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Gao Z, Huang M, Wang J, Jia H, Lv P, Zeng J, Ti G. Efficacy and safety of orlistat in controlling the progression of prediabetes to diabetes: A meta-analysis and systematic review. Medicine (Baltimore) 2024; 103:e38354. [PMID: 38787971 PMCID: PMC11124680 DOI: 10.1097/md.0000000000038354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 05/03/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND The aim of this study is to examine the impact of the Orlistat on glucose levels and glucose tolerance in individuals with prediabetes, as well as assess its efficacy and safety in preventing the progression to diabetes. METHODS For achieving the appropriate randomized controlled trials, we enrolled the public datas from the following electronic databases: The Cochrane library, Embase, China National Knowledge Infrastructure, VIP, Wan-Fang, and China Biology Medicine disc. The article focused on the orlistat intervention of glucose tolerance and glycemic status in prediabetic patients. We restricted the publication time from the creation to May 2023. RESULTS Six subjects were included in the study, with a total of 1076 participants (532 in the control group vs 544 in the experimental group). The results indicated that the orlistat can reduce the fasting blood glucose [relative risk (RR) = -2.18, 95% confidence intervals (CI) (-2.471, -1.886)], as well as the 2 hour postprandial blood glucose [RR = -1.497, 95% CI (-1.811, -1.183)]. Furthermore, it can prevent the impaired glucose tolerance patients to type 2 diabetes mellitus [RR = 0.605, 95% CI (0.462, 0.791)], and reversal the impaired glucose tolerance [RR = 2.092, 95% CI (1.249, 3.503)]. CONCLUSIONS In prediabetic people, the orlistat can control weight, reduce the fasting blood glucose and the 2 hour postprandial blood glucose, and then delay the progression of diabetes. However, due to the quantitative restrictions, additional high-quality study needs to be conducted to improve the reliability of the results.
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Affiliation(s)
- Zhao Gao
- Preventive Medicine Center, China Academy of Traditional Chinese Medicine Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Mengwen Huang
- Preventive Medicine Center, China Academy of Traditional Chinese Medicine Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiaxin Wang
- China Science and Technology Development Center for Chinese Medicine, State Administration of Traditional Chinese Medicine of The Peoples Republic of China, Beijing, China
| | - Huihui Jia
- State Key Laboratory of Membrane Biology, School of Medicine, Tsinghua University, Beijing, China
- Department of Orthopaedics, The Fourth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Pin Lv
- Preventive Medicine Center, China Academy of Traditional Chinese Medicine Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jing Zeng
- Preventive Medicine Center, China Academy of Traditional Chinese Medicine Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Guixiang Ti
- Preventive Medicine Center, China Academy of Traditional Chinese Medicine Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Williams A, Lennox L, Harris M, Antonacci G. Supporting translation of research evidence into practice-the use of Normalisation Process Theory to assess and inform implementation within randomised controlled trials: a systematic review. Implement Sci 2023; 18:55. [PMID: 37891671 PMCID: PMC10612208 DOI: 10.1186/s13012-023-01311-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/02/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The status of randomised controlled trials (RCTs) as the 'gold standard' for evaluating efficacy in healthcare interventions is increasingly debated among the research community, due to often insufficient consideration for implementation. Normalisation Process Theory (NPT), which focuses on the work required to embed processes into practice, offers a potentially useful framework for addressing these concerns. While the theory has been deployed in numerous RCTs to date, more work is needed to consolidate understanding of if, and how, NPT may aid implementation planning and processes within RCTs. Therefore, this review seeks to understand how NPT contributes to understanding the dynamics of implementation processes within RCTs. Specifically, this review will identify and characterise NPT operationalisation, benefits and reported challenges and limitations in RCTs. METHODS A qualitative systematic review with narrative synthesis of peer-reviewed journal articles from eight databases was conducted. Studies were eligible for inclusion if they reported sufficient detail on the use of NPT within RCTs in a healthcare domain. A pre-specified data extraction template was developed based on the research questions of this review. A narrative synthesis was performed to identify recurrent findings. RESULTS Searches identified 48 articles reporting 42 studies eligible for inclusion. Findings suggest that NPT is primarily operationalised prospectively during the data collection stage, with limited sub-construct utilisation overall. NPT is beneficial in understanding implementation processes by aiding the identification and analysis of key factors, such as understanding intervention fidelity in real-world settings. Nearly three-quarters of studies failed to report the challenges and limitations of utilising NPT, though coding difficulties and data falling outside the NPT framework are most common. CONCLUSIONS NPT appears to be a consistent and generalisable framework for explaining the dynamics of implementation processes within RCTs. However, operationalisation of the theory to its full extent is necessary to improve its use in practice, as it is currently deployed in varying capacities. Recommendations for future research include investigation of NPT alongside other frameworks, as well as earlier operationalisation and greater use of NPT sub-constructs. TRIAL REGISTRATION The protocol for this systematic review was accepted for public registration on PROSPERO (registration number: CRD42022345427) on 26 July 2022.
