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Aubrey-Basler K, Bursey K, Pike A, Penney C, Furlong B, Howells M, Al-Obaid H, Rourke J, Asghari S, Hall A. Interventions to improve primary healthcare in rural settings: A scoping review. PLoS One 2024; 19:e0305516. [PMID: 38990801 PMCID: PMC11239038 DOI: 10.1371/journal.pone.0305516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 06/01/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Residents of rural areas have poorer health status, less healthy behaviours and higher mortality than urban dwellers, issues which are commonly addressed in primary care. Strengthening primary care may be an important tool to improve the health status of rural populations. OBJECTIVE Synthesize and categorize studies that examine interventions to improve rural primary care. ELIGIBILITY CRITERIA Experimental or observational studies published between January 1, 1996 and December 2022 that include an historical or concurrent control comparison. SOURCES OF EVIDENCE Pubmed, CINAHL, Cochrane Library, Embase. CHARTING METHODS We extracted and charted data by broad category (quality, access and efficiency), study design, country of origin, publication year, aim, health condition and type of intervention studied. We assigned multiple categories to a study where relevant. RESULTS 372 papers met our inclusion criteria, divided among quality (82%), access (20%) and efficiency (13%) categories. A majority of papers were completed in the USA (40%), Australia (15%), China (7%) or Canada (6%). 35 (9%) papers came from countries in Africa. The most common study design was an uncontrolled before-and-after comparison (32%) and only 24% of studies used randomized designs. The number of publications each year has increased markedly over the study period from 1-2/year in 1997-99 to a peak of 49 papers in 2017. CONCLUSIONS Despite substantial inequity in health outcomes associated with rural living, very little attention is paid to rural primary care in the scientific literature. Very few studies of rural primary care use randomized designs.
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Affiliation(s)
- Kris Aubrey-Basler
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Division of Public Health and Applied Health Sciences, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Krystal Bursey
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Andrea Pike
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Carla Penney
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Bradley Furlong
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Mark Howells
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Harith Al-Obaid
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - James Rourke
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Shabnam Asghari
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Division of Public Health and Applied Health Sciences, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Amanda Hall
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Division of Public Health and Applied Health Sciences, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
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McGuffog R, Bryant J, Booth K, Collis F, Brown A, Hughes JT, Chamberlain C, McGhie A, Hobden B, Kennedy M. Exploring the Reported Strengths and Limitations of Aboriginal and Torres Strait Islander Health Research: A Narrative Review of Intervention Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3993. [PMID: 36901001 PMCID: PMC10001772 DOI: 10.3390/ijerph20053993] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/10/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
High quality intervention research is needed to inform evidence-based practice and policy for Aboriginal and Torres Strait Islander communities. We searched for studies published from 2008-2020 in the PubMed database. A narrative review of intervention literature was conducted, where we identified researcher reported strengths and limitations of their research practice. A total of 240 studies met inclusion criteria which were categorised as evaluations, trials, pilot interventions or implementation studies. Reported strengths included community engagement and partnerships; sample qualities; Aboriginal and Torres Strait Islander involvement in research; culturally appropriate and safe research practice; capacity building efforts; providing resources or reducing costs for services and communities; understanding local culture and context; and appropriate timelines for completion. Reported limitations included difficulties achieving the target sample size; inadequate time; insufficient funding and resources; limited capacity of health workers and services; and inadequate community involvement and communication issues. This review highlights that community consultation and leadership coupled with appropriate time and funding, enables Aboriginal and Torres Strait Islander health intervention research to be conducted. These factors can enable effective intervention research, and consequently can help improve health and wellbeing outcomes for Aboriginal and Torres Strait Islander people.
