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Xu W, Wang Y, Tanuseputro P, Lam CLK, Wan EYF. Optimizing physician-encounter frequency for type 2 diabetes patients in primary care based on cardiovascular risk assessment: A target trial emulation study. Diabetes Obes Metab 2024; 26:5358-5367. [PMID: 39205656 DOI: 10.1111/dom.15899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 08/07/2024] [Accepted: 08/08/2024] [Indexed: 09/04/2024]
Abstract
AIM To investigate whether the physician-encounter interval for patients with type 2 diabetes (T2D) can be optimized from 2-3 to 4-6 months among those with a calculated 10-year cardiovascular disease (CVD) risk score of less than 20% without compromising their long-term outcomes. MATERIALS AND METHODS Using territory-wide public electronic medical records in Hong Kong, we emulated a target trial to compare the effectiveness of the physician-encounter intervals of 4-6 versus 2-3 months for T2D patients without prior CVDs and with a predicted risk for CVDs of less than 20% (i.e. those patients not in the high-risk category). Propensity score matching was used to emulate the randomization of participants at baseline, where 42 154 matched individuals were included for analysis. The marginal structural model was applied to estimate the hazard ratio (HR) for CVD incidence and all-cause mortality, the incidence rate ratio of secondary and tertiary care utilization, as well as the between-group differences in HbA1c, blood pressure and cholesterol levels. RESULTS During a follow-up period of up to 12 (average: 5.1) years, there was no significantly increased risk of CVD in patients with physician-encounter intervals of 4-6 months compared with those patients with physician-encounter intervals of 2-3 months (HR [95% confidence interval {CI}]: 1.01 [0.90, 1.14]; standardized 10-year risk difference [95% CI]: -0.1% [-0.7%, 0.6%]), nor for all-cause mortality (HR: 1.00 [0.84, 1.20]; standardized 10-year risk difference: -0.1% [-0.5%, 0.3%]). Additionally, there was no observable difference in the utilization of secondary and tertiary care or key clinical parameters between these two follow-up frequencies. CONCLUSIONS For T2D patients with a calculated 10-year CVD risk of less than 20%, the interval of regular physician encounters can be optimized from 2-3 to 4-6 months without compromising patients' long-term outcomes and saving substantial service resources in primary care.
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Affiliation(s)
- Wanchun Xu
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Yuan Wang
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Peter Tanuseputro
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Department of Family Medicine, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong, China
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Xu W, Mak IL, Zhang R, Yu EYT, Ng APP, Lui DTW, Chao DVK, Wong SYS, Lam CLK, Wan EYF. Optimizing the frequency of physician encounters in follow - up care for patients with type 2 diabetes mellitus: a systematic review. BMC PRIMARY CARE 2024; 25:41. [PMID: 38279105 PMCID: PMC10811944 DOI: 10.1186/s12875-024-02277-9] [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: 02/06/2023] [Accepted: 01/15/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Decisions on the frequency of physician encounters for patients with type 2 diabetes mellitus (T2DM) have significant impacts on both patients' health outcomes and burden on health systems, whereas definitive intervals for physician encounters are still lacking in most clinical guidelines. This study systematically reviewed the existing evidence evaluating different frequencies of physician encounters among T2DM patients. METHODS Systematic search of studies evaluating different visit frequencies for follow - up care in T2DM patients was performed in MEDLINE Ovid, Embase Ovid, and Cochrane library from database inception to 25 March 2022. Studies on the follow - up encounters driven by non - physicians and those on the episodic visits in the acute care settings were excluded in the screening. Citation searching was conducted via Google Scholar on the identified papers after screening. The risk of bias was assessed using Cochrane RoB2 tool for randomized controlled trials and Newcastle - Ottawa Scale for cohort studies. Findings were summarized narratively. RESULTS Among 6363 records from the database search and 231 references from the citation search, 12 articles were eligible for in - depth review. The results showed that for patients who had not achieved cardiometabolic control, intensifying encounter frequency could enhance medication adherence, shorten the time to achieve the treatment target, and improve the patients' quality of life. However, for the patients who had already achieved the treatment targets, less frequent encounters were equivalent to intensive encounters in maintaining their cardiometabolic control, and could save considerable healthcare costs without substantially lowering the quality of care and patients' satisfaction. CONCLUSION Existing evidence suggested that the optimal frequency of physician encounters for patients with T2DM should be individualized, which can be stratified by patients' risk levels based on the cardiometabolic control to guide the differential scheduling of physician encounters in the follow - up. More research is needed to determine how to optimize the frequency of physician encounters for this large and heterogeneous population.
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Affiliation(s)
- Wanchun Xu
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ivy Lynn Mak
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ran Zhang
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Esther Yee Tak Yu
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Amy Pui Pui Ng
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - David Tak Wai Lui
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - David Vai Kiong Chao
- Department of Family Medicine and Primary Health Care, United Christian Hospital & Tseung Kwan O Hospital, Kowloon East Cluster, Hospital Authority, Hong Kong SAR, China
| | - Samuel Yeung Shan Wong
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
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Zhao Q, Li H, Ni Q, Dai Y, Zheng Q, Wang Y, Ke T, Li L, Zhao D, Dong Q, Ji B, Shi J, Peng Y, Zhang Y, Xu F, Wang W. Follow-up frequency and clinical outcomes in patients with type 2 diabetes: A prospective analysis based on multicenter real-world data. J Diabetes 2022; 14:306-314. [PMID: 35613850 PMCID: PMC9366569 DOI: 10.1111/1753-0407.13271] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 04/12/2022] [Accepted: 04/21/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND To determine whether the follow-up frequency for type 2 diabetes mellitus (T2DM) patients in the National Metabolic Management Centers (MMCs) leads to different clinical outcomes. METHODS A total of 19 908 T2DM patients with at least 6 months of facility-based follow-up were recruited in MMCs between June 2017 and April 2021 and divided into lower-frequency and higher-frequency follow-up (LFF and HFF) groups according to the median follow-up frequency of 2.0 (interquartile range 1.2) times per year. Metabolic parameters at baseline and at the last follow-up visit were analyzed. Multivariable linear regression models were performed to assess the relationship between follow-up frequency and between-group percentage changes, adjusting for the major covariables. Additional stratified analyses were conducted to evaluate the metabolic outcomes in the subgroups. RESULTS The characteristics of the participants in the LFF and HFF groups were significantly different at baseline. Participants had significant improvements in multiple metabolic parameters after follow-up. Patients with HFF showed significantly greater decrease in percentage changes of fasting blood glucose (-4.95% ± 37.96% vs -2.21% ± 43.08%, P < .0001) and glycosylated hemoglobin (HbA1c) (-12.14% ± 19.78% vs -9.67% ± 20.29%, P < .0001) after adjustments compared to those with LFF. Furthermore, stratification analyses showed that significant between-group percentage changes of HbA1c were observed in those with younger age (<55 years) and higher HbA1c (>9%) at baseline (P for interaction <.001). CONCLUSIONS HFF is associated with better metabolic outcomes. Participants, especially with younger age or worse HbA1c at baseline in the HFF group achieved better glycemic control than those in the LFF group.
