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Mekhael M, Ho C, Noujaim C, Assaf A, Younes H, El Hajjar AH, Chaudhry HA, Lanier B, Chouman N, Makan N, Shan B, Zhang Y, Dagher L, Kreidieh O, Marrouche N, Donnellan E. Compliance challenges in a longitudinal COVID-19 cohort using wearables for continuous monitoring. J Med Internet Res 2023; 25:e43134. [PMID: 36763647 PMCID: PMC10131852 DOI: 10.2196/43134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/16/2022] [Accepted: 01/06/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Wearables to Investigate the Long Term Cardiovascular and Behavioral Impacts of COVID-19 (WEAICOR) study is a prospective observational study using continuous monitoring to detect and analyze biometrics. Compliance to wearables was a major challenge when conducting the study and was crucial for the results. OBJECTIVE The aim of this study is to evaluate patients' compliance to wearable wristbands and determinants of compliance in a prospective COVID-19 cohort. METHODS Biostrap wearable device was used to monitor participants' biometric data. Compliance was calculated by dividing the total number of days in which transmissions were sent by the total number of days in the study. Univariate correlation was performed between compliance, days in the study and age, BMI, sex, symptom severity, and number of complications/comorbidites as independent variables. Also, multivariate linear regression was then performed with days in the study as a dependent variable to assess the power of different parameters in determining days in the study. RESULTS On hundred twenty-two patients were included in the study. Patients were on average 43 years old and 32% were female. Age was found to be correlated with compliance (r=0.23, P=0.01). In addition, age (r=0.30, P=0.001), BMI (r=0.19, P=0.03) and severity of symptoms (r=0.19, P=0.03) were found to be correlated with days spent in the study. On multivariate analysis with days spent in the study as a dependent variable, only increased age was a significant determinant of compliance with wearables (adjusted R2 = 0.1, β = 1.6, P= 0.01). CONCLUSIONS Compliance is a major obstacle in remote monitoring studies and the reasons for a lack thereof are multifactorial. Patient factors such as age, in addition to environmental factors can affect compliance to wearables.
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Affiliation(s)
- Mario Mekhael
- Tulane University School of Medicine, Tulane University1324 Tulane Ave, Suite A128, New Orleans, US
| | - Chan Ho
- Tulane University School of Medicine, Tulane University1324 Tulane Ave, Suite A128, New Orleans, US
| | - Charbel Noujaim
- Tulane University School of Medicine, Tulane University1324 Tulane Ave, Suite A128, New Orleans, US
| | - Ala Assaf
- Tulane University School of Medicine, Tulane University1324 Tulane Ave, Suite A128, New Orleans, US
| | - Hadi Younes
- Tulane University School of Medicine, Tulane University1324 Tulane Ave, Suite A128, New Orleans, US
| | | | - Humza A Chaudhry
- Tulane University School of Medicine, Tulane University1324 Tulane Ave, Suite A128, New Orleans, US
| | - Brennan Lanier
- Tulane University School of Medicine, Tulane University1324 Tulane Ave, Suite A128, New Orleans, US
| | - Nour Chouman
- Tulane University School of Medicine, Tulane University1324 Tulane Ave, Suite A128, New Orleans, US
| | - Noor Makan
- Tulane University School of Medicine, Tulane University1324 Tulane Ave, Suite A128, New Orleans, US
| | - Botao Shan
- Tulane University School of Medicine, Tulane University1324 Tulane Ave, Suite A128, New Orleans, US
| | - Yichi Zhang
- Tulane University School of Medicine, Tulane University1324 Tulane Ave, Suite A128, New Orleans, US
| | - Lilas Dagher
- Emory University, Department of Medicine, Atlanta, US
| | - Omar Kreidieh
- Tulane University School of Medicine, Tulane University1324 Tulane Ave, Suite A128, New Orleans, US
| | - Nassir Marrouche
- Tulane University School of Medicine, Tulane University1324 Tulane Ave, Suite A128, New Orleans, US
| | - Eoin Donnellan
- Tulane University School of Medicine, Tulane University1324 Tulane Ave, Suite A128, New Orleans, US
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Racial and Ethnic Disparities in Diabetes Clinical Care and Management: A Narrative Review. Endocr Pract 2022; 29:295-300. [PMID: 36464131 DOI: 10.1016/j.eprac.2022.11.013] [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: 08/01/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022]
Abstract
Diabetes affects nearly 37 million Americans, with disproportionately higher disease burden amongst those from minoritized communities. The result of this is greater rates of diabetic complications and mortality. To close this gap in care, it is important to assess the differences in both diagnosis and care between White and ethnic/racial minoritized persons with diabetes. The purpose of this narrative review is to explore this further by assessing the differences in diagnosis, management, diabetes education, and complications.
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Yoshida Y, Hong D, Nauman E, Price-Haywood EG, Bazzano AN, Stoecker C, Hu G, Shen Y, Katzmarzyk PT, Fonseca VA, Shi L. Patient-specific factors associated with use of diabetes self-management education and support programs in Louisiana. BMJ Open Diabetes Res Care 2021; 9:9/Suppl_1/e002136. [PMID: 34933871 PMCID: PMC8679102 DOI: 10.1136/bmjdrc-2021-002136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/22/2021] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION The prevalence of diabetes self-management education and support (DSME/S) use among patients with newly diagnosed type 2 diabetes mellitus (T2DM) and patients with insulin prescription has not been evaluated. It is also unclear what demographic, behavioral, and clinical factors associated with use of DSME/S. RESEARCH DESIGN AND METHODS This retrospective analysis was based on electronic health records from the Research Action for Health Network (2013-2019). Patients with newly diagnosed T2DM were identified as 35-94 year-olds diagnosed with T2DM≥1 year after the first recorded office visit. Patients with insulin were identified by the first insulin prescription records. DSME/S (Healthcare Common Procedure Coding System G0108 and G0109) codes that occurred from 2 months before the 'new diagnosis date' or first insulin prescription date through 1 year after were defined as use of DSME/S. Age-matched controls (non-users) were identified from the Electronic Health Records (EHR). The date of first DSME/S record was selected as the index date. Logistic regression was used to estimate the associations between patient factors and use of DSME/S. RESULTS The prevalence of DSME/S use was 6.5% (8909/137 629) among patients with newly diagnosed T2DM and 32.7% (13,152/40,212) among patients with diabetes taking insulin. Multivariable analysis found that among patients with newly diagnosed T2DM, black and male patients were less likely to use DSME/S, while in patients with insulin, they were more likely to use the service compared with white and female counterparts, respectively. Among patients taking insulin, those with private insurance or self-pay status were significantly less likely, while those with Medicaid were more likely to use the service compared with their Medicare counterparts. A strong positive association was found between HbA1c, obesity, and DSME/S use in both cohorts, while hypertension was negatively associated with DSME/S in both cohorts. CONCLUSION We showed a low rate of DSME/S use in Louisiana, especially in patients with newly diagnosed T2DM. Our findings demonstrated heterogeneity in factors influencing DSME/S use between patients with newly diagnosed T2D and patients with insulin.
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Affiliation(s)
- Yilin Yoshida
- Section of Endocrinology and Metabolism, Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Dongzhe Hong
- Department of Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | | | - Eboni G Price-Haywood
- Ochsner Center for Outcomes and Health Services Research, Ochsner Health System, New Orleans, Louisiana, USA
| | - Alessandra N Bazzano
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Charles Stoecker
- Department of Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Gang Hu
- Chronic Disease Epidemiology, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Yun Shen
- Chronic Disease Epidemiology, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
- Shanghai Jiao Tong University, Shanghai, China
| | - Peter T Katzmarzyk
- Physical Activity and Obesity Epidemiology, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Vivian A Fonseca
- Section of Endocrinology and Metabolism, Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Lizheng Shi
- Department of Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
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Yoshida Y, Patil SJ, Brownson RC, Boren SA, Kim M, Dobson R, Waki K, Greenwood DA, Torbjørnsen A, Ramachandran A, Masi C, Fonseca VA, Simoes EJ. Using the RE-AIM framework to evaluate internal and external validity of mobile phone-based interventions in diabetes self-management education and support. J Am Med Inform Assoc 2021; 27:946-956. [PMID: 32377676 DOI: 10.1093/jamia/ocaa041] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/13/2020] [Accepted: 04/01/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE We evaluated the extent to which studies that tested short message service (SMS)- and application (app)-based interventions for diabetes self-management education and support (DSMES) report on factors that inform both internal and external validity as measured by the RE-AIM (Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance) framework. MATERIALS AND METHODS We systematically searched PubMed, Embase, Web of Science, CINAHL (Cumulative Index of Nursing and Allied Health Literature), and IEEE Xplore Digital Library for articles from January 1, 2009, to February 28, 2019. We carried out a multistage screening process followed by email communications with study authors for missing or discrepant information. Two independent coders coded eligible articles using a 23-item validated data extraction tool based on the RE-AIM framework. RESULTS Twenty studies (21 articles) were included in the analysis. The comprehensiveness of reporting on the RE-AIM criteria across the SMS- and app-based DSMES studies was low. With respect to internal validity, most interventions were well described and primary clinical or behavioral outcomes were measured and reported. However, gaps exist in areas of attrition, measures of potential negative outcomes, the extent to which the protocol was delivered as intended, and description on delivery agents. Likewise, we found limited information on external validity indicators across adoption, implementation, and maintenance domains. CONCLUSIONS Reporting gaps were found in internal validity but more so in external validity in the current SMS- and app-based DSMES literature. Because most studies in this review were efficacy studies, the generalizability of these interventions cannot be determined. Future research should adopt the RE-AIM dimensions to improve the quality of reporting and enhance the likelihood of translating research to practice.
