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Tu Q, Lin S, Hyun K, Hafiz N, Manandi D, Koh AS, Redfern J. The effects of multidisciplinary collaborative care on cardiovascular risk factors among patients with diabetes in primary care settings: A systematic review and meta-analysis. Prim Care Diabetes 2024; 18:381-392. [PMID: 38852029 DOI: 10.1016/j.pcd.2024.05.003] [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: 01/18/2024] [Revised: 05/22/2024] [Accepted: 05/26/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Multidisciplinary collaborative care has been widely recommended as an effective strategy for managing diabetes; however, the cardiovascular risk factors of patients with diabetes are often inadequately managed in primary care settings. This study aimed to assess the effect of multidisciplinary collaboration on cardiovascular risk factors among patients with diabetes in primary care settings. METHODS Five databases (i.e., Medline, Embase, CINAHL, SCOPUS and CENTRAL) were systematically searched to retrieve randomised controlled trials. Studies were eligible for inclusion if the interventions included a multidisciplinary team with professionals from at least three health disciplines and focused on patients with diabetes in primary care settings. A random-effects model was used to calculate the pooled effects. RESULTS In total, 19 studies comprising 6538 patients were included in the meta-analysis. The results showed that compared with usual care, multidisciplinary collaborative care significantly reduced cardiovascular risk factors, including mean systolic blood pressure (-3.27 mm Hg, 95 % confidence interval [CI]: -4.72 to -1.82, p < 0.01), diastolic blood pressure (-1.4 mm Hg, 95 % CI: -2.32 to -0.47, p < 0.01), glycated haemoglobin (-0.42 %, 95 % CI: -0.59 to -0.25, p < 0.01), low-density lipoprotein (-0.16 mmol/L, 95 % CI: -0.26 to -0.06, p < 0.01) and high-density lipoprotein (0.06 mmol/L, 95 % CI: 0.00-0.12, p < 0.05). The subgroup analysis showed multidisciplinary collaboration was more effective in reducing cardiovascular risk factors when it comprised team members from a number of different disciplines, combined pharmacological and non-pharmacological components, included both face-to-face and remote interactions and was implemented in high-income countries. CONCLUSION Multidisciplinary collaborative care is associated with reduced cardiovascular risk factors among patients with diabetes in primary care. Further studies need to be conducted to determine the optimal team composition.
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Affiliation(s)
- Qiang Tu
- Faculty of Medicine and Health, The University of Sydney, Australia.
| | | | - Karice Hyun
- Faculty of Medicine and Health, The University of Sydney, Australia; Department of Cardiology, Concord Hospital, Sydney, Australia
| | - Nashid Hafiz
- Faculty of Medicine and Health, The University of Sydney, Australia
| | - Deborah Manandi
- Faculty of Medicine and Health, The University of Sydney, Australia
| | - Angela S Koh
- National Heart Centre, Singapore, Singapore; Duke-National University of Singapore, Singapore
| | - Julie Redfern
- Faculty of Medicine and Health, The University of Sydney, Australia; The George Institute for Global Health, University of New South Wales, Sydney, Australia
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Lum ZK, Tan JY, Wong CSM, Kok ZY, Kwek SC, Tsou KYK, Gallagher PJ, Lee JYC. Reducing economic burden through split-shared care model for people living with uncontrolled type 2 diabetes and polypharmacy: a multi-center randomized controlled trial. BMC Health Serv Res 2024; 24:760. [PMID: 38907254 PMCID: PMC11193226 DOI: 10.1186/s12913-024-11199-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 06/12/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Interprofessional collaborative care such as a split-shared care model involving family physicians and community pharmacists can reduce the economic burden of diabetes management. This study aimed to evaluate the economic outcome of a split-shared care model between family physicians and community pharmacists within a pharmacy chain in managing people with uncontrolled type 2 diabetes and polypharmacy. METHOD This was a multi-center, parallel arm, open label, randomized controlled trial comparing the direct and indirect economic outcomes of people who received collaborative care involving community pharmacists (intervention) versus those who received usual care without community pharmacist involvement (control). People with uncontrolled type 2 diabetes, defined as HbA1c > 7.0% and taking ≥ 5 chronic medications were included while people with missing baseline economic data (such as consultation costs, medication costs) were excluded. Direct medical costs were extracted from the institution's financial database while indirect costs were calculated from self-reported gross income and productivity loss, using Work Productivity Activity Impairment Global Health questionnaire. Separate generalized linear models with log link function and gamma distribution were used to analyze changes in direct and indirect medical costs. RESULTS A total of 175 patients (intervention = 70, control = 105) completed the trial and were included for analysis. The mean age of the participants was 66.9 (9.2) years, with majority being male and Chinese. The direct medical costs were significantly lower in the intervention than the control group over 6 months (intervention: -US$70.51, control: -US$47.66, p < 0.001). Medication cost was the main driver in both groups. There were no significant changes in productivity loss and indirect costs in both groups. CONCLUSION Implementation of split-shared visits with frontline community partners may reduce economic burden for patient with uncontrolled type 2 diabetes and polypharmacy. TRIAL REGISTRATION Clinicaltrials.gov Reference Number: NCT03531944 (Date of registration: June 6, 2018).
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Affiliation(s)
- Zheng Kang Lum
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Science, MD1, Tahir Foundation Building, National University of Singapore, 12 Science Drive #06-03, Singapore, 117549, Singapore
| | - Jia Yeong Tan
- Keat Hong Family Medicine Clinic, Trilink Healthcare Private Limited, 2 Choa Chu Kang Loop, Singapore, #03-02, Singapore
| | - Cynthia Sze Mun Wong
- Bukit Batok Polyclinic, National University Polyclinics, 50 Bukit Batok West Ave 3, Singapore, 659164, Singapore
| | - Zi Yin Kok
- Keat Hong Family Medicine Clinic, Trilink Healthcare Private Limited, 2 Choa Chu Kang Loop, Singapore, #03-02, Singapore
| | - Sing Cheer Kwek
- Bukit Batok Polyclinic, National University Polyclinics, 50 Bukit Batok West Ave 3, Singapore, 659164, Singapore
| | - Keith Yu Kei Tsou
- Bukit Batok Polyclinic, National University Polyclinics, 50 Bukit Batok West Ave 3, Singapore, 659164, Singapore
| | - Paul John Gallagher
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Science, MD1, Tahir Foundation Building, National University of Singapore, 12 Science Drive #06-03, Singapore, 117549, Singapore.
| | - Joyce Yu-Chia Lee
- Department of Clinical Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University of California, 101 Theory, Suite 100, Irvine, CA, 92697, USA.
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Morales-Rodriguez DP, González-Cantú A, Garza-Silva A, Rivera-Cavazos A, Fernández-Chau IF, Cepeda-Medina AB, Sanz-Sánchez MA, Del Rio-Parra GF, Torres-Fuentes MA, Rodriguez-Puente MA, Romero-Ibarguengoitia ME. Effect of the SARS-CoV-2 pandemic on metabolic control in patients with type 2 diabetes: a 5-year cohort follow-up managed by a dynamic multidisciplinary team in Northeastern Mexico. Diabetol Metab Syndr 2024; 16:94. [PMID: 38664823 PMCID: PMC11044561 DOI: 10.1186/s13098-024-01318-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The SARS-CoV-2 pandemic brought a radical shift in the healthcare system and suboptimal care for vulnerable patients, such as those with Type 2 Diabetes Mellitus (T2D). Therefore, we compared metabolic control and macro/microvascular complications of patients with T2D before and throughout the three-year SARS-CoV-2 pandemic. RESEARCH DESIGN AND METHODS A retrospective observational cohort of subjects with T2D studied from 2018 to 2022 in Northern Mexico was treated by a dynamic multidisciplinary team. Levels of Glycated hemoglobin (HbA1c), fasting serum glucose (FG), LDL-Cholesterol (LDL-C), blood pressure (BP), albuminuria, triglycerides, Body Mass Index (BMI), and FIB-4 score, micro and macrovascular complications were evaluated. RESULTS A total of 999 patients were studied, 51.7% males with a mean (SD) age of 60.1 (12.7) years. Adequate glycemic control based on HbA1c increased by 15.2% and 42.3% in FSG (p < 0.001) between the beginning 2018 and the end of 2022. LDL-C control decreased by 5.1% between 2018 and 2022 (p < 0.001). Systolic BP control decreased by 2.6% (p < 0.001), whereas diastolic BP control increased by 1.8% (p = 0.01) between 2018 and 2022. Albuminuria control increased by 8.5% (p = 0.002). When comparing the Area Under the Curve (AUC) of metabolic parameters between patients who developed SARS-CoV-2 vs. those who did not, AUC was statistically higher in those who developed SARS-CoV-2 (p < 0.05). Diabetic neuropathy was the most prevalent microvascular complication (n = 35; 3.6%); ischemic heart disease was the most frequent macrovascular complication (n = 11;1.1%). CONCLUSIONS A multidisciplinary dynamic team that adapts to the pandemic SARS-CoV-2 maintains and increases metabolic control in subjects with type 2 diabetes in Mexico. This represents a low percentage of chronic complications. The AUC of metabolic parameters of subjects with SARS-CoV-2 infection is higher, reflecting more variability in metabolic control.
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Affiliation(s)
- Devany Paola Morales-Rodriguez
- Reseach Deparment, Hospital Clinica Nova de Monterrey, San Nicolas de los Garza, Nuevo Leon, Mexico
- Medical School, Vicerrectoria de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Arnulfo González-Cantú
- Reseach Deparment, Hospital Clinica Nova de Monterrey, San Nicolas de los Garza, Nuevo Leon, Mexico
- Medical School, Vicerrectoria de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Arnulfo Garza-Silva
- Reseach Deparment, Hospital Clinica Nova de Monterrey, San Nicolas de los Garza, Nuevo Leon, Mexico
| | - Andrea Rivera-Cavazos
- Reseach Deparment, Hospital Clinica Nova de Monterrey, San Nicolas de los Garza, Nuevo Leon, Mexico
| | - Iván Francisco Fernández-Chau
- Reseach Deparment, Hospital Clinica Nova de Monterrey, San Nicolas de los Garza, Nuevo Leon, Mexico
- Medical School, Vicerrectoria de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Andrea Belinda Cepeda-Medina
- Reseach Deparment, Hospital Clinica Nova de Monterrey, San Nicolas de los Garza, Nuevo Leon, Mexico
- Medical School, Vicerrectoria de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Miguel Angel Sanz-Sánchez
- Reseach Deparment, Hospital Clinica Nova de Monterrey, San Nicolas de los Garza, Nuevo Leon, Mexico
- Medical School, Vicerrectoria de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | | | - María Angelina Torres-Fuentes
- Medical School, Vicerrectoria de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Miguel Assael Rodriguez-Puente
- Medical School, Vicerrectoria de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Maria Elena Romero-Ibarguengoitia
- Reseach Deparment, Hospital Clinica Nova de Monterrey, San Nicolas de los Garza, Nuevo Leon, Mexico.
