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Tsiamparlis-Wildeboer AHC, Feijen-De Jong EI, Tichelman E, de Jonge A, Scheele F. Self-management support from health care providers in Shared Medical Appointments: Didactic techniques, peer learning, group dynamics and motivation. PEC INNOVATION 2024; 5:100337. [PMID: 39279817 PMCID: PMC11399736 DOI: 10.1016/j.pecinn.2024.100337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 07/25/2024] [Accepted: 08/21/2024] [Indexed: 09/18/2024]
Abstract
Objective We investigated the support of self-management by health care providers (HCP) in prenatal Shared Medical Appointments (SMA). Methods on an topic list, semi-structured interviews were conducted. HCP who provided prenatal care in SMA in the last five years were recruited. Thematic analysis was used. Results We conducted 15 interviews. Four research themes were defined: didactic techniques, peer learning, motivation and the health care providers. Self-management support in SMA is based on peer-learning and is influenced by group dynamics. HCP play a role in the creation of an effective learning climate by using practical and communication techniques. HCP motivate participants for self-management through peer learning and person centered care. HCP need certain personality traits and leadership skills. Conclusion Self-management support in SMA is based on peer-learning and is influenced by group dynamics. HCP create an effective learning climate using practical and communication techniques and motivate participants for self-management through peer learning and person-centered care. Innovation This is the first study that gives insight in self-management support in SMA. HCP and medical schools should be aware of the fact that HCP in SMA need insight in didactic techniques, peer learning, group dynamics and leadership skills.
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Affiliation(s)
- Anna H C Tsiamparlis-Wildeboer
- Department of Primary and Long-Term Care, University of Groningen, Groningen, the Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Groningen, the Netherlands
- Midwifery Science, Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
| | - Esther I Feijen-De Jong
- Department of Primary and Long-Term Care, University of Groningen, Groningen, the Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Groningen, the Netherlands
- Midwifery Science, Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
| | - Elke Tichelman
- Department of Midwifery Education, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
| | - Ank de Jonge
- Department of Primary and Long-Term Care, University of Groningen, Groningen, the Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Groningen, the Netherlands
- Midwifery Science, Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development, Amsterdam, the Netherlands
| | - Fedde Scheele
- Athena Institute for Transdisciplinary Research, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam UMC, Amsterdam, the Netherlands
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Alonso-Carril N, Rodriguez-Rodríguez S, Quirós C, Berrocal B, Amor AJ, Barahona MJ, Martínez D, Ferré C, Perea V. Could Online Education Replace Face-to-Face Education in Diabetes? A Systematic Review. Diabetes Ther 2024; 15:1513-1524. [PMID: 38743305 PMCID: PMC11211299 DOI: 10.1007/s13300-024-01595-6] [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: 03/21/2024] [Accepted: 04/18/2024] [Indexed: 05/16/2024] Open
Abstract
OBJECTIVE Diabetes Self-Management Education and Support (DSMES) is a critical component of diabetes care. This study aims to examine the effect of online-based educational interventions on diabetes management compared to face-to-face interventions. METHODS A systematic review was conducted by searching three databases for studies in English or Spanish between December 2023 and March 2024. The inclusion criteria were studies that compared face-to-face DSMES with online interventions. RESULTS The follow-up duration of the trials ranged from 1 to 12 months. Multidisciplinary teams delivered online DSMES through various means, including Short Message Service (SMS), telephone calls, video calls, websites, and applications. Online DSMES was found to be comparable to face-to-face interventions in terms of glycated hemoglobin (HbA1c) levels in people with type 1 diabetes (T1D). In contrast, online interventions that focus on weight management in people with type 2 diabetes (T2D) have shown a significant reduction in HbA1c compared to face-to-face interventions. Online DSMES was found to be superior in terms of quality of life and cost-effectiveness in both T1D and T2D. None of the analyzed studies explored the differences between individual and group methodologies. CONCLUSIONS The current evidence indicates that online DSMES services provide at least comparable biomedical benefits to face-to-face interventions, suggesting that online interventions could be incorporated into clinical practice as a complement or reinforcement. However, further research is needed to explore the potential benefits and effectiveness of online group sessions in DSMES.
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Affiliation(s)
- Núria Alonso-Carril
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Dr Robert 5, 08221, Terrassa, Spain
- Department of Nursing, Rovira i Virgili University, Tarragona, Spain
| | - Silvia Rodriguez-Rodríguez
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Dr Robert 5, 08221, Terrassa, Spain
| | - Carmen Quirós
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Dr Robert 5, 08221, Terrassa, Spain
| | - Belén Berrocal
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Dr Robert 5, 08221, Terrassa, Spain
| | - Antonio J Amor
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Maria-José Barahona
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Dr Robert 5, 08221, Terrassa, Spain
| | - Davinia Martínez
- Nursing Department, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | - Carme Ferré
- Department of Nursing, Rovira i Virgili University, Tarragona, Spain
| | - Verónica Perea
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Dr Robert 5, 08221, Terrassa, Spain.
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Kania M, Suduł P, Wilk M, Szopa M, Katra B, Małecki MT, Poklepović Peričić T, Prill R, Klugarová J, Vrbova T, Klugar M, Leśniak W, Bała MM. Education of adult type 1 diabetes patients in a diabetes ward setting: a best practice implementation project. JBI Evid Implement 2024:02205615-990000000-00105. [PMID: 38899903 DOI: 10.1097/xeb.0000000000000436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
INTRODUCTION AND OBJECTIVES Type 1 diabetes is an autoimmune disease that destroys insulin-producing cells in the pancreas. Education is the cornerstone of effective diabetes care. In this implementation project, we aimed to improve compliance with best practices regarding type 1 diabetes educational interventions for adult hospitalized patients. METHODS This project was guided by the JBI Evidence Implementation Framework. A baseline audit was conducted involving 20 nurses and 20 type 1 diabetes patients who received regular educational measures. Areas of non-compliance were identified and an improvement strategy was implemented. A follow-up audit was then conducted to evaluate the effectiveness of the improvement strategy. The project was conducted in Poland in 2021 in a tertiary referral unit that specializes in the diagnosis and treatment of diabetes. RESULTS Substantial improvements were noted for all audit criteria after the implementation of strategies to address areas of non-compliance. Use of the education program improved from 0% to 100%. Compliance regarding patients receiving handouts and personalization of the program increased to 100%. We observed a significant improvement from 0% to 80% in the structuring of the program content. CONCLUSIONS This project successfully improved the quality of education provided for type 1 diabetes patients in all relevant areas. We devised an education program, covering important aspects of diabetes education, with the patients reporting increased satisfaction with the personalized educational measures during their hospital stay. SPANISH ABSTRACT http://links.lww.com/IJEBH/A215.
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Affiliation(s)
- Michał Kania
- Doctoral School of Medicine and Health Sciences, Jagiellonian University Medical College, Kraków, Poland
- Department of Metabolic Diseases, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Paulina Suduł
- Department of Metabolic Diseases, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Magdalena Wilk
- Department of Metabolic Diseases, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Magdalena Szopa
- Department of Metabolic Diseases, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Barbara Katra
- Department of Metabolic Diseases, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Maciej T Małecki
- Department of Metabolic Diseases, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Tina Poklepović Peričić
- Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
| | - Robert Prill
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg/Havel; Evidence Based Practice in Brandenburg - A JBI Affiliated Group, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
| | - Jitka Klugarová
- The Czech Republic Centre for Evidence-Based Healthcare: A JBI Centre of Excellence, Institute of Health Informatics and Statistics of the Czech Republic, Czech Republic
| | - Tereza Vrbova
- The Czech Republic Centre for Evidence-Based Healthcare: A JBI Centre of Excellence, Institute of Health Informatics and Statistics of the Czech Republic, Czech Republic
| | - Miloslav Klugar
- The Czech Republic Centre for Evidence-Based Healthcare: A JBI Centre of Excellence, Institute of Health Informatics and Statistics of the Czech Republic, Czech Republic
| | | | - Małgorzata M Bała
- Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Kraków, Poland
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Boyd CT, Spangler JG, Strickland CG, Roper JE, Kirk JK. Impact of group medical visits on patient engagement and quality of life. Expert Rev Endocrinol Metab 2023; 18:549-554. [PMID: 37822145 DOI: 10.1080/17446651.2023.2268716] [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: 05/25/2023] [Accepted: 10/05/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Group medical visits (GMV) effectively improve patient care and outcomes through interactive education, increased patient contact, and facilitated social support. This quality improvement research examined if patient activation and quality of life correlate with weight, blood pressure (BP), and hemoglobin A1c (A1C) through GMV interventions. METHODS Participants were enrolled in GMV Lighten Up for weight management or GMV Diabetes. At pre- and post-intervention, patients completed the Patient Activation Measure (PAM) and the health-related quality of life measure, the SF-12; and were assessed for weight, blood pressure (BP), and hemoglobin A1c (A1C). RESULTS Weight and PAM scores significantly improved regardless of group. For patients in GMV Diabetes, A1C significantly decreased. GMV Lighten Up participants had statistically significant declines in diastolic BP. Both groups improved patient activation, but statistically significantly so only in GMV Diabetes participants. SF-12 scores did not statistically significantly improve. There were no predictors of A1C and PAM score change for the Diabetes GMV. However, age, SBP and SF-12 scores predicted PAM score changes in GMV Lighten up participants. CONCLUSIONS Participants in this study showed overall improvement in biomarkers and patient activation. Thus, GMV continue to be a viable method for healthcare delivery.
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Affiliation(s)
- Charlotte T Boyd
- Department of Family and Community Medicine, Atrium Health Wake Forest Baptist, Winston Salem, NC, USA
| | - John G Spangler
- Department of Family and Community Medicine, Atrium Health Wake Forest Baptist, Winston Salem, NC, USA
| | - Carmen G Strickland
- Department of Family and Community Medicine, Atrium Health Wake Forest Baptist, Winston Salem, NC, USA
| | - Jennifer E Roper
- Department of Family and Community Medicine, Atrium Health Wake Forest Baptist, Winston Salem, NC, USA
| | - Julienne K Kirk
- Department of Family and Community Medicine, Atrium Health Wake Forest Baptist, Winston Salem, NC, USA
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5
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Tsiamparlis-Wildeboer AHC, Feijen-De Jong EI, van Lohuizen MT, Tichelman E, de Jonge A, Scheele F. Self-management support by health care providers in prenatal Shared Medical Appointments (CenteringPregnancy©) and prenatal individual appointments. PATIENT EDUCATION AND COUNSELING 2023; 107:107579. [PMID: 36463823 DOI: 10.1016/j.pec.2022.107579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 11/20/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE This cross-sectional questionnaire study investigates if there a difference in the extent to which health care providers in prenatal Shared Medical Appointments (CenteringPregnancy©) and in prenatal individual appointments support self-management in patient education. It also investigates if there is a difference in the extent to which health care providers in CenteringPregnancy@ and in individual appointments pay attention to the factors of the Integrated Model for Behavioral Change (I-Change) in supporting self-management. METHODS Dutch health care providers in prenatal care were invited to fill out a questionnaire. Respondents who provided care in CenteringPregnancy© formed the CenteringPregnancy© group, the others were categorized in the individual appointments' group. After a definition of self-management and an introduction of the I-Change model, respondents were asked if they supported self-management and if they paid attention to the I-Change model for each of 17 themes of prenatal patient education. Pearson's chi-squared tests and Fisher's Exact tests were performed to compare both groups. RESULTS We included 133 respondents. Health care providers in the CenteringPregnancy@ group supported self-management to a higher extent compared to the individual appointments group. This difference was statistically significant for eight themes (body position and exercises, oral health, domestic violence, birth mechanism and premature birth, postnatal period, transition from pregnancy to parenthood, taking care of the baby and newborn's safety). In both groups, health care providers paid most attention to information or to awareness factors instead of motivation factors. CONCLUSION We found a first prove that health care providers in CenteringPregnancy@ support self-management to a higher extent than health care providers in individual appointments. This could be explained by factors as time, feelings of safety and bonding, continuity of care and emphasis on future health behaviour changes. For effective self-management support, attention to motivation factors is important. However, we found that health care providers in both groups paid more attention to information or to awareness factors than to motivation. PRACTICE IMPLICATIONS Health care providers in prenatal individual appointments should be aware of the fact that they possibly support self-management less than health care providers in CenteringPregnancy@ . Health care providers in both types of prenatal care should be aware of the fact that they pay little attention to motivation factors. They might need some skills to change their role from teaching professional to supportive leader.