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Affiliation(s)
- Yilin Yoshida
- Section of Endocrinology, Department of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Sonal J Patil
- Department of Family Medicine, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
- Division of Public Health Sciences, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Suzanne A Boren
- Department of Health Management and Informatics, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Min Kim
- Department of Health Management and Informatics, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Rosie Dobson
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Kayo Waki
- Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | | | - Astrid Torbjørnsen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | | | | | - Vivian A Fonseca
- Section of Endocrinology, Department of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Eduardo J Simoes
- Department of Health Management and Informatics, School of Medicine, University of Missouri, Columbia, Missouri, USA
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Brown-Podgorski BL, de Groot MK, Shi Y, Vest JR. Mandated Benefits for Diabetes Education and the Availability of Accredited Programs and Certified Diabetes Educators. Popul Health Manag 2021; 24:560-566. [PMID: 33535014 DOI: 10.1089/pop.2020.0216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
States have the latitude to mandate coverage of diabetes self-management education (DSME) services for privately insured and Medicaid patients. The impact of these mandates on the supply of DSME resources is unknown. This study compared changes in the supply of DSME programs and program sites accredited by the American Association for Diabetes Educators (AADE) and certified diabetes educators (CDE) between states that did and did not mandate benefits for DSME. Using a unique combination of legal and programmatic data sources, the authors employed fixed effects regression models with clustered robust standard errors to compare changes in the supply of AADE-accredited DSME programs, program sites, and CDEs in states that mandated benefits with states that did not. Given the variation in state mandates, models also estimated the impact of "flexible" reimbursement provisions on the supply of resources among adopting states. The supply of DSME resources has increased over time, but results indicate that mandated benefits were not a significant driver of these changes in the supply. The impact of flexible reimbursement provisions varied. Interestingly, provisions of the Affordable Care Act were associated with an increased supply of resources. Results suggest that extending benefits to previously insured patients does not increase the supply of DSME resources, but a rapid increase in patients entering the health system does encourage growth.
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Affiliation(s)
| | - Mary K de Groot
- Endocrinology Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Yunfeng Shi
- Health Policy and Administration, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Joshua R Vest
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, USA
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Alsayed Hassan D, Curtis A, Kerver J, Vangsnes E. Diabetes Self-Management Education and Support: Referral and Attendance at a Patient-Centered Medical Home. J Prim Care Community Health 2020; 11:2150132720967232. [PMID: 33118451 PMCID: PMC7605030 DOI: 10.1177/2150132720967232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Although evidence shows that diabetes self-management education and support (DSMES) is an effective tool to help individuals with type 2 diabetes (T2DM) improve their health outcomes, there remains a large number of individuals not attending DSMES. Understanding how frequently patients receive referrals to DSMES and the number of DSMES hours they receive is important to determine, as well as patients' health outcomes of utilizing DSMES. This will help us understand patterns of utilization and the outcomes that occur when such a valuable resource is utilized. METHODS Secondary data analysis was conducted of patient electronic medical records at a primary healthcare federally qualified clinic and 2 area hospitals. We identified 105 adult patients with a new T2DM diagnosis with at least 2 A1c lab results 3 to 12 months apart during the study period. RESULTS Only 53.5% were referred to DSMES. Out of those who were referred, 66% received no DSMES, 17% received 1-hour assessment, 4% received partial DSMES, and 13% received 8 or more hours. Linear regression of percent change in A1c and number of DSMES hours received, revealed that receiving 1 (P = .001) or 8 or more hours of DSMES (P = .022) had a significant negative relationship with the percent difference in A1c compared to the group who received no DSMES. Patients who had an hour of assessment had a similar percent reduction in A1c to those who had partial DSMES. CONCLUSION Referral rates and enrollment in DSMES remain low. Those who enrolled often dropped out after the one-hour assessment session. Results suggest making the one-hour assessment session more educationally comprehensive or longer to retain patients. Improving the DSMES referral process and further investing physicians' decisions on whether to refer or not refer patients to DSMES are key for future studies.
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Affiliation(s)
| | - Amy Curtis
- Western Michigan University, Kalamazoo, MI, USA
| | - Jean Kerver
- Michigan State University, Traverse City, MI, USA
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Advancing Diabetes-Related Equity Through Diabetes Self-Management Education and Training: Existing Coverage Requirements and Considerations for Increased Participation. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2020; 26 Suppl 2, Advancing Legal Epidemiology:S37-S44. [DOI: 10.1097/phh.0000000000001109] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Siminerio L, Hamm M, Kanter J, Cameron FDA, Krall J. A Diabetes Education Model in Primary Care: Provider and Staff Perspectives. DIABETES EDUCATOR 2019; 45:498-506. [DOI: 10.1177/0145721719865181] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this qualitative study was to explore the effectiveness of Glucose to Goal (G2G), a diabetes self-management education and support (DSMES) model for primary care (PC). Methods PC providers and staff were recruited from 5 PC practices participating in the 18-month intervention to participate in focus groups and interviews, which were used to gain insights about their perspectives on DSMES and how G2G was implemented across the intervention. Data were collected by qualitative researchers at baseline, midpoint, and study completion. Results At baseline, PC participants held a favorable view of DSMES and welcomed having a diabetes educator (DE) in their practice. Most participants suggested DEs would be helpful in meeting patients’ nutrition needs but should give therapeutic advice only with a doctor’s oversight. Participants anticipated that having a DE onsite would mitigate transportation, scheduling, communication, and cost barriers. Participant viewpoints about G2G remained unchanged from midpoint to study end, while barriers regarding location and transportation were perceived as being reduced by having a DE in the practice. Despite referral rates remaining low in some practices, many concerns stated at earlier timepoints appeared to have been attenuated by G2G components (eg, bringing the DE onsite, preidentifying patients, and DE ability to communicate and make diabetes management recommendations). Conclusions This study demonstrates that G2G, providing DSMES in PC, appeared to be a welcome service where acceptance of and enthusiasm for the model grew over the course of the intervention.
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Affiliation(s)
| | - Megan Hamm
- University of Pittsburgh, Pittsburgh, Pennsylvania
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Murray E, Ross J, Pal K, Li J, Dack C, Stevenson F, Sweeting M, Parrott S, Barnard M, Yardley L, Michie S, May C, Patterson D, Alkhaldi G, Fisher B, Farmer A, O’Donnell O. A web-based self-management programme for people with type 2 diabetes: the HeLP-Diabetes research programme including RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2018. [DOI: 10.3310/pgfar06050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background
In the UK, 6% of the UK population have diabetes mellitus, 90% of whom have type 2 diabetes mellitus (T2DM). Diabetes mellitus accounts for 10% of NHS expenditure (£14B annually). Good self-management may improve health outcomes. NHS policy is to refer all people with T2DM to structured education, on diagnosis, to improve their self-management skills, with annual reinforcement thereafter. However, uptake remains low (5.6% in 2014–15). Almost all structured education is group based, which may not suit people who work, who have family or other caring commitments or who simply do not like group-based formats. Moreover, patient needs vary with time and a single education session at diagnosis is unlikely to meet these evolving needs. A web-based programme may increase uptake.
Objectives
Our aim was to develop, evaluate and implement a web-based self-management programme for people with T2DM at any stage of their illness journey, with the goal of improving access to, and uptake of, self-management support, thereby improving health outcomes in a cost-effective manner. Specific objectives were to (1) develop an evidence-based theoretically informed programme that was acceptable to patients and health-care professionals (HCPs) and that could be readily implemented within routine NHS care, (2) determine the clinical effectiveness and cost-effectiveness of the programme compared with usual care and (3) determine how best to integrate the programme into routine care.
Design
There were five linked work packages (WPs). WP A determined patient requirements and WP B determined HCP requirements for the self-management programme. WP C developed and user-tested the Healthy Living for People with type 2 Diabetes (HeLP-Diabetes) programme. WP D was an individually randomised controlled trial in primary care with a health economic analysis. WP E used a mixed-methods and case-study design to study the potential for implementing the HeLP-Diabetes programme within routine NHS practice.
Setting
English primary care.
Participants
People with T2DM (WPs A, D and E) or HCPs caring for people with T2DM (WPs B, C and E).
Intervention
The HeLP-Diabetes programme; an evidence-based theoretically informed web-based self-management programme for people with T2DM at all stages of their illness journey, developed using participatory design principles.
Main outcome measures
WPs A and B provided data on user ‘wants and needs’, including factors that would improve the uptake and accessibility of the HeLP-Diabetes programme. The outcome for WP C was the HeLP-Diabetes programme itself. The trial (WP D) had two outcomes measures: glycated haemoglobin (HbA1c) level and diabetes mellitus-related distress, as measured with the Problem Areas in Diabetes (PAID) scale. The implementation outcomes (WP E) were the adoption and uptake at clinical commissioning group, general practice and patient levels and the identification of key barriers and facilitators.