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Affiliation(s)
- Allison Williams
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) Northwest London, Charing Cross Campus, London, W6 8RP, UK.
| | - Laura Lennox
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) Northwest London, Charing Cross Campus, London, W6 8RP, UK
- Business School, Centre for Health Economics and Policy Innovation (CHEPI), Imperial College London, Chelsea and Westminster Campus, London, SW10 9N, UK
| | - Matthew Harris
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) Northwest London, Charing Cross Campus, London, W6 8RP, UK
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Grazia Antonacci
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) Northwest London, Charing Cross Campus, London, W6 8RP, UK
- Business School, Centre for Health Economics and Policy Innovation (CHEPI), Imperial College London, Chelsea and Westminster Campus, London, SW10 9N, UK
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Kolltveit BCH, Graue M, Orvik E, Fløde M, Haltbakk J. Diabetessykepleieres rolle i primærhelsetjenesten – en kvalitativ studie. TIDSSKRIFT FOR OMSORGSFORSKNING 2022. [DOI: 10.18261/tfo.8.1.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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4
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Davidson AR, Kelly J, Ball L, Morgan M, Reidlinger DP. What do patients experience? Interprofessional collaborative practice for chronic conditions in primary care: an integrative review. BMC PRIMARY CARE 2022; 23:8. [PMID: 35172731 PMCID: PMC8759162 DOI: 10.1186/s12875-021-01595-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 11/22/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Improving the patient experience is one of the quadruple aims of healthcare. Therefore, understanding patient experiences and perceptions of healthcare interactions is paramount to quality improvement. This integrative review aimed to explore how patients with chronic conditions experience Interprofessional Collaborative Practice in primary care. METHODS An integrative review was conducted to comprehensively synthesize primary studies that used qualitative, quantitative, and mixed methods. Databases searched were Medline, Embase, CINAHL and Web of Science on June 1st, 2021. Eligible studies were empirical full-text studies in primary care that reported experiences or perceptions of Interprofessional Collaborative Practice by adult patients with a chronic condition, in any language published in any year. Quality appraisal was conducted on included studies using the Mixed Method Appraisal Tool. Data on patients' experiences and perceptions of Interprofessional Collaborative Practice in primary care were extracted, and findings were thematically analyzed through a meta-synthesis. RESULTS Forty-eight (n = 48) studies met the inclusion criteria with a total of n = 3803 participants. Study quality of individual studies was limited by study design, incomplete reporting, and the potential for positive publication bias. Three themes and their sub-themes were developed inductively: (1) Interacting with Healthcare Teams, subthemes: widening the network, connecting with professionals, looking beyond the condition, and overcoming chronic condition collectively; (2) Valuing Convenient Healthcare, subthemes: sharing space and time, care planning creates structure, coordinating care, valuing the general practitioner role, and affording healthcare; (3) Engaging Self-care, subthemes: engaging passively is circumstantial, and, engaging actively and leading care. CONCLUSIONS Patients overwhelmingly had positive experiences of Interprofessional Collaborative Practice, signaling it is appropriate for chronic condition management in primary care. The patient role in managing their chronic condition was closely linked to their experience. Future studies should investigate how the patient role impacts the experience of patients, carers, and health professionals in this context. SYSTEMATIC REVIEW REGISTRATION PROSPERO: CRD42020156536.