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Affiliation(s)
- Qiubo Zhao
- Department of Endocrinology and Metabolism, Hebi Coal (group) LtdGeneral HospitalHebiChina
| | - Hongwei Li
- Department of Endocrinology and Metabolism, Hebi Coal (group) LtdGeneral HospitalHebiChina
| | - Qicheng Ni
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yuancheng Dai
- Department of Internal Medicine of Traditional Chinese MedicineSheyang Diabetes HospitalYanchengChina
| | - Qidong Zheng
- Department of Internal MedicineThe Second People's Hospital of YuhuanYuhuanChina
| | - Yufan Wang
- Department of Endocrinology and Metabolism, Shanghai General HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Tingyu Ke
- Department of EndocrinologyThe Second Affiliated Hospital of Kunming Medical UniversityKunmingChina
| | - Li Li
- Department of EndocrinologyNingbo First HospitalChina
| | - Dong Zhao
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe HospitalCapital Medical UniversityBeijingChina
| | - Qijuan Dong
- Department of Endocrinology and MetabolismPeople's Hospital of Zhengzhou Affiliated Henan University of Chinese MedicineZhengzhouChina
| | - Bangqun Ji
- Department of EndocrinologyXingyi People's HospitalXingyiChina
| | - Juan Shi
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Ying Peng
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yifei Zhang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Fengmei Xu
- Department of Endocrinology and Metabolism, Hebi Coal (group) LtdGeneral HospitalHebiChina
| | - Weiqing Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
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Hartmann R, Grubhofer F, Waibel FWA, Götschi T, Viehöfer AF, Wirth SH. Treatment of hindfoot and ankle infections with Ilizarov external fixator or spacer, followed by secondary arthrodesis. J Orthop Res 2021; 39:2151-2158. [PMID: 33280159 DOI: 10.1002/jor.24938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/27/2020] [Accepted: 12/01/2020] [Indexed: 02/04/2023]
Abstract
An established treatment strategy in surgical site infection after hindfoot and ankle surgery is a two-stage procedure with debridement and placement of a cement spacer, followed by antibiotic treatment and secondary arthrodesis. However, there is little evidence to favor this treatment over a one-stage procedure with debridement, followed by primary arthrodesis with an Ilizarov external fixator and antibiotic treatment. We compared the infection control and clinical and radiological outcome of a two-stage and a one-stage procedure. In this study, 7 patients with a two-stage revision and 11 patients with a one-stage revision between 2005 and 2015 were included. The primary outcome was infection control (absence of the Musculoskeletal Infection Society PJI criteria) 2 years after the ankle or hindfoot arthrodesis. Secondary outcome measures were the AOFAS hindfoot score and radiological consolidation rate. Infection control was 85% (6 out of 7 patients) in the two-stage group and 81% (9 out of 11 patients) in the one-stage group (p = 1.0). One patient (14%) of the two-stage and two patients (18%) in the one-stage group needed below-knee amputation. In the two-stage group, the mean postoperative AOFAS score was 74.8 (SD: ±11.3) versus 71.7 (SD: ±17.8) in the one-stage group. Radiological consolidation could be achieved in 71% in the spacer group (n = 5) and in 72% in the Ilizarov external fixator group (n = 9). Infection control, AOFAS score, and radiologic consolidation of hindfoot and ankle arthrodesis were comparable in both groups of patients with complicated postsurgical hindfoot or ankle infections.
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Affiliation(s)
- Rebecca Hartmann
- Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Florian Grubhofer
- Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Felix W A Waibel
- Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Tobias Götschi
- Department of Orthopaedic Surgery, Institute for Biomechanics, ETH Zurich, Balgrist Campus, University of Zurich, Zurich, Switzerland
| | - Arnd F Viehöfer
- Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Stephan H Wirth
- Department of Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
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Elwenspoek MMC, Scott LJ, Alsop K, Patel R, Watson JC, Mann E, Whiting P. What methods are being used to create an evidence base on the use of laboratory tests to monitor long-term conditions in primary care? A scoping review. Fam Pract 2020; 37:845-853. [PMID: 32820328 PMCID: PMC7759753 DOI: 10.1093/fampra/cmaa074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Studies have shown unwarranted variation in test ordering among GP practices and regions, which may lead to patient harm and increased health care costs. There is currently no robust evidence base to inform guidelines on monitoring long-term conditions. OBJECTIVES To map the extent and nature of research that provides evidence on the use of laboratory tests to monitor long-term conditions in primary care, and to identify gaps in existing research. METHODS We performed a scoping review-a relatively new approach for mapping research evidence across broad topics-using data abstraction forms and charting data according to a scoping framework. We searched CINAHL, EMBASE and MEDLINE to April 2019. We included studies that aimed to optimize the use of laboratory tests and determine costs, patient harm or variation related to testing in a primary care population with long-term conditions. RESULTS Ninety-four studies were included. Forty percent aimed to describe variation in test ordering and 36% to investigate test performance. Renal function tests (35%), HbA1c (23%) and lipids (17%) were the most studied laboratory tests. Most studies applied a cohort design using routinely collected health care data (49%). We found gaps in research on strategies to optimize test use to improve patient outcomes, optimal testing intervals and patient harms caused by over-testing. CONCLUSIONS Future research needs to address these gaps in evidence. High-level evidence is missing, i.e. randomized controlled trials comparing one monitoring strategy to another or quasi-experimental designs such as interrupted time series analysis if trials are not feasible.