Results
Data from WPs A and B supported our holistic approach and addressed all areas of self-management (medical, emotional and role management). HCPs voiced concerns about linkage with the electronic medical records (EMRs) and supporting patients to use the programme. The HeLP-Diabetes programme was developed and user-tested in WP C. The trial (WP D) recruited to target (n = 374), achieved follow-up rates of over 80% and the intention-to-treat analysis showed that there was an additional improvement in HbA1c levels at 12 months in the intervention group [mean difference –0.24%, 95% confidence interval (CI) –0.44% to –0.049%]. There was no difference in overall PAID score levels (mean difference –1.5 points, 95% CI –3.9 to 0.9 points). The within-trial health economic analysis found that incremental costs were lower in the intervention group than in the control group (mean difference –£111, 95% CI –£384 to £136) and the quality-adjusted life-years (QALYs) were higher (mean difference 0.02 QALYs, 95% CI 0.000 to 0.044 QALYs), meaning that the HeLP-Diabetes programme group dominated the control group. In WP E, we found that the HeLP-Diabetes programme could be successfully implemented in primary care. General practices that supported people in registering for the HeLP-Diabetes programme had better uptake and registered patients from a wider demographic than those relying on patient self-registration. Some HCPs were reluctant to do this, as they did not see it as part of their professional role.
Limitations
We were unable to link the HeLP-Diabetes programme with the EMRs or to determine the effects of the HeLP-Diabetes programme on users in the implementation study.
Conclusions
The HeLP-Diabetes programme is an effective self-management support programme that is implementable in primary care.
Future work
The HeLP-Diabetes research team will explore the following in future work: research to determine how to improve patient uptake of self-management support; develop and evaluate a structured digital educational pathway for newly diagnosed people; develop and evaluate a digital T2DM prevention programme; and the national implementation of the HeLP-Diabetes programme.
Trial registration
Research Ethics Committee reference number 10/H0722/86 for WPs A–C; Research Ethics Committee reference number 12/LO/1571 and UK Clinical Research Network/National Institute for Health Research (NIHR) Portfolio 13563 for WP D; and Research Ethics Committee 13/EM/0033 for WP E. In addition, for WP D, the study was registered with the International Standard Randomised Controlled Trial Register as reference number ISRCTN02123133.
Funding details
This project was funded by the NIHR Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 6, No. 5. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Jamie Ross
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Kingshuk Pal
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Jinshuo Li
- Department of Health Sciences, University of York, Heslington, York, UK
| | - Charlotte Dack
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Fiona Stevenson
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Michael Sweeting
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, Heslington, York, UK
| | - Maria Barnard
- Whittington Hospital, Whittington Health NHS Trust, London, UK
| | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, UK
| | - Susan Michie
- Centre for Behaviour Change, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Carl May
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - David Patterson
- Whittington Hospital, Whittington Health NHS Trust, London, UK
| | - Ghadah Alkhaldi
- Research Department of Primary Care and Population Health, University College London, London, UK
- Community Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Brian Fisher
- Patient Access to Electronic Records Systems Ltd (PAERS), Evergreen Life, Manchester, UK
| | - Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Orla O’Donnell
- Research Department of Primary Care and Population Health, University College London, London, UK
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Kramer H, Jimenez EY, Brommage D, Vassalotti J, Montgomery E, Steiber A, Schofield M. Medical Nutrition Therapy for Patients with Non-Dialysis-Dependent Chronic Kidney Disease: Barriers and Solutions. J Acad Nutr Diet 2018; 118:1958-1965. [PMID: 30076072 DOI: 10.1016/j.jand.2018.05.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 05/25/2018] [Indexed: 01/11/2023]
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Ju C, Shi R, Yao L, Ye X, Jia M, Han J, Yang T, Lu Q, Jin H, Cai X, Yuan S, Xie B, Yu X, Coufal MM, Fisher EB, Sun Z. Effect of peer support on diabetes distress: a cluster randomized controlled trial. Diabet Med 2018; 35:770-775. [PMID: 29574995 DOI: 10.1111/dme.13625] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2018] [Indexed: 01/19/2023]
Abstract
AIM To investigate whether peer support would reduce diabetes distress and improve glycaemic control when added to usual diabetes education among adults with Type 2 diabetes in China. METHODS We conducted a cluster randomized trial involving 400 adults with Type 2 diabetes from eight communities in Nanjing. All participants received usual education for an average of 2 h each month from physicians, certified diabetes educators, dieticians, psychologists and podiatric nurses. Peer support was led by trained peer leaders and included diabetes knowledge- and skills-sharing at least once a month, as well as peer-to-peer communication. The primary outcome was diabetes distress measured using the Diabetes Distress Scale at 12 months. Secondary outcomes included fasting plasma glucose, 2-h postprandial glucose and HbA1c concentration. Outcome data were collected from all participants at baseline, 6 months and 12 months. RESULTS From 2012 to 2013, there were 200 participants in each study arm at baseline. Compared with the usual education arm, the peer support with usual education arm had greater reductions in regimen-related distress (1.4 ± 0.6 vs 1.2 ± 0.4; P=0.004) and total distress (1.3 ± 0.4 vs 1.2 ± 0.3; P=0.038) at 6 months. At 12 months, the scores for emotional burden (1.2 ± 0.3 vs 1.4 ± 0.6; P=0.002), physician-related distress (1.1 ± 0.3 vs 1.3 ± 0.4; P=0.001) and total scores (1.2 ± 0.3 vs 1.3 ± 0.4; P=0.002) were significantly lower in the peer support with usual education arm than in the usual education arm. Fasting plasma glucose levels were lower in the peer support with usual education arm than in the usual education arm at 6 months (7.5 ± 1.95 vs 8.0 ± 2.2; P=0.044) and 12 months (7.0 ± 2.3 vs 7.6 ± 1.5; P=0.008). CONCLUSIONS Beyond the benefits of usual education, peer support was effective in reducing diabetes distress for Type 2 diabetes mellitus. (Clinical Trials Registry no: NCT02119572).
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Affiliation(s)
- C Ju
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Medical School, Nanjing, Jiangsu, China
| | - R Shi
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Medical School, Nanjing, Jiangsu, China
| | - L Yao
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Medical School, Nanjing, Jiangsu, China
| | - X Ye
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Medical School, Nanjing, Jiangsu, China
| | - M Jia
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Medical School, Nanjing, Jiangsu, China
| | - J Han
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Medical School, Nanjing, Jiangsu, China
| | - T Yang
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Medical School, Nanjing, Jiangsu, China
| | - Q Lu
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Medical School, Nanjing, Jiangsu, China
| | - H Jin
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Medical School, Nanjing, Jiangsu, China
| | - X Cai
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Medical School, Nanjing, Jiangsu, China
| | - S Yuan
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Medical School, Nanjing, Jiangsu, China
| | - B Xie
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Medical School, Nanjing, Jiangsu, China
| | - X Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing, Jiangsu, China
| | - M M Coufal
- Asian Centre for Health Education, Plano, American Samoa
| | - E B Fisher
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Z Sun
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, Medical School, Nanjing, Jiangsu, China
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12
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Whitehouse CR, Sharts-Hopko NC, Smeltzer SC, Horowitz DA. Supporting Transitions in Care for Older Adults With Type 2 Diabetes Mellitus and Obesity. Res Gerontol Nurs 2018; 11:71-81. [PMID: 29498747 PMCID: PMC6026545 DOI: 10.3928/19404921-20180223-02] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 01/15/2018] [Indexed: 01/08/2023]
Abstract
The aim of the current study was to compare outcomes for older adults with type 2 diabetes mellitus and obesity following participation in a transitional care intervention that included diabetes self-management education (DSME) and homecare. The three groups analyzed comprised an inpatient DSME plus homecare group (n = 35); an inpatient DSME only group (n = 100); and a group who received usual care (n = 45). Outcomes of interest included rehospitalization rates and hemoglobin A1C (A1C) for up to 1-year post hospital discharge. Rates of rehospitalization and A1C improved for older adults who received nurse-led inpatient DSME and homecare during transitions of care from hospital to home. Rehospitalization rates up to 90 days were decreased for the DSME plus homecare group (10%) compared to DSME only (20%) and usual care groups (26.7%) (p < 0.05). A decrease of -0.4 and -2.3 A1C units was observed for the DSME group and DSME plus homecare group, respectively, at 90 days. These results support a transitional care educational intervention for older adults with type 2 diabetes mellitus and obesity. TARGETS Older adults with type 2 diabetes mellitus and obesity. INTERVENTION DESCRIPTION Transitional care intervention including diabetes self-management education and homecare. MECHANISMS OF ACTION Inpatient diabetes education and homecare helps improve rates of rehospitalization and hemoglobin A1C during care transitions from hospital to home. OUTCOMES Rehospitalization rates, glycemic control (i.e., A1C level). [Res Gerontol Nurs. 2018; 11(2):71-81.].