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Affiliation(s)
- Alexandra R Davidson
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia.
| | - Jaimon Kelly
- Centre for Online Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Lauren Ball
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Mark Morgan
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Dianne P Reidlinger
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
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5
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Husdal R, Thors Adolfsson E, Leksell J, Nordgren L. Diabetes care provided by national standards can improve patients' self-management skills: A qualitative study of how people with type 2 diabetes perceive primary diabetes care. Health Expect 2021; 24:1000-1008. [PMID: 33774899 PMCID: PMC8235889 DOI: 10.1111/hex.13247] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/11/2021] [Accepted: 03/16/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The increasing incidence of type 2 diabetes mellitus [T2DM] has resulted in extensive research into the characteristics of successful primary diabetes care. Even if self-management support and continuity are increasingly recognized as important, there is still a need for deeper understanding of how patients' experiences of continuity of care coincide with their needs for self-management and/or self-management support. OBJECTIVE To gain a deeper understanding of how people with T2DM perceive Swedish primary diabetes care and self-management support. METHODS This qualitative study used focus groups as the means for data collection. Participants were identified through a purposive sampling method differing in age, sex, diabetes duration and latest registered glycated haemoglobin level. Twenty-eight participants formed five focus groups. Qualitative content analysis was applied to interview transcripts. RESULTS The main theme emerging from the focus group data was that diabetes care provided by national standards improved self-management skills. Two themes that emerged from the analysis were (a) the importance of a clarification of structures and procedures in primary diabetes care and (b) health-care staff 'being there' and providing support enables trust and co-operation to enhance self-management. CONCLUSIONS Individual patients' self-management resources are strengthened if the importance of providing relational continuity, management continuity and informational continuity is considered. Patients also need assistance on 'how' self-management activities should be performed. PATIENT CONTRIBUTION Prior to the study, one pilot focus group was conducted with patients to obtain their perspectives on the content of the planned focus groups; thus, patients were involved in both planning and conduct of the study.
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Affiliation(s)
- Rebecka Husdal
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Eva Thors Adolfsson
- Centre for Clinical Research Västmanland, Uppsala University, Västerås, Sweden
| | - Janeth Leksell
- Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Lena Nordgren
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.,Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
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Donald M, Jackson CL, Byrnes J, Vaikuntam BP, Russell AW, Hollingworth SA. Community-based integrated care versus hospital outpatient care for managing patients with complex type 2 diabetes: costing analysis. AUST HEALTH REV 2021; 45:42-50. [PMID: 33563370 DOI: 10.1071/ah19226] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 04/19/2020] [Indexed: 11/23/2022]
Abstract
Objective This study compared the cost of an integrated primary-secondary care general practitioner (GP)-based Beacon model with usual care at hospital outpatient departments (OPDs) for patients with complex type 2 diabetes. Methods A costing analysis was completed alongside a non-inferiority randomised control trial. Costs were calculated using information from accounting data and interviews with clinic managers. Two OPDs and three GP-based Beacon practices participated. In the Beacon practices, GPs with a special interest in advanced diabetes care worked with an endocrinologist and diabetes nurse educator to care for referred patients. The main outcome was incremental cost saving per patient course of treatment from a health system perspective. Uncertainty was characterised with probabilistic sensitivity analysis using Monte Carlo simulation. Results The Beacon model is cost saving: the incremental cost saving per patient was A$365 (95% confidence interval -A$901, A$55) and was cost saving in 93.7% of simulations. The key contributors to the variance in the cost saving per patient course of treatment were the mean number of patients seen per site and the number of additional presentations per course of treatment associated with the Beacon model. Conclusions Beacon clinics were less costly per patient course of treatment than usual care in hospital OPDs for equivalent clinical outcomes. Local contractual arrangements and potential variation in the operational cost structure are of significant consideration in determining the cost-efficiency of Beacon models. What is known about this topic? Despite the growing importance of achieving care quality within constrained budgets, there are few costing studies comparing clinically-equivalent hospital and community-based care models. What does this paper add? Costing analyses comparing hospital-based to GP-based health services require considerable effort and are complex. We show that GP-based Beacon clinics for patients with complex chronic disease can be less costly per patient course of treatment than usual care offered in hospital OPDs. What are the implications for practitioners? In addition to improving access and convenience for patients, transferring care from hospital to the community can reduce health system costs.