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Affiliation(s)
- Martha M C Elwenspoek
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lauren J Scott
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Katharine Alsop
- Nightingale Valley Practice, Bristol, UK
- Brisdoc Healthcare Services, Bristol, UK
| | - Rita Patel
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jessica C Watson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ed Mann
- Tyntesfield Medical Group, Bristol, UK
| | - Penny Whiting
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Hertroijs DFL, Elissen AMJ, Brouwers MCGJ, Hiligsmann M, Schaper NC, Ruwaard D. Preferences of people with Type 2 diabetes for diabetes care: a discrete choice experiment. Diabet Med 2020; 37:1807-1815. [PMID: 31001855 PMCID: PMC7586937 DOI: 10.1111/dme.13969] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2019] [Indexed: 01/05/2023]
Abstract
AIMS Limited knowledge exists on the preferences of people with Type 2 diabetes towards diabetes care. Consequently, these care preferences cannot yet be considered in the development of tailored diabetes care approaches. Therefore, this study aimed to assess care preferences and their determinants in people with Type 2 diabetes. METHODS A discrete choice experiment was conducted to elicit people's preferences. People with Type 2 diabetes, treated in 30 Dutch primary care practices, were asked to choose repeatedly between two hypothetical diabetes care packages, which differed in six attributes: role division in daily diabetes care planning, lifestyle education method, type of medication management support, consultation frequency, emotional support and time spend on self-management. A mixed-logit model was used to estimate the relative importance of the included attributes. Preference heterogeneity among people with different person- and disease-related characteristics was investigated. RESULTS In total, 288 participants completed the experiment. They preferred to plan their daily diabetes care together with a healthcare provider, to receive individual lifestyle education, medication and emotional support from a healthcare provider, one consultation visit every 3 months and to spend less time on self-management. Participants did not prefer to receive emotional support from a psychologist. Heterogeneity in preferences could partly be explained by differences in sex, education level and glucose-lowering drug use. CONCLUSION People with Type 2 diabetes show a preference for traditional care models. Emotional support was identified by participants as the most important attribute. It is therefore important to adequately guide them when changes in diabetes care organization are implemented.
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Affiliation(s)
- D. F. L. Hertroijs
- Department of Health Services ResearchCAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - A. M. J. Elissen
- Department of Health Services ResearchCAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - M. C. G. J. Brouwers
- Department of Internal MedicineMaastricht University Medical CentreMaastrichtThe Netherlands
| | - M. Hiligsmann
- Department of Health Services ResearchCAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - N. C. Schaper
- Department of Internal MedicineMaastricht University Medical CentreMaastrichtThe Netherlands
| | - D. Ruwaard
- Department of Health Services ResearchCAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
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van Bruggen S, Rauh SP, Bonten TN, Chavannes NH, Numans ME, Kasteleyn MJ. Association between GP participation in a primary care group and monitoring of biomedical and lifestyle target indicators in people with type 2 diabetes: a cohort study (ELZHA cohort-1). BMJ Open 2020; 10:e033085. [PMID: 32345697 PMCID: PMC7213889 DOI: 10.1136/bmjopen-2019-033085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Whether care group participation by general practitioners improves delivery of diabetes care is unknown. Using 'monitoring of biomedical and lifestyle target indicators as recommended by professional guidelines' as an operationalisation for quality of care, we explored whether (1) in new practices monitoring as recommended improved a year after initial care group participation (aim 1); (2) new practices and experienced practices differed regarding monitoring (aim 2). DESIGN Observational, real-life cohort study. SETTING Primary care registry data from Eerstelijns Zorggroep Haaglanden (ELZHA) care group. PARTICIPANTS Aim 1: From six new practices (n=538 people with diabetes) that joined care group ELZHA in January 2014, two practices (n=211 people) were excluded because of missing baseline data; four practices (n=182 people) were included. Aim 2: From all six new practices (n=538 people), 295 individuals were included. From 145 experienced practices (n=21 465 people), 13 744 individuals were included. EXPOSURE Care group participation includes support by staff nurses on protocolised diabetes care implementation and availability of a system providing individual monitoring information. 'Monitoring as recommended' represented minimally one annual registration of each biomedical (HbA1c, systolic blood pressure, low-density lipoprotein) and lifestyle-related target indicator (body mass index, smoking behaviour, physical exercise). PRIMARY OUTCOME MEASURES Aim 1: In new practices, odds of people being monitored as recommended in 2014 were compared with baseline (2013). Aim 2: Odds of monitoring as recommended in new and experienced practices in 2014 were compared. RESULTS Aim 1: After 1-year care group participation, odds of being monitored as recommended increased threefold (OR 3.00, 95% CI 1.84 to 4.88, p<0.001). Aim 2: Compared with new practices, no significant differences in the odds of monitoring as recommended were found in experienced practices (OR 1.21, 95% CI 0.18 to 8.37, p=0.844). CONCLUSIONS We observed a sharp increase concerning biomedical and lifestyle monitoring as recommended after 1-year care group participation, and subsequently no significant difference between new and experienced practices-indicating that providing diabetes care within a collective approach rapidly improves registration of care.
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Affiliation(s)
- Sytske van Bruggen
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Chronical Care, Hadoks, The Hague, The Netherlands
| | - Simone P Rauh
- Department of Epidemiology and Biostatistics, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Tobias N Bonten
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Niels H Chavannes
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Mattijs E Numans
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Marise J Kasteleyn
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
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8
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van Smoorenburg AN, Hertroijs DFL, Dekkers T, Elissen AMJ, Melles M. Patients' perspective on self-management: type 2 diabetes in daily life. BMC Health Serv Res 2019; 19:605. [PMID: 31462220 PMCID: PMC6714441 DOI: 10.1186/s12913-019-4384-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 07/30/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The number of type 2 diabetes mellitus (T2DM) patients and related treatment costs are rapidly increasing. Consequentially, more cost-effective and efficient strategies for the treatment of T2DM are needed. One such strategy is improving patients' self-management. As patients are more and more expected to self-manage their disease, it is important to provide them with suitable self-management support. This way, success of self-management will increase and complications and related costs of T2DM can be reduced. Currently, self-management support is developed mainly from the perspective of health professionals and caregivers, rather than patients. This research focused on gaining a better understanding of patients' perspectives on self-management and support. METHODS Semi-structured interviews, preceded by preparatory assignments, were conducted with ten patients with T2DM treated in Dutch primary care. RESULTS We found that patients experience 'active' self-management when recently diagnosed. As time progresses and no problems occur, patients do not experience their disease-related behaviour as self-management. Diabetes has 'just' become part of their daily life, now including new routines taking diabetes into account. CONCLUSIONS With this knowledge, support solutions can be designed and implemented that better fit the needs, preferences and abilities of patients with T2DM.