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Affiliation(s)
- Anna H C Tsiamparlis-Wildeboer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Midwifery Science, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Medicine, Groningen, the Netherlands; AVAG (Academy Midwifery Amsterdam and Groningen), Groningen, the Netherlands.
| | - Esther I Feijen-De Jong
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Midwifery Science, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Medicine, Groningen, the Netherlands; AVAG (Academy Midwifery Amsterdam and Groningen), Groningen, the Netherlands
| | | | - Elke Tichelman
- School of Health Care Studies, Rotterdam University of Applied Sciences, department of Midwifery Education, the Netherlands; Research Centre Innovations in Care, Rotterdam University of Applied Sciences, the Netherlands
| | - Ank de Jonge
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Midwifery Science, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; AVAG (Academy Midwifery Amsterdam and Groningen), Groningen, the Netherlands
| | - Fedde Scheele
- Vrije Universiteit Amsterdam, Athena institute for Transdisciplinary Research, Amsterdam, the Netherlands; Amsterdam UMC, the Netherlands
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Savarese M, Sapienza M, Acquati GM, Nurchis MC, Riccardi MT, Mastrilli V, D’Elia R, Graps EA, Graffigna G, Damiani G. Educational Interventions for Promoting Food Literacy and Patient Engagement in Preventing Complications of Type 2 Diabetes: A Systematic Review. J Pers Med 2021; 11:jpm11080795. [PMID: 34442439 PMCID: PMC8399193 DOI: 10.3390/jpm11080795] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/09/2021] [Accepted: 08/12/2021] [Indexed: 01/02/2023] Open
Abstract
The present review aims to map the current literature on educational interventions to promote food literacy in type 2 diabetes, with a particular focus on the concept of patient engagement. The systematic review was implemented on five databases with no restrictions on the publication year. The studies selected for the review were focused on patients with type 2 diabetes, ranging from 2003 to 2021 and published in 13 countries (44% USA). Thirty-three articles were analyzed. Twenty-seven articles targeted singular patients; fifteen articles conceptualized patient engagement as self-management. In seven articles, the provider is a multidisciplinary team. Twenty articles did not report a theoretical framework in the intervention development, and eleven did not use an intervention material. Twenty-six articles did not use a technology proxy. Outcome categories were narratively mapped into four areas: clinical, psychological, behavioral, and literacy. To date, most of the interventions are heterogeneous in the adopted methodology, measures, and outcomes considered. More attention should be given to the psychosocial characterization of patient engagement as well as the technological support. High-quality, randomized controlled trials and longitudinal studies are lacking and need to be conducted to verify the efficacy of these insights.
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Affiliation(s)
- M. Savarese
- EngageMinds HUB–Consumer Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Largo A.Gemelli 1, 20123 Milano, Italy; (M.S.); (G.G.)
- Faculty of Agriculture Food and Environmental Sciences, Università Cattolica del Sacro Cuore, 20123 Milano, Italy
| | - M. Sapienza
- Department of Health Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.S.); (G.D.)
| | - G. M. Acquati
- Faculty of Psychology, Università Cattolica del Sacro Cuore, 20123 Milano, Italy;
| | - M. C. Nurchis
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A.Gemelli IRCCS, Largo A.Gemelli 8, 00168 Rome, Italy;
| | - M. T. Riccardi
- Department of Health Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.S.); (G.D.)
- Correspondence: ; Tel.: +39-06-3015-4396
| | - V. Mastrilli
- Ministero Della Salute, Direzione Generale della Prevenzione, Ufficio 8-Promozione Salute e Prevenzione Controllo Malattie Cronico-Degenerative, 20123 Milano, Italy; (V.M.); (R.D.)
| | - R. D’Elia
- Ministero Della Salute, Direzione Generale della Prevenzione, Ufficio 8-Promozione Salute e Prevenzione Controllo Malattie Cronico-Degenerative, 20123 Milano, Italy; (V.M.); (R.D.)
| | - E. A. Graps
- A.Re.S.S. Puglia-Agenzia Regionale Strategica per la Salute ed il Sociale Area Valutazione e Ricerca, 20123 Milano, Italy;
| | - G. Graffigna
- EngageMinds HUB–Consumer Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Largo A.Gemelli 1, 20123 Milano, Italy; (M.S.); (G.G.)
- Faculty of Agriculture Food and Environmental Sciences, Università Cattolica del Sacro Cuore, 20123 Milano, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo A.Gemelli 1, 20123 Milano, Italy
| | - G. Damiani
- Department of Health Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.S.); (G.D.)
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A.Gemelli IRCCS, Largo A.Gemelli 8, 00168 Rome, Italy;
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Lambert LK, Balneaves LG, Howard AF. It's not an easy fix: Adherence to adjuvant endocrine therapy after breast cancer. Can Oncol Nurs J 2021; 31:221-227. [PMID: 34036161 PMCID: PMC8128422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
Adjuvant endocrine therapy (AET) is a highly efficacious treatment that significantly reduces breast cancer recurrence and mortality for women with hormone-receptor positive breast cancer. Yet, many women do not adhere to prescribed AET. The overarching aim of this research was to gain a better understanding of why a significant number of women diagnosed with breast cancer have suboptimal adherence to AET. A mixed-methods approach was used to explore the personal, social, and structural factors influencing breast cancer survivors' AET adherence, including: (1) an integrative review of patient-reported factors associated with AET adherence; and (2) interviews with breast cancer survivors prescribed AET. In this paper, we summarize and discuss the key contributions of both phases of this research, implication for clinical practice, and how we might leverage the expertise of nurses in practicing to full scope to address the complex needs of breast cancer survivors prescribed AET.
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Affiliation(s)
- Leah K Lambert
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC V6T 2B5; British Columbia Cancer, 600 W 10th Ave, Vancouver, BC V5Z 4E6
| | - Lynda G Balneaves
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Helen Glass Centre for Nursing, Winnipeg, MB R3T 2N2
| | - A Fuchsia Howard
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC V6T 2B5
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8
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Lambert LK, Balneaves LG, Howard AF. [Not Available]. Can Oncol Nurs J 2021; 31:228-234. [PMID: 34036162 PMCID: PMC8128429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
Chez les femmes atteintes d’un cancer du sein à récepteurs hormonaux positifs, l’endocrinothérapie adjuvante est très efficace pour réduire le risque de récidive et de mortalité. Pourtant, ce ne sont pas toutes les femmes qui se conforment au traitement. L’objectif principal de cette recherche était de mieux comprendre pourquoi de nombreuses femmes ayant reçu un diagnostic de cancer du sein n’adhèrent pas au traitement adjuvant. Une approche méthodologique mixte a été utilisée afin d’explorer les facteurs personnels, sociaux et structurels qui influencent l’adhésion à l’endocrinothérapie adjuvante chez les survivantes du cancer du sein. L’approche comprend: 1) une revue intégrative des facteurs mentionnés par les patientes pour expliquer l’adhésion au traitement endocrinien; et 2) des entretiens avec des survivantes du cancer du sein à qui on a prescrit le traitement adjuvant. Le présent article résume et présente les principales contributions des deux phases de cette recherche, les implications pour la pratique clinique et la manière dont nous pourrons tirer parti de l’expertise des infirmières en les amenant à exercer pleinement leur pratique pour répondre aux besoins complexes des survivantes du cancer du sein à qui l’on prescrit l’endocrinothérapie adjuvante.
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Affiliation(s)
- Leah K Lambert
- École des sciences infirmières, Université de la Colombie-Britannique, T201-221 Wesbrook Mall, Vancouver, C.-B. V6T 2B5 ; British Columbia Cancer, 600 West 10th Ave, Vancouver, C.-B. V5Z 4E6
| | - Lynda G Balneaves
- Collège des sciences infirmières, Faculté des sciences de la santé Rady, Université du Manitoba, 89 Curry Place, Helen Glass Centre for Nursing, Winnipeg, MB R3T 2N2
| | - A Fuchsia Howard
- École des sciences infirmières, Université de la Colombie-Britannique, T201-221 Wesbrook Mall, Vancouver, C.-B. V6T 2B5
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9
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Tam EK, De Arrigunaga S, Shah M, Kefella H, Soriano S, Rowe S. Patient and Clinician Satisfaction With Shared Medical Appointments for Glaucoma. Semin Ophthalmol 2021; 37:17-22. [PMID: 33720810 DOI: 10.1080/08820538.2021.1896758] [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] [Indexed: 10/24/2022]
Abstract
Shared Medical Appointments (SMAs) are patient-centered care tools designed to administer patient counseling and education, typically delivered individually, in a group setting. SMAs are effective in facilitating peer-learning, resulting in improvement in knowledge and health behavior. This study aimed to implement what we know of as the first ophthalmology SMA done in the United States. We evaluated the implementation feasibility, patient and provider experience, changes in patient knowledge, and provider stress. Five glaucoma patients who expressed issues with adherence during their clinic visit at Boston Medical Center (BMC) who were interested in the SMA were recruited. Patients and staff had a positive experience with the SMA. There was a marked increase in patient glaucoma knowledge and a decrease in average staff member stress level score during the SMA. From all standpoints, including billing and management, we conclude that SMA implementation is feasible in ophthalmology departments in academic settings.
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Affiliation(s)
- Emily K Tam
- Department of Ophthalmology, Boston University Medical Center, Boston, USA
| | - Sofia De Arrigunaga
- Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Madhura Shah
- Boston University School of Medicine, Boston, USA
| | - Haben Kefella
- Department of Ophthalmology, Boston University Medical Center, Boston, USA
| | - Scarlet Soriano
- Department of Family Medicine, Boston University Medical Center, Boston, USA
| | - Susannah Rowe
- Department of Ophthalmology, Boston University Medical Center, Boston, USA
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10
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Storz MA. Adherence to Low-Fat, Vegan Diets in Individuals With Type 2 Diabetes: A Review. Am J Lifestyle Med 2020; 16:300-310. [DOI: 10.1177/1559827620964755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/16/2020] [Accepted: 09/18/2020] [Indexed: 11/16/2022] Open
Abstract
Low-fat, vegan diets seem to be particularly effective for glycemic control and may significantly lower hemoglobin A1c levels in individuals with type 2 diabetes. However, health care providers report low levels of practice and argue that this diet is hard to follow. This controversy on the acceptability of low-fat vegan diets appears to be a significant barrier to its broader clinical implementation. This review investigated dropout and adherence rates in intervention studies using a low-fat vegan diet in individuals with type 2 diabetes. In contrast to the common belief that this diet is poorly accepted, this review suggests different findings. Dietary adherence appears to be good with approximately 50% of individuals meeting the criteria for high adherence in most studies. Adherence to a low-fat vegan diet was higher than adherence to conventional diets in several studies. Group support and regular supervision improve adherence. Moreover, relatively low dropout rates were found—indirectly indicating good acceptance and high patient interest in this particular dietary modification. Although this review has several important limitations, it appears inappropriate to associate low-fat, vegan diets with poor adherence in individuals with type 2 diabetes. With good and regular support, adherence rates are more than solid and physicians should advocate for this diet more frequently.
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Tsiamparlis-Wildeboer AHC, Feijen-De Jong EI, Scheele F. Factors influencing patient education in shared medical appointments: Integrative literature review. PATIENT EDUCATION AND COUNSELING 2020; 103:1667-1676. [PMID: 32376140 DOI: 10.1016/j.pec.2020.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/28/2020] [Accepted: 03/06/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE This integrative literature review investigates the factors influencing patient education in Shared Medical Appointments. METHODS Following template analysis method, we used key concepts of the Social Cognitive Theory (SCT) and Social Constructivism as a priori themes. After detailed analysis of the included studies, we deduced subthemes, forming a final template. Based on this final template, we analysed our data again as a final check. RESULTS We included 22 studies. We found that the factors feeling of bonding, humour, feeling of safety, access to information, time, relationship participants-staff, modelling and self-regulation influence the education of SMA participants. Furthermore, we found that health care providers function both as leaders and peers. CONCLUSION We found eight factors that influence the education of SMA participants. Health care providers exert influence on these factors, but in turn, they are also influenced by them in their transfer of knowledge. PRACTICE IMPLICATIONS In order to create a climate of learning and to promote transfer of knowledge, these eight factors should be considered. Health care providers should be aware of their roles and they might need some extra skills for their leadership roles. This can also lead to practical implications for the curriculum in medical schools.
