 youth with type 1 diabetes aged 8 to 18 years completed 3-day youth diet records. Cost of each food reported was calculated based on the average price obtained from two online grocery stores. Diet cost was estimated as average daily cost of foods consumed. The Healthy Eating Index 2005 (HEI2005), Nutrient Rich Foods Index version 9.3, and Whole Plant Food Density scores were evaluated. Differences in mean daily diet cost across tertiles of HEI2005, Nutrient Rich Foods Index version 9.3, and Whole Plant Food Density were modest, with none reaching statistical significance. Those in the upper tertile of HEI2005 spent more on whole fruit, whole grains, lean meat, and low-fat dairy, and less on high-fat meat and high-fat dairy compared with those in the lower tertiles. Higher-quality diets can be obtained at comparable costs to lesser-quality diets, suggesting that cost need not be an insurmountable barrier to more healthful eating. Reallocation of spending may increase overall quality without substantially increasing overall spending. Findings suggest potential strategies for assisting families of youth with type 1 diabetes in identifying cost-effective ways to achieve a more healthful diet.
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Affiliation(s)
- Tonja Nansel
- Prevention Research Branch, Division of Epidemiology, Statistics, and Prevention Research, Eunice Shriver Kennedy National Institute of Child Health and Human Development, National Institutes of Health, 6100 Executive Blvd., Rm 7B13, Bethesda, MD 20892-7510, 301-435-6937, 301-402-2084(FAX)
| | - Denise Haynie
- Prevention Research Branch, Division of Epidemiology, Statistics, and Prevention Research, Eunice Shriver Kennedy National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892-7510
| | - Leah Lipsky
- Prevention Research Branch, Division of Epidemiology, Statistics, and Prevention Research, Eunice Shriver Kennedy National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892-7510
| | - Sanjeev Mehta
- Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, Boston, MA 02215
| | - Lori Laffel
- Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, Boston, MA 02215
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Markowitz JT, Volkening LK, Laffel LMB. Care utilization in a pediatric diabetes clinic: cancellations, parental attendance, and mental health appointments. J Pediatr 2014; 164:1384-9. [PMID: 24612905 PMCID: PMC4035443 DOI: 10.1016/j.jpeds.2014.01.045] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 12/23/2013] [Accepted: 01/23/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To examine care utilization, family attendance, and hemoglobin A1c levels in a multidisciplinary pediatric diabetes clinic. STUDY DESIGN This retrospective electronic record review of deidentified data included patients (99% with type 1 diabetes) with established diabetes care, aged <30 years (mean age, 15 ± 5.2 years), and duration of diabetes >1 year (mean 8.5 ± 5.1 years) at first visit during a 2-year period. Outcomes included care utilization, family attendance, and glycemic control, as indicated by hemoglobin A1c level. Analyses included t tests, ANOVA, χ2 tests, ORs and 95% CIs, and multivariate analyses. RESULTS The study cohort comprised 1771 patients, with a mean of 5.8 ± 2.8 visits per patient. Roughly 15% of the scheduled appointments resulted in a cancellation or no-show; 61% of patients missed ≥1 visit. Patients with ≥2 missed appointments had higher A1c values and were older than those with <2 missed visits. Almost one-half of visits were attended by mothers alone; fathers attended 22% of visits. Patients whose fathers attended ≥1 visit had lower A1c values than patients whose fathers never attended. Eighteen percent of patients had onsite mental health visits. Patients with ≥1 mental health visit had higher mean A1c values, shorter duration of diabetes, and were younger compared with those with no mental health visits. CONCLUSION Our observations suggest the need to encourage attendance at diabetes visits and to include fathers to improve A1c values. The high rate of missed visits, especially in patients with poor glycemic control, identifies wasted provider effort when late cancellations/no-shows result in vacant clinic time. It is important to explore reasons for missed visits and to identify approaches to maximizing attendance, such as extended evening/weekend clinic hours and virtual visits.