- Medical School, Vicerrectoria de Ciencias de la Salud, Universidad de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico.
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Pontoppidan JRN, Nielsen EE, Olsen MH, Skjødt MK, Christensen JO, Raymond IE, Møller SH, Soja AMB, Gæde PH. A multidisciplinary, shared care clinic using personalized medicine and coordinated care in patients with concomitant type 2 diabetes and cardiovascular disease. Protocol and baseline characteristics. Prev Med Rep 2024; 38:102594. [PMID: 38283962 PMCID: PMC10821603 DOI: 10.1016/j.pmedr.2024.102594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/03/2024] [Accepted: 01/03/2024] [Indexed: 01/30/2024] Open
Abstract
Background Concomitant type 2 diabetes (T2DM) and cardiovascular disease (CVD) is frequent with a poor prognosis with high risk of comorbidities. Strict risk factor control reduces the risk for complications - yet many people do not achieve treatment targets. The complexity and fragmentation of the healthcare system may, together with the vulnerability of these patients, be a reason. Objective The purpose of this paper is to describe the protocol of a non-randomized interventional pilot study testing the feasibility and effect of a multidisciplinary, shared care clinic using personalized medicine and coordinated care in people living with concomitant T2D and CVD. Methods Participants were included from the Holbaek area in Denmark. People suffered from T2DM and CVD and were dysregulated regarding to HbA1c, cholesterol, micro/macroalbuminuaria or blood pressure. Participants went through a thorough evaluation to identify their needs and resources and received consultations every three months for one year. Results A total of 63 participants with T2DM and CVD were enrolled in the clinic. The participants had a mean age of 69 years and a BMI of 30.9 kg/m2. Almost 50 % had heart failure, 95 % dyslipidemia and 91 % hypertension. Around 54 % received GLP-1 agonists and 39 % received SGLT-2-inhibitors. Perspectives To our knowledge, a similar study with a multidisciplinary, shared care, outpatient clinic treating people living with concomitant T2DM and CVD, has not been performed previously. This study will provide information about the feasibility and efficacy of a multidisciplinary clinic based on changes in cardiovascular risk factors and medication.
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Affiliation(s)
- Julie Rye Noer Pontoppidan
- Department of Internal Medicine, Cardiology Section, Holbæk Sygehus, Denmark
- Department of Endocrinology and Cardiology, Slagelse Sygehus, Denmark
| | - Emil Eik Nielsen
- Department of Internal Medicine, Cardiology Section, Holbæk Sygehus, Denmark
| | - Michael Hecht Olsen
- Department of Internal Medicine, Cardiology Section, Holbæk Sygehus, Denmark
| | - Michael Kriegbaum Skjødt
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Denmark
- Department Internal Medicine, Holbæk Sygehus, Denmark
| | | | | | - Sara Hedlund Møller
- Department of Internal Medicine, Cardiology Section, Holbæk Sygehus, Denmark
| | | | - Peter Haulund Gæde
- Department of Endocrinology and Cardiology, Slagelse Sygehus, Denmark
- University of Southern Denmark, Institute for Regional Health, Denmark
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Kroenke K, Corrigan JD, Ralston RK, Zafonte R, Brunner RC, Giacino JT, Hoffman JM, Esterov D, Cifu DX, Mellick DC, Bell K, Scott SG, Sander AM, Hammond FM. Effectiveness of care models for chronic disease management: A scoping review of systematic reviews. PM R 2024; 16:174-189. [PMID: 37329557 DOI: 10.1002/pmrj.13027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 05/14/2023] [Accepted: 05/31/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE To conduct a scoping review of models of care for chronic disease management to identify potentially effective components for management of chronic traumatic brain injury (TBI). METHODS Information sources: Systematic searches of three databases (Ovid MEDLINE, Embase, and Cochrane Database of Systematic Reviews) from January 2010 to May 2021. ELIGIBILITY CRITERIA Systematic reviews and meta-analyses reporting on the effectiveness of the Chronic Care Model (CCM), collaborative/integrated care, and other chronic disease management models. DATA Target diseases, model components used (n = 11), and six outcomes (disease-specific, generic health-related quality of life and functioning, adherence, health knowledge, patient satisfaction, and cost/health care use). SYNTHESIS Narrative synthesis, including proportion of reviews documenting outcome benefits. RESULTS More than half (55%) of the 186 eligible reviews focused on collaborative/integrated care models, with 25% focusing on CCM and 20% focusing on other chronic disease management models. The most common health conditions were diabetes (n = 22), depression (n = 16), heart disease (n = 12), aging (n = 11), and kidney disease (n = 8). Other single medical conditions were the focus of 22 reviews, multiple medical conditions of 59 reviews, and other or mixed mental health/behavioral conditions of 20 reviews. Some type of quality rating for individual studies was conducted in 126 (68%) of the reviews. Of reviews that assessed particular outcomes, 80% reported disease-specific benefits, and 57% to 72% reported benefits for the other five types of outcomes. Outcomes did not differ by the model category, number or type of components, or target disease. CONCLUSIONS Although there is a paucity of evidence for TBI per se, care model components proven effective for other chronic diseases may be adaptable for chronic TBI care.
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Affiliation(s)
- Kurt Kroenke
- Department of Medicine, Indiana School of Medicine and Regenstrief Institute, Indianapolis, Indiana, USA
| | - John D Corrigan
- Department of Physical Medicine & Rehabilitation, The Ohio State University, Columbus, Ohio, USA
| | - Rick K Ralston
- Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, and Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Robert C Brunner
- Department of Physical Medicine and Rehabilitation, University of Alabama, Birmingham, Alabama, USA
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, and Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Jeanne M Hoffman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Dmitry Esterov
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - David X Cifu
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
- U.S. Department of Veterans Affairs, Washington, DC, USA
| | | | - Kathleen Bell
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, Texas, USA
| | - Steven G Scott
- Center of Innovation on Disability & Rehab Research (CINDRR), James A Haley Veterans' Hospital, Tampa, Florida, USA
| | - Angelle M Sander
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, and Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas, USA
| | - Flora M Hammond
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Te V, Ma S, Por I, Van Damme W, Wouters E, van Olmen J. Diabetes care components effectively implemented in the ASEAN health systems: an umbrella review of systematic reviews. BMJ Open 2023; 13:e071427. [PMID: 37816569 PMCID: PMC10565207 DOI: 10.1136/bmjopen-2022-071427] [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: 12/27/2022] [Accepted: 09/11/2023] [Indexed: 10/12/2023] Open
Abstract
OBJECTIVES Association of Southeast Asian Nations (ASEAN) is among the hardest hit low-income and middle-income countries by diabetes. Innovative Care for Chronic Conditions (ICCC) framework has been adopted by the WHO for health system transformation towards better care for chronic conditions including diabetes. We conducted an umbrella review of systematic reviews on diabetes care components effectively implemented in the ASEAN health systems and map those effective care components into the ICCC framework. DESIGN An umbrella review of systematic reviews and/or meta-analyses following JBI (Joanna Briggs Institute) guidelines. DATA SOURCES Health System Evidence, Health Evidence, PubMed and Ovid MEDLINE. ELIGIBILITY CRITERIA We included systematic reviews and/or meta-analyses which focused on management of type 2 diabetes, reported improvements in measured outcomes and had at least one ASEAN member state in the study setting. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted the data and mapped the included studies into the ICCC framework. A narrative synthesis method was used to summarise the findings. The included studies were assessed for methodological quality based on the JBI critical appraisal checklist for systematic reviews and research syntheses. RESULTS 479 records were found of which 36 studies were included for the analysis. A multidisciplinary healthcare team including pharmacists and nurses has been reported to effectively support patients in self-management of their conditions. This can be supported by effective use of digital health interventions. Community health workers either peers or lay people with necessary software (knowledge and skills) and hardware (medical equipment and supplies) can provide complementary care to that of the healthcare staff. CONCLUSION To meet challenges of the increased burden of chronic conditions including diabetes, health policy-makers in the ASEAN member states can consider a paradigm shift in human resources for health towards the multidisciplinary, inclusive, collaborative and complementary team.
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Affiliation(s)
- Vannarath Te
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
- Health Policy Unit, Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
- Department of Family Medicine and Population Health, University of Antwerp, Antwerpen, Belgium
| | - Sokvy Ma
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
| | - Ir Por
- School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
- Management Team, National Institute of Public Health, Phnom Penh, Cambodia
| | - Wim Van Damme
- Health Policy Unit, Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Edwin Wouters
- Department of Sociology, Centre for Population, Family & Health, University of Antwerp, Antwerp, Belgium
- Center for Health Systems Research & Development, University of the Free State, Bloemfontein, South Africa
| | - Josefien van Olmen
- Department of Family Medicine and Population Health, University of Antwerp, Antwerpen, Belgium
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Lum ZK, Kng KK, Goh CEM, Sule AA, Gallagher PJ, Lee JYC. Clinical activities that contributed to the effectiveness of a cardiologist-pharmacist collaborative care model in managing diabetes. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2023; 31:540-547. [PMID: 37410963 DOI: 10.1093/ijpp/riad046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 06/29/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVES The primary objectives of this study were to evaluate the change in glycated haemoglobin (HbA1c) and its association to clinical activities. The secondary objective was to elucidate moderators of the relationship between pharmacist-involved collaborative care (PCC) and change in HbA1c. METHODS This study was a retrospective cohort study conducted in a tertiary hospital over 12 months. Individuals with Type 2 diabetes, aged ≥21 years with established cardiovascular diseases were included while individuals with incomplete care documentation or missing data related to cardiovascular diseases were excluded. Individuals under the care of PCC were matched 1:1 based on baseline HbA1c with an eligible person who received care from the cardiologists (CC). Changes in mean HbA1c were analysed using linear mixed model. Linear regression was used to determine clinical activities that associated with improvement in HbA1c. Moderation analyses were conducted using the MacArthur framework. KEY FINDINGS A total of 420 participants (PCC:210, CC:210) were analysed. The mean age of the participants was 65.6 ± 11.1 years, with the majority being male and Chinese. The mean HbA1c among participants in the PCC group decreased significantly after 6 months (PCC: -0.4% versus CC: -0.1%, P = 0.016), with maintenance of improvement at 12 months (PCC: -0.4% versus CC: -0.2%, P < 0.001). Frequencies of lifestyle counselling, reinforcement of visits to healthcare providers, health education, resolution of drug-related problems, emphasis on medication adherence, dose adjustments and advice on self-care techniques were significantly higher in the intervention group (P < 0.001). CONCLUSION Improvements in HbA1c were associated with the provision of health education and medication adjustments.