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Affiliation(s)
- Astrid N van Smoorenburg
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands
| | - Dorijn F L Hertroijs
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Tessa Dekkers
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands
| | - Arianne M J Elissen
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Marijke Melles
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands. .,Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
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Hertroijs DFL, Brouwers MCGJ, Elissen AMJ, Schaper NC, Ruwaard D. Relevant patient characteristics for estimating healthcare needs according to healthcare providers and people with type 2 diabetes: a Delphi survey. BMC Health Serv Res 2019; 19:575. [PMID: 31419980 PMCID: PMC6698036 DOI: 10.1186/s12913-019-4371-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 07/25/2019] [Indexed: 01/02/2023] Open
Abstract
Background Recently, there has been growing interest in providing more tailored, patient-centered care for the treatment of type 2 diabetes mellitus (T2DM). Yet it remains unclear which patient characteristics should be determined to guide such an approach. Therefore, the opinions of healthcare providers (HCP) and people with T2DM about relevant patient characteristics for estimating healthcare needs of people with T2DM were assessed and compared. Methods Two separate online Delphi studies were conducted according to the RAND-UCLA Appropriateness Method: one with HCPs (n = 22) from Dutch primary and secondary care and one with people with T2DM treated in Dutch primary care (n = 46). The relevance of patient characteristics for estimating healthcare needs, defined as the number of yearly consultations, was assessed on a 5-point Likert scale. Characteristics with a median of 4 or 5 and an interquartile range ≤ 1.5 were considered relevant with consensus. Participants were also asked to select the top 5 of most relevant patient characteristics. To determine the overall top 5, the mean relative importance score of each characteristic was calculated. Results In two Delphi rounds, 28 and 15 patient characteristics were rated by HCPs and people with T2DM, respectively. Both HCPs and people with T2DM found health-related characteristics relevant for estimating healthcare needs of people with T2DM. However, HCPs preferred to estimate healthcare needs using person- and context-related characteristics. They ranked self-efficacy as the most relevant estimator. In contrast, people with T2DM were more in favor of health-related characteristics and ranked HbA1c as the most relevant estimator. Conclusions The findings show that there is discrepancy in opinions on relevant patient characteristics for estimating healthcare needs between HCPs and people with T2DM. To achieve more tailored, patient-centered care, it is important that both groups agree on the topics to be discussed during patient consultations. Electronic supplementary material The online version of this article (10.1186/s12913-019-4371-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dorijn F L Hertroijs
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229, GT, Maastricht, the Netherlands.
| | - Martijn C G J Brouwers
- Department of Internal Medicine, Division of Endocrinology and Metabolic Diseases, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
| | - Arianne M J Elissen
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229, GT, Maastricht, the Netherlands
| | - Nicolaas C Schaper
- Department of Internal Medicine, Division of Endocrinology and Metabolic Diseases, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229, GT, Maastricht, the Netherlands
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10
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Ukai T, Ichikawa S, Sekimoto M, Shikata S, Takemura Y. Effectiveness of monthly and bimonthly follow-up of patients with well-controlled type 2 diabetes: a propensity score matched cohort study. BMC Endocr Disord 2019; 19:43. [PMID: 31046742 PMCID: PMC6498692 DOI: 10.1186/s12902-019-0372-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/17/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND On average, patients in Japan with type 2 diabetes mellitus have a clinical consultation every month, although evidence for a favorable follow-up interval is lacking. This study investigated whether the follow-up interval can be extended by comparing the clinical outcomes and cost for monthly versus bimonthly follow-up of patients with well-controlled diabetes mellitus. METHODS We combined administrative claims data from the National Health Insurance and the Health Checkups Program data of Tsu city, Japan between 2011 and 2014 to conduct a retrospective cohort study of patients with well-controlled type 2 diabetes mellitus. Propensity scores were used to assemble a matched-pairs cohort from patients who had monthly and bimonthly follow-up. Equivalence between two groups was assessed by designating the proportion of patients who maintained good control of their diabetes in the subsequent year as a primary outcome. The proportion achieving target blood pressure and lipid levels, favorable lifestyle, and annual cost were compared as secondary outcomes. RESULTS Of 12,145 participants, 693 with monthly follow-up and 693 with bimonthly follow-up were matched using propensity scores. In the monthly follow-up group 654 (94.4%) remained under good diabetic control, versus 658 (95.0%) in the bimonthly group (difference: 0.6%; 95% confidence interval: - 1.8 to 2.9%). All secondary outcomes were equivalent for the monthly and bimonthly follow-up groups except the proportion achieving target blood pressure, the proportion engaging in regular exercise, and annual cost. CONCLUSIONS For patients with well-controlled diabetes mellitus, although frequent follow-up by a physician does not affect the control of blood glucose level in the subsequent year, the annual treatment cost becomes much higher. We suggest that patients with well-controlled diabetes can be followed up less often.