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Affiliation(s)
- Anna H C Tsiamparlis-Wildeboer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Midwifery Science, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Medicine, Groningen, The Netherlands; AVAG (Academy Midwifery Amsterdam and Groningen), Groningen, The Netherlands.
| | - Esther I Feijen-De Jong
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Midwifery Science, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Medicine, Groningen, The Netherlands; AVAG (Academy Midwifery Amsterdam and Groningen), Groningen, The Netherlands
| | - Fedde Scheele
- Vrije Universiteit Amsterdam, Athena Institute for Transdisciplinary Research, Amsterdam, The Netherlands; Amsterdam UMC, The Netherlands
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12
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Shibuya K, Ji X, Pfoh ER, Milinovich A, Weng W, Bauman J, Ganguly R, Misra-Hebert AD, Hobbs TM, Kattan MW, Pantalone KM, Ramasamy A, Burguera B. Association between shared medical appointments and weight loss outcomes and anti-obesity medication use in patients with obesity. Obes Sci Pract 2020; 6:247-254. [PMID: 32523713 PMCID: PMC7278906 DOI: 10.1002/osp4.406] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/17/2020] [Accepted: 01/21/2020] [Indexed: 01/19/2023] Open
Abstract
Objective In shared medical appointments (SMAs), multiple patients with a similar clinical diagnosis are seen by a multidisciplinary team for interactive group sessions. Very few studies have specifically studied SMAs and weight loss in patients with obesity. This study compared weight loss outcomes and anti‐obesity medication (AOM) access between patients with obesity managed through (SMAs) versus individual appointments. Methods Retrospective study of adults seen for obesity between September 2014 and February 2017 at Cleveland Clinic Institute of Endocrinology and Metabolism. Percent weight loss from baseline was compared between two propensity score‐matched populations: patients who attended ≥1 SMA and patients managed with individual medical appointments. Results From all eligible patients identified (n=310 SMA, n=1,993 non‐SMA), 301 matched pairs were evaluated for weight loss. The SMA group (n=301) lost a mean of 4.2%, 5.2% and 3.8% of baseline weight over 6, 12 and 24 months; the non‐SMA group (n=301) lost significantly less weight (1.5%, 1.8% and 1.6%, respectively) (paired t‐test, P<.05). All patients were eligible for US Food and Drug Administration‐approved AOMs based on obesity diagnosis; however, 49.8% (150/301) of matched SMA patients were prescribed an AOM versus 12.3% (37/301) of matched non‐SMA patients. Conclusion This study suggests that SMAs may offer a promising alterative for obesity management and one that may facilitate greater utilization of AOMs. In propensity score‐matched cohorts, SMAs were associated with greater weight loss outcomes when compared to usual care facilitated through individual medical appointments alone.
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Affiliation(s)
- Kelly Shibuya
- Cleveland Clinic Lerner College of Medicine Case Western Reserve University Cleveland Ohio
| | - Xinge Ji
- Cleveland Clinic Lerner College of Medicine Case Western Reserve University Cleveland Ohio.,Quantitative Health Sciences Cleveland Clinic Cleveland Ohio.,Department of Internal Medicine Cleveland Clinic Community Care Cleveland Ohio.,Health Economics and Outcomes Research Novo Nordisk Inc. Plainsboro New Jersey.,Diabetes, Chief Medical Officer Novo Nordisk Inc. Plainsboro New Jersey.,Endocrinology and Metabolism Institute Cleveland Clinic Cleveland New Jersey.,National Diabetes and Obesity Research Institute Tradition Mississippi
| | - Elizabeth R Pfoh
- Department of Internal Medicine Cleveland Clinic Community Care Cleveland Ohio
| | - Alex Milinovich
- Quantitative Health Sciences Cleveland Clinic Cleveland Ohio
| | - Wayne Weng
- Health Economics and Outcomes Research Novo Nordisk Inc. Plainsboro New Jersey
| | - Janine Bauman
- Quantitative Health Sciences Cleveland Clinic Cleveland Ohio
| | - Rahul Ganguly
- Health Economics and Outcomes Research Novo Nordisk Inc. Plainsboro New Jersey
| | - Anita D Misra-Hebert
- Quantitative Health Sciences Cleveland Clinic Cleveland Ohio.,Department of Internal Medicine Cleveland Clinic Community Care Cleveland Ohio
| | - Todd M Hobbs
- Diabetes, Chief Medical Officer Novo Nordisk Inc. Plainsboro New Jersey
| | | | - Kevin M Pantalone
- Endocrinology and Metabolism Institute Cleveland Clinic Cleveland New Jersey
| | - Abhilasha Ramasamy
- Health Economics and Outcomes Research Novo Nordisk Inc. Plainsboro New Jersey
| | - Bartolome Burguera
- Cleveland Clinic Lerner College of Medicine Case Western Reserve University Cleveland Ohio.,Endocrinology and Metabolism Institute Cleveland Clinic Cleveland New Jersey.,National Diabetes and Obesity Research Institute Tradition Mississippi
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13
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Liu F, Guan Y, Li X, Xie Y, He J, Zhou ZG, Li L. Different Effects of Structured Education on Glycemic Control and Psychological Outcomes in Adolescent and Adult Patients with Type 1 Diabetes: A Systematic Review and Meta-Analysis. Int J Endocrinol 2020; 2020:9796019. [PMID: 32184823 PMCID: PMC7061135 DOI: 10.1155/2020/9796019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 11/30/2019] [Indexed: 12/16/2022] Open
Abstract
AIM This systematic review aimed at investigating the effectiveness of structured education (SE) in improving glycemic control and psychological outcomes in adolescent and adult patients with type 1 diabetes. METHODS Electronic databases (EMBASE, Medline, PubMed, and the Cochrane Library) and the reference lists of included studies were searched from the beginning of the database through April 2019. Randomized controlled trials comparing SE with a control condition and reporting a change in glycosylated hemoglobin (HbA1c) level were included. The primary outcome was glycemic control measured by HbA1c. Secondary outcomes were diabetes-related distress, well-being, depression, and quality of life. RESULTS Eighteen studies representing 2759 patients were included. Twelve studies targeted adolescents and six targeted adults. Adolescent patients who were randomized to the intervention group did not show significant improvement of HbA1c in the short (SMD = -0.04; 95% CI: -0.14 to 0.06; P=0.41), medium (SMD = -0.03; 95% CI: -0.13 to 0.07; P=0.41), medium (SMD = -0.03; 95% CI: -0.13 to 0.07; P=0.41), medium (SMD = -0.03; 95% CI: -0.13 to 0.07; P=0.41), medium (SMD = -0.03; 95% CI: -0.13 to 0.07; P=0.41), medium (SMD = -0.03; 95% CI: -0.13 to 0.07. CONCLUSIONS Development of more efficient SE programs according to the patients' personal characteristics is needed.
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Affiliation(s)
- Fang Liu
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China
- Department of Metabolism and Endorinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Yuzhu Guan
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China
| | - Xia Li
- Department of Metabolism and Endorinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Yuting Xie
- Department of Metabolism and Endorinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Jing He
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Zhi-Guang Zhou
- Department of Metabolism and Endorinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
- National Clinical Research Center for Metabolic Disease, Changsha, China
| | - Lezhi Li
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China
- Clinic Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
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14
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Zijlstra WT, Os‐Medendorp H, Fieten KB, Sinnema G, Bruijnzeel‐Koomen CAFM, Zuithoff NPA, L'Hoir MP, Pasmans SGMA. Effects of shared medical appointments compared to individual appointments in children with atopic dermatitis: A pragmatic randomized controlled trial. Clin Exp Allergy 2019; 49:1095-1106. [DOI: 10.1111/cea.13416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 04/02/2019] [Accepted: 04/10/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Wieneke T. Zijlstra
- Department of Dermatology and Allergology University Medical Centre Utrecht Utrecht The Netherlands
- Department of Pediatrics OLVG Amsterdam Amsterdam The Netherlands
| | - Harmieke Os‐Medendorp
- Department of Dermatology and Allergology University Medical Centre Utrecht Utrecht The Netherlands
| | - Karin B. Fieten
- Department of Dermatology and Allergology University Medical Centre Utrecht Utrecht The Netherlands
| | - Gerben Sinnema
- Department of Pediatric Psychology and Social Work, Wilhelmina Children's Hospital University Medical Center Utrecht Utrecht The Netherlands
| | | | - Nicolaas P. A. Zuithoff
- Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht The Netherlands
| | - Monique P. L'Hoir
- Human Nutrition Wageningen University & Research (WUR) Wageningen The Netherlands
| | - Suzanne G. M. A. Pasmans
- Department of Dermatology and Allergology University Medical Centre Utrecht Utrecht The Netherlands
- Department of Pediatric Dermatology, Sophia Children's Hospital Erasmus University Medical Centre Rotterdam The Netherlands
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15
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Wadsworth KH, Archibald TG, Payne AE, Cleary AK, Haney BL, Hoverman AS. Shared medical appointments and patient-centered experience: a mixed-methods systematic review. BMC FAMILY PRACTICE 2019; 20:97. [PMID: 31286876 PMCID: PMC6615093 DOI: 10.1186/s12875-019-0972-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 05/31/2019] [Indexed: 12/25/2022]
Abstract
Background Shared medical appointments (SMAs), or group visits, are a healthcare delivery method with the potential to improve chronic disease management and preventive care. In this review, we sought to better understand opportunities, barriers, and limitations to SMAs based on patient experience in the primary care context. Methods An experienced biomedical librarian conducted literature searches of PubMed, Cochrane Library, PsycINFO, CINAHL, Web of Science, ClinicalTrials.gov, and SSRN for peer-reviewed publications published 1997 or after. We searched grey literature, nonempirical reports, social science publications, and citations from published systematic reviews. The search yielded 1359 papers, including qualitative, quantitative, and mixed method studies. Categorization of the extracted data informed a thematic synthesis. We did not perform a formal meta-analysis. Results Screening and quality assessment yielded 13 quantitative controlled trials, 11 qualitative papers, and two mixed methods studies that met inclusion criteria. We identified three consistent models of care: cooperative health care clinic (five articles), shared medical appointment / group visit (10 articles) and group prenatal care / CenteringPregnancy® (11 articles). Conclusions SMAs in a variety of formats are increasingly employed in primary care settings, with no singular gold standard. Accepting and implementing this nontraditional approach by both patients and clinicians can yield measurable improvements in patient trust, patient perception of quality of care and quality of life, and relevant biophysical measurements of clinical parameters. Further refinement of this healthcare delivery model will be best driven by standardizing measures of patient satisfaction and clinical outcomes. Electronic supplementary material The online version of this article (10.1186/s12875-019-0972-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kim H Wadsworth
- Pacific Northwest University of Health Sciences, College of Osteopathic Medicine, Yakima, WA, USA.
| | - Trevor G Archibald
- Pacific Northwest University of Health Sciences, College of Osteopathic Medicine, Yakima, WA, USA
| | - Allison E Payne
- Pacific Northwest University of Health Sciences, College of Osteopathic Medicine, Yakima, WA, USA
| | - Anita K Cleary
- Pacific Northwest University of Health Sciences, College of Osteopathic Medicine, Yakima, WA, USA
| | - Byron L Haney
- Pacific Northwest University of Health Sciences, College of Osteopathic Medicine, Yakima, WA, USA.,Family Health Care of Ellensburg, Ellensburg, WA, USA
| | - Adam S Hoverman
- Multnomah County Health Department, Oregon Health and Science University-Portland State University School of Public Health, Portland, OR, USA
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16
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Singer J, Levy S, Shimon I. Group versus Individual Care in Patients with Long-Standing Type 1 and Type 2 Diabetes: A One-Year Prospective Noninferiority Study in a Tertiary Diabetes Clinic. J Diabetes Res 2018; 2018:1807246. [PMID: 29998139 PMCID: PMC5994582 DOI: 10.1155/2018/1807246] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 03/22/2018] [Accepted: 04/11/2018] [Indexed: 12/02/2022] Open
Abstract
AIMS To explore the feasibility and noninferiority of group care in a diabetes outpatient clinic in comparison with individual care. METHODS In this prospective, randomized, nonblinded, one center (university hospital) trial, 60 patients (28 with type 1 and 32 with type 2 diabetes) with a mean duration of diabetes of 22.5 ± 11.7 years were randomly assigned to group (6 patients per group) or individual care for one year. The primary endpoints were the change in HbA1c and visits to outpatient clinics. The secondary endpoints were changes in body mass index, blood pressure levels, waist circumference, non-HDL cholesterol, diabetes-related and well-being index questionnaires, and the number of hospitalizations. RESULTS Group care was not inferior to individual care for any of the above parameters except for the number of visits to a primary care physician. CONCLUSION Group care is feasible in a diabetes clinic and is as effective as individual care. Implementation of group care may facilitate access to specialized care to a larger population of patients with diabetes type 1 and 2.