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Affiliation(s)
- Zheng Kang Lum
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
| | - Kwee Keng Kng
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore
| | | | - Ashish Anil Sule
- Department of General Medicine, Tan Tock Seng Hospital, Singapore
| | - Paul John Gallagher
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
| | - Joyce Yu-Chia Lee
- Department of Clinical Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University of California, Irvine, CA, USA
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Schaaf L, Ley S, Riegler A, Poetker A, Xanthakos S, Sizemore J, Crimmins N, Helmrath M, Tracy R, Arce-Clachar AC, Crail J, Morwessel N, Frenck K, Tariq F, Shah AS. Development and Implementation of a Multidisciplinary Clinic Focused on the Care of Adolescents with Youth-Onset Type 2 Diabetes. J Multidiscip Healthc 2023; 16:2799-2807. [PMID: 37750161 PMCID: PMC10518146 DOI: 10.2147/jmdh.s414849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/07/2023] [Indexed: 09/27/2023] Open
Abstract
Introduction Diabetes self-management education and lifestyle interventions are the cornerstones of type 2 diabetes (T2D) care; however, the higher risk of comorbidities among youth with T2D requires a comprehensive care model. Traditionally, sub-specialty care relies on a referral model placing the burden on patients/families. In response, we developed a pediatric T2D multidisciplinary clinic (MDC)-A single physical location where patients can access various sub-specialists. The goals of the MDC are to aid with lifestyle modifications and provide referral/access to sub-specialists within the MDC, as determined through screening labs and assessment tools. Methods We conducted a retrospective chart review of youth seen in the T2D MDC clinic at Cincinnati Children's Hospital from 1/2020 to 12/2021. We evaluated the frequency that youth met with each specialist and completion rates of annual screening labs. Results The cohort consisted of 227 youth with T2D (mean age 17.6 years, mean BMI 40.9kg/m2, 64% female, 50% Black or African American, 65% public insurance). All patients met with a diabetes provider and 81.2% met with a registered dietitian/certified diabetes education specialist. Exercise physiology met with 51.5% of patients, gastroenterology met with 34.8% of patients, social work met with 44.1% of patients, clinical psychology met with 27.3% of patients, and bariatric surgery met with 9.7% of patients. Percent completion of annual labs were: 98.2% for HbA1c, 84.6% for urine microalbumin, 83.7% for lipids, 90% for liver function, 59.5% for retinopathy, and 45.4% for the Patient Health Questionnaire-9. Conclusion The majority of patients received diabetes and nutrition education and annual screening labs. Exercise counseling and sub-specialty care remain below 60% in part due to services not being available at every MDC. Our goals are to increase access to subspecialty care within the MDC's and consider additional care delivery methods to provide comprehensive care to youth with T2D.
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Affiliation(s)
- Lisa Schaaf
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Sanita Ley
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center and the University of Cincinnati, Cincinnati, OH, USA
| | - Allen Riegler
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Amy Poetker
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Stavra Xanthakos
- Department of Pediatrics, Division of Gastroenterology, Cincinnati Children’s Hospital Medical Center and the University of Cincinnati, Department of Pediatrics, Cincinnati, OH, USA
| | - Jennifer Sizemore
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Nancy Crimmins
- Department of Pediatrics, Division of Endocrinology, Cincinnati Children’s Hospital Medical Center and the University of Cincinnati, Cincinnati, OH, USA
| | - Michael Helmrath
- Department of Surgery, Cincinnati Children’s Hospital Medical Center and the University of Cincinnati, Cincinnati, OH, USA
| | - Rebekah Tracy
- Center for Better Health and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Ana Catalina Arce-Clachar
- Department of Pediatrics, Division of Gastroenterology, Cincinnati Children’s Hospital Medical Center and the University of Cincinnati, Department of Pediatrics, Cincinnati, OH, USA
| | - Jennifer Crail
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Nancy Morwessel
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Kelsey Frenck
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Fatima Tariq
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Amy Sanghavi Shah
- Department of Pediatrics, Division of Endocrinology, Cincinnati Children’s Hospital Medical Center and the University of Cincinnati, Cincinnati, OH, USA
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Lim PC, Tan HH, Mohd Noor NA, Chang CT, Wong TY, Tan EL, Ong CT, Nagapa K, Tai LS, Chan WP, Sin YB, Tan YS, Velaiutham S, Mohd Hanafiah R. The impact of pharmacist interventions, follow-up frequency and default on glycemic control in Diabetes Medication Therapy Adherence Clinic program: a multicenter study in Malaysia. J Pharm Policy Pract 2023; 16:83. [PMID: 37408067 DOI: 10.1186/s40545-023-00583-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/11/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Pharmacist's involvement in optimizing medication adherence among diabetic patients has been implemented for over a decade. Diabetes Medication Therapy Adherence Clinic (DMTAC) was set up to educate diabetic patients, monitor treatment outcomes, and manage drug-related problems. While evidence shows that pharmacist-led DMTAC was effective in reducing HbA1c, there was limited data regarding the impact of different intervention types and default to follow-up on glycemic control. AIM To assess the impact DMTAC on glycemic control and the difference in glycemic control between hospital and health clinic settings as well as defaulter and non-defaulter. In addition, the impact of pharmacist's interventions, DMTAC follow-up frequencies, and duration of diabetes on glycemic control were also determined. METHODS A retrospective study was conducted among diabetes patients under DMTAC care between January 2019 and June 2020 in five hospitals and 23 primary health clinics. Patients' demographics data, treatment regimens, frequencies of DMTAC visits, defaulter (absent from DMTAC visits) and types of pharmacists' intervention were retrieved from patients' medical records and electronic database. HbA1c was collected at baseline, 4-6 months (post-1), and 8-12 months (post-2). RESULTS We included 956 patients, of which 60% were females with a median age of 58.0 (IQR: 5.0) years. Overall, the HbA1c reduced significantly from baseline (median: 10.2, IQR: 3.0) to post-1 (median: 8.8, IQR: 2.7) and post-2 (median: 8.3, IQR: 2.6%) (p < 0.001). There were 4317 pharmacists' interventions performed, with the majority being dosage adjustment (n = 2407, 55.8%), followed by lab investigations (849, 19.7%), drugs addition (653, 15.1%), drugs discontinuation (408, 9.5%). Patients treated in hospitals received significantly more interventions than those treated in primary health clinics (p < 0.001). We observed significantly less reduction in HbA1c in DMTAC follow-up defaulters than non-defaulters after 1 year (- 1.02% vs. - 2.14%, p = 0.001). Frequencies of DMTAC visits (b: 0.19, CI: 0.079-0.302, p = 0.001), number of dosage adjustments (b: 0.83, CI: 0.015-0.151, p = 0.018) and number of additional drugs recommended (b: 0.37, CI: 0.049-0.691, p = 0.024) had positive impact on glycemic control whereas duration of diabetes (b: - 0.0302, CI: - 0.0507, - 0.007, p = 0.011) had negative impact. CONCLUSION Glycemic control improved significantly and sustained up to one year among patients in pharmacists-led DMTAC. However, DMTAC defaulters experienced poorer glycemic control. Considering more frequent visits and targeted interventions by pharmacists at DMTAC resulted in improved HbA1c control, these strategies should be taken into account for future program planning.
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Affiliation(s)
- Phei Ching Lim
- Pharmacy Department, Hospital Pulau Pinang, Ministry of Health Malaysia, George Town, Malaysia
- School of Pharmaceutical Sciences, University Science Malaysia, Gelugor, Malaysia
| | - Hooi Hoon Tan
- Pharmacy Department, Northeast District Health Office, Penang, Ministry of Health Malaysia, George Town, Malaysia
| | - Nurul Ain Mohd Noor
- Pharmacy Department, Hospital Balik Pulau, Ministry of Health Malaysia, Balik Pulau, Malaysia
| | - Chee Tao Chang
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health Malaysia, Ipoh, Malaysia.
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Malaysia.
| | - Te Ying Wong
- Pharmacy Department, Hospital Pulau Pinang, Ministry of Health Malaysia, George Town, Malaysia
| | - Ee Linn Tan
- Pharmacy Department, Hospital Bukit Mertajam, Ministry of Health Malaysia, Bukit Mertajam, Malaysia
| | - Chiou Ting Ong
- Pharmacy Department, Hospital Sungai Bakap, Ministry of Health Malaysia, Sungai Jawi, Malaysia
| | - Kalyhani Nagapa
- Pharmacy Department, Hospital Seberang Jaya, Ministry of Health Malaysia, Perai, Malaysia
| | - Lee Shyong Tai
- Pharmacy Department, Southwest District Health Office, Penang, Ministry of Health Malaysia, Balik Pulau, Malaysia
| | - Wei Ping Chan
- Pharmacy Department, North District Health Office, Seberang Perai, Ministry of Health Malaysia, Kepala Batas, Malaysia
| | - Yong Boey Sin
- Pharmacy Department, Center District Health Office, Seberang Perai, Ministry of Health Malaysia, Bukit Mertajam, Malaysia
| | - Yin Shan Tan
- Pharmacy Department, South District Health Office, Seberang Perai, Ministry of Health Malaysia, Nibong Tebal, Malaysia
| | - Shanty Velaiutham
- Medical Department, Hospital Pulau Pinang, Ministry of Health Malaysia, George Town, Malaysia
| | - Rohaizan Mohd Hanafiah
- Penang Pharmaceutical Services Division, Ministry of Health Malaysia, George Town, Malaysia
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10
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Vaughan EM, Cepni AB, Le UPN, Johnston CA. The Rationale and Logistics for Incorporating Community Health Workers Into the Multidisciplinary Team. Am J Lifestyle Med 2023; 17:355-358. [PMID: 37304752 PMCID: PMC10248369 DOI: 10.1177/15598276231151866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023] Open
Abstract
Community Health Workers (CHWs) have shown value in diabetes care. CHWs are often the individuals who provide behavioral lifestyle intervention to underserved communities and are often the first to assist patients in gaining appropriate access to care. As trusted members of their communities, they have the ability to significantly impact psychosocial and biomedical outcomes, making them important members of the behavioral medicine team. However, lack of recognition of CHWs within multidisciplinary teams (MDTs) gives rise to the issue of the underutilization of their services. Therefore, barriers to including CHWs in MDTs including standardized training and strategies to overcome these are discussed.
