Group Diabetes Self-Management Education in a Primary Care Setting: A Quality Improvement Project

Assessment of a patient-centered initiative to improve hypertension management for adults with comorbid type 2 diabetes at a free clinic in the rural south

BACKGROUND

Hypertension is the most modifiable risk factor for cardiovascular disease. Low levels of adherence to medication regimens, positive health behaviors, and ideal metric goals are associated with low rates of morbidity and mortality, impaired physical function, and frailty.

AIM

This quality improvement study sought to assess whether a program of patient and provider education, combined with a decision aid (DA) designed to increase shared decision making, would improve (a) patient knowledge about hypertension management, (b) provider adherence to prescription guidelines for the management of hypertension, (c) medication adherence for the management of hypertension by the patient, and (d) communication between provider and patient.

SETTING

Free clinic in the United States rural south.

PARTICIPANTS

Twenty-four patients with comorbid hypertension and type 2 diabetes.

METHODS

A pretest/posttest design utilizing a provider education, pre-encounter quiz, focused patient education, and DA was used to evaluate the intervention.

RESULTS

A significant increase in pretest/posttest scores 60% (SD = 29%) to 93% (SD = 15%), P < .001 about hypertension and its management was observed. Adherence to guideline-based medication use increased angiotensin-converting enzyme inhibitors 38% to 64%, angiotensin II receptor blockers 17% to 29%, dihydropyridine calcium channel blockers 29% to 43%, beta-blockers 8% to 25%, statins 65% to 83%, and diuretics 38% to 46%.

CONCLUSIONS

The intervention was an efficient method to provide patient-centered education that increased patient knowledge about medication and lifestyle management of hypertension.

Evaluation of frailty status among older people living in urban communities by Edmonton Frail Scale in Wuhu, China: a cross-sectional study

BACKGROUND

Few studies have explored the factors that are associated with frailty among older people.

OBJECTIVE

To investigate the frailty status and examine the sociodemographic factors that are associated with of older peoples' frailty status in China.

DESIGN

Cross-sectional study.

METHODS

We used convenience sampling to recruit the participants (aged 60 and above) from four communities in an urban area of Wuhu, Anhui, China. Participants completed a questionnaire which included the Edmonton Frail Scale (EFS) and sociodemographic factorsWe used convenience sampling to recruit the participants (aged 60 and above) from four communities in an urban area of Wuhu, Anhui, China. Participants completed a questionnaire which included the Edmonton Frail Scale (EFS) and sociodemographic factors.

RESULTS

Of 306 participants, the percentage of participants with a robust score (0-4) on the EFS was 71.9%, 14.1% had an apparently vulnerable score (5-6), and 14.0% had a frail score (7-17). Age, chronic disease status and marital status were significantly associated with frailty.

CONCLUSIONS

There are a high percentage of frail older Chinese adults in the urban area. The present study findings could provide better understanding of the factors associated with frailty status of this population.

Health education via mobile text messaging for glycemic control in adults with type 2 diabetes: a systematic review and meta-analysis

BACKGROUND

Diabetes type 2 is an increasing problem worldwide that may be managed through education. Text-messaging using a cell phone can assist with self-care. The aim of this study was to systematically review the impact of education through mobile text-messaging on glycemic control.

METHODS

The design was a systematic review with meta-analysis. Five electronic databases were searched to access English studies involving a randomized controlled trial design that used text-messaging educational interventions in patients with type 2 diabetes during an 11-year period (2003-2013). Studies were evaluated using a quality assessment scale adapted from Jadad scale and Cochrane handbook. Extraction of data was carried out by two reviewers. A random-effect model with a standardized mean difference and Hedges's g indices was used for conducting the meta-analysis. Subgroup analyses were conducted and a Funnel plot was used to examine publication bias.

RESULTS

Ten studies overall were identified that fulfilled inclusion criteria, involving a total of 960 participants. The mean age of the sample was 52.8 years and majority were females. Data were heterogeneous (I(2)=67.6). Analyses suggested a publication bias based on Egger's regression (P<0.05). HbA1c was reduced significantly in experimental groups compared to control groups (P<0.001). The effect size for glycemic control in studies that used text-messaging only was 44%. For studies that used both text-messaging and Internet, the effect size was 86%.

CONCLUSION

Mobile text-messaging for educating Type 2 diabetics appears to be effective on glycemic control. Further investigations on mobile applications to achieve educational goals involving other diseases are recommended.