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Affiliation(s)
- Joelle Singer
- Institute of Endocrinology, Diabetes and Metabolism, Beilinson Hospital, Rabin Medical Center, Jabotinski Road 39, 49100 Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Chaim Lebanon 30, 6997801 Tel Aviv, Israel
| | - Sigal Levy
- Statistical Education Unit, The Academic College of Tel Aviv-Yaffo, Khever ha-Le'umim St 10, Tel Aviv-Yafo, Israel
| | - Ilan Shimon
- Institute of Endocrinology, Diabetes and Metabolism, Beilinson Hospital, Rabin Medical Center, Jabotinski Road 39, 49100 Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Chaim Lebanon 30, 6997801 Tel Aviv, Israel
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17
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Hartzler ML, Shenk M, Williams J, Schoen J, Dunn T, Anderson D. Impact of Collaborative Shared Medical Appointments on Diabetes Outcomes in a Family Medicine Clinic. DIABETES EDUCATOR 2018; 44:361-372. [DOI: 10.1177/0145721718776597] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose The purpose of this study is to evaluate the impact of a collaborative diabetes shared medical appointment on patient outcomes in an urban family medicine practice. Methods Fifty-nine patients were enrolled to participate in multiple shared medical appointments (SMAs) over 12 months. Baseline data included hemoglobin (A1C), lipids, systolic blood pressure (SBP), weight, adherence to American Diabetes Association (ADA) guidelines, and surveys, including the Problem Areas in Diabetes (PAID-2) scale and the Spoken Knowledge in Low Literacy in Diabetes Scale (SKILLD). A1C and SBP were evaluated at each visit. Lipid control was assessed at baseline and at 6 and 12 months. Adherence to ADA guidelines, SKILLD and PAID-2 survey scores, and number of antihyperglycemic and antihypertensive medications were also evaluated at 12 months. Results Thirty-eight patients completed the study. Compared with baseline, A1C and low-density lipoprotein cholesterol (LDL-C) levels decreased significantly over 12 months ( P < .001 and P = .004, respectively). More patients became compliant with the ADA guidelines throughout the course of the study. Specifically, more patients achieved the LDL-C goal of ≤100 mg/dL (2.59 mmol/L; P < .001), were prescribed appropriate antihypertensive medications ( P < .001) and aspirin ( P < .001), and received the pneumonia vaccine ( P < .001). PAID-2 and SKILLD survey scores also significantly improved over the course of the study ( P ≤ .001 and P = .003, respectively). Conclusion Short-term interdisciplinary SMAs decreased A1C and LDL-C, improved patient adherence to ADA guidelines, improved emotional distress related to diabetes, and increased knowledge of diabetes.
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Affiliation(s)
| | - McKenzie Shenk
- Cedarville University School of Pharmacy, Cedarville, Ohio
| | - Julie Williams
- Wright State University, School of Professional Psychology, Dayton, Ohio
| | - James Schoen
- Grandview Medical Center, Family Medicine, Dayton, Ohio
| | - Thomas Dunn
- Kettering Physicians Network, Family Medicine, Dayton, Ohio
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18
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Saha S, Riemenschneider H, Müller G, Levin-Zamir D, Van den Broucke S, Schwarz PEH. Comparative analysis of diabetes self-management education programs in the European Union Member States. Prim Care Diabetes 2017; 11:529-537. [PMID: 28663021 DOI: 10.1016/j.pcd.2017.05.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/19/2017] [Accepted: 05/30/2017] [Indexed: 01/13/2023]
Abstract
Diabetes self-management education (DSME) is generally considered as an integral part of diabetes care. The availability of different types of self-management in the European Union Member States (EUMS) remains uncertain. The aim of this study is to perform a comparative analysis of existing DSME programs (DSMEP) implemented in EUMS. Unpublished data regarding DSME in the EUMS was assessed with Diabetes Literacy Survey using wiki tool (WT) targeting patients and different stakeholders. An additional literature review (LR) was performed in PubMed to identify published studies regarding DSMEP in the EUMS from 2004 to 2014. A total of 102 DSMEP implemented in EUMS were reported in the WT and 154 programs were identified from the LR. Comparative analysis of the data indicated that a majority of programs are aimed at adults and only a minority at children and elderly. Only a small percentage of the programs utilize information technology for teaching and learning, and only one out of five programs pay attention to depression. The identified DSMEP aimed primarily to empower patients through increasing knowledge and changing attitudes and beliefs towards diabetes. This study provides an overview of the present state-of-the-art on diabetes self-management education programs in the 28 EUMS. To increase participation, existing DSMEP should be made more accessible to the patients as well as tailored to specific patient groups.
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Affiliation(s)
- Sarama Saha
- Medical Clinic 3, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Henna Riemenschneider
- Medical Clinic 3, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany.
| | - Gabriele Müller
- Center for Evidence-based Healthcare, Medical Faculty, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Diane Levin-Zamir
- Clalit Health Services, University of Haifa School of Public Health, Israel
| | | | - Peter E H Schwarz
- Medical Clinic 3, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
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19
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Trento M, Merlo S, Durando O, Rapetti S, Cavallo F, Porta M. Self-management education and psychological support improve self-esteem in people with type 1 diabetes. Acta Diabetol 2017; 54:415-416. [PMID: 27796657 DOI: 10.1007/s00592-016-0935-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 10/15/2016] [Indexed: 02/07/2023]
Affiliation(s)
- Marina Trento
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Corso AM. Dogliotti 14, 10126, Turin, Italy.
| | - Stefano Merlo
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Corso AM. Dogliotti 14, 10126, Turin, Italy
| | - Olga Durando
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Corso AM. Dogliotti 14, 10126, Turin, Italy
| | - Serena Rapetti
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Corso AM. Dogliotti 14, 10126, Turin, Italy
| | - Franco Cavallo
- Department of Public Health and Paediatrics, University of Turin, Turin, Italy
| | - Massimo Porta
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Corso AM. Dogliotti 14, 10126, Turin, Italy
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Kirsh SR, Aron DC, Johnson KD, Santurri LE, Stevenson LD, Jones KR, Jagosh J. A realist review of shared medical appointments: How, for whom, and under what circumstances do they work? BMC Health Serv Res 2017; 17:113. [PMID: 28160771 PMCID: PMC5291948 DOI: 10.1186/s12913-017-2064-z] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 01/31/2017] [Indexed: 12/22/2022] Open
Abstract
Background Shared medical appointments (SMAs) are doctor-patient visits in which groups of patients are seen by one or more health care providers in a concurrent session. There is a growing interest in understanding the potential benefits of SMAs in various contexts to improve clinical outcomes and reduce healthcare costs. This study builds upon the existing evidence base that suggests SMAs are indeed effective. In this study, we explored how they are effective in terms of the underlying mechanisms of action and under what circumstances. Methods Realist review methodology was used to synthesize the literature on SMAs, which included a broad search of 800+ published articles. 71 high quality primary research articles were retained to build a conceptual model of SMAs and 20 of those were selected for an in depth analysis using realist methodology (i.e.,middle-range theories and and context-mechanism-outcome configurations). Results Nine main mechanisms that serve to explain how SMAs work were theorized from the data immersion process and configured in a series of context-mechanism-outcome configurations (CMOs). These are: (1) Group exposure in SMAs combats isolation, which in turn helps to remove doubts about one’s ability to manage illness; (2) Patients learn about disease self-management vicariously by witnessing others’ illness experiences; (3) Patients feel inspired by seeing others who are coping well; (4) Group dynamics lead patients and providers to developing more equitable relationships; (5) Providers feel increased appreciation and rapport toward colleagues leading to increased efficiency; (6) Providers learn from the patients how better to meet their patients’ needs; (7) Adequate time allotment of the SMA leads patients to feel supported; (8) Patients receive professional expertise from the provider in combination with first-hand information from peers, resulting in more robust health knowledge; and (9) Patients have the opportunity to see how the physicians interact with fellow patients, which allows them to get to know the physician and better determine their level of trust. Conclusions Nine overarching mechanisms were configured in CMO configurations and discussed as a set of complementary middle-range programme theories to explain how SMAs work. It is anticipated that this innovative work in theorizing SMAs using realist review methodology will provide policy makers and SMA program planners adequate conceptual grounding to design contextually sensitive SMA programs in a wide variety of settings and advance an SMA research agenda for varied contexts.
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Affiliation(s)
- Susan R Kirsh
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA.,School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - David C Aron
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA. .,School of Medicine, Case Western Reserve University, Cleveland, OH, USA. .,Weatherhead School of Management, Case Western Reserve University, Cleveland, OH, USA.
| | - Kimberly D Johnson
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA.,College of Nursing, University of Cincinnati, Cincinnati, OH, USA
| | - Laura E Santurri
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA.,School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | | | - Katherine R Jones
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Justin Jagosh
- Centre for the Advancement of Realist Evaluation and Synthesis, University of Liverpool, Liverpool, UK
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21
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Housden L, Browne AJ, Wong ST, Dawes M. Attending to power differentials: How NP-led group medical visits can influence the management of chronic conditions. Health Expect 2017; 20:862-870. [PMID: 28071841 PMCID: PMC5600247 DOI: 10.1111/hex.12525] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2016] [Indexed: 11/28/2022] Open
Abstract
Objective In Canada, primary care reform has encouraged innovations, including nurse practitioners (NPs) and group medical visits (GMVs). NP‐led GMVs provide an opportunity to examine barriers and enablers to implementing this innovation in primary care. Design An instrumental case study design (n=3): two cases where NPs were using GMVs and one case where NPs were not using GMVs, was completed. In‐depth interviews with patients and providers (N=24) and 10 hours of direct observation were completed. Interpretive descriptive methods were used to analyse data. Results/Findings Two main themes were identified: (i) acquisition of knowledge and (ii) GMVs help shift relationships between patients and health‐care providers. Participants discussed how patients and providers learn from one another to facilitate self‐management of chronic conditions. They also discussed how the GMV shifts inherent power differentials between providers and between patients and providers. Discussion NP‐led GMVs are a method of care delivery that harness NPs’ professional agency through increased leadership and interprofessional collaboration. GMVs also facilitate an environment that is patient‐centred and interprofessional, providing patients with increased confidence to manage their chronic conditions. The GMV provides the opportunity to meet both team‐based and patient‐centred health‐care objectives and may disrupt inherent power differentials that exist in primary care.
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Affiliation(s)
- Laura Housden
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Annette J Browne
- School of Nursing, University of British Columbia, Vancouver, BC, Canada.,CRiHHI: Critical Research in Health and Healthcare Inequities, University of British Columbia, Vancouver, BC, Canada
| | - Sabrina T Wong
- School of Nursing, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada.,CRiHHI: Critical Research in Health and Healthcare Inequities, University of British Columbia, Vancouver, BC, Canada
| | - Martin Dawes
- Department of Family Practice, Faculty of Medicine, Vancouver, BC, Canada
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Abstract
The number of people with diabetes is expected to rise to over 592 million by the year 2035. Past work provides evidence that the conventional method of primary care delivery may not meet many patients' needs. An alternative to the conventional one-on-one appointment is care offered to a group of patients through group medical visits (GMVs). Group medical visits for diabetes have a positive impact on physiologic and self-care outcomes including improved HbA1c, blood pressure control and self-management skills. Less work has examined the impacts of GMVs on systems of care; however, evidence suggests improved primary and secondary prevention strategies and the potential for GMVs to decrease emergency room visits and hospitalizations. Additional work is needed to examine the effect of GMVs on patient reported quality of life, functional health status and cost-savings. Further work is also needed on which patients GMVs work best for and patient barriers to attending GMVs.