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Affiliation(s)
- Elizabeth M Vaughan
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Aliye B Cepni
- Department of Health and Human Performance, University of Houston, Houston, TX, USA
| | - Uyen Phuong N Le
- Department of Health and Human Performance, University of Houston, Houston, TX, USA
| | - Craig A Johnston
- Department of Health and Human Performance, University of Houston, Houston, TX, USA
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11
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Andersen JD, Jensen MH, Vestergaard P, Jensen V, Hejlesen O, Hangaard S. The multidisciplinary team in diagnosing and treatment of patients
with diabetes and comorbidities: A scoping review. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2023; 13:26335565231165966. [PMID: 36968789 PMCID: PMC10031602 DOI: 10.1177/26335565231165966] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 03/09/2023] [Indexed: 03/24/2023]
Abstract
Background Multidisciplinary Teams (MDTs) has been suggested as an intervention to
overcome some of the complexities experienced by people with diabetes and
comorbidities in terms of diagnosis and treatment. However, evidence
concerning MDTs within the diabetes field remains sparse. Objective This review aims to identify and map available evidence on key
characteristics of MDTs in the context of diagnosis and treatment in people
with diabetes and comorbidities. Methods This review followed the PRISMA-ScR guidelines. Databases PubMed, EMBASE, and
CINAHL were systematically searched for studies assessing any type of MDT
within the context of diagnosis and treatment in adult people (≥ 18 years)
with diabetes and comorbidities/complications. Data extraction included
details on study characteristics, MDT interventions, digital health
solutions, and key findings. Results Overall, 19 studies were included. Generally, the MDTs were characterized by
high heterogeneity. Four overall components characterized the MDTs: Both
medical specialists and healthcare professionals (HCPs) of different team
sizes were represented; interventions spanned elements of medication,
assessment, nutrition, education, self-monitoring, and treatment adjustment;
digital health solutions were integrated in 58% of the studies; MDTs were
carried out in both primary and secondary healthcare settings with varying
frequencies. Generally, the effectiveness of the MDTs was positive across
different outcomes. Conclusions MDTs are characterized by high diversity in their outline yet seem to be
effective and cost-effective in the context of diagnosis and treatment of
people with diabetes and comorbidities. Future research should investigate
the cross-sectorial collaboration to reduce care fragmentation and enhance
care coordination.
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Affiliation(s)
- Jonas Dahl Andersen
- Department of Health Science and
Technology, Faculty of Medicine, Aalborg
University, Aalborg, Denmark
- Steno Diabetes Center North
Denmark, Aalborg, Denmark
- Jonas Dahl Andersen, Department of Health
Science and Technology, Aalborg University, Selma Lagerløfs Vej 249, DK-9260
Gistrup, Denmark.
| | - Morten Hasselstrøm Jensen
- Department of Health Science and
Technology, Faculty of Medicine, Aalborg
University, Aalborg, Denmark
- Steno Diabetes Center North
Denmark, Aalborg, Denmark
| | - Peter Vestergaard
- Department of Health Science and
Technology, Faculty of Medicine, Aalborg
University, Aalborg, Denmark
- Steno Diabetes Center North
Denmark, Aalborg, Denmark
- Department of Endocrinology and
Clinical Medicine, Aalborg
University Hospital,
Aalborg, Denmark
| | - Vigga Jensen
- Steno Diabetes Center North
Denmark, Aalborg, Denmark
| | - Ole Hejlesen
- Department of Health Science and
Technology, Faculty of Medicine, Aalborg
University, Aalborg, Denmark
| | - Stine Hangaard
- Department of Health Science and
Technology, Faculty of Medicine, Aalborg
University, Aalborg, Denmark
- Steno Diabetes Center North
Denmark, Aalborg, Denmark
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12
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Greenlee MC, Bolen S, Chong W, Dokun A, Gonzalvo J, Hawkins M, Herman WH, Leake E, Linder B, Conlin PR. The National Clinical Care Commission Report to Congress: Leveraging Federal Policies and Programs to Improve Diabetes Treatment and Reduce Complications. Diabetes Care 2023; 46:e51-e59. [PMID: 36701593 PMCID: PMC9887628 DOI: 10.2337/dc22-0621] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 09/08/2022] [Indexed: 01/27/2023]
Abstract
The Treatment and Complications subcommittee of the National Clinical Care Commission focused on factors likely to improve the delivery of high-quality care to all people with diabetes. The gap between available resources and the needs of people living with diabetes adversely impacts both treatment and outcomes. The Commission's recommendations are designed to bridge this gap. At the patient level, the Commission recommends reducing barriers and streamlining administrative processes to improve access to diabetes self-management training, diabetes devices, virtual care, and insulin. At the practice level, we recommend enhancing programs that support team-based care and developing capacity to support technology-enabled mentoring interventions. At the health system level, we recommend that the Department of Health and Human Services routinely assess the needs of the health care workforce and ensure funding of training programs directed to meet those needs. At the health policy level, we recommend establishing a process to identify and ensure pre-deductible insurance coverage for high-value diabetes treatments and services and developing a quality measure that reduces risk of hypoglycemia and enhances patient safety. We also identified several areas that need additional research, such as studying the barriers to uptake of diabetes self-management education and support, exploring methods to implement team-based care, and evaluating the importance of digital connectivity as a social determinant of health. The Commission strongly encourages Congress, the Department of Health and Human Services, and other federal departments and agencies to take swift action to implement these recommendations to improve health outcomes and quality of life among people living with diabetes.
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Affiliation(s)
| | - Shari Bolen
- Population Health Research Institute and Center for Health Care Research and Policy, Case Western Reserve at The MetroHealth System, Cleveland, OH
| | - William Chong
- Office of Generic Drugs, Center for Drug Evaluation and Research, Food and Drug Administration, Rockville, MD
| | - Ayotunde Dokun
- Division of Endocrinology and Metabolism, Carver School of Medicine, University of Iowa, Iowa City, IA
| | - Jasmine Gonzalvo
- Center for Health Equity and Innovation, Purdue University, Indianapolis, IN
| | - Meredith Hawkins
- Global Diabetes Institute, Albert Einstein College of Medicine, Bronx, NY
| | | | - Ellen Leake
- Juvenile Diabetes Research Foundation, Jackson, MS
| | - Barbara Linder
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Paul R. Conlin
- Department of Veterans Affairs Boston Healthcare System, Boston, MA
- Harvard Medical School, Boston, MA
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13
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Diabetes tipo 2 e transplante renal: estudo comparativo sobre adesão medicamentosa. ACTA PAUL ENFERM 2023. [DOI: 10.37689/acta-ape/2023ao03461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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14
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Abu-Alfa AK, Atallah PJ, Azar ST, Dagher EC, Echtay AS, El-Amm MA, Hazkial HG, Kassab RY, Medlej RC, Mohamad MA. Recommendations for Early and Comprehensive Management of Type 2 Diabetes and Its Related Cardio-Renal Complications. Diabetes Ther 2023; 14:11-28. [PMID: 36517708 PMCID: PMC9880119 DOI: 10.1007/s13300-022-01340-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/03/2022] [Indexed: 12/23/2022] Open
Abstract
Type 2 diabetes (T2D) is a global health problem accompanied by an elevated risk of complications, the most common being cardiac and renal diseases. In Lebanon, the prevalence of T2D is estimated at 8-13%. Local medical practice generally suffers from clinical inertia, with gaps in the yearly assessment of clinical manifestations and suboptimal screening for major complications. The joint statement presented here, endorsed by five Lebanese scientific medical societies, aims at providing physicians in Lebanon with a tool for early, effective, and comprehensive care of patients with T2D. Findings from major randomized clinical trials of antidiabetic medications with cardio-renal benefits are presented, together with recommendations from international medical societies. Optimal care should be multidisciplinary and should include a multifactorial risk assessment, lifestyle modifications, and a regular evaluation of risks, including the risks for cardiovascular (CV) and renal complications. With international guidelines supporting a shift in T2D management from glucose-lowering agents to disease-modifying drugs, the present statement recommends treatment initiation with metformin, followed by the addition of sodium-glucose cotransporter 2 inhibitors or glucagon-like peptide-1 receptor agonists due to their CV and renal protection properties, whenever possible. In addition to the selection of the most appropriate pharmacological therapy, efforts should be made to provide continuous education to patients about their disease, with the aim to achieve a patient-centered approach and to foster self-management and adherence to the medical plan. Increasing the level of patient engagement is expected to be associated with favorable health outcomes. Finally, this statement recommends setting an achievable individualized management plan and conducting regular follow-ups to monitor the patients' glycemic status and assess their risks every 3-6 months.