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Affiliation(s)
- Tomohiko Ukai
- Department of Community Medicine, TSU, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
- Division of Public Health, Osaka Institute of Public Health, 1-3-69 Nakamichi, Higashinari, Osaka, 537-0025, Japan.
| | - Shuhei Ichikawa
- Department of Education and Research in Family and Community Medicine, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Miho Sekimoto
- Research Center for Health Policy and Economics, Hitotsubashi Institute for Advanced Study, 2-1-2 Hitotsubashi, Chiyodaku, Tokyo, 101-8439, Japan
| | - Satoru Shikata
- Department of Family Medicine, Mie Prefectural Ichishi Hospital, 616 Minamiieki, Hakunsan-cho, Tsu, Mie, 515-3133, Japan
| | - Yousuke Takemura
- Department of Community Medicine, TSU, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
- Department of Education and Research in Family and Community Medicine, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
- Department of Family Medicine, MIE, Mie University School of Medicine & Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
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11
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Ronda MCM, Dijkhorst-Oei LT, Vos RC, Westers P, Rutten GEHM. Cluster randomised trial on the effectiveness of a computerised prompt to refer (back) patients with type 2 diabetes. PLoS One 2018; 13:e0207653. [PMID: 30517164 PMCID: PMC6281259 DOI: 10.1371/journal.pone.0207653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 11/03/2018] [Indexed: 11/20/2022] Open
Abstract
Aims Information and communications technology (ICT) could support care organisations to cope with the increasing number of patients with diabetes mellitus. We aimed to aid diabetes care providers in allocating patients to the preferred treatment setting (hospital outpatient clinic or primary care practice), by using the Electronic Medical Record (EMR). Methods A cluster randomised controlled trial. Physicians in primary and secondary care practices of the intervention group received an advisory message in the EMR during diabetes consultations if patients were treated in the ‘incorrect’ setting according to national management guidelines. Primary outcome: the proportion of patients that shifted to the correct treatment setting at one year follow-up. Results 47 (38 primary care and 9 internist) practices and 2778 patients were included. At baseline, 1197 (43.1%) patients were in the correct treatment setting (intervention 599; control 598). Advice most often (68.4%) regarded a consultation with the internist. After one year 12.4% of the patients in the intervention and 10.6% in the control group (p = 0.30) had shifted to the correct setting. Main reasons for not following advice were: 1. physician’s preference to consider other treatment options; 2. patients’ preferences. Conclusions We could not find evidence that using the EMR to send consultation-linked advice to physicians resulted in a shift in patients. Physicians will not follow the advice, at least partly due to patients’ preferences.
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Affiliation(s)
- Maaike C M Ronda
- Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands
| | | | - Rimke C Vos
- Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands.,Department of Public Health and Primary Care/LUMC-Campus the Hague, Leiden University Medical Centre, The Hague, The Netherlands
| | - Paul Westers
- Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands
| | - Guy E H M Rutten
- Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands
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12
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Blonde L, Khunti K, Harris SB, Meizinger C, Skolnik NS. Interpretation and Impact of Real-World Clinical Data for the Practicing Clinician. Adv Ther 2018; 35:1763-1774. [PMID: 30357570 PMCID: PMC6223979 DOI: 10.1007/s12325-018-0805-y] [Citation(s) in RCA: 424] [Impact Index Per Article: 70.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Indexed: 12/18/2022]
Abstract
Real-world studies have become increasingly important in providing evidence of treatment effectiveness in clinical practice. While randomized clinical trials (RCTs) are the “gold standard” for evaluating the safety and efficacy of new therapeutic agents, necessarily strict inclusion and exclusion criteria mean that trial populations are often not representative of the patient populations encountered in clinical practice. Real-world studies may use information from electronic health and claims databases, which provide large datasets from diverse patient populations, and/or may be observational, collecting prospective or retrospective data over a long period of time. They can therefore provide information on the long-term safety, particularly pertaining to rare events, and effectiveness of drugs in large heterogeneous populations, as well as information on utilization patterns and health and economic outcomes. This review focuses on how evidence from real-world studies can be utilized to complement data from RCTs to gain a more complete picture of the advantages and disadvantages of medications as they are used in practice. Funding: Sanofi US, Inc.
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Affiliation(s)
- Lawrence Blonde
- Ochsner Diabetes Clinical Research Unit, Department of Endocrinology, Frank Riddick Diabetes Institute, Ochsner Medical Center, New Orleans, LA, USA.
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
| | - Stewart B Harris
- Schulich School of Medicine and Dentistry, Centre for Studies in Family Medicine, Western Centre for Public Health and Family Medicine, Western University, London, ON, Canada
| | - Casey Meizinger
- Department of Family Medicine, Abington Jefferson Health, Abington, PA, 19001, USA
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13
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Blonde L, Khunti K, Harris SB, Meizinger C, Skolnik NS. Interpretation and Impact of Real-World Clinical Data for the Practicing Clinician. Adv Ther 2018. [PMID: 30357570 DOI: 10.1007/s12325‐018‐0805‐y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Real-world studies have become increasingly important in providing evidence of treatment effectiveness in clinical practice. While randomized clinical trials (RCTs) are the "gold standard" for evaluating the safety and efficacy of new therapeutic agents, necessarily strict inclusion and exclusion criteria mean that trial populations are often not representative of the patient populations encountered in clinical practice. Real-world studies may use information from electronic health and claims databases, which provide large datasets from diverse patient populations, and/or may be observational, collecting prospective or retrospective data over a long period of time. They can therefore provide information on the long-term safety, particularly pertaining to rare events, and effectiveness of drugs in large heterogeneous populations, as well as information on utilization patterns and health and economic outcomes. This review focuses on how evidence from real-world studies can be utilized to complement data from RCTs to gain a more complete picture of the advantages and disadvantages of medications as they are used in practice.Funding: Sanofi US, Inc.
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Affiliation(s)
- Lawrence Blonde
- Ochsner Diabetes Clinical Research Unit, Department of Endocrinology, Frank Riddick Diabetes Institute, Ochsner Medical Center, New Orleans, LA, USA.