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Affiliation(s)
- Laura M Housden
- University of British Columbia School of Nursing, T201 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
| | - Sabrina T Wong
- Centre for Health Services and Policy Research, University of British Columbia School of Nursing, T201 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
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Isla Pera P, Ferrér MCO, Nuñez Juarez M, Nuñez Juarez E, Maciá Soler L, López Matheu C, Rigol Cuadra A, Pérez MH, Marre D. Obesity, knee osteoarthritis, and polypathology: factors favoring weight loss in older people. Patient Prefer Adherence 2016; 10:957-65. [PMID: 27313449 PMCID: PMC4890692 DOI: 10.2147/ppa.s92183] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
AIM We aimed to explore the meaning of obesity in elderly persons with knee osteoarthritis (KO) and to determine the factors that encourage or discourage weight loss. BACKGROUND Various studies have demonstrated that body mass index is related to KO and that weight loss improves symptoms and functional capacity. However, dietary habits are difficult to modify and most education programs are ineffective. DESIGN A phenomenological qualitative study was conducted. Intentional sampling was performed in ten older persons with KO who had lost weight and improved their health-related quality of life after participating in a health education program. A thematic content analysis was conducted following the stages proposed by Miles and Huberman. FINDINGS Participants understood obesity as a risk factor for health problems and stigma. They believed that the cause of obesity was multifactorial and criticized health professionals for labeling them as "obese" and for assigning a moral value to slimness and diet. The factors identified as contributing to the effectiveness of the program were a tolerant attitude among health professionals, group education that encouraged motivation, quantitative dietary recommendations, and a meaningful learning model based on social learning theories. CONCLUSION Dietary self-management without prohibitions helped participants to make changes in the quantity and timing of some food intake and to lose weight without sacrificing some foods that were deeply rooted in their culture and preferences. Dietary education programs should focus on health-related quality of life and include scientific knowledge but should also consider affective factors and the problems perceived as priorities by patients.
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Affiliation(s)
- Pilar Isla Pera
- School of Nursing, University of Barcelona, Barcelona, Spain
| | | | - Montserrat Nuñez Juarez
- Department of Rheumatology, Musculoskeletal Clínic Institute Hospital Clínic, Barcelona, Spain
| | | | | | | | | | | | - Diana Marre
- Universitat Autònoma de Barcelona, Barcelona, Spain
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Booth A, Cantrell A, Preston L, Chambers D, Goyder E. What is the evidence for the effectiveness, appropriateness and feasibility of group clinics for patients with chronic conditions? A systematic review. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03460] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundGroup clinics are a form of delivering specialist-led care in groups rather than in individual consultations.ObjectiveTo examine the evidence for the use of group clinics for patients with chronic health conditions.DesignA systematic review of evidence from randomised controlled trials (RCTs) supplemented by qualitative studies, cost studies and UK initiatives.Data sourcesWe searched MEDLINE, EMBASE, The Cochrane Library, Web of Science and Cumulative Index to Nursing and Allied Health Literature from 1999 to 2014. Systematic reviews and RCTs were eligible for inclusion. Additional searches were performed to identify qualitative studies, studies reporting costs and evidence specific to UK settings.Review methodsData were extracted for all included systematic reviews, RCTs and qualitative studies using a standardised form. Quality assessment was performed for systematic reviews, RCTs and qualitative studies. UK studies were included regardless of the quality or level of reporting. Tabulation of the extracted data informed a narrative synthesis. We did not attempt to synthesise quantitative data through formal meta-analysis. However, given the predominance of studies of group clinics for diabetes, using common biomedical outcomes, this subset was subject to quantitative analysis.ResultsThirteen systematic reviews and 22 RCT studies met the inclusion criteria. These were supplemented by 12 qualitative papers (10 studies), four surveys and eight papers examining costs. Thirteen papers reported on 12 UK initiatives. With 82 papers covering 69 different studies, this constituted the most comprehensive coverage of the evidence base to date. Disease-specific outcomes – the large majority of RCTs examined group clinic approaches to diabetes. Other conditions included hypertension/heart failure and neuromuscular conditions. The most commonly measured outcomes for diabetes were glycated haemoglobin A1c(HbA1c), blood pressure and cholesterol. Group clinic approaches improved HbA1cand improved systolic blood pressure but did not improve low-density lipoprotein cholesterol. A significant effect was found for disease-specific quality of life in a few studies. No other outcome measure showed a consistent effect in favour of group clinics. Recent RCTs largely confirm previous findings. Health services outcomes – the evidence on costs and feasibility was equivocal. No rigorous evaluation of group clinics has been conducted in a UK setting. A good-quality qualitative study from the UK highlighted factors such as the physical space and a flexible appointment system as being important to patients. The views and attitudes of those who dislike group clinic provision are poorly represented. Little attention has been directed at the needs of people from ethnic minorities. The review team identified significant weaknesses in the included research. Potential selection bias limits the generalisability of the results. Many patients who could potentially be included do not consent to the group approach. Attendance is often interpreted liberally.LimitationsThis telescoped review, conducted within half the time period of a conventional systematic review, sought breadth in covering feasibility, appropriateness and meaningfulness in addition to effectiveness and cost-effectiveness and utilised several rapid-review methods. It focused on the contribution of recently published evidence from RCTs to the existing evidence base. It did not reanalyse trials covered in previous reviews. Following rapid review methods, we did not perform independent double data extraction and quality assessment.ConclusionsAlthough there is consistent and promising evidence for an effect of group clinics for some biomedical measures, this effect does not extend across all outcomes. Much of the evidence was derived from the USA. It is important to engage with UK stakeholders to identify NHS considerations relating to the implementation of group clinic approaches.Future workThe review team identified three research priorities: (1) more UK-centred evaluations using rigorous research designs and economic models with robust components; (2) clearer delineation of individual components within different models of group clinic delivery; and (3) clarification of the circumstances under which group clinics present an appropriate alternative to an individual consultation.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Andrew Booth
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anna Cantrell
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Louise Preston
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Duncan Chambers
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Elizabeth Goyder
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Smith C, McNaughton DA, Meyer S. Client perceptions of group education in the management of type 2 diabetes mellitus in South Australia. Aust J Prim Health 2015; 22:360-367. [PMID: 26351268 DOI: 10.1071/py15008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 05/01/2015] [Indexed: 11/23/2022]
Abstract
Type 2 diabetes mellitus (T2DM) is a progressive chronic disease that requires significant self-surveillance and adherence to the treatment protocols for successful management and future health. There is a growing body of evidence suggesting that diabetes education is beneficial for patient outcomes. However, there is some debate about how best to deliver diabetes education, whether individually or in groups. Although several studies have investigated the role of group education in improving the management of T2DM, few studies have examined this issue from the client's perspective. It is here that this study makes a contribution to understanding diabetes management. Drawing on systematic observation of group education sessions provided by diabetic resource nurses and in-depth interviews with clients, this paper describes the experiences, perspectives and significance of these sessions to clients. Our results suggest that group education sessions were seen as valuable to the clients for: the opportunity they provided to meet others living with diabetes; to improve motivation for managing the disease; and to enhance knowledge of diabetes, its management and long-term implications. In short, this study demonstrates that the clients value group education sessions for the social contact, increasing knowledge about the disease for self-management and support they provide; factors recognised as important to maintaining health. In addition, group education sessions appear to be a cost-effective method for diabetes self-management that funders need to consider.
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Affiliation(s)
- Cynthia Smith
- Discipline of Public Health, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
| | - Darlene A McNaughton
- Discipline of Public Health, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
| | - Samantha Meyer
- Discipline of Public Health, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
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Ruggeri M, Manca A, Coretti S, Codella P, Iacopino V, Romano F, Mascia D, Orlando V, Cicchetti A. Investigating the Generalizability of Economic Evaluations Conducted in Italy: A Critical Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2015; 18:709-720. [PMID: 26297100 DOI: 10.1016/j.jval.2015.03.1795] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 02/27/2015] [Accepted: 03/29/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To assess the methodological quality of Italian health economic evaluations and their generalizability or transferability to different settings. METHODS A literature search was performed on the PubMed search engine to identify trial-based, nonexperimental prospective studies or model-based full economic evaluations carried out in Italy from 1995 to 2013. The studies were randomly assigned to four reviewers who applied a detailed checklist to assess the generalizability and quality of reporting. The review process followed a three-step blinded procedure. The reviewers who carried out the data extraction were blind as to the name of the author(s) of each study. Second, after the first review, articles were reassigned through a second blind randomization to a second reviewer. Finally, any disagreement between the first two reviewers was solved by a senior researcher. RESULTS One hundred fifty-one economic evaluations eventually met the inclusion criteria. Over time, we observed an increasing transparency in methods and a greater generalizability of results, along with a wider and more representative sample in trials and a larger adoption of transition-Markov models. However, often context-specific economic evaluations are carried out and not enough effort is made to ensure the transferability of their results to other contexts. In recent studies, cost-effectiveness analyses and the use of incremental cost-effectiveness ratio were preferred. CONCLUSIONS Despite a quite positive temporal trend, generalizability of results still appears as an unsolved question, even if some indication of improvement within Italian studies has been observed.
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Affiliation(s)
- Matteo Ruggeri
- Director of Post-Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Manca
- Centre for Health Economics, University of York, York, UK
| | - Silvia Coretti
- Director of Post-Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Paola Codella
- Director of Post-Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valentina Iacopino
- Director of Post-Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Federica Romano
- Director of Post-Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Daniele Mascia
- Director of Post-Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valentina Orlando
- Inter-departmental Research Centre of PharmacoEconomics and Drug utilization (CIRFF), Center of Pharmacoeconomics, Federico II University of Naples, Naples, Italy
| | - Americo Cicchetti
- Director of Post-Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
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Catling CJ, Medley N, Foureur M, Ryan C, Leap N, Teate A, Homer CSE. Group versus conventional antenatal care for women. Cochrane Database Syst Rev 2015; 2015:CD007622. [PMID: 25922865 PMCID: PMC6465187 DOI: 10.1002/14651858.cd007622.pub3] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Antenatal care is one of the key preventive health services used around the world. In most Western countries, antenatal care traditionally involves a schedule of one-to-one visits with a care provider. A different way of providing antenatal care involves use of a group model. OBJECTIVES 1. To compare the effects of group antenatal care versus conventional antenatal care on psychosocial, physiological, labour and birth outcomes for women and their babies.2. To compare the effects of group antenatal care versus conventional antenatal care on care provider satisfaction. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2014), contacted experts in the field and reviewed the reference lists of retrieved studies. SELECTION CRITERIA All identified published, unpublished and ongoing randomised and quasi-randomised controlled trials comparing group antenatal care with conventional antenatal care were included. Cluster-randomised trials were eligible, and one has been included. Cross-over trials were not eligible. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias and extracted data; all review authors checked data for accuracy. MAIN RESULTS We included four studies (2350 women). The overall risk of bias for the included studies was assessed as acceptable in two studies and good in two studies. No statistically significant differences were observed between women who received group antenatal care and those given standard individual antenatal care for the primary outcome of preterm birth (risk ratio (RR) 0.75, 95% confidence interval (CI) 0.57 to 1.00; three trials; N = 1888). The proportion of low-birthweight (less than 2500 g) babies was similar between groups (RR 0.92, 95% CI 0.68 to 1.23; three trials; N = 1935). No group differences were noted for the primary outcomes small-for-gestational age (RR 0.92, 95% CI 0.68 to 1.24; two trials; N = 1473) and perinatal mortality (RR 0.63, 95% CI 0.32 to 1.25; three trials; N = 1943).Satisfaction was rated as high among women who were allocated to group antenatal care, but this outcome was measured in only one trial. In this trial, mean satisfaction with care in the group given antenatal care was almost five times greater than that reported by those allocated to standard care (mean difference 4.90, 95% CI 3.10 to 6.70; one study; N = 993). No differences in neonatal intensive care admission, initiation of breastfeeding or spontaneous vaginal birth were observed between groups. Several outcomes related to stress and depression were reported in one trial. No differences between groups were observed for any of these outcomes.No data were available on the effects of group antenatal care on care provider satisfaction.We used the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach to assess evidence for seven prespecified outcomes; results ranged from low quality (perinatal mortality) to moderate quality (preterm birth, low birthweight, neonatal intensive care unit admission, breastfeeding initiation) to high quality (satisfaction with antenatal care, spontaneous vaginal birth). AUTHORS' CONCLUSIONS Available evidence suggests that group antenatal care is positively viewed by women and is associated with no adverse outcomes for them or for their babies. No differences in the rate of preterm birth were reported when women received group antenatal care. This review is limited because of the small numbers of studies and women, and because one study contributed 42% of the women. Most of the analyses are based on a single study. Additional research is required to determine whether group antenatal care is associated with significant benefit in terms of preterm birth or birthweight.