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Affiliation(s)
- Ali K. Abu-Alfa
- Division of Nephrology and Hypertension, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Paola J. Atallah
- Department of Internal Medicine, Saint George University Medical Center, Beirut, Lebanon
| | - Sami T. Azar
- Faculty of Medicine and Medical Affairs, University of Balamand, Beirut, Lebanon
| | - Elissar C. Dagher
- Department of Internal Medicine and Clinical Immunology, School of Medicine and Medical Sciences, Holy Spirit University of Kaslik–Kaslik Notre Dame des Secours University Hospital Center, Byblos, Lebanon
| | - Akram S. Echtay
- Division of Endocrinology, Department of Internal Medicine, Rafic Hariri University Hospital, Jnah, Beirut, Lebanon
| | - Mireille A. El-Amm
- Department of Endocrinology, Faculty of Medicine, Holy Spirit University of Kaslik, Kaslik, Lebanon
| | | | - Roland Y. Kassab
- Department of Cardiology, Saint Joseph University–Hôtel-Dieu de France Hospital, Beirut, Lebanon
| | - Rita C. Medlej
- Department of Endocrinology, Hôtel-Dieu de France Hospital, Beirut, Lebanon
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15
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Wang Z, Xie L, Liang Z, Fan J, Fan L, Deng J, Xu X. Perceived stress and humanistic care ability among Chinese healthcare workers: The chain mediating role of social support and life satisfaction. Front Psychol 2022; 13:1029265. [PMID: 36438328 PMCID: PMC9683107 DOI: 10.3389/fpsyg.2022.1029265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 10/21/2022] [Indexed: 11/11/2022] Open
Abstract
Previous studies have indicated high perceived stress and its relationship with life satisfaction among healthcare workers. However, most of the existing studies have focused on the investigation and evaluation of the humanistic care abilities among nurses, but few studies revealed the levels of humanistic care ability among other healthcare workers including doctors and technicians. The study aimed to investigate the perceived stress and humanistic care abilities among Chinese healthcare workers. In addition, we further examined the mediating and moderating effects of social support and life satisfaction. A convenience sample of 955 health professionals from 29 hospitals in China was recruited to fill out the questionnaires about perceived stress, humanistic care ability, social support, and life satisfaction. The correlation and multivariate logistic regression analysis were carried out by SPSS 24.0. The Hayes SPSS macro program process (version 2.16.3) was used to analyze the significance of mediating and moderating model. The findings indicated that humanistic care ability was negatively associated with perceived stress and positively correlated with social support and life satisfaction. The effect of the path “perceived stress → social support → humanistic care ability” was −0.017, and the path “perceived stress → life satisfaction → social support → humanistic care ability” was −0.129. The current study contributed to a better understanding of humanistic care abilities and influential factors in Chinese healthcare workers. Thus, it may suggest studies on interventions to interventions to alleviate or eliminate the negative impact of perceived stress and improve humanistic care abilities.
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Affiliation(s)
- Zonghua Wang
- Department of Clinical Nursing, School of Nursing, Army Medical University, Chongqing, China
| | - Langlang Xie
- Department of Clinical Nursing, School of Nursing, Army Medical University, Chongqing, China
- Department of Health Management and Geriatric Nursing, Daping Hospital, Chongqing, China
| | - Zeping Liang
- Department of Nursing, Daping Hospital, Chongqing, China
| | - Jiangshan Fan
- Department of Clinical Nursing, School of Nursing, Army Medical University, Chongqing, China
| | - Liqi Fan
- Department of Health Management and Geriatric Nursing, Daping Hospital, Chongqing, China
| | - Jing Deng
- Department of Respiratory and Critical Care Medicine, Southwest Hospital, Chongqing, China
- *Correspondence: Jing Deng
| | - Xia Xu
- Department of Health Management and Geriatric Nursing, Daping Hospital, Chongqing, China
- Xia Xu
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16
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Blonde L, Umpierrez GE, Reddy SS, McGill JB, Berga SL, Bush M, Chandrasekaran S, DeFronzo RA, Einhorn D, Galindo RJ, Gardner TW, Garg R, Garvey WT, Hirsch IB, Hurley DL, Izuora K, Kosiborod M, Olson D, Patel SB, Pop-Busui R, Sadhu AR, Samson SL, Stec C, Tamborlane WV, Tuttle KR, Twining C, Vella A, Vellanki P, Weber SL. American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. Endocr Pract 2022; 28:923-1049. [PMID: 35963508 PMCID: PMC10200071 DOI: 10.1016/j.eprac.2022.08.002] [Citation(s) in RCA: 154] [Impact Index Per Article: 77.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The objective of this clinical practice guideline is to provide updated and new evidence-based recommendations for the comprehensive care of persons with diabetes mellitus to clinicians, diabetes-care teams, other health care professionals and stakeholders, and individuals with diabetes and their caregivers. METHODS The American Association of Clinical Endocrinology selected a task force of medical experts and staff who updated and assessed clinical questions and recommendations from the prior 2015 version of this guideline and conducted literature searches for relevant scientific papers published from January 1, 2015, through May 15, 2022. Selected studies from results of literature searches composed the evidence base to update 2015 recommendations as well as to develop new recommendations based on review of clinical evidence, current practice, expertise, and consensus, according to established American Association of Clinical Endocrinology protocol for guideline development. RESULTS This guideline includes 170 updated and new evidence-based clinical practice recommendations for the comprehensive care of persons with diabetes. Recommendations are divided into four sections: (1) screening, diagnosis, glycemic targets, and glycemic monitoring; (2) comorbidities and complications, including obesity and management with lifestyle, nutrition, and bariatric surgery, hypertension, dyslipidemia, retinopathy, neuropathy, diabetic kidney disease, and cardiovascular disease; (3) management of prediabetes, type 2 diabetes with antihyperglycemic pharmacotherapy and glycemic targets, type 1 diabetes with insulin therapy, hypoglycemia, hospitalized persons, and women with diabetes in pregnancy; (4) education and new topics regarding diabetes and infertility, nutritional supplements, secondary diabetes, social determinants of health, and virtual care, as well as updated recommendations on cancer risk, nonpharmacologic components of pediatric care plans, depression, education and team approach, occupational risk, role of sleep medicine, and vaccinations in persons with diabetes. CONCLUSIONS This updated clinical practice guideline provides evidence-based recommendations to assist with person-centered, team-based clinical decision-making to improve the care of persons with diabetes mellitus.
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Affiliation(s)
| | | | - S Sethu Reddy
- Central Michigan University, Mount Pleasant, Michigan
| | | | | | | | | | | | - Daniel Einhorn
- Scripps Whittier Diabetes Institute, La Jolla, California
| | | | | | - Rajesh Garg
- Lundquist Institute/Harbor-UCLA Medical Center, Torrance, California
| | | | | | | | | | | | - Darin Olson
- Colorado Mountain Medical, LLC, Avon, Colorado
| | | | | | - Archana R Sadhu
- Houston Methodist; Weill Cornell Medicine; Texas A&M College of Medicine; Houston, Texas
| | | | - Carla Stec
- American Association of Clinical Endocrinology, Jacksonville, Florida
| | | | - Katherine R Tuttle
- University of Washington and Providence Health Care, Seattle and Spokane, Washington
| | | | | | | | - Sandra L Weber
- University of South Carolina School of Medicine-Greenville, Prisma Health System, Greenville, South Carolina
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17
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Nieto-Martínez R, Velásquez-Rodríguez A, Neira C, Mou X, Neira A, Garcia G, Velásquez-Rodríguez P, Levy M, Mechanick JI, Velásquez-Mieyer PA. Impact of a Multidisciplinary Approach on Cardiometabolic Risk Reduction in a Multiracial Cohort of Adults: A 1-Year Pilot Study. Nutrients 2022; 14:nu14163391. [PMID: 36014896 PMCID: PMC9412886 DOI: 10.3390/nu14163391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/09/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022] Open
Abstract
Evidence examining specific effects of a multidisciplinary team (MDT) on cardiometabolic risk factors (CMRFs) among multi-ethnic patients in real-world clinical settings is lacking. This one-year retrospective chart review (2018) analyzed 598 adults (African American 59%, Hispanic 35%, and Caucasian 6%) with mean age of 43.8 ± 14.0 years. Qualifying patients with primary inclusion criteria of having body mass indices and blood pressure (BP) measurements in the first and last quarter of the study period were treated under an MDT protocol and compared to those qualifying for MDT but treated solely by a primary care provider (PCP). MDT included endocrinologist-directed visits, lifestyle counseling, and shared medical appointments. MDT patients experienced a greater reduction (β; 95% CI) in weight (−4.29 kg; −7.62, −0.97), BMI (−1.43 kg/m2; −2.68, −0.18), systolic BP (−2.18 mmHg; −4.09, −0.26), and diastolic BP (−1.97 mmHg; −3.34, −0.60). Additionally, MDT patients had 77%, 83%, and 59% higher odds of reducing ≥5% of initial weight, 1 BMI point, and ≥2 mmHg DBP, respectively. Improvements in hemoglobin A1C measurements were observed in the MDT group (insufficient data to compare with the PCP group). Compared to PCP only, MDT co-management improves CMRF related to adiposity and hypertension in a multiethnic adult cohort in real-world clinical settings. Patient access to best practices in cardiometabolic care is a priority, including the incorporation of culturally adapted evidence-based recommendations translated within a multi-disciplinary infrastructure, where competing co-morbidities are better managed, and associated research and education programs can promote operational sustainability.
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Affiliation(s)
- Ramfis Nieto-Martínez
- Lifedoc Health, Memphis, TN 38119, USA
- Departments of Global Health and Population and Epidemiology, Harvard TH Chan School of Public Health, Harvard University, Boston, MA 02115, USA
- Foundation for Clinic, Public Health, Epidemiology Research of Venezuela (FISPEVEN INC), Caracas 1010, Venezuela
| | | | | | - Xichen Mou
- School of Public Health, The University of Memphis, Memphis, TN 38152, USA
| | | | | | | | - Marian Levy
- School of Public Health, The University of Memphis, Memphis, TN 38152, USA
| | - Jeffrey I. Mechanick
- The Marie-Josée and Henry R. Kravis Center for Cardiovascular Health at Mount Sinai Heart, Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Pedro A. Velásquez-Mieyer
- Lifedoc Health, Memphis, TN 38119, USA
- LifeDOC Research, Memphis, TN 38119, USA
- DarSalud Management, Memphis, TN 38115, USA
- Correspondence: ; Tel.: +1-901-683-0024; Fax: +1-901-683-0028
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18
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Ng CH, Lim WH, Chin YH, Yong JN, Zeng RW, Chan KE, Tan DJH, Fu CE, Tang ASP, Goh LH, Devi K, Chew NWS, Mak LYL, Tamaki N, Huang DQ, Noureddin M, Siddiqui MS, Loomba R, Sanyal AJ, Muthiah M. Living in the non-alcoholic fatty liver disease silent epidemic: a qualitative systematic review of patients' perspectives. Aliment Pharmacol Ther 2022; 56:570-579. [PMID: 35791632 DOI: 10.1111/apt.17121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/04/2022] [Accepted: 06/22/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) affects one-fourth of the global population. Yet, the care of these patients is limited and awareness of NAFLD remains low in the general public. Investigations into the lives of these patients are often forgotten and traditional quantitative studies only paint part of the picture. AIM To assess the first-hand accounts of these individuals and their perspective on living with NAFLD. METHODS A systematic search was conducted on Medline, Embase, CINAHL, PsycINFO and Web of Science database for qualitative literature regarding patients' perspectives on NAFLD. An inductive thematic analysis was conducted to generate themes and supportive subthemes. RESULTS We incuded eight articles in the review. There were three major themes including the impact on the quality of life, knowledge and information, and attitudes and perceptions on care. The impact of the quality of life details the emotional and physical distress of NAFLD. Knowledge and information include the lack of sufficient communication between healthcare providers and patients with a distinct knowledge gap. Attitudes and perceptions on care extrapolate the current active participation of patients and needs of the patients and the future care that they desire. CONCLUSION This review synthesises first-hand accounts of individuals with NAFLD. With the growing burden of NAFLD, future public interventions must consider individual views for success to be found. The identified themes serve as a forefront for consideration for public policies. Ultimately, NAFLD is a multisystem disease, which must be managed by a multidisciplinary team.