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Affiliation(s)
- Romany McGuffog
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Jamie Bryant
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Kade Booth
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Felicity Collis
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Alex Brown
- Indigenous Genomics, Australia National University, Canberra, ACT 2601, Australia
- Telethon Kids Institute, Nedlands, WA 6009, Australia
| | - Jaquelyne T. Hughes
- Rural and Remote Health, College of Medicine and Public Health, Flinders University, Darwin, NT 0810, Australia
| | - Catherine Chamberlain
- Centre for Health Equity, School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010, Australia
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia
| | - Alexandra McGhie
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Breanne Hobden
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW 2308, Australia
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Michelle Kennedy
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW 2308, Australia
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Eer ASY, Hearn T, Atkinson-Briggs S, Drake S, Singh S, Neoh S, Pyrlis F, Hachem M, Zajac JD, Burchill LJ, Ekinci EI. Improved metabolic parameters of people with diabetes attending an aboriginal health service in regional victoria. Intern Med J 2022; 53:787-797. [PMID: 35717668 DOI: 10.1111/imj.15856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 06/14/2022] [Indexed: 12/01/2022]
Abstract
AIMS To evaluate the baseline metabolic parameters and presence of diabetes complications in people with type 2 diabetes attending Rumbalara Aboriginal Co-operative in 2017 and compare it with other Aboriginal and Torres Strait Islander studies and Australian specialist diabetes services. METHODS Clinical and biochemical characteristics were determined, including diabetes type, age, weight, body mass index (BMI), blood pressure, micro- and macrovascular complications, glycosylated haemoglobin (HbA1c), haemoglobin, renal function, lipid profile, urine albumin:creatinine ratio, diabetes medications, renin angiotensin system inhibition therapies, HMG-CoA reductase inhibitors, and antiplatelet agents. RESULTS 126 individuals had diabetes, 121 had type 2 diabetes. 113 identified as Aboriginal and/or Torres Strait Islander. Median age was 57.5 (48 - 68) years, median HbA1c was 7.8% (6.8 - 9.6), and median BMI 33.4kg/m2 (29 - 42.3). Compared to other Australian Aboriginal and Torres Strait Islander populations, this population was older, had more obesity but with better glycaemia management. Compared to specialist diabetes services, this population was of similar age, with greater BMI but comparable HbA1c. CONCLUSIONS Aboriginal people living with type 2 diabetes attending this regional Aboriginal health service have comparable glycaemic management to specialist diabetes services in Australia, managed largely by primary care physicians with limited access to specialist care for the last five years. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Audrey Sing Yi Eer
- Department of Endocrinology, Austin Health, Heidelberg, VIC, Australia.,Department of Medicine, The University of Melbourne (Austin Health)
| | - Tracey Hearn
- Rumbalara Aboriginal Co-operative, Mooroopna, VIC, Australia
| | | | - Shannon Drake
- Rumbalara Aboriginal Co-operative, Mooroopna, VIC, Australia
| | - Satpal Singh
- Rumbalara Aboriginal Co-operative, Mooroopna, VIC, Australia
| | - Sandra Neoh
- Department of Endocrinology, Austin Health, Heidelberg, VIC, Australia
| | - Felicity Pyrlis
- Department of Endocrinology, Austin Health, Heidelberg, VIC, Australia
| | - Mariam Hachem
- Department of Medicine, The University of Melbourne (Austin Health)
| | - Jeffrey David Zajac
- Department of Endocrinology, Austin Health, Heidelberg, VIC, Australia.,Department of Medicine, The University of Melbourne (Austin Health)
| | - Luke James Burchill
- Department of Medicine, The University of Melbourne (Royal Melbourne Hospital)
| | - Elif Ilhan Ekinci
- Department of Endocrinology, Austin Health, Heidelberg, VIC, Australia.,Department of Medicine, The University of Melbourne (Austin Health)
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Atkinson-Briggs S, Ryan C, Keech A, Jenkins A, Brazionis L. Nurse-led vascular risk assessment in a regional Victorian Indigenous primary care diabetes clinic: An integrated Diabetes Education and Eye disease Screening [iDEES] study. J Adv Nurs 2022; 78:3652-3661. [PMID: 35441731 DOI: 10.1111/jan.15260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 12/06/2021] [Accepted: 12/24/2021] [Indexed: 12/15/2022]
Abstract
AIM The aim was to describe vascular risk factors in Australian adults with diabetes attending an Indigenous primary care nurse-led diabetes clinic. DESIGN This was a cross-sectional descriptive single-site study. METHODS Vascular risk factor data were extracted from the electronic health records of participants in the nurse-led integrated Diabetes Education and Eye disease Screening (iDEES) study at a regional Victorian Indigenous primary health-care clinic between January 2018 and March 2020. RESULTS Of 172 eligible adults, 135 (79%) provided data. Median (IQR) age was 56 (46-67) years; 89% were Indigenous; 95% had Type 2 diabetes of median (IQR) duration of 6 (2-12) years and 48 (36%) were male. Median HbA1c, blood pressure, cholesterol (total; LDL and HDL), triglycerides, eGFR, CRP and BMI were 8.0% (64 mmol/mol), 127/78 mm Hg, 4.2; 1.9; 1.1 mmol/L, 2.3 mmol/L, 89 ml/min/1.73 m2 , 7.0 mg/L and 32.4 kg/m2 . Of nine clinical risk factors, the median (IQR) number of risk factors at target was 4 (3-5) for women and 3 (2-5) for men, pχ2 = 0.563. Clinical targets for BMI, HbA1c, blood pressure, triglycerides, total