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13
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Mardanian Dehkordi L, Abdoli S. Diabetes Self-Management Education; Experience of People with Diabetes. J Caring Sci 2017; 6:111-118. [PMID: 28680865 PMCID: PMC5488666 DOI: 10.15171/jcs.2017.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 11/30/2015] [Indexed: 11/25/2022] Open
Abstract
Introduction: Diabetes self-management education (DSME) is a major factor which can affects quality of life of people with diabetes (PWD). Understanding the experience of PWD participating in DSME programs is an undeniable necessity in providing effective DSME to this population. The Aim of the study was to explore the experiences of PWD from a local DSME program in Iran. Methods: This study applied a descriptive phenomenological approach. The participants were PWD attending a well-established local DSME program in an endocrinology and diabetes center in Isfahan, Iran. Fifteen participants willing to share their experience about DSME were selected through purposive sampling from September 2011 to June 2012. Data were collected via unstructured interviews and analyzed using Colaizzi's approach. Results: The experience of participants were categorized under three main themes including content of diabetes education (useful versus repetitive, intensive and volatile), teaching methods (traditional, technology ignorant) and learning environment (friendly atmosphere, cramped and dark). Conclusion: It seems the current approach for DSME cannot meet the needs and expectations of PWD attending the program. Needs assessment, interactive teaching methods, multidisciplinary approach, technology as well as appropriate physical space need to be considered to improve DSME.
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Affiliation(s)
- Leila Mardanian Dehkordi
- Department of Adult Health Nursing, Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Samereh Abdoli
- College of Nursing, University of Tennessee, Knoxville, TN, USA
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14
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Use of secondary clinical data for research related to diabetes self-management education. Res Social Adm Pharm 2017; 13:494-502. [DOI: 10.1016/j.sapharm.2016.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 07/14/2016] [Indexed: 01/23/2023]
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15
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Horigan G, Davies M, Findlay-White F, Chaney D, Coates V. Reasons why patients referred to diabetes education programmes choose not to attend: a systematic review. Diabet Med 2017; 34:14-26. [PMID: 26996982 DOI: 10.1111/dme.13120] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2016] [Indexed: 11/29/2022]
Abstract
AIMS To identify the reasons why those offered a place on diabetes education programmes declined the opportunity. BACKGROUND It is well established that diabetes education is critical to optimum diabetes care; it improves metabolic control, prevents complications, improves quality of life and empowers people to make informed choices to manage their condition. Despite the significant clinical and personal rewards offered by diabetes education, programmes are underused, with a significant proportion of patients choosing not to attend. METHODS A systematic search of the following databases was conducted for the period from 2005-2015: Medline; EMBASE; Scopus; CINAHL; and PsycINFO. Studies that met the inclusion criteria focusing on patient-reported reasons for non-attendance at structured diabetes education were selected. RESULTS A total of 12 studies spanning quantitative and qualitative methodologies were included. The selected studies were published in Europe, USA, Pakistan, Canada and India, with a total sample size of 2260 people. Two broad categories of non-attender were identified: 1) those who could not attend for logistical, medical or financial reasons (e.g. timing, costs or existing comorbidities) and 2) those who would not attend because they perceived no benefit from doing so, felt they had sufficient knowledge already or had emotional and cultural reasons (e.g. no perceived problem, denial or negative feelings towards education). Diabetes education was declined for many reasons, and the range of expressed reasons was more diverse and complex than anticipated. CONCLUSION New and innovative methods of delivering diabetes education are required which address the needs of people with diabetes whilst maintaining quality and efficiency.
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MESH Headings
- Activities of Daily Living
- Adult
- Appointments and Schedules
- Child
- Combined Modality Therapy/economics
- Cost of Illness
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/economics
- Diabetes Mellitus, Type 1/therapy
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/economics
- Diabetes Mellitus, Type 2/therapy
- Health Care Costs
- Health Knowledge, Attitudes, Practice
- Humans
- Insurance, Health, Reimbursement
- Patient Acceptance of Health Care
- Patient Education as Topic/economics
- Referral and Consultation/economics
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Affiliation(s)
- G Horigan
- Institute of Nursing and Health Research, University of Ulster, Magee Campus, Londonderry
| | - M Davies
- Department of Clinical Psychology, Belfast Health and Care Trust, Belfast
| | | | - D Chaney
- Diabetes UK Northern Ireland, Belfast, UK
| | - V Coates
- Institute of Nursing and Health Research, University of Ulster, Magee Campus, Londonderry
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16
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Fan L, Sidani S. Preferences of Persons with Type 2 Diabetes for Diabetes Self-Management Education Interventions: An Exploration. Health (London) 2017. [DOI: 10.4236/health.2017.911115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Murray E, Hekler EB, Andersson G, Collins LM, Doherty A, Hollis C, Rivera DE, West R, Wyatt JC. Evaluating Digital Health Interventions: Key Questions and Approaches. Am J Prev Med 2016; 51:843-851. [PMID: 27745684 PMCID: PMC5324832 DOI: 10.1016/j.amepre.2016.06.008] [Citation(s) in RCA: 378] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 06/13/2016] [Accepted: 06/13/2016] [Indexed: 12/16/2022]
Abstract
Digital health interventions have enormous potential as scalable tools to improve health and healthcare delivery by improving effectiveness, efficiency, accessibility, safety, and personalization. Achieving these improvements requires a cumulative knowledge base to inform development and deployment of digital health interventions. However, evaluations of digital health interventions present special challenges. This paper aims to examine these challenges and outline an evaluation strategy in terms of the research questions needed to appraise such interventions. As they are at the intersection of biomedical, behavioral, computing, and engineering research, methods drawn from all of these disciplines are required. Relevant research questions include defining the problem and the likely benefit of the digital health intervention, which in turn requires establishing the likely reach and uptake of the intervention, the causal model describing how the intervention will achieve its intended benefit, key components, and how they interact with one another, and estimating overall benefit in terms of effectiveness, cost effectiveness, and harms. Although RCTs are important for evaluation of effectiveness and cost effectiveness, they are best undertaken only when: (1) the intervention and its delivery package are stable; (2) these can be implemented with high fidelity; and (3) there is a reasonable likelihood that the overall benefits will be clinically meaningful (improved outcomes or equivalent outcomes at lower cost). Broadening the portfolio of research questions and evaluation methods will help with developing the necessary knowledge base to inform decisions on policy, practice, and research.
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Affiliation(s)
- Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom.
| | - Eric B Hekler
- Designing Health Lab, School of Nutrition and Health Promotion, Arizona State University, Phoenix, Arizona
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Linda M Collins
- The Methodology Center and Department of Human Development and Family Studies, The Pennsylvania State University, State College, Pennsylvania
| | - Aiden Doherty
- MRC Clinical Trial Service Unit Hub, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Chris Hollis
- NIHR MindTech HTC, University of Nottingham, Nottingham, United Kingdom
| | - Daniel E Rivera
- School for the Engineering of Matter, Transport, and Energy, Ira A. Fulton Schools of Engineering, Arizona State University, Phoenix, Arizona
| | - Robert West
- Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Jeremy C Wyatt
- Wessex Institute, University of Southampton, Southampton, United Kingdom
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18
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Morgan HM, Entwistle VA, Cribb A, Christmas S, Owens J, Skea ZC, Watt IS. We need to talk about purpose: a critical interpretive synthesis of health and social care professionals' approaches to self-management support for people with long-term conditions. Health Expect 2016; 20:243-259. [PMID: 27075246 PMCID: PMC5354019 DOI: 10.1111/hex.12453] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2016] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Health policies internationally advocate 'support for self-management', but it is not clear how the promise of the concept can be fulfilled. OBJECTIVE To synthesize research into professional practitioners' perspectives, practices and experiences to help inform a reconceptualization of support for self-management. DESIGN Critical interpretive synthesis using systematic searches of literature published 2000-2014. FINDINGS We summarized key insights from 164 relevant papers in an annotated bibliography. The literature illustrates striking variations in approaches to support for self-management and interpretations of associated concepts. We focused particularly on the somewhat neglected question of the purpose of support. We suggest that this can illuminate and explain important differences between narrower and broader approaches. Narrower approaches support people to manage their condition(s) well in terms of disease control. This purpose can underpin more hierarchical practitioner-patient communication and more limited views of patient empowerment. It is often associated with experiences of failure and frustration. Broader approaches support people to manage well with their condition(s). They can keep work on disease control in perspective as attention focuses on what matters to people and how they can be supported to shape their own lives. Broader approaches are currently less evident in practice. DISCUSSION AND CONCLUSION Broader approaches seem necessary to fulfil the promise of support for self-management, especially for patient empowerment. A commitment to enable people to live well with long-term conditions could provide a coherent basis for the forms and outcomes of support that policies aspire to. The implications of such a commitment need further attention.