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Affiliation(s)
- Maria Donald
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Herston Road, Herston, Qld 4029, Australia; and Corresponding authors. ;
| | - Claire L Jackson
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Herston Road, Herston, Qld 4029, Australia; and Corresponding authors. ;
| | - Joshua Byrnes
- Centre for Applied Health Economics, Sir Samuel Griffith Centre, Griffith University, Nathan, Qld 4111, Australia.
| | - Bharat Phani Vaikuntam
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Herston Road, Herston, Qld 4029, Australia; and Present address: John Walsh Centre for Rehabilitation Research, Sydney Medical School - Northern, The University of Sydney, St Leonards, NSW 2065, Australia.
| | - Anthony W Russell
- Faculty of Medicine, The University of Queensland, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Qld 4102, Australia. ; and Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Qld 4102, Australia
| | - Samantha A Hollingworth
- School of Pharmacy, The University of Queensland, 20 Cornwall Street, Woolloongabba, Qld 4102, Australia.
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7
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Murtagh S, McCombe G, Broughan J, Carroll Á, Casey M, Harrold Á, Dennehy T, Fawsitt R, Cullen W. Integrating Primary and Secondary Care to Enhance Chronic Disease Management: A Scoping Review. Int J Integr Care 2021; 21:4. [PMID: 33613136 PMCID: PMC7880002 DOI: 10.5334/ijic.5508] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 10/28/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND In Ireland, as in many healthcare systems, health policy has committed to delivering an integrated model of care to address the increasing burden of chronic disease. Integrated care is an approach to healthcare systems delivery that aims to minimise fragmentation of patient services and improve care continuity. To this end, how best to integrate primary and secondary care is a challenge. This paper aims to undertake a scoping review of empirical work on the integration of primary and secondary care in relation to chronic disease management. METHODS A search was conducted of 'PubMed', 'Cochrane Library' and 'Google Scholar' for papers published between 2009-2019 using Arksey and O'Malley's framework for conducing scoping reviews. RESULTS Twenty-two studies were included. These reported research from a wide range of healthcare systems (most commonly UK, Australia, the Netherlands), adopted a range of methodologies (most commonly randomised/non-randomised controlled trials, case studies, qualitative studies) and among patients with a range of chronic conditions (most commonly diabetes, COPD, Parkinson's disease). No studies reported on interventions to address the needs of whole populations. Interventions to enhance integration included multidisciplinary teams, education of healthcare professionals, and e-health interventions. Among the effectiveness measures reported were improved disease specific outcomes, and cost effectiveness. CONCLUSION With healthcare systems increasingly recognising that integrated approaches to patient care can enhance chronic disease management, considerable literature now informs how this can be done. However, most of the research published has focussed on specific diseases and their clinical outcomes. Future research should focus on how such approaches may improve health outcomes for populations as a whole.