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
| | - Stewart B Harris
- Schulich School of Medicine and Dentistry, Centre for Studies in Family Medicine, Western Centre for Public Health and Family Medicine, Western University, London, ON, Canada
| | - Casey Meizinger
- Department of Family Medicine, Abington Jefferson Health, Abington, PA, 19001, USA
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14
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Rutten GEHM, van Vugt HA, de Weerdt I, de Koning E. Implementation of a Structured Diabetes Consultation Model to Facilitate a Person-Centered Approach: Results From a Nationwide Dutch Study. Diabetes Care 2018; 41:688-695. [PMID: 29363538 DOI: 10.2337/dc17-1194] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 12/17/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We assessed both from a patient and provider perspective the usefulness and added value of a consultation model that facilitates person-centered diabetes care. RESEARCH DESIGN AND METHODS The model consists of 1) inventory of disease and patient-related factors; 2) setting personal goals; 3) choosing treatment; and 4) determination of required care. It was implemented in 47 general practices and 6 hospital outpatient clinics. Providers were trained, and patients were recommended to prepare their visit. All filled out a questionnaire after every consultation. Differences between primary and secondary care practices and between physician-led and nurse-led consultations were analyzed. RESULTS Seventy-four physicians and thirty-one nurses participated, reporting on 1,366 consultations with type 2 diabetes patients. According to providers, the model was applicable in 72.4% (nurses 79.3% vs. physicians 68.5%, P < 0.001). Physicians more often had a consultation time <25 min (80.4% vs. 56.9%, P < 0.001). According to providers, two of three patients spoke more than half of the consultation time (outpatient clinics 75.2% vs. general practices 66.6%, P = 0.002; nurses 73.2% vs. physicians 64.4%, P = 0.001). Providers stated that person-related factors often determined treatment goals. Almost all patients (94.4%) reported that they made shared decisions; they felt more involved than before (with physicians 45.1% vs. with nurses 33.6%, P < 0.001) and rated the consultation 8.6 of 10. After physician-led consultations, 52.5% reported that the consultation was better than before (nurse visit 33.7%, P < 0.001). CONCLUSIONS A consultation model to facilitate person-centered care seems well applicable and results in more patient involvement, including shared decision making, and is appreciated by a substantial number of patients.
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Affiliation(s)
- Guy E H M Rutten
- Julius Center for Health Sciences and Primary Care, Department of General Practice, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Heidi A van Vugt
- Julius Center for Health Sciences and Primary Care, Department of General Practice, University Medical Center Utrecht, Utrecht, the Netherlands .,Dutch Diabetes Federation, Amersfoort, the Netherlands
| | | | - Eelco de Koning
- Department of Medicine, Leiden University Medical Center, Leiden, the Netherlands
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15
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Hertroijs DFL, Elissen AMJ, Brouwers MCGJ, Schaper NC, Köhler S, Popa MC, Asteriadis S, Hendriks SH, Bilo HJ, Ruwaard D. A risk score including body mass index, glycated haemoglobin and triglycerides predicts future glycaemic control in people with type 2 diabetes. Diabetes Obes Metab 2018; 20:681-688. [PMID: 29095564 PMCID: PMC5836941 DOI: 10.1111/dom.13148] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 10/10/2017] [Accepted: 10/29/2017] [Indexed: 12/12/2022]
Abstract
AIM To identify, predict and validate distinct glycaemic trajectories among patients with newly diagnosed type 2 diabetes treated in primary care, as a first step towards more effective patient-centred care. METHODS We conducted a retrospective study in two cohorts, using routinely collected individual patient data from primary care practices obtained from two large Dutch diabetes patient registries. Participants included adult patients newly diagnosed with type 2 diabetes between January 2006 and December 2014 (development cohort, n = 10 528; validation cohort, n = 3777). Latent growth mixture modelling identified distinct glycaemic 5-year trajectories. Machine learning models were built to predict the trajectories using easily obtainable patient characteristics in daily clinical practice. RESULTS Three different glycaemic trajectories were identified: (1) stable, adequate glycaemic control (76.5% of patients); (2) improved glycaemic control (21.3% of patients); and (3) deteriorated glycaemic control (2.2% of patients). Similar trajectories could be discerned in the validation cohort. Body mass index and glycated haemoglobin and triglyceride levels were the most important predictors of trajectory membership. The predictive model, trained on the development cohort, had a receiver-operating characteristic area under the curve of 0.96 in the validation cohort, indicating excellent accuracy. CONCLUSIONS The developed model can effectively explain heterogeneity in future glycaemic response of patients with type 2 diabetes. It can therefore be used in clinical practice as a quick and easy tool to provide tailored diabetes care.
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Affiliation(s)
- Dorijn F. L. Hertroijs
- Department of Health Services Research, Care and Public Health Research InstituteFaculty of Health, Medicine and Life Sciences, Maastricht UniversityMaastrichtThe Netherlands
| | - Arianne M. J. Elissen
- Department of Health Services Research, Care and Public Health Research InstituteFaculty of Health, Medicine and Life Sciences, Maastricht UniversityMaastrichtThe Netherlands
| | - Martijn C. G. J. Brouwers
- Department of Internal Medicine, Division of Endocrinology and Metabolic DiseasesMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Nicolaas C. Schaper
- Department of Internal Medicine, Division of Endocrinology and Metabolic DiseasesMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and NeuropsychologySchool for Mental Health and Neuroscience, Maastricht UniversityMaastrichtThe Netherlands
| | - Mirela C. Popa
- Department of Data Science and Knowledge Engineering, Faculty of Humanities and SciencesMaastricht UniversityMaastrichtThe Netherlands
| | - Stylianos Asteriadis
- Department of Data Science and Knowledge Engineering, Faculty of Humanities and SciencesMaastricht UniversityMaastrichtThe Netherlands
| | | | - Henk J. Bilo
- Diabetes CentreIsalaZwolleThe Netherlands
- Department of Internal MedicineUniversity Medical Centre Groningen and University of GroningenGroningenThe Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, Care and Public Health Research InstituteFaculty of Health, Medicine and Life Sciences, Maastricht UniversityMaastrichtThe Netherlands
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16
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Seidu S, Davies MJ, Farooqi A, Khunti K. Integrated primary care: is this the solution to the diabetes epidemic? Diabet Med 2017; 34:748-750. [PMID: 28294386 DOI: 10.1111/dme.13348] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/06/2017] [Indexed: 12/31/2022]
Affiliation(s)
- S Seidu
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - M J Davies
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - A Farooqi
- Leicester City Clinical Commissioning Group, Leicester, UK
| | - K Khunti
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
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17
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Hart HE, Geilen IE, de Leeuw E, Rutten GE, Vos RC. Internet-based Self-Management Support for Patients With Well-Controlled Type 2 Diabetes: A Real-Life Study. JMIR Res Protoc 2017; 6:e47. [PMID: 28336505 PMCID: PMC5383800 DOI: 10.2196/resprot.6910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 01/12/2017] [Accepted: 02/03/2017] [Indexed: 12/25/2022] Open