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Affiliation(s)
- Christine J Catling
- University of Technology SydneyCentre for Midwifery, Child and Family HealthFaculty of HealthBroadwayNSWAustralia2007
| | - Nancy Medley
- The University of LiverpoolCochrane Pregnancy and Childbirth Group, Department of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
| | - Maralyn Foureur
- University of Technology SydneyCentre for Midwifery, Child and Family HealthFaculty of HealthBroadwayNSWAustralia2007
| | - Clare Ryan
- University of Technology SydneyCentre for Midwifery, Child and Family HealthFaculty of HealthBroadwayNSWAustralia2007
| | - Nicky Leap
- University of Technology SydneyCentre for Midwifery, Child and Family HealthFaculty of HealthBroadwayNSWAustralia2007
| | - Alison Teate
- University of Technology SydneyCentre for Midwifery, Child and Family HealthFaculty of HealthBroadwayNSWAustralia2007
| | - Caroline SE Homer
- University of Technology SydneyCentre for Midwifery, Child and Family HealthFaculty of HealthBroadwayNSWAustralia2007
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Shared medical appointments for patients with diabetes mellitus: a systematic review. J Gen Intern Med 2015; 30:99-106. [PMID: 25107290 PMCID: PMC4284267 DOI: 10.1007/s11606-014-2978-7] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Revised: 03/31/2014] [Accepted: 07/15/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Shared medical appointments (SMAs) are an increasingly used system-redesign strategy for improving access to and quality of chronic illness care. We conducted a systematic review of the existing literature on SMA interventions for patients with diabetes in order to understand their impact on outcomes. DATA SOURCES MEDLINE, EMBASE, CINAHL, PsycINFO, and Web of Science from January 1996 through April 2012. PubMed search updated June 2013. STUDY SELECTION English-language peer-reviewed publications of randomized controlled trials (RCTs), nonrandomized cluster controlled trials, controlled before-and-after studies, or interrupted time-series designs conducted among adult patients with diabetes. Two independent reviewers used prespecified criteria to screen titles and abstracts for full text review. STUDY APPRAISAL AND SYNTHESIS METHODS Two different reviewers abstracted data and rated study quality and strength of evidence. When possible, we used random-effects models to synthesize the effects quantitatively, reporting by a weighted difference of the means when the same scale was used across studies, and a standardized mean difference when the scales differed. We measured heterogeneity in study effects using Forest Plots, Cochran's Q, and I(2), and explored heterogeneity by using subgroup analyses for categorical variables and meta-regression analyses for continuous or discrete variables. Outcomes not suitable to meta-analysis were summarized qualitatively. RESULTS Twenty-five articles representing 17 unique studies compared SMA interventions with usual care. Among patients with diabetes, SMAs improved hemoglobin A1c (∆ = -0.55 percentage points [95 % CI, -0.11 to -0.99]); improved systolic blood pressure (∆ = -5.2 mmHg [95 % CI, -3.0 to -7.4]); and did not improve LDL cholesterol (∆ = -6.6 mg/dl [95 % CI, 2.8 to -16.1]). Nonbiophysical outcomes, including economic outcomes, were reported too infrequently to meta-analyze, or to draw conclusions from. The A1c result had significant heterogeneity among studies, likely secondary to the heterogeneity among included SMA interventions. LIMITATION Heterogeneity among the components of diabetes SMAs leads to uncertainty about what makes a particular SMA successful. CONCLUSION SMA interventions improve biophysical outcomes among patients with diabetes. There was inadequate literature to determine SMA effects on patient experience, utilization, and costs.
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Research Versus Quality Improvement: Distinct or a Distinction Without a Difference? A Case Study Comparison of Two Studies. Jt Comm J Qual Patient Saf 2014; 40:365-75. [DOI: 10.1016/s1553-7250(14)40048-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Gillespie P, O'Shea E, O'Hara MC, Dinneen SF. Cost effectiveness of group follow-up after structured education for type 1 diabetes: a cluster randomised controlled trial. Trials 2014; 15:227. [PMID: 24927851 PMCID: PMC4070096 DOI: 10.1186/1745-6215-15-227] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 05/28/2014] [Indexed: 11/10/2022] Open
Abstract
Background This study examines the cost effectiveness of group follow-up after participation in the Dose Adjustment for Normal Eating (DAFNE) structured education programme for type 1 diabetes. Methods Economic evaluation conducted alongside a cluster randomised controlled trial involving 437 adults with type 1 diabetes in Ireland. Group follow-up involved two group education ‘booster’ sessions post-DAFNE. Individual follow-up involved two standard one-to-one hospital clinic visits. Incremental costs, quality-adjusted life years (QALYs) gained and cost effectiveness were estimated at 18 months. Uncertainty was explored using sensitivity analysis and by estimating cost effectiveness acceptability curves. Results Group follow-up was associated with a mean reduction in QALYs gained of 0.04 per patient (P value, 0.052; 95% CI, −0.08 to 0.01, intra-class correlation (ICC), 0.033) and a mean reduction in total healthcare costs of €772 (P value, 0.020; 95% CI, −1,415 to −128: ICC, 0.016) per patient. At alternative threshold values of €5,000, €15,000, €25,000, €35,000, and €45,000, the probability of group follow-up being cost effective was estimated to be 1.000, 0.762, 0.204, 0.078, and 0.033 respectively. Conclusions The results do not support implementation of group follow-up as the sole means of follow-up post-DAFNE. Given the reported cost savings, future studies should explore the cost effectiveness of alternative models of group care for diabetes. Trial registration Current Controlled Trials ISRCTN79759174 (assigned: 9 February 2007).
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Affiliation(s)
- Paddy Gillespie
- School of Business and Economics, J,E, Cairnes Building, NUI Galway, Galway, Ireland.
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Thompson C, Meeuwisse I, Dahlke R, Drummond N. Group Medical Visits in Primary Care for Patients with Diabetes and Low Socioeconomic Status: Users' Perspectives and Lessons for Practitioners. Can J Diabetes 2014; 38:198-204. [DOI: 10.1016/j.jcjd.2014.03.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 03/04/2014] [Accepted: 03/04/2014] [Indexed: 11/28/2022]
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Hwee J, Cauch-Dudek K, Victor JC, Ng R, Shah BR. Diabetes education through group classes leads to better care and outcomes than individual counselling in adults: a population-based cohort study. Canadian Journal of Public Health 2014; 105:e192-7. [PMID: 25165838 DOI: 10.17269/cjph.105.4309] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 05/23/2014] [Accepted: 03/22/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Self-management education, supported by multidisciplinary health care teams, is essential for optimal diabetes management. We sought to determine whether acute diabetes complications or quality of care differed for patients in routine clinical care when their self-management education was delivered through group diabetes education classes versus individual counselling. METHODS With the use of population-level administrative and primary data, all diabetic patients in Ontario who attended a self-management education program in 2006 were identified and grouped according to whether they attended group classes (n=12,234), individual counselling (n=55,761) or a mixture of both (n=9,829). Acute complications and quality of care in the following year were compared among groups. RESULTS Compared with those attending individual counselling, patients who attended group classes were less likely to have emergency department visits for hypo/hyperglycemia (odds ratio 0.54, 95% confidence interval [CI]: 0.42-0.68), hypo/hyperglycemia hospitalizations (OR 0.49, CI: 0.32-0.75) or foot ulcers/cellulitis (OR 0.64, CI: 0.50-0.81). They were more likely to have adequate HbA1c testing (OR 1.10, CI: 1.05-1.15) and lipid testing (OR 1.25, CI: 1.19-1.32), and were more likely to receive statins (OR 1.22, CI: 1.07-1.39). CONCLUSION Group self-management education was associated with fewer acute complications and some improvements in processes of care. Group sessions can offer care to more patients with reduced human resource requirements. With increased pressure to find efficiencies in health care delivery, group diabetes education may provide an opportunity to deliver less resource-intensive care that simultaneously improves patient care.
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Crowley MJ, Melnyk SD, Ostroff JL, Fredrickson SK, Jeffreys AS, Coffman CJ, Edelman D. Can group medical clinics improve lipid management in diabetes? Am J Med 2014; 127:145-51. [PMID: 24462012 DOI: 10.1016/j.amjmed.2013.09.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 09/20/2013] [Accepted: 09/24/2013] [Indexed: 01/17/2023]
Abstract
BACKGROUND Group medical clinics may improve diabetes and hypertension control, but data about dyslipidemia are limited. We examined the impact of group medical clinics on lipids among patients with uncontrolled diabetes and hypertension. METHODS Prespecified secondary analysis of 239 veterans randomized to group medical clinics or usual care. Lipids were assessed at study baseline, midpoint, and end. We used linear mixed models to compare lipid levels between arms and generalized estimating equation models to compare low-density lipoprotein cholesterol (LDL-C) goal attainment. An additional post hoc analysis examined intensification of cholesterol-lowering medications in both arms. RESULTS At baseline, mean total cholesterol was 169.7 mg/dL (SD 47.8), LDL-C 98.2 mg/dL (SD 41.7), and high-density lipoprotein cholesterol (HDL-C) 39.3 mg/dL (SD 13.0). Median baseline triglycerides were 131 mg/dL (interquartile range 122). By study end, mean total cholesterol and LDL-C in group medical clinics were 14.2 mg/dL (P = .01) and 9.2 mg/dL (P = .02) lower than usual care, respectively; 76% of group medical clinic patients met goals for LDL-C, versus 61% of usual care patients (P = .02). Triglycerides and HDL-C remained similar between study arms. Treatment intensification occurred in 52% of group medical clinic patients, versus 37% of usual care patients between study baseline and end (P = .04). The mean statin dose was higher in group medical clinic patients at study midpoint and end. CONCLUSIONS Group medical clinics appear to enhance lipid management among patients with diabetes and hypertension. This may be a result of greater intensification of cholesterol-lowering medications in group medical clinics relative to usual care.