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Affiliation(s)
| | | | - Alan Cribb
- Centre for Public Policy Research, King's College London, London, UK
| | - Simon Christmas
- Centre for Public Policy Research, King's College London, London, UK
| | - John Owens
- Centre for Public Policy Research, King's College London, London, UK
| | - Zoë C Skea
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Ian S Watt
- Department of Health Sciences/Hull York Medical School, Faculty of Science, University of York, Heslington, York, UK
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Huxley C, Sturt J, Dale J, Walker R, Caramlau I, O'Hare JP, Griffiths F. Is it possible to predict improved diabetes outcomes following diabetes self-management education: a mixed-methods longitudinal design. BMJ Open 2015; 5:e008781. [PMID: 26525722 PMCID: PMC4636624 DOI: 10.1136/bmjopen-2015-008781] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To predict the diabetes-related outcomes of people undertaking a type 2 Diabetes Self-Management Education (DSME) programme from their baseline data. DESIGN A mixed-methods longitudinal experimental study. 6 practice nurses and 2 clinical academics undertook blind assessments of all baseline and process data to predict clinical, behavioural and psychological outcomes at 6 months post-DSME programme. SETTING Primary care. PARTICIPANTS -31 people with type 2 diabetes who had not previously undertaken DSME. INTERVENTION All participants undertook the Diabetes Manual 1:1 self-directed learning 12-week DSME programme supported by practice nurses trained as Diabetes Manual facilitators. OUTCOME VARIABLES Glycated haemoglobin (HbA1c), diabetes knowledge, physical activity, waist circumference, self-efficacy, diabetes distress, anxiety, depression, demographics, change talk and treatment satisfaction. These variables were chosen because they are known to influence self-management behaviour or to have been influenced by a DSME programme in empirical evidence. RESULTS Baseline and 6-month follow-up data were available for 27 participants of which 13 (48%) were male, 22 (82%) white British, mean age 59 years and mean duration of type 2 diabetes 9.1 years. Significant reductions were found in HbA1c t(26)=2.35, p=0.03, and diabetes distress t(26)=2.30, p=0.03, and a significant increase in knowledge t(26)=-2.06, p=0.05 between baseline and 6 months. No significant changes were found in waist circumference, physical activity, anxiety, depression or self-efficacy. Accuracy of predictions varied little between clinical academics and practice nurses but greatly between outcome (0-100%). The median and mode accuracy of predicted outcome was 66.67%. Accuracy of prediction for the key outcome of HbA1c was 44.44%. Diabetes distress had the highest prediction accuracy (81.48%). CONCLUSIONS Clinicians in this small study were unable to identify individuals likely to achieve improvement in outcomes from DSME. DSME should be promoted to all patients with diabetes according to guidelines.
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Affiliation(s)
| | - Jackie Sturt
- Warwick Medical School, University of Warwick, Coventry, UK
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Isabela Caramlau
- Warwick Medical School, University of Warwick, Coventry, UK
- Department of Psychology, Beaumont Hospital, Dublin, Ireland
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Chen R, Cheadle A, Johnson D, Duran B. US trends in receipt of appropriate diabetes clinical and self-care from 2001 to 2010 and racial/ethnic disparities in care. DIABETES EDUCATOR 2014; 40:756-66. [PMID: 25142006 DOI: 10.1177/0145721714546721] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE The purpose of this study was to examine trends in the receipt of 8 recommended diabetes clinical and self-care indicators from 2001 to 2010 and assess racial/ethnic disparities in care. METHODS This observational study examined receipt of A1C tests, annual eye and foot exams, flu vaccination, diabetes self-management education (DSME), exercise, self-monitoring of blood glucose (SMBG), and self feet examinations among US adults with diabetes using national survey data from 2001 to 2010. Analyses included estimating proportions for each indicator by year, testing differences in magnitude of change from 2001 to 2010 by race/ethnicity, and regression models to assess changes in care over time and factors associated with care. RESULTS There were significant increases from 2001 to 2010 in A1C tests, annual foot exams, flu shots, DSME, and SMBG but declines in eye and self feet exams. DSME was positively associated with receipt of several care indicators. However, only half of respondents received DSME. White and black non-Hispanics, respectively, experienced improvements in at least 3 indicators. Hispanics experienced a significant increase in exercise but were consistently less likely than whites to receive or engage in most care. CONCLUSIONS While improvements in several indicators were observed, patterns varied by race/ethnicity, with Hispanics falling short on most measures. DSME was strongly associated with most care and demonstrates the potential to improve receipt of recommended care by increasing DSME participation. With the Affordable Care Act (ACA), health professionals have a prime opportunity to leverage ACA provisions to increase access to recommended services, including DSME.
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Affiliation(s)
- Roxana Chen
- Department of Health Services, University of Washington, Seattle, Washingon (Drs Chen, Johnson, and Duran)
| | - Allen Cheadle
- Group Health Research Institute-Center for Community Health and Evaluation, Seattle, Washington (Dr Cheadle)
| | - Donna Johnson
- Department of Health Services, University of Washington, Seattle, Washingon (Drs Chen, Johnson, and Duran)
| | - Bonnie Duran
- Department of Health Services, University of Washington, Seattle, Washingon (Drs Chen, Johnson, and Duran)
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Fournier C, Gautier A, Mosnier-Pudar H, Druet C, Fagot-Campagna A, Aujoulat I. ENTRED 2007: Results of a French national survey on self-management education to people with diabetes... still a long way to go! ACTA ACUST UNITED AC 2014. [DOI: 10.1051/tpe/2014006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
Diabetes is a chronic, progressive disease that affects millions worldwide. The paradigm of diabetes management has shifted to focus on empowering the person with diabetes to manage the disease successfully and to improve their quality of life. Diabetes self-management education is a collaborative process through which people with diabetes gain the knowledge and skills needed to modify their behavior and to self-manage successfully the disease and its related conditions. Diabetes educators are health care professionals who apply in-depth knowledge and skills in the biological and social sciences, communication, counseling, and pedagogy to enable patients to manage daily and future challenges. Diabetes educators are integral in providing individualized education and promoting behavior change, using a framework of seven self-care behaviors known as the AADE7 Self-Care Behaviors™, developed by the American Association of Diabetes Educators. The iterative process of promoting behavior change includes assessment, goal setting, planning, implementation, evaluation, and documentation. Diabetes educators work as part of the patient's health care team to engage with the patient in informed, shared decision making. The increasing prevalence of diabetes and the growing focus on its prevention require strategies for providing people with knowledge, skills, and strategies they need and can use. The diabetes educator is the logical facilitator of change. Access to diabetes education is critically important; incorporating diabetes educators into more and varied practice settings will serve to improve clinical and quality of life outcomes for persons with diabetes.
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Affiliation(s)
- Sandra D Burke
- American Association of Diabetes educators, Chicago, IL, USA
- University of Illinois at Chicago College of Nursing, Urbana, IL, USA
- Correspondence: Sandra D Burke, University of Illinois at Chicago College of Nursing, 845 South Damen Avenue, MC 802, Chicago, IL 60612, USA, Tel +1 217 333 2507, Email
| | - Dawn Sherr
- Science and Practice, American Association of Diabetes Educators, Chicago, IL, USA
| | - Ruth D Lipman
- Science and Practice, American Association of Diabetes Educators, Chicago, IL, USA
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Factors associated with consulting a dietitian for diabetes management: a cross-sectional study. BMC Health Serv Res 2013; 13:504. [PMID: 24305435 PMCID: PMC3880219 DOI: 10.1186/1472-6963-13-504] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 11/28/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Type 2 Diabetes (T2D) has reached epidemic levels in the Middle East region. Despite evidence that it improves health outcomes and saves health costs, dietary counseling for T2D remains grossly under-investigated in this region. The aim of this study was to assess the frequency and determinants of use of dietary counseling services by T2D patients in Lebanon and recommend corrective measures that may guide the planning, organization and delivery of care for chronic diseases in general and diabetes care in particular. METHODS A non-experimental cross-sectional design was utilized to survey outpatients with T2D in two major health centers in Lebanon. Patients diagnosed with T2D were invited to complete a questionnaire consisting of five sections: socio-demographic characteristics, disease attributes, patients' perceptions regarding T2D management, practice of lifestyle modifications, and referral by a physician to a dietitian. The outcome of interest was the use of dietary counseling services by T2D patients at least once since their diagnosis. Descriptive statistics and logistic regression analyses were used to evaluate the frequency and determinants of dietary counseling services utilization. RESULTS A total of 332 T2D patients completed the questionnaire (response rate 94.6%). Although 75% of study participants believed that dietitians can assist them in changing their dietary habits, only 38% had consulted with a dietitian. Among study participants, only 34% were referred to a dietitian by their physician. The main determinants of the use of dietary counseling services were referral by a physician (OR: 112.25; 95% CI = 42.74-294.84), the presence of outpatient social or private health insurance (OR: 5.86; 95% CI = 2.40-14.25) and the belief that a dietitian can assist in changing dietary habits (OR: 3.74; 95% CI = 1.33-10.54). CONCLUSIONS The findings of this study show suboptimal use of dietary counseling services by T2D patients in Lebanon. Key determinants were physicians' referral, financial support for outpatient care, and patients' belief in the usefulness of dietary counseling. Suggested interventions entail enhancing the planning and organization of care through inter-professional collaboration between physicians and dietitians; promoting public financing for high quality outpatient care that includes dietary counseling; and promoting the value of dietary counseling and improving the public image of dietitians.
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McEwen MM, Lin PC, Pasvogel A. Analysis of Behavior Risk Factor Surveillance System Data to Assess the Health of Hispanics With Diabetes in US-Mexico Border Communities. DIABETES EDUCATOR 2013; 39:742-51. [DOI: 10.1177/0145721713504629] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this study is to describe and compare personal characteristics, health care access and utilization, and self-management behaviors of Hispanic American adults diagnosed with diabetes who reside in 3 US-Mexico border counties in Arizona, New Mexico, and Texas. This study also examines the status of this population in attaining Healthy People (HP) 2020 diabetes target goals. Methods Data were extracted from the 2005-2009 Selected Metropolitan/Micropolitan Area Risk Trends (SMART): Behavioral Risk Factor Surveillance System (BRFSS) to analyze behavioral and health system factors associated with diabetes management among Hispanic American adults who reside in the border counties (N = 600). Data were analyzed using descriptive statistics and compared using chi-square and one-way analysis of variance. Results There were significant differences in health care access and utilization and in 1 self-management behavior (daily feet checks) across the counties. The majority of participants (83.4%) had a care provider, however the HP 2020 diabetes target goals for A1C monitoring or foot exams conducted by a care provider were not met. Participants in all counties met the target goal for dilated eye exams. Conclusions Improvement of diabetes management among this population should focus on border health system barriers to attaining HP 2020 diabetes target goals.