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Affiliation(s)
- Jessica T Markowitz
- Pediatric, Adolescent, and Young Adult Section, and the Section on Genetics and Epidemiology, Joslin Diabetes Center, Boston, MA.
| | - Lisa K Volkening
- Pediatric, Adolescent, and Young Adult Section, and the Section on Genetics and Epidemiology, Joslin Diabetes Center, Boston, MA
| | - Lori M B Laffel
- Pediatric, Adolescent, and Young Adult Section, and the Section on Genetics and Epidemiology, Joslin Diabetes Center, Boston, MA
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Jönsson L, Lundqvist P, Tiberg I, Hallström I. Type 1 diabetes - impact on children and parents at diagnosis and 1 year subsequent to the child's diagnosis. Scand J Caring Sci 2014; 29:126-35. [DOI: 10.1111/scs.12140] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 03/16/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Lisbeth Jönsson
- Department of Health Sciences; Faculty of Medicine; Lund University; Lund Sweden
| | - Pia Lundqvist
- Department of Health Sciences; Faculty of Medicine; Lund University; Lund Sweden
| | - Irén Tiberg
- Department of Health Sciences; Faculty of Medicine; Lund University; Lund Sweden
| | - Inger Hallström
- Department of Health Sciences; Faculty of Medicine; Lund University; Lund Sweden
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Abstract
The patient-centered medical home (PCMH) is an innovative care model for the provision of primary care that is being rapidly adopted in the U.S. with the support of federal agencies and professional organizations. Its goal is to provide comprehensive, patient-centered care with increased access, quality, and efficiency. Diabetes, as a common, costly, chronic disease that requires ongoing management by patients and providers, is a condition that is frequently monitored as a test case in PCMH implementations. While in theory a PCMH care model that supports patient engagement and between-visit care may help improve diabetes care delivery and outcomes, the success of this approach may depend largely upon the specific strategies used and implementation approach. The cost-effectiveness of diabetes care in the PCMH model is not yet clear. Interventions have been most effective and most cost-effective for those with the poorest diabetes management at baseline.
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Affiliation(s)
- Sarah A. Ackroyd
- University of Rochester School of Medicine and Dentistry Rochester, NY 14642
| | - Deborah J. Wexler
- Corresponding Author: Massachusetts General Hospital Diabetes Center and Harvard Medical School, 50 Staniford Street, Boston MA 02114, 617-726-8767 (phone); 617.726.6781 (fax),
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Hsueh YSA, Dunt D, Anjou MD, Boudville A, Taylor H. Close the gap for vision: The key is to invest on coordination. Aust J Rural Health 2013; 21:299-305. [DOI: 10.1111/ajr.12061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2013] [Indexed: 12/28/2022] Open
Affiliation(s)
- Ya-seng Arthur Hsueh
- Centre for Health Policy, Programs and Economics; Melbourne School of Population and Global Health; The University of Melbourne; Carlton Victoria Australia
| | - David Dunt
- Centre for Health Policy, Programs and Economics; Melbourne School of Population and Global Health; The University of Melbourne; Carlton Victoria Australia
| | - Mitchell D Anjou
- Indigenous Eye Health Unit; Melbourne School of Population and Global Health; The University of Melbourne; Carlton Victoria Australia
| | - Andrea Boudville
- Indigenous Eye Health Unit; Melbourne School of Population and Global Health; The University of Melbourne; Carlton Victoria Australia
| | - Hugh Taylor
- Indigenous Eye Health Unit; Melbourne School of Population and Global Health; The University of Melbourne; Carlton Victoria Australia
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Tiberg I, Katarina SC, Carlsson A, Hallström I. Children diagnosed with type 1 diabetes: a randomized controlled trial comparing hospital versus home-based care. Acta Paediatr 2012; 101:1069-73. [PMID: 22759081 DOI: 10.1111/j.1651-2227.2012.02775.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIM To compare two different regimens for children diagnosed with type 1 diabetes: hospital-based care or hospital-based home care (HBHC), referring to specialist care in a home-based setting. METHOD The trial took place in Sweden with a randomized controlled design and included 60 children, aged 3-15 years. After 2-3 days with hospital-based care, children were randomized to either continued hospital-based care or to HBHC for 6 days. The primary outcome was the child's metabolic control after 2 years. Secondary outcomes were set to evaluate the family and child situation as well as the healthcare services. This article presents data 6 months after diagnosis. RESULTS Results showed equivalence between groups in terms of metabolic control, insulin dose, parents' employment and working hours as well as parents' and significant others' absence from work related to the child's diabetes. Parents in the HBHC were more satisfied with the received health care and showed less subsequent healthcare resource use. The level of risk for the family's psychosocial distress assessed at diagnosis was associated with the subsequent use of resources, but not with metabolic control. CONCLUSION HBHC was found to be an equally safe and effective way of providing care as hospital-based care at the onset of type 1 diabetes for children who are medically stable.
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Affiliation(s)
- Irén Tiberg
- Department of Health Sciences and The Swedish Institute for Health Sciences, Lund University, Lund, Sweden.
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