cholesterol, LDL cholesterol, urine albumin: creatinine ratio, HDL cholesterol and smoking were met by 14%, 34%, 38%, 39%, 44%, 52%, 54%, 62% and 64%, respectively. CONCLUSION A nurse-led model of integrated clinical risk factor assessment and diabetes education identified suboptimal levels of clinical risk factor control for avoiding diabetes chronic complications amongst Australian adults with diabetes in an Indigenous primary care setting. IMPACT A nurse-led model of diabetes care integrating clinical risk factor assessment into a diabetes education service is achievable. Understanding by stakeholders, including people with diabetes, their clinicians and health services, of the importance of regular monitoring of risk factors impacting diabetes complications is important. The novel nurse-managed iDEES primary-care model of care can assist. TRIAL REGISTRATION This study was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12618001204235).
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Affiliation(s)
| | - Christopher Ryan
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Anthony Keech
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Alicia Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Laima Brazionis
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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Kennedy EL, Gordon BA, Ng AH, Smith G, Forsyth AK. Barriers and enablers to health service access amongst people with diabetes: An exploration of the perceptions of health care staff in regional Australia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e234-e244. [PMID: 34322923 DOI: 10.1111/hsc.13433] [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: 08/29/2020] [Revised: 03/12/2021] [Accepted: 04/28/2021] [Indexed: 06/13/2023]
Abstract
Healthcare staff are in a unique position of understanding client experiences, physiological impacts of client behaviour, the local healthcare system and the physical environment in which the services operate. Their perspectives may provide insights into the feasibility and effectiveness of existing models of diabetes care and suggestions for improvements to models of care (MoC). The objective of this qualitative study was to explore the experiences of healthcare staff delivering care for people with diabetes at the request of an existing healthcare service. Semi-structured interviews were conducted with 21 healthcare staff from three community health centres in one region of Victoria, Australia, in 2018. Interviews were audio-recorded and transcribed verbatim. Data were subject to qualitative content analysis and, subsequently, emerging themes were classified at individual, relationship, community and societal levels of the social-ecological model (SEM). Perceived barriers of access to health services using the current MoC included a lack of public transport, low socioeconomic status, job insecurity (resulting in an inability to take time away from work) and inflexible appointment times, all of which negatively impact diabetes management. Perceived enablers included having a co-located, multidisciplinary team, a holistic approach to diabetes management and motivation resulting from improvement in diabetes-related health outcomes. The findings indicate that there is potential to improve the service in this region by adopting a more integrated, team-focused and accessible MoC.
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Affiliation(s)
- Elizabeth L Kennedy
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Vic., Australia
- Inspiro Community Health, Melbourne, Vic., Australia
| | - Brett A Gordon
- Holsworth Research Initiative and La Trobe Rural Health School, La Trobe University, Melbourne, Vic., Australia
| | - Ashley H Ng
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Vic., Australia
| | - Gillian Smith
- Inspiro Community Health, Melbourne, Vic., Australia
| | - Adrienne K Forsyth
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Vic., Australia
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Nigenda G, Lee G, Aristizabal P, Walters G, Zárate-Grajales RA. Progress and challenges for advanced practice nursing in Mexico and the United Kingdom. J Nurs Manag 2021; 29:2461-2469. [PMID: 34251714 DOI: 10.1111/jonm.13413] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/03/2021] [Accepted: 07/09/2021] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study is to compare the advanced practice nursing development in Mexico with the United Kingdom. BACKGROUND In spite of the involvement of global and local bodies to establish and develop advanced practice nursing worldwide, progress remains variable due to the lack of homogeneity in health care systems and policies. EVALUATION Using thematic analysis from interviews of 29 health care professionals in Mexico, we identified four major issues that impact on the development of advanced practice nursing: (a) workforce, (b) organizational and institutional, (c) regulatory and legal and (d) academic and educational. KEY ISSUES Learning from the UK experience in relation to overcoming some of these issues has been insightful in terms of how advanced practice nursing skills in Mexican nurses can be developed. CONCLUSIONS Mexico is still in early stages of the development of APN. Based on the UK experience, the government may have to move forward to support higher level training, create labour market positions, establish new nursing functions, promote task-shifting and particularly implement solid regulation. IMPLICATIONS FOR NURSING MANAGEMENT The development of advanced practice nursing represents important challenges for training and practice of nursing in Mexico and the United Kingdom; therefore, interested actors will have to reach key agreements that could work as the foundations of an assertive planning process.