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Affiliation(s)
- Marylyn Morris McEwen
- The University of Arizona College of Nursing, Tucson, Arizona, USA (Dr McEwen, Dr Pasvogel)
- Pei-Chao Lin - Primary affiliation is a lecturer in Yuh-Ing Junior College of Health Care & Management in Taiwan. Secondary affiliation is a doctoral candidate in School of Nursing, Kaohsiung Medical University in Taiwan
| | - Pei-Chao Lin
- The University of Arizona College of Nursing, Tucson, Arizona, USA (Dr McEwen, Dr Pasvogel)
- Pei-Chao Lin - Primary affiliation is a lecturer in Yuh-Ing Junior College of Health Care & Management in Taiwan. Secondary affiliation is a doctoral candidate in School of Nursing, Kaohsiung Medical University in Taiwan
| | - Alice Pasvogel
- The University of Arizona College of Nursing, Tucson, Arizona, USA (Dr McEwen, Dr Pasvogel)
- Pei-Chao Lin - Primary affiliation is a lecturer in Yuh-Ing Junior College of Health Care & Management in Taiwan. Secondary affiliation is a doctoral candidate in School of Nursing, Kaohsiung Medical University in Taiwan
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Brownson CA, Heisler M. The role of peer support in diabetes care and self-management. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2013; 2:5-17. [PMID: 22273055 DOI: 10.2165/01312067-200902010-00002] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
In light of the growing prevalence and healthcare costs of diabetes mellitus, it is critically important for healthcare providers to improve the efficiency and effectiveness of their diabetes care. A key element of effective disease management for diabetes is support for patient self-management. Barriers to care exist for both patients and healthcare systems. As a result, many people with diabetes do not get the care and support needed to successfully manage their diabetes.Disease management approaches that incorporate peer support may be a promising way to help provide self-management support to patients with diabetes. Trained peers provide emotional support, instrumental (tangible or material) support, education, and skills training to those they serve, and outreach and care coordination for provider systems. They play a unique role that complements and supports clinical care.To describe how peers are currently supporting diabetes care, a number of databases were searched for studies describing the roles of peers using relevant key words. This paper reviews current literature that describes the roles and duties of peers in interventions to improve diabetes care, with a focus on their contributions to six essential elements of self-management support: (i) access to regular, high-quality clinical care; (ii) an individualized approach to assessment and treatment; (iii) patient-centered collaborative goal setting; (iv) education and skills training; (v) ongoing follow-up and support; and (vi) linkages to community resources.Peers worked under a variety of titles, which did not define their duties. The scope of their work ranged from assisting health professionals to playing a central role in care. Providing education and follow-up support were the two most common roles. In all but one study, these roles were carried out during face-to-face contact, most frequently in community sites.A growing body of literature supports the value of peer models for diabetes management. Additional research can answer remaining questions related to such issues as cost effectiveness, sustainability, integration of peers into health and social service delivery systems, and recruitment, training, and support of peers. Continuing to develop and evaluate innovative models for more effectively mobilizing and integrating peers into diabetes care has great potential for improving diabetes outcomes worldwide.
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Affiliation(s)
- Carol A Brownson
- 1 Division of Health Behavior Research, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA 2 Veterans Affairs Center for Clinical Practice Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA 3 Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA 4 Michigan Diabetes Research and Training Center, Ann Arbor, Michigan, USA
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Wallace AS, Sussman AL, Anthoney M, Parker EA. From intervention to innovation: applying a formal implementation strategy in community primary care. Nurs Res Pract 2013; 2013:605757. [PMID: 23606957 PMCID: PMC3625572 DOI: 10.1155/2013/605757] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 02/18/2013] [Indexed: 11/30/2022] Open
Abstract
Objective. To describe a comprehensive strategy for implementing an effective diabetes self-management support intervention incorporating goal-setting and followup support in community health clinics (CHCs) serving vulnerable patients. Methods. The Replicating Effective Programs (REP) framework was applied to develop an intervention strategy. In order to create a strategy consistent with the REP framework, four CHCs engaged in an iterative process involving key-informant interviews with clinic staff, ongoing involvement of clinic staff facilitating translational efforts, feedback from national experts, and an instructional designer. Results. Moving through the REP process resulted in an implementation strategy that aims to facilitate commitment, communication, and change at the clinic level, as well as means of providing interactive, time-limited education about patient behavior change and support to health care providers. Conclusion. The REP offered a useful framework for providing guidance toward the development of a strategy to implement a diabetes self-management intervention in CHCs serving medically underserved and underrepresented patient populations.
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Affiliation(s)
- Andrea S. Wallace
- The University of Iowa College of Nursing, 330 CNB, 50 Newton Road, Iowa City, IA 52242, USA
| | - Andrew L. Sussman
- Department of Family and Community Medicine, The University of New Mexico School of Medicine, USA
| | - Mark Anthoney
- Department of Information and Technology Services, The University of Iowa, USA
| | - Edith A. Parker
- Department of Community and Behavioral Health, The University of Iowa College of Public Health, USA
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Cauch-Dudek K, Victor JC, Sigmond M, Shah BR. Disparities in attendance at diabetes self-management education programs after diagnosis in Ontario, Canada: a cohort study. BMC Public Health 2013; 13:85. [PMID: 23360373 PMCID: PMC3568403 DOI: 10.1186/1471-2458-13-85] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 01/24/2013] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Patients newly-diagnosed with diabetes require self-management education to help them understand and manage the disease. The goals of the study were to determine the frequency of diabetes self-management education program utilization by newly-diagnosed patients, and to evaluate whether there were any demographic or clinical disparities in utilization. METHODS Using population-level health care data, all 46,553 adults who were diagnosed with any type of non-gestational diabetes in Ontario, Canada between January and June 2006 were identified. They were linked with a diabetes self-management education program registry to identify those who attended within 6 months of diagnosis. The demographic and clinical characteristics of attendees and non-attendees were compared. RESULTS A total of 9,568 (20.6%) patients attended a diabetes self-management education program within 6 months of diagnosis. Younger age, increasing socioeconomic status, and the absence of mental health conditions or other medical comorbidity were associated with attendance. Patients living in rural areas, where access to physicians may be limited, were markedly more likely to attend. Recent immigrants were 40% less likely to attend self-management education programs than longer-term immigrants or nonimmigrants. CONCLUSION Only one in five newly-diagnosed diabetes patients attended a diabetes self-management education program. Demographic and clinical disparities in utilization persisted despite a publicly-funded health care system where patients could access these services without direct charges. Primary care providers and education programs must ensure that more newly-diagnosed diabetes patients receive self-management education, particularly those who are older, poorer, sicker, or recent immigrants.
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Affiliation(s)
- Karen Cauch-Dudek
- Institute for Clinical Evaluative Sciences, G106 – 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - J Charles Victor
- Institute for Clinical Evaluative Sciences, G106 – 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Marianne Sigmond
- Division of Endocrinology, University Health Network, Toronto, Canada
| | - Baiju R Shah
- Institute for Clinical Evaluative Sciences, G106 – 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
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Weymann N, Härter M, Petrak F, Dirmaier J. Health information, behavior change, and decision support for patients with type 2 diabetes: development of a tailored, preference-sensitive health communication application. Patient Prefer Adherence 2013; 7:1091-9. [PMID: 24174871 PMCID: PMC3808151 DOI: 10.2147/ppa.s46924] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Patient involvement in diabetes treatment such as shared decision-making and patient self-management has significant effects on clinical parameters. As a prerequisite for active involvement, patients need to be informed in an adequate and preference-sensitive way. Interactive Health Communication Applications (IHCAs) that combine web-based health information for patients with additional support offer the opportunity to reach great numbers of patients at low cost and provide them with high-quality information and support at the time, place, and learning speed they prefer. Still, web-based interventions often suffer from high attrition. Tailoring the intervention to patients' needs and preferences might reduce attrition and should thereby increase effectiveness. The purpose of this study was to develop a tailored IHCA offering evidence-based, preference-sensitive content and treatment decision support to patients with type 2 diabetes. The content was developed based on a needs assessment and two evidence-based treatment guidelines. The delivery format is a dialogue-based, tunneled design tailoring the content and tone of the dialogue to relevant patient characteristics (health literacy, attitudes toward self-care, and psychological barriers to insulin treatment). Both content and tailoring were revised by an interdisciplinary advisory committee. CONCLUSION The World Wide Web holds great potential for patient information and self-management interventions. With the development and evaluation of a tailored IHCA, we complement face-to-face consultations of patients with their health care practitioners and make them more efficient and satisfying for both sides. Effects of the application are currently being tested within a randomized controlled trial.