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Affiliation(s)
- Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yip Han Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jie Ning Yong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Kai En Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Clarissa Elysia Fu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ansel Shao Pin Tang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lay Hoon Goh
- Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kamala Devi
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nicholas W S Chew
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Cardiology, National University Heart Centre, National University Hospital, Singapore
| | - Lung-Yi Loey Mak
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Nobuharu Tamaki
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California at San Diego, San Diego, California, USA.,Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Daniel Q Huang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore.,National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Mazen Noureddin
- Cedars-Sinai Fatty Liver Program, Division of Digestive and Liver Diseases, Department of Medicine, Comprehensive Transplant Center, Cedars-Sinai Medical Centre, Los Angeles, California, USA
| | - Mohammad Shadab Siddiqui
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Rohit Loomba
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California at San Diego, San Diego, California, USA
| | - Arun J Sanyal
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Mark Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore.,National University Centre for Organ Transplantation, National University Health System, Singapore
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Borst AJ, Swerdlin RF, Phillips JD, Hawkins CM, Briones MA. How we established a multidisciplinary program for vascular anomalies. Pediatr Blood Cancer 2022; 69 Suppl 3:e28863. [PMID: 36070214 DOI: 10.1002/pbc.28863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/02/2020] [Indexed: 11/09/2022]
Abstract
The care of patients with vascular anomalies is quickly becoming a complex field requiring high-quality, coordinated multidisciplinary care. In this article, we review the history of multidisciplinary care in this field, discuss the benefits of this model of care, and outline some of the essential components and structure of a successful vascular anomalies team. We provide an overview of two example programs and a roadmap for other centers to develop their own multidisciplinary vascular anomalies teams.
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Affiliation(s)
- Alexandra J Borst
- Department of Otolaryngology Head and Neck Surgery, Monroe Carell Jr Childrens' Hospital, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rachel F Swerdlin
- Vascular Anomalies Clinic, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - James D Phillips
- Department of Otolaryngology Head and Neck Surgery, Monroe Carell Jr Childrens' Hospital, Vanderbilt University Medical Center, Nashville, Tennessee
| | - C Matthew Hawkins
- Department of Radiology and Imaging Services, Children's Healthcare of Atlanta, Emory University Medical Center and Children's Pediatric Institute, Atlanta, Georgia
| | - Michael A Briones
- Division of Pediatric Hematology-Oncology, Children's Healthcare of Atlanta, Emory University Medical Center and Children's Pediatric Institute, Atlanta, Georgia
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20
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Mansour MHH, Pokhrel S, Anokye N. Effectiveness of integrated care interventions for patients with long-term conditions: a review of systematic reviews. INTEGRATED HEALTHCARE JOURNAL 2022. [DOI: 10.1136/ihj-2021-000083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
To examine the effectiveness of integrated care intervention (ICI) models (stand-alone or combination of self-management, discharge management, case management and multidisciplinary teams models) targeting patients with one or more chronic conditions, and to identify outcome measures/indicators of effectiveness, we conducted a systematic review of published systematic reviews and meta-analyses. Included reviews comprise ICIs targeting adult patients with one or more long-term conditions. We searched MEDLINE, CINAHL and the Cochrane Database of Systematic Reviews: 60 reviews were included in the final analysis; 28 reviews evaluated ICIs focused on self-management, 4 on case management, 10 on discharge management and 5 on multidisciplinary teams; 13 reviews assessed multiple interventions that were labelled as complex. Across all reviews, only 19 reviews included intervention with multiple ICIs. Overall, interventions with multiple components, compared with interventions with single components, were more likely to improve hospital use outcomes effectively. Clinical/lifestyle/condition-specific outcomes were more likely to be improved by self-management interventions. Outcome measures identified could be classified into three main categories: organisational, patient-centred and clinical/lifestyle/condition-specific. The findings of this review may provide inputs to future design and evaluation of ICIs.
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21
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Kumar L, Mohammadnezhad M. Health Care Workers' Perceptions on Factors Affecting Diabetes Self-Management Among Type 2 Diabetes Mellitus Patients in Fiji: A Qualitative Study. Front Public Health 2022; 10:779266. [PMID: 35444994 PMCID: PMC9013814 DOI: 10.3389/fpubh.2022.779266] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/14/2022] [Indexed: 02/05/2023] Open
Abstract
Background Type 2 Diabetes Mellitus (T2DM) is known as a major cause of mortality globally. Diabetes self-management refers to daily activities undertaken to control or reduce the impact of diabetes on health and well-being to avoid further illness. Health Care Workers' (HCWs) can assist patients to be aware of self-care and solve the challenges diabetes presents. The management of diabetes can improve once HCWs promote measures that facilitate self-care activities by providing necessary information and supporting patients' initiatives to make lifestyle changes. This study aimed to explore HCWs perceptions on factors affecting diabetes self-management among T2DM patients of Fiji. Methods A qualitative study design was conducted to explore HCWs perceptions on factors affecting diabetes self-management using two Focus Group Discussions (FGDs) in Labasa, Fiji in 2021. The study settings were the Diabetic Hub Center, special outpatient department Labasa hospital and Nasea health Center Labasa. The study settings are located in an urban area. These health facilities provide special outpatient clinics to T2DM patients including clinics for other medical conditions. Nasea Health Center had 1,300 patients, the special outpatient's department Labasa hospital had 560 patients and the diabetic hub center Labasa had 295 patients at the time of the study. These patients either had T2DM or T2DM with other medical conditions. Purposive sampling was employed to recruit HCWs. The data were collected using an interview guide in semi-structured interviews and the interviews were audio recorded. The recorded data was transcribed verbatim and analyzed using thematic analysis process. Results The participants were 9 HCWs with age range of 25-49 years. A counselor, a medical officer, physiotherapist, nurses and dieticians were among the HCWs. Three major themes and seven sub themes were identified. These included Theme 1- "availability of services" with the sub themes of clinical services for T2DM and other support services available for T2DM patients. Theme 2- "barriers and challenges to diabetes self-management" with the sub themes of health system factors, socioeconomic factors and health system factors. Theme 3- "Needs for diabetes management" with the sub themes resources and skilled personnel. Conclusion The findings of this study demonstrate health system challenges such as lack of material resources and human resources compounded the factors affecting diabetes self-management. HCWs training as diabetes educators and developing policy on diabetes self-management are highly recommended to facilitate diabetes self-management.
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Duncan R, Cheng L, Law MR, Shojania K, De Vera MA, Harrison M. The impact of introducing multidisciplinary care assessments on access to rheumatology care in British Columbia: an interrupted time series analysis. BMC Health Serv Res 2022; 22:327. [PMID: 35277162 PMCID: PMC8915460 DOI: 10.1186/s12913-022-07715-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background In 2011 the British Columbia (BC) Ministry of Health introduced a new fee-for-service billing code that allowed “Multidisciplinary Care Assessment” (MCA). This change has the potential to change access to and quality of care for patients. This study aimed to explore the impact on access to rheumatology services in the province. Methods Fee-for-service rheumatology billings were evaluated for each rheumatologist 2 years before and after use of the MCA code. Numbers of 1) unique patients and 2) services provided per month were used as proxy measures of access to care. A multiple-baseline interrupted time series model assessed the impact of the MCA on levels and trends of the access outcomes. Results Our analysis consisted of 82,360 patients cared for by 26 rheumatologists who billed for an MCA. In our primary analysis we observed a sustained increase in the mean number of unique patients of 4.9% (95% CI: 0.0% to 9.9%, p = 0.049) and the mean number of services of 7.1% (95% CI: 1.0% to 13.6%, (p = 0.021), per month provided by a rheumatologist, corresponding to the initial use of MCA. Conclusion The introduction of the MCA code was associated with an initial increase in the measures of access, which was maintained but did not increase over time. Our study suggests that the use of Multidisciplinary Care Assessment can contribute to expanding and/or sustaining access to care for people with complex chronic conditions, like rheumatic diseases. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07715-x.
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Xu Y, Tan CWY, Tsou KYK, Tan DHY, Gallagher PJ, Lee JYC. Long-term clinical and cost-effectiveness of collaborative care in people with uncontrolled type 2 diabetes mellitus and polypharmacy: A multicenter randomized controlled trial. Prim Care Diabetes 2022; 16:188-195. [PMID: 34953748 DOI: 10.1016/j.pcd.2021.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/06/2021] [Accepted: 12/16/2021] [Indexed: 12/25/2022]
Abstract
AIMS This study examined the effectiveness of a collaborative care model on clinical and humanistic outcomes, medical cost, productivity loss, and its cost-effectiveness in managing uncontrolled Type 2 Diabetes Mellitus (T2DM). METHODS A randomized controlled study was conducted in two outpatient health institutions in Singapore. Patients aged above 21 years with HbA1c > 7% and polypharmacy were included. Eligible patients were randomized into the intervention (collaborative care) and control (usual care) arms. RESULTS A total of 255 patients were included in the analysis. Compared to the control arm, the intervention arm achieved significantly greater glycated hemoglobin (HbA1c) reduction (mean difference: 0.25, 95%CI: [0.001, 0.50], p = 0.049) and quality-adjusted life year (QALY) (+0.011, 95%CI: [0.003, 0.019], p = 0.011) at 12 months. The costs per additional HbA1c and QALY improvements over one year were $40.52 and $920.91 respectively. Activity impairment was lower in the intervention group both at 6 months (12.7% vs 19.0%; p = 0.022) and at 12 months (6.7% vs 14.0%; p = 0.008). CONCLUSIONS The collaborative care model achieved earlier HbA1c reduction and reduced patients' activity impairment without decreasing work productivity or increasing medical costs. This intervention is cost-effective for improving glycemic control and quality of life in patients with T2DM.