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Affiliation(s)
- Matthew J Crowley
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC; Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Duke University, Durham, NC.
| | - Stephanie D Melnyk
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC; Eshelman School of Pharmacy, University of North Carolina, Chapel Hill
| | - Jared L Ostroff
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC
| | | | - Amy S Jeffreys
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC
| | - Cynthia J Coffman
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC
| | - David Edelman
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC; Department of Medicine, Division of General Internal Medicine, Duke University, Durham, NC
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Trento M, Panero F, Porta M, Gruden G, Barutta F, Cerutti F, Gambino R, Perotto M, Cavallo Perin P, Bruno G. Diabetes-specific variables associated with quality of life changes in young diabetic people: the type 1 diabetes Registry of Turin (Italy). Nutr Metab Cardiovasc Dis 2013; 23:1031-1036. [PMID: 23466181 DOI: 10.1016/j.numecd.2013.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 01/07/2013] [Accepted: 01/07/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIMS Type 1 diabetes (T1DM) affects young people during the most active years of their life. Our aim was to assess quality of life (QoL) and associated variables in a large cohort of adults with childhood-onset and adult-onset T1DM. METHODS A cohort of adult patients (18 years and older) from the T1DM Registry of Turin, Italy, was recruited. Clinical characteristics and Diabetes QoL (DQOL) questionnaire were assessed by standardized procedures. RESULTS 310 adults completed the questionnaire. Age and diabetes duration at assessment (mean ± SD) were 32.8 ± 7.3 years and 17.3 ± 6.3 years, respectively. DQOL and its subscores were in the lower quartiles of their distributions, indicating a good level of QoL. However, scores were significantly higher in females than in males, particularly for the subscale of diabetes-related worries. In multivariate analysis, lower QoL was independently associated with female sex (β = 1.07, 95% CI 1.03-1.11, p = 0.003), higher age at onset (β = 1.03, 1.00-1.05, p = 0.009), lower schooling (β = 1.05, 1.00-1.09, p = 0.02), higher fasting plasma glucose (β = 1.03, 1.01-1.05, p = 0.008), daily SMBG >4 (β = 1.06, 1.01-1.10, p = 0.01), severe hypoglycemia over the last year (β = 1.06, 1.01-1.11, p = 0.02), lower numbers of diabetologic visits (β = 1.07, 1.01-1.13, p = 0.02) and hypertension (β = 1.06, 1.02-1.10, p = 0.005). Autonomic neuropathy was associated with diabetes impact. Female sex (β = 4.36, 2.43-7.83) and daily SMBG >4 (β = 3.77, 1.72-8.30) were independently associated with worst level and CSII with better level (β = 0.22, 0.07-0.68) of diabetes-related worries. CONCLUSIONS The impact of T1DM on QoL may depend on demographic, metabolic control-related variables, presence of complications and insulin delivery modality.
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Affiliation(s)
- M Trento
- Laboratory of Clinical Pedagogy, Dept of Medical Sciences, University of Turin, Italy
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Housden L, Wong ST, Dawes M. Effectiveness of group medical visits for improving diabetes care: a systematic review and meta-analysis. CMAJ 2013; 185:E635-44. [PMID: 23939218 PMCID: PMC3778483 DOI: 10.1503/cmaj.130053] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Group medical visits, whereby health care professionals meet with groups of patients who have the same disease, have been introduced in primary care as a way to meet the increasing demand for health care delivery to patients with chronic diseases. We performed a systematic review and meta-analysis of the evidence on the effectiveness of such visits for patients with diabetes. METHODS We conducted a systematic review of all relevant studies published from 1947 to February 2012 identified in a search of electronic databases and grey literature. We included randomized controlled trials (RCTs) and observational studies published in English that included patients aged 16-80 years with type 1 or 2 diabetes and that had group medical visits as the intervention. These studies were assessed for methodologic quality. We included data only from the RCTs in the meta-analysis. RESULTS Of the 94 studies identified, we selected 26 that met our inclusion criteria, 13 of which were RCTs. Group medical visits had a positive effect on clinical and patient-reported outcomes, with significant reductions in glycated hemoglobin (HbA1c reduction -0.46%, 95% confidence interval -0.80% to -0.31%). We were unable to assess the effect of group medical visits on processes of care because of an insufficient number of RCTs that reported on this outcome. INTERPRETATION Group medical visits for patients with diabetes were found to be effective in terms of reducing HbA1c. The results of our meta-analysis suggest that wider implementation of group medical visits for patients with diabetes will have a positive effect on patient outcomes.
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Affiliation(s)
- Laura Housden
- School of Nursing (Housden, Wong), Centre for Health Services and Policy Research (Wong) and Department of Family Practice, Faculty of Medicine (Wong, Dawes), University of British Columbia, Vancouver BC
| | - Sabrina T. Wong
- School of Nursing (Housden, Wong), Centre for Health Services and Policy Research (Wong) and Department of Family Practice, Faculty of Medicine (Wong, Dawes), University of British Columbia, Vancouver BC
| | - Martin Dawes
- School of Nursing (Housden, Wong), Centre for Health Services and Policy Research (Wong) and Department of Family Practice, Faculty of Medicine (Wong, Dawes), University of British Columbia, Vancouver BC
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Crowley MJ, Melnyk SD, Coffman CJ, Jeffreys AS, Edelman D. Impact of baseline insulin regimen on glycemic response to a group medical clinic intervention. Diabetes Care 2013; 36:1954-60. [PMID: 23393214 PMCID: PMC3687258 DOI: 10.2337/dc12-1905] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Group medical clinics (GMC) combine medication management and self-management training, and may improve diabetes outcomes. It remains unclear which patients benefit most from GMC. This secondary analysis examined the impact of baseline insulin regimen on GMC response. RESEARCH DESIGN AND METHODS We analyzed a trial of 239 veterans with type 2 diabetes randomized to GMC or usual care (UC). We categorized baseline insulin regimen as the following: no insulin; basal insulin only; or complex insulin (basal-prandial or mixed regimens). Using linear mixed models adjusted for clustering within GMC, we evaluated the differential impact of GMC relative to UC on hemoglobin A1c (HbA1c) and self-efficacy among patients on different baseline insulin regimens. RESULTS From linear mixed models, the effect of GMC on HbA1c differed by baseline insulin regimen versus UC (P = 0.05); there was no differential effect on self-efficacy (P = 0.29). Among those using complex insulin regimens at baseline, GMC reduced HbA1c by study end compared with UC (-1.0%; 95% CI -1.8 to -0.2; P = 0.01). We found no such HbA1c difference between GMC and UC patients using no insulin (P = 0.65) or basal insulin only (P = 0.71). There were no clinically significant differences in hypoglycemia by baseline insulin regimen and intervention group. CONCLUSIONS We found that compared with UC, GMC lowered HbA1c specifically among patients using complex insulin regimens at study baseline, which may relate to this group's demanding medication and self-management requirements. Implementing GMC among patients using complex insulin regimens may maximize this care delivery strategy's potential.
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Affiliation(s)
- Matthew J Crowley
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, North Carolina, USA.
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Abstract
Innovative group medical visit programs have emerged in an effort to increase efficiency, improve service and quality of healthcare, and better manage high-risk patient populations. A case study program for cancer survivors, adapted from the Centering Healthcare Institute's model, demonstrates how nurse practitioners can lead the implementation and measurement outcomes of group visit models.
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Dinneen SF, O'Hara MC, Byrne M, Smith D, Courtney CH, McGurk C, Heller SR, Newell J, Coffey N, Breen C, O'Scannail M, O'Shea D. Group follow-up compared to individual clinic visits after structured education for type 1 diabetes: a cluster randomised controlled trial. Diabetes Res Clin Pract 2013; 100:29-38. [PMID: 23398978 DOI: 10.1016/j.diabres.2013.01.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 12/11/2012] [Accepted: 01/14/2013] [Indexed: 01/23/2023]
Abstract
AIM To compare the effectiveness of group follow-up with individual follow-up after participation in the Dose Adjustment for Normal Eating (DAFNE) structured education programme. METHODS Cluster randomised controlled trial involving 437 adults with type 1 diabetes attending hospital diabetes clinics in Ireland. All participants received DAFNE at baseline. Intervention arm participants received 2 group education sessions post-DAFNE and did not attend clinics. Control arm participants received 2 one-to-one clinic visits post-DAFNE. RESULTS We observed no significant difference in the primary outcome (change in HbA1c) at 18 months follow-up (mean difference 0.14%; 95% CI -0.33 to 0.61; p=0.47). Secondary outcomes, including rates of severe hypoglycaemia, anxiety, depression, the burden of living with diabetes and quality of life did not differ between groups. Mean level of HbA1c for the entire sample (regardless of treatment arm) did not change between baseline and 18 month follow-up (p=0.09), but rates of severe hypoglycaemia, diabetes related hospital attendance, levels of anxiety, depression, the burden of living with diabetes, quality of life and treatment satisfaction all significantly improved. CONCLUSIONS Our data suggest that group follow-up as the sole means of follow-up after structured education for individuals with type 1 diabetes is as effective as a return to one-to-one clinic visits.
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Eisenstat SA, Ulman K, Siegel AL, Carlson K. Diabetes group visits: integrated medical care and behavioral support to improve diabetes care and outcomes from a primary care perspective. Curr Diab Rep 2013. [PMID: 23207990 DOI: 10.1007/s11892-012-0349-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Of the many innovations in health care delivery proposed in the context of health reform for those with chronic diseases such as diabetes, the group visit model is relatively easy to implement and is effective for improving health outcomes and patient and provider satisfaction, with a neutral to positive effect on health care costs. This article describes the evolution of group visits for those with diabetes, the theory underlying group visits for patients with chronic medical conditions, and the existing evidence for the effectiveness of this model. It also addresses implementation of groups in practice, with an emphasis on the practical aspects of program implementation, integration of behavioral expertise into medical groups, individualization in various practice settings, and reimbursement issues.
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Homer CSE, Ryan C, Leap N, Foureur M, Teate A, Catling-Paull CJ. Group versus conventional antenatal care for women. Cochrane Database Syst Rev 2012; 11:CD007622. [PMID: 23152247 DOI: 10.1002/14651858.cd007622.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Antenatal care is one of the key preventive health services used around the world. In most Western countries, antenatal care traditionally involves a schedule of one-to-one visits with a care provider. A different way of providing antenatal care is through a group model. OBJECTIVES The first objective was to compare the effects of group antenatal care versus one-to-one care on outcomes for women and their babies. The primary outcomes were preterm birth (birth occurring before 37 completed gestational weeks), low birthweight (less than 2500 g), small-for-gestational age (less than the tenth percentile for gestation and gender) and perinatal mortality. Secondary outcomes included psychological measures and satisfaction as well as labour and birth and postnatal outcomes.The second objective was to compare the effects of group care versus one-to-one care on care provider satisfaction. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (9 March 2012), contacted experts in the field and reviewed the reference lists of retrieved studies. SELECTION CRITERIA All identified published, unpublished and ongoing randomised and quasi-randomised controlled trials comparing group antenatal care with conventional antenatal care were included. Cluster-randomised trials were eligible for inclusion but none were identified. Cross-over trials were not eligible. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion and evaluated trial quality. Two authors extracted data. Data were checked for accuracy. MAIN RESULTS We included two studies (1369 women). There were no statistically significant differences between women who received group antenatal care compared with standard one-to-one care in relation to the primary outcomes. In particular, there was no difference in the rate of preterm birth rate between the two groups (risk ratio (RR) 0.87; 95% confidence interval (CI) 0.47 to 1.60; two trials; N = 1315) and the proportion of low birthweight (less than 2500 g) babies was similar between the groups (RR 1.03; 95% CI 0.73 to 1.46; two trials; N = 1315).Satisfaction was rated highly in women who were allocated to group antenatal care but only measured in one trial. In this trial, the mean satisfaction with care in group antenatal care was almost five times higher compared with those allocated to standard care (N = 993). A number of outcomes related to stress, distress and depression were reported in one trial. There were no differences between the groups in any of these outcomes.There were no data available on the effects of group antenatal care on care provider satisfaction. AUTHORS' CONCLUSIONS The available evidence suggests that group antenatal care is positively viewed by women with no adverse outcomes for themselves or their babies. This review is limited owing to the small number of studies/women and the majority of the analyses are based on a single study. More research is required to determine if group antenatal care is associated with significant benefits.
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Affiliation(s)
- Caroline S E Homer
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Broadway, Australia.
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Raballo M, Trevisan M, Trinetta AF, Charrier L, Cavallo F, Porta M, Trento M. A study of patients' perceptions of diabetes care delivery and diabetes: propositional analysis in people with type 1 and 2 diabetes managed by group or usual care. Diabetes Care 2012; 35:242-7. [PMID: 22210565 PMCID: PMC3263876 DOI: 10.2337/dc11-1495] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We investigated the perceptions of diabetes care and diabetes in patients followed long-term by group or usual care. RESEARCH DESIGN AND METHODS Three open questions were administered to 120 patients (43 with T1DM and 77 with T2DM) who had been randomized at least 2 years before to be followed by group care and 121 (41 T1DM and 80 T2DM) who had always been on usual care. The responses were analyzed by propositional analysis, by identifying the focal nuclei, i.e., the terms around which all sentences are organized, and then other predicates, according to their hierarchical relationship to the nuclear proposition. Specific communicative units were arbitrarily classified into three categories: attitudes, empowerment, and locus of control. RESULTS Patients on group care showed more positive attitudes, higher sense of empowerment, and more internal locus of control than those on usual care. In addition, they expressed a wider and more articulated range of concepts associated with the care received and made less use of medical terminology (P < 0.001, all). Higher HbA(1c) was associated with negative attitudes (P = 0.025) and negative empowerment (P = 0.055). CONCLUSIONS Group treatment reinforces communication and peer identification and may achieve its clinical results by promoting awareness, self-efficacy, positive attitudes toward diabetes and the setting of care, an internal locus of control, and, ultimately, empowerment in the patients.