Abstract
Background Little attention has been paid to self-management support of patients with well-controlled type 2 diabetes mellitus (T2DM). Most studies evaluated the addition of self-management support to regular diabetes care, but self-management as an alternative for part of regular diabetes care has hardly been studied. In this study, we offered patients with well-controlled T2DM the opportunity to perform the 3 quarterly monitoring sessions at home using an Internet-based self-management program, resulting in online personalized advice. Objective The aim of our study was to assess the reach and feasibility of an Internet-based diabetes self-management support program for patients with well-controlled T2DM, addressing both primary care providers’ (PCPs) opinions and patients’ willingness to participate in such a support program. Methods PCPs assessed patients’ eligibility for Internet-based self-management, and patients were offered the opportunity to participate. Characteristics of eligible and ineligible patients were compared, as well as those of participants and nonparticipants, also with regard to quality of life, treatment satisfaction, and illness perceptions. Multivariate logistic regression models were performed and odds ratios (ORs) calculated with 95% CIs. Results Almost half (128/282, 45.4%) of the patients with well-controlled T2DM were considered ineligible by their PCPs mainly because of cognitive impairment and language barriers (8.2% and 8.9%). Older patients (OR for each year 1.06, 95% CI 1.03-1.09, P<.001), non–Western European patients (OR 3.64, 95% CI 1.67-7.92, P=.001), and patients with a longer diabetes duration (OR for each year 1.56, 95% CI 1.04-2.34, P=.03) were more often regarded as ineligible. Of the 154 patients considered eligible, 57 (37.0%) consented to participate and 30 (10.6%) started the program. Of 57 participants, 45 returned the 3 questionnaires; 21 of 97 nonparticipants returned the questionnaires. Nonparticipants less often thought that their disease would last their entire life (median 8.0 vs 10.0, P=.03) and they were more satisfied with their current treatment than participants (DTSQ total score 44.0 vs 40.0, P=.05). There was no significant difference in quality of life between the 2 groups. Conclusions PCPs considered half of their patients with well-controlled T2DM incapable of Internet-based self-management mainly because of cognitive impairment and language barriers; of the selected patients, about 1 out of 3 was willing to participate. Older patients, non–Western European patients, and patients with a higher BMI were less likely to participate. Predominantly, practical issues (such as Internet problems) hindered implementation of the Internet-based self-management program.
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Affiliation(s)
- Huberta E Hart
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands.,Leidsche Rijn Julius Health Centers, Utrecht, Netherlands
| | - Inge Etm Geilen
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands
| | - Elke de Leeuw
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands
| | - Guy Ehm Rutten
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands
| | - Rimke C Vos
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands
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18
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Zanders MMJ, van Herk-Sukel MPP, Herings RMC, van de Poll-Franse LV, Haak HR. Impact of cancer diagnosis and treatment on glycaemic control among individuals with colorectal cancer using glucose-lowering drugs. Acta Diabetol 2016; 53:727-35. [PMID: 27087004 DOI: 10.1007/s00592-016-0863-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 03/31/2016] [Indexed: 12/12/2022]
Abstract
AIMS This study aims to evaluate the impact of cancer and its treatment on HbA1c values among individuals with colorectal cancer (CRC) using glucose-lowering drugs (GLDs). METHODS Patients with primary CRC (1998-2011) were selected from the Eindhoven Cancer Registry and linked to the PHARMO Database Network including outpatient pharmacy and clinical laboratory data. Patients with more than 2 years of GLDs use prior to cancer diagnosis were included. Linear mixed-effects models were conducted to evaluate changes in HbA1c for colon cancer (CC) and rectal cancer (RC) patients in the 4 years around CRC diagnosis. RESULTS Of all CRC patients (n = 4714), 294 (6 %) GLDs users with CC and 144 (3 %) with RC were selected. In the crude model, mean HbA1c at cancer diagnosis was 6.9 % (51.6 mmol/mol) among CC patients and 7.1 % (53.5 mmol/mol) among RC patients. Among CC patients, HbA1c decreased with 0.12 % per year (p = 0.0002) before cancer diagnosis in the adjusted model, and after diagnosis, it increased with 0.12 % per year (p = 0.02). In subgroup analyses, effects on HbA1c were more pronounced in users of anti-anaemic preparations. Among RC patients, HbA1c decreased before diagnosis with 0.18 % per year (p = 0.0006), whereas after diagnosis it changed non-significantly. CONCLUSIONS Among users of GLDs, HbA1c decreased with 0.12-0.18 % (1-2 mmol/mol) per year before CRC diagnosis. Only among CC patients, HbA1c increased after diagnosis (0.12 % per year; 1.3 mmol/mol). Modest changes in HbA1c before CRC diagnosis may reflect the effects of an undiagnosed cancer, such as weight loss, anaemia, or the use of anti-anaemic preparations.
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Affiliation(s)
- Marjolein M J Zanders
- Netherlands Comprehensive Cancer Organisation, P.O. Box 231, 5600 AE, Eindhoven, The Netherlands.
- Department of Internal Medicine, Máxima Medical Centre, Eindhoven, Veldhoven, The Netherlands.
| | | | - Ron M C Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Lonneke V van de Poll-Franse
- Netherlands Comprehensive Cancer Organisation, P.O. Box 231, 5600 AE, Eindhoven, The Netherlands
- Department of Medical Psychology, CoRPS- Centre of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands
| | - Harm R Haak
- Department of Internal Medicine, Máxima Medical Centre, Eindhoven, Veldhoven, The Netherlands
- Department of Internal Medicine, Division of General Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Health Services Research, and CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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19
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Boonman-de Winter LJM, Cramer MJ, Hoes AW, Rutten FH. Uncovering heart failure with preserved ejection fraction in patients with type 2 diabetes in primary care: time for a change. Neth Heart J 2016; 24:237-43. [PMID: 26905581 PMCID: PMC4796062 DOI: 10.1007/s12471-016-0809-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Undetected heart failure appears to be an important health problem in patients with type 2 diabetes and aged ≥ 60 years. The prevalence of previously unknown heart failure in these patients is high, steeply rises with age, and is overall higher in women than in men. The majority of the patients with newly detected heart failure have a preserved ejection fraction. A diagnostic algorithm to detect or exclude heart failure in these patients with variables from the medical files combined with items from history taking and physical examination provides a good to excellent accuracy. Annual screening appears to be cost-effective. Both unrecognised heart failure with reduced and with preserved ejection fraction were associated with a clinically relevant lower health status in patients with type 2 diabetes. Also the prognosis of these patients was worse than of those without heart failure. Existing disease-management programs for type 2 diabetes pay insufficient attention to early detection of cardiovascular diseases, including heart failure. We conclude that more attention is needed for detection of heart failure in older patients with type 2 diabetes.