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Affiliation(s)
- Yingqi Xu
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
| | | | | | | | - Paul John Gallagher
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore.
| | - Joyce Yu-Chia Lee
- Department of Clinical Pharmacy Practice, University of California, Irvine, United States.
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Kumar S, Wong R, Newberry C, Yeung M, Peña JM, Sharaiha RZ. Multidisciplinary Clinic Models: A Paradigm of Care for Management of NAFLD. Hepatology 2021; 74:3472-3478. [PMID: 34324727 DOI: 10.1002/hep.32081] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 06/16/2021] [Accepted: 07/15/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Sonal Kumar
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY
| | - Rochelle Wong
- Department of Medicine, NewYork Presbyterian-Weill Cornell Medical Center, New York, NY
| | - Carolyn Newberry
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY
| | - Michele Yeung
- Division of Endocrinology, Weill Cornell Medicine, New York, NY
| | - Jessica M Peña
- Department of Medicine, NewYork Presbyterian-Weill Cornell Medical Center, New York, NY.,Dalio Institute of Cardiovascular Imaging, Department of Radiology, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
| | - Reem Z Sharaiha
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY
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Heisler M, Simmons D, Piatt GA. Update on Approaches to Improve Delivery and Quality of Care for People with Diabetes. Endocrinol Metab Clin North Am 2021; 50:e1-e20. [PMID: 34763822 DOI: 10.1016/j.ecl.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
To translate improvements in diabetes management into improved outcomes, it is essential to improve care delivery. To help guide clinicians and health organizations in their efforts to achieve these improvements, this article briefly describes key components underpinning effective diabetes care and six categories of innovations in approaches to improve diabetes care delivery: (1) team-based clinical care; (2) cross-specialty collaboration/integration; (3) virtual clinical care/telehealth; (4) use of community health workers (CHWs) and trained peers to provide pro-active self-management support; (5) incorporating screening for and addressing social determinants of health into clinical practice; and (6) cross-sectoral clinic/community partnerships.
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Affiliation(s)
- Michele Heisler
- Department of Internal Medicine, University of Michigan Medical School; Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System; Department of Health Behavior and Health Education, School of Public Health, University of Michigan.
| | - David Simmons
- School of Medicine, Western Sydney University, Sydney, Australia; Macarthur Clinical School, Campbelltown Hospital, Therry Road, Campbelltown, New South Wales 2560, Australia
| | - Gretchen A Piatt
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan; Department of Learning Health Sciences, University of Michigan Medical School, 1111 E. Catherine Street, Victor Vaughan Building, Room 225, Ann Arbor, MI 48109, USA
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Ino J, Kasama E, Kodama M, Sato K, Eizumi H, Kawashima Y, Sekiguchi M, Fujiwara T, Yamazaki A, Suzuki C, Ina S, Okuma A, Nitta K. Multidisciplinary Team Care Delays the Initiation of Renal Replacement Therapy in Diabetes: A Five-year Prospective, Single-center Study. Intern Med 2021; 60:2017-2026. [PMID: 33518556 PMCID: PMC8313920 DOI: 10.2169/internalmedicine.4927-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective Although recent reports have highlighted the benefits of multidisciplinary team care (MTC) for chronic kidney disease (CKD) in slowing the progress of renal insufficiency, its long-term effects have not been evaluated for patients with diabetes mellitus (DM). We compared the renal survival rate between MTC and conservative care (CC). Methods In this five-year, single-center, prospective, observational study, we examined 24 patients (mean age 65.5±12.1 years old, men/women 18/6) with DM-induced CKD stage ≥3 in an MTC clinic. The control group included 24 random patients with DM (mean age 61.0±12.8 years old, men/women 22/2) who received CC. MTC was provided by a nephrologist and medical staff, and CC was provided by a nephrologist. Results In total, 10 MTC and 20 CC patients experienced renal events [creatinine doubling, initiation of renal replacement therapy (RRT), or death due to end-stage CKD]. During the five-year observation period, there were significantly fewer renal events in the MTC group than in the CC group according to the cumulative incidence method (p=0.006). Compared to CC, MTC significantly reduced the need for urgent initiation of hemodialysis (relative risk reduction 0.79, 95% confidence interval [CI] 0.107-0.964). On a multivariate analysis, MTC (hazard ratio [HR], 0.434, 95% CI 0.200-0.939) and the slope of the estimated glomerular filtration rate during the first year (HR, 0.429 per 1 mL/min/m2/year, 95% CI 0.279-0.661) were negatively associated with renal events. Conclusion MTC for DM-induced CKD is an effective strategy for delaying RRT. Long-term MTC can demonstrate reno-protective effects.
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Affiliation(s)
- Jun Ino
- Department of Nephrology, Kidney Center, Toda Central General Hospital, Japan
| | - Eri Kasama
- Department of Nephrology, Kidney Center, Toda Central General Hospital, Japan
| | - Mio Kodama
- Department of Nephrology, Kidney Center, Toda Central General Hospital, Japan
| | - Keitaro Sato
- Department of Nephrology, Kidney Center, Toda Central General Hospital, Japan
| | - Hitoshi Eizumi
- Department of Nephrology, Kidney Center, Toda Central General Hospital, Japan
| | - Youichiro Kawashima
- Department of Nephrology, Kidney Center, Toda Central General Hospital, Japan
| | - Maki Sekiguchi
- Department of Nursing, Kidney Center, Toda Central General Hospital, Japan
| | - Tomoko Fujiwara
- Department of Nutrition, Toda Central General Hospital, Japan
| | - Aya Yamazaki
- Department of Nutrition, Toda Central General Hospital, Japan
| | - Chie Suzuki
- Department of Pharmacy, Toda Central General Hospital, Japan
| | - Shuji Ina
- Department of Pharmacy, Toda Central General Hospital, Japan
| | - Astushi Okuma
- Department of Rehabilitation, Toda Central General Hospital, Japan
| | - Kosaku Nitta
- Department of Nephrology, Tokyo Women's Medical University, Japan
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Roscoe C, Moczygemba LR, Garza A, Linedecker-Smith S, Simien L, Siañez M. Perceptions of collaborative care team members on facilitators and barriers to care and glycosylated hemoglobin level as a diabetes quality metric at a federally qualified health center in Texas. J Am Pharm Assoc (2003) 2021; 61:S57-S67. [PMID: 33485814 DOI: 10.1016/j.japh.2020.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/26/2020] [Accepted: 12/20/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Facilitators and barriers to collaborative patient care have been explored in previous studies. Few studies provide information about collaborative care team (CCT) members' roles in treating patients with diabetes and how CCT members should be evaluated for their contributions to diabetes care. To describe the roles and responsibilities of CCT members at CommUnityCare (CUC), a federally qualified health center in Central Texas; identify the facilitators and barriers affecting referrals to other CCT members within CUC; explore the facilitators and barriers to collaborative patient care at CUC; and assess CCT members' perceptions of quality metrics for diabetes care. METHODS A cross-sectional design was used. Data was collected by a survey and semistructured interviews of CCT members. The survey (32 questions) assessed roles and responsibilities, including the percentage of time spent on clinic activities, referral criteria, perceptions of quality diabetes care, and facilitators and barriers to care. The interview (32 questions) gathered a description of the CCT member's role, referral process, and ideas for diabetes quality metrics. Descriptive statistics and content analysis were used for data analysis. RESULTS Twenty-two CCT members (4 diagnosticians, 4 clinical pharmacists, 4 behavioral health professionals, 4 registered dietitians, 2 community health workers, and 4 care managers) participated in this study. Co-location (54%) and professional relationships with coworkers (32%) facilitated referrals to other CCT members. Appointment availability (32%) and lack of referral criteria knowledge (27%) were barriers to other CCT member referrals. Seventy-five percent of the dietitians and care managers thought that the glycosylated hemoglobin (A1C) level was a good quality metric for diabetes care, followed by 50% of the clinical pharmacists, 25% of the behavioral health counselors, and 0% of the community health workers and diagnosticians. CONCLUSION Co-location and professional relationships facilitated referrals to CCT members, whereas lack of CCT member availability and lack of referral criteria knowledge were barriers to CCT referrals. Metrics other than the lowering of the A1C level should be further explored to assess the quality of diabetes care.
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Agarwal SK, Antunez-Flores O, Foster WG, Hermes A, Golshan S, Soliman AM, Arnold A, Luna R. Real-world characteristics of women with endometriosis-related pain entering a multidisciplinary endometriosis program. BMC WOMENS HEALTH 2021; 21:19. [PMID: 33413295 PMCID: PMC7792175 DOI: 10.1186/s12905-020-01139-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/26/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Women with endometriosis are commonly treated by their sole provider. In this single-provider model of care, women frequently report long diagnostic delays, unresolved pelvic pain, multiple laparoscopic surgeries, sequential consultations with numerous providers, and an overall dissatisfaction with care. The emergence of multidisciplinary endometriosis centers aims to reduce diagnostic delays, improve pain management, and promote patient satisfaction; however, baseline data at the time of presentation to a multidisciplinary center are lacking. METHODS A real-world, retrospective, single-site, cross-sectional study of women with surgically confirmed and/or clinically diagnosed endometriosis generated baseline data for a planned longitudinal assessment of multidisciplinary care of endometriosis. The primary objective was to determine the proportion of patients experiencing mild, moderate, or severe pain for dysmenorrhea, non-menstrual pelvic pain (NMPP), and dyspareunia at entry into a multidisciplinary endometriosis clinic. Also explored were relationships between pain scores and clinical endpoints obtained from electronic medical records. RESULTS More than half (59%) of the study participants (n = 638) reported experiencing pelvic pain for ≥ 5 years. Pain intensity was highest for patients reporting dysmenorrhea, followed by NMPP, and dyspareunia. Significant correlations were observed between total pelvic pain and patient age (r = -0.22, p < 0.001, n = 506) and number of previous healthcare providers (r = 0.16, p = 0.006, n = 292); number of previous providers and duration of pain (r = 0.21, p = < 0.0001, n = 279); and duration of pain and years since diagnosis (r = 0.60, p < 0.001, n = 302). Mean pain scores differed significantly by age group for dysmenorrhea (p < 0.001), NMPP (p = 0.005), and total pelvic pain (p < 0.001), but not for dyspareunia (p = 0.06), with the highest mean pain scores reported among those < 30 years of age. CONCLUSION These real-world data indicate that in the single-provider model of care, unresolved pelvic pain is common among women with endometriosis. Alternative care models, including a multidisciplinary approach, need to be evaluated for improvements in clinical outcomes. These data also highlight the importance of addressing NMPP, which may be particularly troublesome for patients.