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Affiliation(s)
- Nina Weymann
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Correspondence: Nina Weymann, University Medical Center Hamburg-Eppendorf, Department of Medical Psychology (W 26), Martinistraße 52, 20246 Hamburg, Germany, Tel +49 0 40 7410 57134, Fax +49 0 40 7410 54965, Email
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frank Petrak
- Clinic of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Jörg Dirmaier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Schechter CB, Cohen HW, Shmukler C, Walker EA. Intervention costs and cost-effectiveness of a successful telephonic intervention to promote diabetes control. Diabetes Care 2012; 35:2156-60. [PMID: 22851599 PMCID: PMC3476890 DOI: 10.2337/dc12-0048] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To characterize the costs and cost-effectiveness of a telephonic behavioral intervention to promote glycemic control in the Improving Diabetes Outcomes study. RESEARCH DESIGN AND METHODS Using the provider perspective and a time horizon to the end of the 1-year intervention, we calculate the costs of a telephonic intervention by health educators compared with an active control (print) intervention to improve glycemic control in adults with type 2 diabetes. We calculate the cost-effectiveness ratios for a reduction of one percentage point in hemoglobin A(1c) (A1C), as well as for one participant to achieve an A1C <7%. Base-case and sensitivity analysis results are presented. RESULTS The intervention cost $176.61 per person randomized to the telephone group to achieve a mean 0.36 percentage point of A1C improvement. The incremental cost-effectiveness ratio was $490.58 per incremental percentage point of A1C improvement and $2,617.35 per person over a 1-year intervention in achieving the A1C goal. In probabilistic sensitivity analysis, the median (interquartile range) of per capita cost, cost per percentage point reduction in A1C, and cost per person achieving the A1C goal of <7% are $175.82 (147.32-203.56), $487.75 (356.50-718.32), and $2,312.88 (1,785.58-3,220.78), respectively. CONCLUSIONS The costs of a telephonic intervention for diabetes self-management support are moderate and commensurate to the modest associated improvement in glycemic control.
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Affiliation(s)
- Clyde B Schechter
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
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Mankovsky BN. 4th Annual Symposium on Self Monitoring of Blood Glucose (SMBG) Applications and Beyond, May 12-14, 2011, Budapest, Hungary. Diabetes Technol Ther 2011; 13:1161-76. [PMID: 21970820 PMCID: PMC3202759 DOI: 10.1089/dia.2011.0200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Boris N Mankovsky
- Department of Diabetology, National Medical Academy for Postgraduate Education, Kiev, Ukraine.
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Shaw K, Killeen M, Sullivan E, Bowman P. Disparities in diabetes self-management education for uninsured and underinsured adults. DIABETES EDUCATOR 2011; 37:813-9. [PMID: 22021026 DOI: 10.1177/0145721711424618] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To examine accessibility, availability, and quality of diabetes self-management education (DSME) for uninsured adults or those utilizing Medicaid in a community with a high poverty rate. METHODS A descriptive needs assessment was conducted in 8 health care agencies serving the uninsured. Face-to-face audiotaped interviews were conducted with 22 health care providers, educators, and administrators to capture descriptive characteristics about clinical care, DSME, continuity of care, and organizational function. RESULTS Twenty-nine percent of adults with diabetes were reported to be uninsured or utilizing Medicaid in these settings. Only 4% of adults received the American Diabetes Association's DSME standards of care. At 5 agencies, there was no direct access to DSME. Uninsured individuals had access to 2 programs; individuals utilizing Medicaid had access to 1 program. Certified diabetes educators were available at only 3 agencies. There were DSME programs that adhered to recommended guidelines but limited availability for these adults. The majority of education (86%) was limited to clinical encounters with providers, which were infrequent and variable in duration. Time spent on education ranged from 2 to 120 minutes depending on agency type. Education topics addressed by providers varied by agency. CONCLUSIONS Findings of this study suggest that adults who are utilizing Medicaid or are uninsured do not get the amount, type, or quality of DSME needed to sustain successful self-management. Limited availability and inadequate access to quality DSME place vulnerable adults at increased risk for devastating and costly complications despite the known benefits.
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Affiliation(s)
- Kathy Shaw
- The Division of Adult and Senior Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado (Ms Shaw)
| | - Maureen Killeen
- The Department of Biobehavioral Nursing, Georgia Health Sciences University College of Nursing, Athens, Georgia (Dr Killeen, Ms Bowman)
| | - Erin Sullivan
- Brenau University, Gainesville, Georgia (Ms Sullivan)
| | - Patricia Bowman
- The Department of Biobehavioral Nursing, Georgia Health Sciences University College of Nursing, Athens, Georgia (Dr Killeen, Ms Bowman)
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Elliott DJ, Robinson EJ, Sanford M, Herrman JW, Riesenberg LA. Systemic barriers to diabetes management in primary care: a qualitative analysis of Delaware physicians. Am J Med Qual 2011; 26:284-90. [PMID: 21393616 DOI: 10.1177/1062860610383332] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Primary care providers deliver the majority of care for patients with diabetes. This article presents a qualitative analysis of systemic barriers to primary care diabetes management in the small office setting in Delaware. Grounded theory was used to identify key themes of focus group discussions with 25 Delaware physicians. A total of 6 systemic barriers were identified: (1) a persistent orientation toward acute care; (2) an inability to provide proactive, population-based patient management; (3) an inability to provide adequate self-management education; (4) poor integration of payer-driven disease management activities; (5) lack of universally available clinical information; and (6) lack of public health support. The results suggest that significant systemic barriers limit the ability of primary care providers, particularly those in small practices, to effectively manage diabetes in current practice. Future primary care reform should consider how to support providers, particularly those in small practices, to overcome these barriers.
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Kahn LS, Glaser K, Fox CH, Patterson A. Diabetes educators in safety-net practices: a qualitative study. DIABETES EDUCATOR 2011; 37:212-9. [PMID: 21357750 DOI: 10.1177/0145721710397385] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to explore the issues and challenges faced by certified diabetes educator (CDE) trainees in providing diabetes self-management education to patients in safety-net practices. METHODS Semi-structured interviews were conducted with CDE trainees and a CDE mentor in 2 primary care practices. Transcripts were analyzed using a content-driven immersion-crystallization approach to identify major themes. RESULTS Four major themes emerged from the qualitative interview data: (1) patient recruitment approaches, (2) patient barriers to attending diabetes education classes, (3) teaching challenges, and (4) CDE integration into the practices. CONCLUSIONS This study underscores the need for diabetes educators and other health education professionals to be creative and flexible in delivering self-management education to patients in underserved settings. The complexity of diabetes care and the self-care responsibilities placed on the patient reinforce the need for a team approach such as that proposed in the medical home model and should include certified diabetes educators.
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Affiliation(s)
- Linda S Kahn
- Primary Care Research Institute, Department of Family Medicine, State University of New York at Buffalo
| | - Kathryn Glaser
- Primary Care Research Institute, Department of Family Medicine, State University of New York at Buffalo
| | - Chester H Fox
- Primary Care Research Institute, Department of Family Medicine, State University of New York at Buffalo
| | - Adam Patterson
- Primary Care Research Institute, Department of Family Medicine, State University of New York at Buffalo
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Gucciardi E, Chan VWS, Fortugno M, Khan S, Horodezny S, Swartzack SJ. Primary Care Physician Referral Patterns to Diabetes Education Programs in Southern Ontario, Canada. Can J Diabetes 2011. [DOI: 10.1016/s1499-2671(11)53009-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Castillo A, Giachello A, Bates R, Concha J, Ramirez V, Sanchez C, Pinsker E, Arrom J. Community-based Diabetes Education for Latinos: The Diabetes Empowerment Education Program. DIABETES EDUCATOR 2010; 36:586-94. [PMID: 20538970 DOI: 10.1177/0145721710371524] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to conduct a diabetes education program delivered by community health workers (CHWs) in community settings and to evaluate its effectiveness in improving glycemic control and self-management skills in Hispanics/Latinos with type 2 diabetes. METHODS Trained CHWs recruited Hispanic/Latino community residents with self-reported type 2 diabetes, implemented intervention in nonclinical locations, and collected data on diabetes knowledge, self-care behaviors, self-efficacy, depression, A1C, weight, and blood pressure. Classes applied participatory techniques and were delivered in 2-hour group sessions over 10 weeks. Two focus groups collected qualitative postintervention data. RESULTS Seventy participants enrolled, and 47 completed pretest and posttest data. Improvements were significant for A1C (P = .001) and systolic blood pressure (P = .006). Other positive outcomes were diabetes knowledge, physical activity, spacing carbohydrates, following a healthy eating plan, and eating fruits and vegetables. Improved behaviors also included foot care, glucose self-monitoring, and medication adherence. Depressive symptoms showed a positive trend in intent-to-treat analysis (P = .07), but self-efficacy did not change significantly (P = .142). Qualitative information reported an increase in participants' perceived competence in self-care and a positive influence of CHWs in participants' compliance with the program. CONCLUSIONS A diabetes self-management education program for Hispanics/Latinos led by CHWs can be implemented in community settings and may effectively improve behavioral skills and glycemic control.