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Affiliation(s)
- L J M Boonman-de Winter
- Department of Scientific and Contract Research, Center for Diagnostic Support in Primary Care (SHL-Groep), Bredaseweg 165, 4872 LA, Etten-Leur, The Netherlands.
| | - M J Cramer
- Department of Cardiology, Heart-Lung Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A W Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - F H Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Espeland MA, Probstfield J, Hire D, Redmon JB, Evans GW, Coday M, Lewis CE, Johnson KC, Wilmoth S, Bahnson J, Dulin MF, Green JB, Knowler WC, Kitabchi A, Murillo AL, Osei K, Rehman SU, Cushman WC. Systolic Blood Pressure Control Among Individuals With Type 2 Diabetes: A Comparative Effectiveness Analysis of Three Interventions. Am J Hypertens 2015; 28:995-1009. [PMID: 25666468 DOI: 10.1093/ajh/hpu292] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 12/11/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The relative effectiveness of 3 approaches to blood pressure control-(i) an intensive lifestyle intervention (ILI) focused on weight loss, (ii) frequent goal-based monitoring of blood pressure with pharmacological management, and (iii) education and support-has not been established among overweight and obese adults with type 2 diabetes who are appropriate for each intervention. METHODS Participants from the Action for Health in Diabetes (Look AHEAD) and the Action to Control Cardiovascular Risk in Diabetes (ACCORD) cohorts who met criteria for both clinical trials were identified. The proportions of these individuals with systolic blood pressure (SBP) <140 mm Hg from annual standardized assessments over time were compared with generalized estimating equations. RESULTS Across 4 years among 480 Look AHEAD and 1,129 ACCORD participants with baseline SBPs between 130 and 159 mm Hg, ILI (OR = 1.46; 95% CI = [1.18-1.81]) and frequent goal-based monitoring with pharmacotherapy (OR = 1.51; 95% CI = [1.16-1.97]) yielded higher rates of blood pressure control compared to education and support. The intensive behavioral-based intervention may have been more effective among individuals with body mass index >30 kg/m2, while frequent goal-based monitoring with medication management may be more effective among individuals with lower body mass index (interaction P = 0.047). CONCLUSIONS Among overweight and obese adults with type 2 diabetes, both ILI and frequent goal-based monitoring with pharmacological management can be successful strategies for blood pressure control. CLINICAL TRIALS REGISTRY clinicaltrials.gov identifiers NCT00017953 (Look AHEAD) and NCT00000620 (ACCORD).
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Affiliation(s)
- Mark A Espeland
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA;
| | | | - Donald Hire
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Gregory W Evans
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Mace Coday
- The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Cora E Lewis
- The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Karen C Johnson
- The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Sharon Wilmoth
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Judy Bahnson
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | | | - William C Knowler
- Diabetes Epidemiology and Clinical Research Section, NIDDK, Phoenix, Arizona, USA
| | - Abbas Kitabchi
- The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | | | - Kwame Osei
- Internal Medicine, Ohio State University, Columbus, Ohio, USA
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Pinior B, Brugger K, Köfer J, Schwermer H, Stockreiter S, Loitsch A, Rubel F. Economic comparison of the monitoring programmes for bluetongue vectors in Austria and Switzerland. Vet Rec 2015; 176:464. [PMID: 25841165 PMCID: PMC4431321 DOI: 10.1136/vr.102979] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2015] [Indexed: 11/09/2022]
Abstract
With the bluetongue virus serotype 8 (BTV-8) outbreak in 2006, vector monitoring programmes (according to EU regulation 1266/2007) were implemented by European countries to obtain information on the spatial distribution of vectors and the vector-free period. This study investigates the vector monitoring programmes in Austria and Switzerland by performing a retrospective cost analysis for the period 2006–2010. Two types of costs were distinguished: costs financed directly via the national bluetongue programmes and costs contributed in-kind by the responsible institutions and agricultural holdings. The total net costs of the monitoring programme in Austria amounted to €1,415,000, whereby in Switzerland the costs were valued at €94,000. Both countries followed the legislation complying with requirements, but differed in regard to sampling frequency, number of trap sites and sampling strategy. Furthermore, the surface area of Austria is twice the area of Switzerland although the number of ruminants is almost the same in both countries. Thus, for comparison, the costs were normalised with regard to the sampling frequency and the number of trap sites. Resulting costs per trap sample comprised €164 for Austria and €48 for Switzerland. In both countries, around 50 per cent of the total costs can be attributed to payments in-kind. The benefit of this study is twofold: first, veterinary authorities may use the results to improve the economic efficiency of future vector monitoring programmes. Second, the analysis of the payment in-kind contribution is of great importance to public authorities as it makes the available resources visible and demonstrates how they have been used.
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Affiliation(s)
- B Pinior
- University of Veterinary Medicine Vienna, Institute for Veterinary Public Health, Veterinärplatz 1, Vienna 1210, Austria
| | - K Brugger
- University of Veterinary Medicine Vienna, Institute for Veterinary Public Health, Veterinärplatz 1, Vienna 1210, Austria
| | - J Köfer
- University of Veterinary Medicine Vienna, Institute for Veterinary Public Health, Veterinärplatz 1, Vienna 1210, Austria
| | - H Schwermer
- Federal Food Safety and Veterinary Office, Schwarzenburgstrasse 155, Bern 3003, Switzerland
| | - S Stockreiter
- Federal Ministry of Health, Radetzkystraße 2, Vienna 1030, Austria
| | - A Loitsch
- Institute for Veterinary Disease Control Mödling, Austrian Agency for Health and Food Safety, Robert Koch-Gasse 17, Mödling 2340, Austria
| | - F Rubel
- University of Veterinary Medicine Vienna, Institute for Veterinary Public Health, Veterinärplatz 1, Vienna 1210, Austria
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