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Affiliation(s)
- Sanjay K Agarwal
- Center for Endometriosis Research and Treatment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, 9500 Gilman Drive, #0633, La Jolla, CA, 92093-0633, USA.
| | | | - Warren G Foster
- Department of Obstetrics and Gynecology, and the School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
| | - Ashwaq Hermes
- Women's Health, US Medical Affairs, AbbVie Inc., Chicago, IL, USA
| | - Shahrokh Golshan
- Department of Psychiatry, University of CA, San Diego, San Diego, CA, USA
| | - Ahmed M Soliman
- Health Economics and Outcomes Research, AbbVie Inc., Chicago, IL, USA
| | - Amanda Arnold
- Center for Endometriosis Research and Treatment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, 9500 Gilman Drive, #0633, La Jolla, CA, 92093-0633, USA
| | - Rebecca Luna
- Center for Endometriosis Research and Treatment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, 9500 Gilman Drive, #0633, La Jolla, CA, 92093-0633, USA
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Jiraporncharoen W, Pinyopornpanish K, Junjom K, Dejkriengkraikul N, Wisetborisut A, Papachristou I, Hashmi A, Angkurawaranon C. Exploring perceptions, attitudes and beliefs of Thai patients with type 2 diabetes mellitus as they relate to medication adherence at an out-patient primary care clinic in Chiang Mai, Thailand. BMC FAMILY PRACTICE 2020; 21:173. [PMID: 32825811 PMCID: PMC7442984 DOI: 10.1186/s12875-020-01233-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 07/29/2020] [Indexed: 12/11/2022]
Abstract
Background Within the sphere of diabetes self-management, much emphasis has been placed on medication adherence. There has been a shift in thinking about medication adherence, moving from “compliance” and historically paternalistic models of care, to seeking better ways of characterizing dynamic and complex relationships that determine medication adherence and diabetes control. This study sought to understand the relationship between patient’s attitudes and medication adherence for oral anti-diabetics in Thailand. Methods In-depth interviews of patients with type 2 diabetes mellitus, taking oral anti-diabetic drugs, at the out-patient clinic run by the Department of Family Medicine, Chiang Mai University between May and December 2016. Thematic analysis followed the WHO framework for medication adherence in chronic disease to explore patient’s attitudes and their influence on medication compliance. Results Of 24 patients, 9 were men. The mean age was 62 years (SD 8.9 years). 67% had high compliance. Four themes were identified as important factors related to medication adherence: attitudes toward disease, attitudes toward treatment, attitudes toward family support and attitudes toward health care team. Specifically, symptoms at diagnosis, understanding and acceptance in taking medication, the presence of family support and the perception of concern by the doctor relate to improved medication compliance. Conclusions Medication adherence in Thai patients with diabetes requires support from both the health care providers and the family. The patient’s perception of the doctor’s concern creates greater patient trust in the health care team. This trust, along with family support, helps deepen patients’ understanding of the disease, accept the chronic nature of their disease, and engenders a positive attitude towards taking medication that can improve medication adherence.
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Affiliation(s)
- Wichuda Jiraporncharoen
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Kanokporn Pinyopornpanish
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Korsin Junjom
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Nisachol Dejkriengkraikul
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Anawat Wisetborisut
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Iliatha Papachristou
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Ahmar Hashmi
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Chaisiri Angkurawaranon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Sriphum, Muang, Chiang Mai, 50200, Thailand.
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30
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West S, Ramis MA, Burgess L, Kynoch K. Effectiveness of multidisciplinary led self-management interventions on glycaemic control in people with type 1 diabetes: a systematic review protocol. JBI Evid Synth 2020; 18:2373-2379. [DOI: 10.11124/jbisrir-d-19-00283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Jiang W, Zhang Y, Yan F, Liu H, Gao R. Effectiveness of a nurse-led multidisciplinary self-management program for patients with coronary heart disease in communities: A randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2020; 103:854-863. [PMID: 31727391 DOI: 10.1016/j.pec.2019.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/28/2019] [Accepted: 11/02/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To examine the effectiveness of a nurse-led multidisciplinary self-management program (NMSP) on self-management behaviors, self-efficacy, health-related quality of life (HRQoL) and unplanned health service utilization (HSU) among Chinese patients with coronary heart disease (CHD) in communities. METHODS A randomized controlled trial with repeated measurements was used. A convenience sample of 144 participants was recruited from a community health center in China. All participants were randomly assigned to an intervention group (n = 72) in the newly developed NMSP or a control group (n = 72) in routine care. Outcome measurement was performed at baseline, 3 months and 6 months using Coronary Artery Disease Self-Management Scale (CADSs), Self-efficacy for Chronic Disease 6-item Scale (SECD6), and Short Form-12 health survey questionnaire (SF-12). RESULTS Over the six months, the two groups reported significant differences in disease medical and emotional management of CADSs, confidence in symptom and disease management of SECD6, physical and mental component summary of SF-12, as well as emergency and outpatient visits of unplanned HSU. CONCLUSIONS The NMSP improves self-management behaviors, self-efficacy, HRQoL and reduces unplanned HSU among CHD patients in communities. PRACTICE IMPLICATIONS This study provides an effective approach to empower CHD patients with emphasizing on collaboration support of health professionals in communities.
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Affiliation(s)
- Wenhui Jiang
- School of Nursing, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China.
| | - Yanan Zhang
- School of Nursing, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Fanghong Yan
- School of Nursing, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China; School of Nursing, Lanzhou University, Lanzhou, 730000, China
| | - Huan Liu
- School of Nursing, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Rong Gao
- School of Nursing, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
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Hansen D, Mellbin L, Cosentino F, De Bacquer D, Grobbee D, Van Ryckeghem L, Standl E, Beulens JWJ. High awareness of diabetes as a key cardiovascular risk factor among healthcare professionals but suboptimal treatment: Results from a survey of the European Association of Preventive Cardiology. Eur J Prev Cardiol 2020; 28:e19-e21. [PMID: 33611354 DOI: 10.1177/2047487320911845] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Dominique Hansen
- REVAL – Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Belgium
- BIOMED – Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Belgium
- Jessa Hospital, Heart Centre Hasselt, Belgium
| | | | | | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Belgium
| | - Diederick Grobbee
- Julius Centre for Health Sciences and Primary Care, University Medical Centre, the Netherlands
| | - Lisa Van Ryckeghem
- REVAL – Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Belgium
- BIOMED – Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, Belgium
| | - Eberhard Standl
- Forschergruppe Diabetes eV, Munich Helmholtz Centre, Germany
| | - Joline WJ Beulens
- Julius Centre for Health Sciences and Primary Care, University Medical Centre, the Netherlands
- Department of Epidemiology & Biostatistics, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam University Medical Centres – location VUmc, the Netherlands
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Chen Y, Zhang W, Wang N, Wang Y, Wang C, Wan H, Lu Y. Thyroid Parameters and Kidney Disorder in Type 2 Diabetes: Results from the METAL Study. J Diabetes Res 2020; 2020:4798947. [PMID: 32337292 PMCID: PMC7149438 DOI: 10.1155/2020/4798947] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/03/2020] [Accepted: 03/09/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Diabetic kidney disease is one of the most common microvascular complications of diabetes mellitus. We aimed to analyze the association of thyroid parameters with kidney disorders, especially in euthyroid participants. METHODS The data were obtained from a cross-sectional study, the METAL study. Thyroid parameters, including thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4), triiodothyronine (T3), thyroxin (T4), thyroid peroxidase antibody (TPOAb), and thyroglobulin antibody (TgAb), of 4136 participants with type 2 diabetes were measured. Two structure parameters of thyroid homeostasis, including the sum activity of step-up deiodinases (SPINA-GD) and thyroid secretory capacity (SPINA-GT), and two pituitary thyrotropic function indices, including Jostel's TSH index (TSHI) and the thyrotroph thyroid hormone resistance index (TTSI), were also calculated. Kidney disorders were described according to the presence of reduced estimated glomerular filtration rate (eGFR) and/or higher urinary albumin to creatinine ratio (UACR). RESULTS The prevalence of kidney disorders increased with decreasing FT3 or T3 and increasing FT4 or T4 quartile levels (all P < 0.05). After full adjustment, linear regression showed that UACR levels were negatively associated with FT3 and T3 (P < 0.001). In addition, eGFR was positively associated with FT3 and T3 and was negatively associated with TSH and FT4 levels and TgAb positivity (all P < 0.05). By using binary logistic regression, higher TSH and FT4 and lower FT3 and T3 were associated with kidney disorders (all P < 0.05). Similar results were seen in sensitivity analyses, which were performed in 3035 euthyroid diabetic participants; however, TSH was no longer related to them. The area under the receiver operating characteristic curve (AUROC) of lower FT3 for existing kidney disorder was greater than that for any other thyroid hormones (all P < 0.001). The cutoff value of FT3 for reduced eGFR was 4.39 pmol/L. Regarding thyroid homeostasis parameters, SPINA-GD was negatively associated with three statuses of kidney disorders, and TSHI and TTSI were positively associated with reduced eGFR (all P < 0.05). CONCLUSIONS Among patients with type 2 diabetes, elevated TSH and FT4 (or T4), lower FT3 (or T3), TgAb positivity, lower SPINA-GD, and higher TSHI and TTSI were associated with kidney disorders. The lower FT3, even within the normal range (<4.38 pmol/L), may be the factor most related to reduced eGFR compared with other thyroid hormones in diabetic patients.
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Affiliation(s)
- Yi Chen
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wen Zhang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ningjian Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuying Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chiyu Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Heng Wan
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingli Lu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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