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Affiliation(s)
- Sara Murtagh
- School of Medicine, University College Dublin, Ireland
| | - Geoff McCombe
- School of Medicine, University College Dublin, Ireland
| | - John Broughan
- School of Medicine, University College Dublin, Ireland
| | - Áine Carroll
- School of Medicine, University College Dublin, Ireland
| | - Mary Casey
- School of Nursing Midwifery and Health Systems, University College Dublin, Ireland
| | - Áine Harrold
- School of Medicine, University College Dublin, Ireland
| | | | - Ronan Fawsitt
- School of Medicine, University College Dublin, Ireland
- Ireland East Hospital Group, Dublin, Ireland
| | - Walter Cullen
- School of Medicine, University College Dublin, Ireland
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Jackson CL, Donald M, Russell AW, McIntyre HD. Establishing a new model of integrated primary and secondary care based around general practice: a case study of lessons learned and challenges. AUST HEALTH REV 2019; 42:299-302. [PMID: 28483036 DOI: 10.1071/ah16147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 03/14/2017] [Indexed: 11/23/2022]
Abstract
This case study describes the development and implementation of an innovative integrated primary-secondary model of care for people with complex diabetes. The aim of the paper is to present the experiences of clinicians and researchers involved in implementing the 'Beacon' model by providing a discussion of the contextual factors, including lessons learned, challenges and solutions. Beacon-type models of community care for people with chronic disease are well placed to deliver on Australia's health care reform agenda, and this commentary provides rich contextual information relevant to the translation of such models into policy and practice.
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Affiliation(s)
- Claire L Jackson
- Primary Care Clinical Unit, Faculty of Medicine, Level 8 Health Sciences Building, Royal Brisbane and Women's Hospital, The University of Queensland, Herston, Qld 4006, Australia. Email
| | - Maria Donald
- Primary Care Clinical Unit, Faculty of Medicine, Level 8 Health Sciences Building, Royal Brisbane and Women's Hospital, The University of Queensland, Herston, Qld 4006, Australia. Email
| | - Anthony W Russell
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Qld 4102, Australia. Email
| | - H David McIntyre
- Mater-Southside Clinical Unit, Faculty of Medicine, Mayne Medical Building, The University of Queensland, 288 Herston Road, Herston, Qld 4006, Australia. Email
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9
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Russell AW, Donald M, Borg SJ, Zhang J, Burridge LH, Ware RS, Begum N, McIntyre HD, Jackson CL. Clinical outcomes of an integrated primary-secondary model of care for individuals with complex type 2 diabetes: a non-inferiority randomised controlled trial. Diabetologia 2019; 62:41-52. [PMID: 30284015 DOI: 10.1007/s00125-018-4740-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 09/05/2018] [Indexed: 10/28/2022]
Abstract
AIMS/HYPOTHESIS The aim of the study was to determine if a Beacon model of integrated care utilising general practitioners (GPs) with special interests could achieve similar clinical outcomes to a hospital-based specialist diabetes outpatient clinic. METHODS This pragmatic non-inferiority multisite randomised controlled trial assigned individuals with complex type 2 diabetes to care delivered by a Beacon clinic or to usual care delivered by a hospital outpatient department, in a 3:1 ratio. Owing to the nature of the study, researchers were only blinded during the allocation process. Eligible participants were aged 18 or over, had been referred by their usual GP to the hospital central referral hub with type 2 diabetes and had been triaged to be seen within 30 or 90 days. The intervention consisted of diabetes management in primary care by GPs with a special interest who had been upskilled in complex diabetes under the supervision of an endocrinologist. The primary outcome was HbA1c at 12 months post-recruitment. The non-inferiority margin was 4.4 mmol/mol (0.4%). Both per-protocol and intention-to-treat analyses are reported. RESULTS Between 27 November 2012 and 14 July 2015, 352 individuals were recruited and 305 comprised the intention-to-treat sample (71 in usual care group and 234 in the Beacon model group). The Beacon model was non-inferior to usual care for both the per-protocol (difference -0.38 mmol/mol [95% CI -4.72, 3.96]; -0.03% [95% CI -0.43, 0.36]) and the intention-to-treat (difference -1.28 mmol/mol [95% CI -5.96, 3.40]; -0.12% [95% CI -0.55, 0.31]) analyses. Non-inferiority was sustained in a sensitivity analysis at 12 months. There were no statistically or clinically significant differences in the secondary outcomes of BP, lipids or quality of life as measured by the 12 item short-form health survey (SF-12v2) and the diabetes-related quality of life (DQoL-Brief) survey. Safety indicators did not differ between groups. Participant satisfaction on the eight-item client satisfaction questionnaire (CSQ-8) was good in both groups, but scores were significantly higher in the Beacon model group than the usual care group (mean [SD] 28.4 [4.9] vs 25.6 [4.9], respectively, p < 0.001). CONCLUSIONS/INTERPRETATION In individuals with type 2 diabetes, a model of integrated care delivered in the community by GPs with a special interest can safely achieve clinical outcomes that are not inferior to those achieved with gold-standard hospital-based specialist outpatient clinics. Individuals receiving care in the community had greater satisfaction. Further studies will determine the cost of delivering this model of care. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12612000380897 FUNDING: The study was funded by the Australian National Health and Medical Research Council (GNT1001157).