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Affiliation(s)
- Marzia Raballo
- Laboratory of Clinical Pedagogy, Department of Internal Medicine, University of Turin, Turin, Italy
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Seesing FM, Drost G, van der Wilt GJ, van Engelen BGM. Effects of shared medical appointments on quality of life and cost-effectiveness for patients with a chronic neuromuscular disease. Study protocol of a randomized controlled trial. BMC Neurol 2011; 11:106. [PMID: 21861909 PMCID: PMC3178478 DOI: 10.1186/1471-2377-11-106] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 08/23/2011] [Indexed: 11/26/2022] Open
Abstract
Background Shared medical appointments are a series of one-to-one doctor-patient contacts, in presence of a group of 6-10 fellow patients. This group visits substitute the annual control visits of patients with the neurologist. The same items attended to in a one-to- one appointment are addressed. The possible advantages of a shared medical appointment could be an added value to the present management of neuromuscular patients. The currently problem-focused one-to-one out-patient visits often leave little time for the patient's psychosocial needs, patient education, and patient empowerment. Methods/design A randomized, prospective controlled study (RCT) with a follow up of 6 months will be conducted to evaluate the clinical and cost-effectiveness of shared medical appointments compared to usual care for 300 neuromuscular patients and their partners at the Radboud University Nijmegen Medical Center. Every included patient will be randomly allocated to one of the two study arms. This study has been reviewed and approved by the medical ethics committee of the region Arnhem-Nijmegen, the Netherlands. The primary outcome measure is quality of life as measured by the EQ-5D, SF-36 and the Individualized neuromuscular Quality of Life Questionnaire. The primary analysis will be an intention-to-treat analysis on the area under the curve of the quality of life scores. A linear mixed model will be used with random factor group and fixed factors treatment, baseline score and type of neuromuscular disease. For the economic evaluation an incremental cost-effectiveness analysis will be conducted from a societal perspective, relating differences in costs to difference in health outcome. Results are expected in 2012. Discussion This study will be the first randomized controlled trial which evaluates the effect of shared medical appointments versus usual care for neuromuscular patients. This will enable to determine if there is additional value of shared medical appointments to the current therapeutical spectrum. When this study shows that group visits produce the alleged benefits, this may help to increase the acceptance of this innovative and creative way of using one of the most precious resources in health care more efficiently: time. Trial registration DutchTrial Register http://www.trialregister.nlNTR1412
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Affiliation(s)
- Femke M Seesing
- Department of Neurology, Radboud University Nijmegen Medical Center, Reinier Postlaan 4, Nijmegen, The Netherlands
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Trento M, Trinetta A, Kucich C, Grassi G, Passera P, Gennari S, Paganin V, Tedesco S, Charrier L, Cavallo F, Porta M. Carbohydrate counting improves coping ability and metabolic control in patients with Type 1 diabetes managed by Group Care. J Endocrinol Invest 2011; 34:101-5. [PMID: 20440106 DOI: 10.1007/bf03347038] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND AIMS To assess, in patients with Type 1 diabetes (T1DM), the effects of adding a carbohydrate counting programme (CCP) to continuing education by Group Care on coping ability, quality of life (QoL), knowledge of diabetes, and metabolic control. MATERIALS AND METHODS Out of 56 patients with T1DM followed by Group Care, 27 were randomized to receive an 8-session CCP and 29 controls continued Group Care without a CCP. QoL, knowledge, and coping ability were assessed at baseline and after 30 months. Glycated hemoglobin (HbA1c), body weight, blood glucose, hypoglycemic episodes, and insulin dosages were checked every 3 months. RESULTS QoL improved (p<0.0001) in both CCP (88.7 ± 9.2 vs 78.0 ± 9.9) and control patients (88.7 ± 12.5 vs 80.4 ± 11.7). At the end of study, patients on CCP had better scores in knowledge [difference 0.72 (95% CI 0.44; 0.99), p<0.0001] and the 3 coping areas [problem solving: 1.75 (1.2; 2.3), p<0.0001; social support seeking: -1.4 (-2.3; -0.48) p<0.005; avoidance: -1.59 (-2.6; -0.56), p<0.005] than controls. All variables showed a greater, although not statistically significant, improvement in patients with poor schooling. At 30 months, HbA1c was lower in the CCP patients than controls (7.2 ± 0.9 vs 7.9 ± 1.4), p<0.05. There were no changes in insulin dosage, hypoglycemic episodes or blood lipids. CONCLUSIONS This study confirms that Group Care improves QoL in people with T1DM, but suggests that specific educational and psychological supports are needed to modify adaptation to the disease. The CCP we developed appears effective in promoting change, also in patients with poor schooling.
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Affiliation(s)
- M Trento
- Laboratory of Clinical Pedagogy, Department of Internal Medicine, University of Turin, Corso AM Dogliotti 14, I-10126 Turin, Italy.
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Brennan J, Hwang D, Phelps K. Group Visits and Chronic Disease Management in Adults: A Review. Am J Lifestyle Med 2010. [DOI: 10.1177/1559827610378331] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Chronic disease management using the traditional 15-minute appointment is exceptionally challenging and arguably inadequate to provide comprehensive, prospective, patient-centered primary care. A model of care designed to promote patient education, patient self-management, and improved access to their physicians and other health care providers is needed. Group visits have been identified as one model that allows physicians to deliver extensive patient education and self-management instruction while enhancing financial productivity. A thorough review of the literature on group visits was performed. Fairly consistent results from level I and II quality of evidence from a revised Strength of Recommendation Taxonomy (SORT) rating system indicate that patients who attended group visits demonstrated improved standards of care, improved quality of life, greater patient and physician satisfaction, lower rates of hospitalization and emergency department utilization, and reduced specialty costs. Discrepancies from the literature review include body mass index, hemoglobin A1C, blood pressure, and lipids. Overall, group visits appear to provide an effective and complementary strategy to traditional primary care in dealing with the complexities of providing chronic disease management in an increasing complex and aging population.
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Affiliation(s)
- Julie Brennan
- University of Toledo/St. Luke's Family Medicine Residency, Maumee, Ohio,
| | - Do Hwang
- University of Toledo/St. Luke's Family Medicine Residency, Maumee, Ohio
| | - Kevin Phelps
- From University of Toledo/St. Luke's Family Medicine Residency, Maumee, Ohio
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American Association of Diabetes Ed. AADE Guidelines for the Practice of Diabetes Self-Management Education and Training (DSME/T). DIABETES EDUCATOR 2009. [DOI: 10.1177/0145721709352436] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Trento M, Borgo E, Kucich C, Passera P, Trinetta A, Charrier L, Cavallo F, Porta M. Quality of life, coping ability, and metabolic control in patients with type 1 diabetes managed by group care and a carbohydrate counting program. Diabetes Care 2009; 32:e134. [PMID: 19875597 DOI: 10.2337/dc09-0903] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Marina Trento
- the Laboratory of Clinical Pedagogy, Department of Internal Medicine, University of Turin, Turin, Italy
| | - Enrica Borgo
- the Laboratory of Clinical Pedagogy, Department of Internal Medicine, University of Turin, Turin, Italy
| | - Claudia Kucich
- the Laboratory of Clinical Pedagogy, Department of Internal Medicine, University of Turin, Turin, Italy
| | - Pietro Passera
- the Laboratory of Clinical Pedagogy, Department of Internal Medicine, University of Turin, Turin, Italy
| | - Anna Trinetta
- the Laboratory of Clinical Pedagogy, Department of Internal Medicine, University of Turin, Turin, Italy
| | - Lorena Charrier
- Department of Public Health and Microbiology, University of Turin, Turin, Italy
| | - Franco Cavallo
- Department of Public Health and Microbiology, University of Turin, Turin, Italy
| | - Massimo Porta
- the Laboratory of Clinical Pedagogy, Department of Internal Medicine, University of Turin, Turin, Italy
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Robertson B, Aycock DM, Darnell LA. Comparison of centering pregnancy to traditional care in Hispanic mothers. Matern Child Health J 2008; 13:407-14. [PMID: 18465216 DOI: 10.1007/s10995-008-0353-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2007] [Accepted: 04/22/2008] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare maternal and infant outcomes in Hispanic women participating in the Centering Pregnancy Model (CPM) to those receiving prenatal care via the traditional model and determine acceptability of the CPM. METHODS Forty-nine women (n = 24 CPM; n = 25 traditional) participated in this quasi-experimental prospective comparative design. Participants self selected the model of care delivery. Data were collected via questionnaires at the initial visit, 34-36 weeks gestation, and postpartum. Outcome measures included: satisfaction with care delivery model, health behaviors, prenatal/postnatal care knowledge, self-esteem and depression. Breastfeeding initiation and continuation, infant birth weight, gestational age at delivery, mode of delivery and infant length of stay were also collected. RESULTS Traditional participants had a history of more pregnancies, more living children, and higher levels of postpartum self-esteem compared to centering participants. Knowledge deficits and health behaviors were similar between groups. No differences were found for infant outcomes. CONCLUSIONS This study provides information regarding Hispanic mothers' responses to an alternative care delivery model. Preliminary evidence suggests CPM compares with traditional care and yields a high degree of patient satisfaction. Specific pregnancy-related knowledge deficits were identified in both groups that could focus prenatal education. In light of similar outcomes in both groups; patient and provider satisfaction and economics would therefore be a factor when choosing a model of prenatal care delivery.
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Affiliation(s)
- Bethany Robertson
- The Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Suite 364, Atlanta, GA 30322, USA.
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Urbanski P, Wolf A, Herman WH. Cost-Effectiveness of Diabetes Education. ACTA ACUST UNITED AC 2008; 108:S6-11. [DOI: 10.1016/j.jada.2008.01.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2007] [Accepted: 12/17/2007] [Indexed: 11/30/2022]
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Trento M, Tomelini M, Basile M, Borgo E, Passera P, Miselli V, Tomalino M, Cavallo F, Porta M. The locus of control in patients with Type 1 and Type 2 diabetes managed by individual and group care. Diabet Med 2008; 25:86-90. [PMID: 18199135 DOI: 10.1111/j.1464-5491.2007.02319.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS The locus of control theory distinguishes people (internals) who attribute events in life to their own control, and those (externals) who attribute events to external circumstances. It is used to assess self-management behaviour in chronic illnesses. Group care is a model of systemic group education that improves lifestyle behaviour and quality of life in patients with Type 1 and Type 2 diabetes. This study investigated the locus of control in Type 1 and Type 2 diabetes and the possible differences between patients managed by group care and control subjects followed by traditional one-to-one care. METHODS Cross-sectional administration of two questionnaires (one specific for diabetes and one generic for chronic diseases) to 83 patients followed for at least 5 years by group care (27 Type 1 and 56 Type 2) and 79 control subjects (28 Type 1 and 51 Type 2) of similar sex, age and diabetes duration. Both tools explore internal control of disease, the role of chance in changing it and reliance upon others (family, friends and health professionals). RESULTS Patients with Type 1 diabetes had lower internal control, greater fatalistic attitudes and less trust in others. Patients with either type of diabetes receiving group care had higher internal control and lower fatalism; the higher trust in others in those with Type 1 diabetes was not statistically significant. The differences associated with group care were independent of sex, age and diabetes duration. CONCLUSIONS Patients with Type 1 diabetes may have lower internal control, fatalism and reliance upon others than those with Type 2 diabetes. Receiving group care is associated with higher internal control, reduced fatalism and, in Type 1 diabetes, increased trust in others.
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Affiliation(s)
- M Trento
- Department of Internal Medicine, Laboratory of Clinical Pedagogy, University of Turin, Turin, Italy.
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