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Affiliation(s)
- Amparo Castillo
- Jane Addams College of Social Work, Midwest Latino Health Research, Training and Policy Center, University of Illinois at Chicago, Chicago, Illinois (Dr Castillo, Dr Giachello, Dr Sanchez, Dr Pinsker, Mr Arrom)
| | - Aida Giachello
- Jane Addams College of Social Work, Midwest Latino Health Research, Training and Policy Center, University of Illinois at Chicago, Chicago, Illinois (Dr Castillo, Dr Giachello, Dr Sanchez, Dr Pinsker, Mr Arrom)
| | | | - Jeannie Concha
- Global Health Division, Project Hope, Albuquerque, New Mexico (Dr Concha)
| | - Vanessa Ramirez
- General Internal Medicine, Northwestern University, Chicago, Illinois (Ms Ramirez)
| | - Carlos Sanchez
- Jane Addams College of Social Work, Midwest Latino Health Research, Training and Policy Center, University of Illinois at Chicago, Chicago, Illinois (Dr Castillo, Dr Giachello, Dr Sanchez, Dr Pinsker, Mr Arrom)
| | - Eve Pinsker
- Jane Addams College of Social Work, Midwest Latino Health Research, Training and Policy Center, University of Illinois at Chicago, Chicago, Illinois (Dr Castillo, Dr Giachello, Dr Sanchez, Dr Pinsker, Mr Arrom)
| | - Jose Arrom
- Jane Addams College of Social Work, Midwest Latino Health Research, Training and Policy Center, University of Illinois at Chicago, Chicago, Illinois (Dr Castillo, Dr Giachello, Dr Sanchez, Dr Pinsker, Mr Arrom)
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Ruppert K, Uhler A, Siminerio L. Examining Patient Risk Factors, Comorbid Conditions, Participation, and Physician Referrals to a Rural Diabetes Self-management Education Program. DIABETES EDUCATOR 2010; 36:603-12. [DOI: 10.1177/0145721710369705] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose The purpose of this study was to examine patients’ diabetes risk factors, comorbid conditions, and patient participation in and primary care practitioner (PCP) referrals to a rural diabetes self-management education (DSME) program. Methods A total of 295 patients in a rural community were identified by their PCP as having type 2 diabetes (T2D). Using patient information that was collected and entered into a diabetes data management system, patients’ risk factors, comorbid conditions, and patient participation in and PCP referral patterns to a DSME program were examined. Results Of the 295 patients with T2D, 162 (65%) reported that they had never received any DSME services. Despite educator efforts to improve patient participation and PCP awareness of local DSME services, 123 (76%) of the 162 patients never received a subsequent referral for DSME. Those patients who did receive a referral had a higher number of risk factors and comorbid conditions than those who did not receive a referral. Eighty-three percent of the patients who received a PCP referral attended the DSME program. Conclusions The findings reaffirm concerns that DSME patient participation and PCP referral practices are poor. Advocacy efforts should force policies and procedures that will make DSME a mandatory service and universally accessible. Unless referral practices are attended to, it is doubtful that the United States will reach the Healthy People 2010 objective for diabetes education.
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Affiliation(s)
| | - Amy Uhler
- University of Pittsburgh Medical Center Pittsburgh,
Pennsylvania
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Concha JB, Kravitz HM, Chin MH, Kelley MA, Chavez N, Johnson TP. Review of type 2 diabetes management interventions for addressing emotional well-being in Latinos. DIABETES EDUCATOR 2009; 35:941-58. [PMID: 19773526 DOI: 10.1177/0145721709344125] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this article is (1) to investigate if type 2 diabetes management programs with Latino participants address emotional well-being in addition to the standard diabetes self-care behaviors and (2) to describe the approaches taken to improve psychological and diabetes management outcomes. METHODS Online article and research databases, Internet searches, and review of article citations were used to identify relevant articles published 1995-2008. Type 2 diabetes management interventions with a psychological (emotion or cognitive) component or outcome measure and Latino sample were selected. Articles were limited to randomized clinical/controlled trials and pre-post comparative studies. RESULTS Thirteen interventions met the inclusion criteria for this review. Eight studies included emotion outcome measures, and 13 included at least one cognitive outcome measure. One study was specifically designed to improve emotional well-being. This study was not targeted for Latinos but did include Latino participants. A specialized depression case manager and collaborative care model showed significant improvements in depression and mental functioning. Psychological improvements were also found in those studies that assessed cognitive outcomes and were based on cognitive theories. The most frequent cognitive outcomes assessed were diabetes knowledge, problem solving, and self-efficacy. CONCLUSIONS Few type 2 diabetes interventions address emotional well-being in Latinos. More attention has been directed toward designing culturally sensitive community-based programs for improving behavior and physical outcomes. Because some Latino groups believe that negative emotions cause diabetes and because depression and anxiety are associated with poor self-management, programs should address emotional well-being as an important aspect of diabetes management.
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Affiliation(s)
- Jeannie Belinda Concha
- University of Washington, Department of Health Services, Seattle, Washington (Dr Concha)
| | - Howard M Kravitz
- Rush University Medical Center, Departments of Psychiatry and Preventive Medicine, Chicago, Illinois (Dr Kravitz)
| | - Marshall H Chin
- University of Chicago, Department of Medicine, Illinois (Dr Chin)
| | - Michele A Kelley
- University of Illinois at Chicago, School of Public Health, Chicago, Illinois (Dr Kelley, Dr Chavez)
| | - Noel Chavez
- University of Illinois at Chicago, School of Public Health, Chicago, Illinois (Dr Kelley, Dr Chavez)
| | - Timothy P Johnson
- University of Illinois at Chicago, Survey Research Laboratory, Chicago, Illinois (Dr Johnson)
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Herrejon K, Hartke JL, Scherer J, Chapman-Novakofski K. The creation and impact evaluation of "Your guide to diet and diabetes," an interactive web-based diabetes tutorial. Diabetes Technol Ther 2009; 11:171-9. [PMID: 19216688 DOI: 10.1089/dia.2008.0043] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Millions of Americans turn to the Internet for health information. A need for a comprehensive website that provides information on diet and diabetes management was identified. Therefore, the goal of this study was to develop an easy-to-use website that provided accurate information about diet and diabetes management in an interactive format that was widely accessible. METHODS The "Your Guide to Diet and Diabetes" website was developed through issue identification, expert panel review, and face validity phase for content and knowledge/skill assessment surveys. During the first 2 weeks of the website's availability, impact data were collected from website visitors. Responses to demographic questions, knowledge, and skill questions were collected in a database. RESULTS Of the 406 individuals who completed a demographic question, a maximum of 104 respondents chose to answer one or more of the interactive knowledge or skills questions. CONCLUSIONS "Your Guide to Diet and Diabetes" filled a need for an easy-to-use website that addressed the issues of diet and diabetes. Based on the number of visits to the login page (n = 6,124) and number of individuals who answered demographic questions, the site was well received. While a smaller group of participants elected to complete the interactive knowledge and skills questions, responses to these questions demonstrated that participants obtained knowledge from the website. In particular, participants increased their knowledge of food sources and appropriate serving sizes of carbohydrate. The "making a plate" skill activity was used with much greater frequency than the more conceptually complex carbohydrate counting skill activity.
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Affiliation(s)
- Katrina Herrejon
- Department of Food Science and Human Nutrition, University of Illinois, Urbana, Illinois, USA
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Peyrot M, Rubin RR, Funnell MM, Siminerio LM. Access to diabetes self-management education: results of national surveys of patients, educators, and physicians. DIABETES EDUCATOR 2009; 35:246-8, 252-6, 258-63. [PMID: 19208816 DOI: 10.1177/0145721708329546] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To examine factors related to access to diabetes self-management education (DSME), including services delivered and sought; patient, physician, and program barriers to access; educator outreach and expansion efforts; and perceptions of alternative DSME delivery strategies. METHODS Internet surveys were completed by 1169 adults with diabetes (661 with prior DSME, 508 with no prior DSME) from a national community survey panel, 1871 educators who were AADE members, and 629 physicians (212 diabetes specialists, 417 primary care practitioners) from a national physician survey panel. RESULTS Physicians want patients to receive more self-management support, but some report that patients are told to do things with which the physician does not agree. Provider (physician and educator)-delivered DSME is more highly regarded among those who have received it than among those who have not received it. Physicians generally have positive perceptions of provider-delivered DSME, and educators see physicians as key to encouraging DSME use in patients. Some physicians are concerned about losing patients sent to DSME, and 11% of patients report changing physicians as a result of DSME. Most DSME programs have grown recently as a result of recruiting efforts and adding new programs/services; most programs plan more such efforts. Patients prefer traditional DSME sources/settings and are moderately accepting of media sources. CONCLUSIONS Additional efforts are required to guarantee that all people with diabetes receive the DSME they need. This will require increased referral by physicians, increased follow-through by patients, and increased availability of DSME in forms that make it appealing to patients and physicians.
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Affiliation(s)
- Mark Peyrot
- Loyola College, Department of Sociology, and Johns Hopkins University, Department of Medicine, Baltimore, Maryland (Dr Peyrot)
| | - Richard R Rubin
- Johns Hopkins University, Departments of Medicine and Pediatrics, Baltimore, Maryland (Dr Rubin)
| | - Martha M Funnell
- Department of Medical Education, University of Michigan, and the Diabetes Research and Training Center, Ann Arbor, Michigan (Ms Funnell)
| | - Linda M Siminerio
- The Department of Medicine and Diabetes Institute, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Siminerio)
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Peragallo-Dittko V. Translating Clinical Trial Data Into New Patterns of Practice. DIABETES EDUCATOR 2009; 35 Suppl 1:18S-21S. [DOI: 10.1177/0145721708330154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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