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Affiliation(s)
- Anthony W Russell
- Faculty of Medicine, The University of Queensland, Level 8, Health Sciences Building, Royal Brisbane and Women's Hospital, Herston, QLD, 4006, Australia.
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, QLD, Australia.
| | - Maria Donald
- Faculty of Medicine, The University of Queensland, Level 8, Health Sciences Building, Royal Brisbane and Women's Hospital, Herston, QLD, 4006, Australia
| | - Samantha J Borg
- Faculty of Medicine, The University of Queensland, Level 8, Health Sciences Building, Royal Brisbane and Women's Hospital, Herston, QLD, 4006, Australia
| | - Jianzhen Zhang
- Faculty of Medicine, The University of Queensland, Level 8, Health Sciences Building, Royal Brisbane and Women's Hospital, Herston, QLD, 4006, Australia
| | - Letitia H Burridge
- Faculty of Medicine, The University of Queensland, Level 8, Health Sciences Building, Royal Brisbane and Women's Hospital, Herston, QLD, 4006, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
| | - Nelufa Begum
- Faculty of Medicine, The University of Queensland, Level 8, Health Sciences Building, Royal Brisbane and Women's Hospital, Herston, QLD, 4006, Australia
| | - H David McIntyre
- Faculty of Medicine, The University of Queensland, Level 8, Health Sciences Building, Royal Brisbane and Women's Hospital, Herston, QLD, 4006, Australia
| | - Claire L Jackson
- Faculty of Medicine, The University of Queensland, Level 8, Health Sciences Building, Royal Brisbane and Women's Hospital, Herston, QLD, 4006, Australia
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10
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Patel PJ, Banh X, Horsfall LU, Hayward KL, Hossain F, Johnson T, Stuart KA, Brown NN, Saad N, Clouston A, Irvine KM, Russell AW, Valery PC, Williams S, Powell EE. Underappreciation of non-alcoholic fatty liver disease by primary care clinicians: limited awareness of surrogate markers of fibrosis. Intern Med J 2018; 48:144-151. [PMID: 29083080 DOI: 10.1111/imj.13667] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/19/2017] [Accepted: 10/23/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) is a common cause of incidental liver test abnormalities. General practitioners (GP) have a key role in identifying people with NAFLD at risk of significant liver disease. Recent specialist guidelines emphasise the use of fibrosis algorithms or serum biomarkers rather than routine liver tests, to assess advanced fibrosis. AIM To evaluate primary care clinicians' current approach to diagnosis, management and referral of NAFLD. METHODS A cross-sectional survey of primary care clinicians was undertaken through a structured questionnaire about NAFLD. A convenience sample of general practice clinics and general practice conferences in Metropolitan Brisbane and regional south east Queensland was selected. RESULTS A total of 108 primary care clinicians completed the survey (participation rate 100%). Fifty-one percent of respondents considered the prevalence of NAFLD in the general population to be ≤10%. Twenty-four percent of respondents felt that liver enzymes were sufficiently sensitive to detect underlying NAFLD. Most respondents were unsure whether the Fibrosis 4 score (62.7% unsure) or Enhanced Liver Fibrosis score (63.7% unsure) could help to identify advanced fibrosis or cirrhosis. Although 47% of respondents said they would refer a patient to a Gastroenterologist/Hepatologist if they suspect the patient has NAFLD, 44.1% do not make any referrals. Of concern, 70.6% of clinicians said they were unlikely to refer a patient to Hepatology unless liver function tests are abnormal. CONCLUSION Our findings demonstrate that many primary care clinicians underestimate the prevalence of NAFLD and under-recognise the clinical spectrum of NAFLD and how this is assessed.