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Affiliation(s)
- Gustavo Nigenda
- Iztacala Faculty of Higher Studies, National school of nursing and obstetrics, National Autonomous University of Mexico, Mexico, Mexico
| | - Geraldine Lee
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Patricia Aristizabal
- Iztacala Faculty of Higher Studies, National school of nursing and obstetrics, National Autonomous University of Mexico, Mexico, Mexico
| | | | - Rosa A Zárate-Grajales
- Iztacala Faculty of Higher Studies, National school of nursing and obstetrics, National Autonomous University of Mexico, Mexico, Mexico
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Ekinci EI, Pyrlis F, Hachem M, Maple-Brown L, Brown A, Maguire G, Churilov L, Cohen N. Feasibility of once weekly exenatide-LAR and enhanced diabetes care in Indigenous Australians with type 2 diabetes. (Long-acting-Once-Weekly-Exenatide laR-SUGAR, "Lower SUGAR" study). Intern Med J 2021; 51:1463-1472. [PMID: 34142743 DOI: 10.1111/imj.15428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 05/26/2021] [Accepted: 06/07/2021] [Indexed: 11/28/2022]
Abstract
AIMS To assess the feasibility and metabolic effects of once weekly supervised injection of exenatide-LAR in addition to standard care in Indigenous Australians with type 2 diabetes. METHODS Two communities in Central Australia with longstanding specialist clinical outreach services were allocated by random coin toss to receive once-weekly exenatide-LAR injection with weekly nurse review and adjustment of medication for 20 weeks (community with exenatide-LAR) or to weekly nurse review in addition to standard care over 20 weeks (community without exenatide-LAR). The primary outcome was the feasibility of the intensive diabetes management model of care with and without weekly supervised exenatide-LAR. Secondary outcomes included change in HbA1c. RESULTS 13 participants from community with exenatide-LAR and 9 participants from the community without exenatide-LAR were analysed. 85% of individuals in the community with exenatide-LAR and 67% in the community without exenatide-LAR attended more than half of clinic visits. Median difference in the change in HbA1c from baseline to final visit, adjusted for baseline HbA1c, between the community with exenatide-LAR and the community without exenatide-LAR was -3.1%, 95% CI (-5.80%, -0.38%; p = 0.03). CONCLUSIONS Weekly exenatide-LAR combined with weekly nurse review demonstrated greater improvements in HbA1c, highlighting its potential for use in remote communities. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Elif I Ekinci
- Department of Endocrinology, Austin Health, Level 2 Centaur Building Repatriation Campus, Heidelberg West, Victoria, 3081, Australia.,The University of Melbourne, Department of Medicine, Austin Health, Victoria, 3081, Australia
| | - Felicity Pyrlis
- Department of Endocrinology, Austin Health, Level 2 Centaur Building Repatriation Campus, Heidelberg West, Victoria, 3081, Australia
| | - Mariam Hachem
- Department of Endocrinology, Austin Health, Level 2 Centaur Building Repatriation Campus, Heidelberg West, Victoria, 3081, Australia.,The University of Melbourne, Department of Medicine, Austin Health, Victoria, 3081, Australia
| | - Louise Maple-Brown
- Menzies School of Health Research, Darwin, NT, 0811.,Department of Endocrinology, Royal Darwin Hospital, Darwin, NT
| | - Alex Brown
- South Australia Health and Medical Research Institute, Adelaide, South Australia, 5000
| | - Graeme Maguire
- Western Clinical School, University of Melbourne, Victoria, 3021
| | - Leonid Churilov
- The University of Melbourne, Department of Medicine, Austin Health, Victoria, 3081, Australia.,The Florey Institute of Neuroscience & Mental Health, Heidelberg, Victoria, 3084, Australia