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Affiliation(s)
- Preya J Patel
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine and Biomedical Science, The University of Queensland, Brisbane, Queensland, Australia
| | - Xuan Banh
- Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine and Biomedical Science, The University of Queensland, Brisbane, Queensland, Australia
| | - Leigh U Horsfall
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine and Biomedical Science, The University of Queensland, Brisbane, Queensland, Australia
| | - Kelly L Hayward
- Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine and Biomedical Science, The University of Queensland, Brisbane, Queensland, Australia.,School of Clinical Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | | | | | - Katherine A Stuart
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Nigel N Brown
- Pathology Queensland, Brisbane, Queensland, Australia
| | - Nivene Saad
- Department of Radiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Andrew Clouston
- Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine and Biomedical Science, The University of Queensland, Brisbane, Queensland, Australia
| | - Katharine M Irvine
- Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine and Biomedical Science, The University of Queensland, Brisbane, Queensland, Australia.,Mater Research, Translational Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Anthony W Russell
- School of Clinical Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Patricia C Valery
- Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine and Biomedical Science, The University of Queensland, Brisbane, Queensland, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | | | - Elizabeth E Powell
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine and Biomedical Science, The University of Queensland, Brisbane, Queensland, Australia
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Dambha-Miller H, Silarova B, Irving G, Kinmonth AL, Griffin SJ. Patients' views on interactions with practitioners for type 2 diabetes: a longitudinal qualitative study in primary care over 10 years. Br J Gen Pract 2018; 68:e36-e43. [PMID: 29203681 PMCID: PMC5737318 DOI: 10.3399/bjgp17x693917] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 07/18/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND It has been suggested that interactions between patients and practitioners in primary care have the potential to delay progression of complications in type 2 diabetes. However, as primary care faces greater pressures, patient experiences of patient-practitioner interactions might be changing. AIM To explore the views of patients with type 2 diabetes on factors that are of significance to them in patient-practitioner interactions in primary care after diagnosis, and over the last 10 years of living with the disease. DESIGN AND SETTING A longitudinal qualitative analysis over 10 years in UK primary care. METHOD The study was part of a qualitative and quantitative examination of patient experience within the existing ADDITION-Cambridge and ADDITION-Plus trials from 2002 to 2016. The researchers conducted a qualitative descriptive analysis of free-text comments to an open-ended question within the CARE measure questionnaire at 1 and 10 years after diagnosis with diabetes. Data were analysed cross-sectionally at each time point, and at an individual level moving both backwards and forwards between time points to describe emergent topics. RESULTS At the 1-year follow-up, 311 out of 1106 (28%) participants had commented; 101 out of 380 (27%) participants commented at 10-year follow-up; and 46 participants commented at both times. Comments on preferences for face-to-face contact, more time with practitioners, and relational continuity of care were more common over time. CONCLUSION This study highlights issues related to the wider context of interactions between patients and practitioners in the healthcare system over the last 10 years since diagnosis. Paradoxically, these same aspects of care that are valued over time from diagnosis are also increasingly unprotected in UK primary care.
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Affiliation(s)
- Hajira Dambha-Miller
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge
| | - Barbora Silarova
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge
| | - Greg Irving
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge
| | - Ann Louise Kinmonth
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge
| | - Simon J Griffin
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge
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