| | - Neale Cohen
- Baker Heart and Diabetes Institute, Level 4, 99 Commercial Rd, Melbourne, Victoria, 3004, Australia
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Zarora R, MacMillan F, Piya MK, Fernandes B, Simmons D. Effectiveness of a locality-based integrated diabetes care service on clinical outcomes. Intern Med J 2021; 52:975-981. [PMID: 33471370 DOI: 10.1111/imj.15211] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 12/01/2022]
Abstract
AIMS To evaluate the effectiveness of a new locality-based integrated diabetes care service for people with Type 2 diabetes in an inner regional area. METHODS A quasi-experimental evaluation comparing baseline and follow up clinical data collected from general practices and specialist services participating in an integrated diabetes care programme in an inner-regional area. Patients had at least one specialist service consultation. The primary outcome was glycated haemoglobin (HbA1c). RESULTS Clinical data were collected for 178/239 patients (74.5% participation; aged 65± 11(SD) years, 46% female; median [interquartile range (IQR)] diabetes duration 19 (11.0-24.0) years from seven general practices over 33 months (median 18.5 months). There were reductions in HbA1c -0.7±1.6 % (8±18 mmol/mol) (p<0.001), systolic blood pressure -5.8±19.5 mmHg (p<0.001), diastolic blood pressure -2.4±14.3 mmHg (p=0.04), total cholesterol -0.5±1.3 mmol/l (p<0.001), low-density lipoprotein (LDL) -0.4±0.9 mmol/l (p<0.001), Body Mass Index -0.5±1.6 kg/m2 (p<0.001), weight -1.8±4.7 kg (p<0.001). Urine albumin creatinine ratio [median (IQR)] at baseline was 3.0 mg/mmol (0.7-7) vs follow up 1.9 mg/mmol (0.8-5.5) p< 0.54). CONCLUSIONS Glycaemia and cardiovascular risk factors can be reduced in patients with long-standing Type 2 diabetes by moving to a locality based integrated primary-secondary care diabetes care service. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Reetu Zarora
- Doctor of Philosophy student, School of Medicine, Western Sydney University.,Diabetes Obesity and Metabolism Translational Research Unit.,Macarthur Clinical School, Campbelltown, New South, Wales.,Western Sydney University, Locked Bag 1797, Penrith, New South Wales, 2751, Australia
| | - Freya MacMillan
- Diabetes Obesity and Metabolism Translational Research Unit.,Western Sydney University, Locked Bag 1797, Penrith, New South Wales, 2751, Australia.,Senior Lecturer, School of Health Science.,The Translational Health Research Institute.,Western Sydney University, Campbelltown, New South, Wales
| | - Milan K Piya
- Diabetes Obesity and Metabolism Translational Research Unit.,Macarthur Clinical School, Campbelltown, New South, Wales.,Western Sydney University, Locked Bag 1797, Penrith, New South Wales, 2751, Australia.,Senior Lecturer in Diabetes, School of Medicine, Western Sydney University
| | - Brunelle Fernandes
- Diabetes Obesity and Metabolism Translational Research Unit.,Registered Nurse/Credentialed Diabetes Educator.,Campbelltown Hospital, Campbelltown, New South Wales, 2751, Australia
| | - David Simmons
- Diabetes Obesity and Metabolism Translational Research Unit.,Macarthur Clinical School, Campbelltown, New South, Wales.,Western Sydney University, Locked Bag 1797, Penrith, New South Wales, 2751, Australia.,The Translational Health Research Institute.,Professor of Medicine, School of Medicine, Western Sydney University
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The design and evaluation of a pilot covisit model: Integration of a pharmacist into a primary care team. J Am Pharm Assoc (2003) 2020; 60:491-496. [DOI: 10.1016/j.japh.2019.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/21/2019] [Accepted: 11/16/2019] [Indexed: 11/21/2022]
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