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Fuse K, Kamimura N, Iguchi S, Kato K, Takahashi HE. Integrating Community Care for the Prevention and Treatment of Diabetes. Int J Integr Care 2024; 24:22. [PMID: 38855027 PMCID: PMC11160400 DOI: 10.5334/ijic.7607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 05/21/2024] [Indexed: 06/11/2024] Open
Abstract
Introduction This paper describes 'Project 8', a campaign that aims to reduce glycated haemoglobin (HbA1c) to 8% or more among patients with diabetes mellitus, utilising healthcare professionals and local community residents and focusing on education and support. The study is based in Uonuma-a small rural city in Japan with a declining population and an increased number of older people. Description 'Project 8' began in Uonuma's Koide Hospital in 2008. The Uonuma School for Community Health and Social Care was established in 2011 with the cooperation of a clinic's general practitioner. Medical students, trainees, doctors, and health care professionals have been holding 'open schools' (daytime lectures) and 'night schools' (evening lectures) to educate the community residents about various health issues. Through repeated lectures, the residents have been made aware of lifestyle-related diseases, including diabetes, and the meaning of 'Project 8'. Discussion Over the last decade, the hospital's campaign has expanded within the community, showing a statistically significant reduction of diabetic patients with HbA1c ≥ 8%, which successfully deferred the start of dialysis for many of them. Conclusion Well-integrated community care requires interprofessional education, collaborative practice, and the participation of community residents in health education.
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Affiliation(s)
- Katsuya Fuse
- Uonuma City Koide Hospital, 34-34 Hiwatari-shinnden, Uonuma-shi, Niigata-ken, 946-0001, Japan
| | - Norihito Kamimura
- Kamimura Clinic, 12 Suwamachi 1-chome, Uonuma-shi, Niigata-ken, 946-0003, Japan
| | - Seitaro Iguchi
- Department of Community Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuoh-ku, Niigata-shi, Niigata-ken, 951-8122, Japan
| | - Kiminori Kato
- Department of Prevention of Noncommunicable, Diseases and Promotion of Health Checkup, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuoh-ku, Niigata-ken, 951-8522, Japan
| | - Hideaki E. Takahashi
- Niigata University, Co-Chair, Niigata Initiative for Promotion of Health and Welfare, Japan
- Niigata Rehabilitation Hospital, Niigata Bone Science Institute, 761 Kizaki, Kita-ku, Niigata-shi, 950-3304, Japan
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Kaveh MH, Faradonbeh MR, Kaveh S. Telehealth impact on biomedical, psychosocial, and behavioural outcomes in patients with diabetes older than 50 years: A systematic synthesis without meta-analysis. J Telemed Telecare 2024; 30:285-304. [PMID: 34792400 DOI: 10.1177/1357633x211052222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Elderly people with diabetes are among high-risk groups that require more attention. With the increasing use of technology in healthcare, much emphasis has been placed on telehealth because of its potential to reduce unnecessary healthcare services consumption. We aimed to review and analyse the evidence of various interventions on the effect of using telehealth on biomedical, behavioural, and psychosocial outcomes in patients with diabetes over 50 years. METHODS The search method of this systematic synthesis without meta-analysis was guided by the preferred reporting items for systematic reviews (PRISMA) and the new reporting guideline synthesis without meta-analysis (SWiM) in systematic reviews. A coherent search strategy was designed to retrieve articles in databases such as PubMed, Embase, Scopus, Web of Science, and ClinicalTrials.gov from inception to June 2020. We excluded articles with eligibility criteria of the age of under 50 years old and studies conducted on patients with gestational diabetes. The outcomes were categorized into biomedical, behavioural, and psychosocial outcomes. The methodology of articles was evaluated by the Standard Cochrane Collaboration risk of bias tool in Revman 5.3 software. FINDINGS Overall, 18 studies with 8273 patients with diabetes over the age of 50 were included in this systematic review. Biomedical outcomes such as blood sugar tests and cholesterol tests had significant improvement by using telehealth. Frequency of self-monitored blood glucose (SMBG) and self-efficacy were behavioural outcomes that increased by telehealth utilization. Telehealth had a positive impact on psychosocial outcomes like depression, quality of life (QoL), cognitive decline, and social support. INTERPRETATION Telehealth has the ability to improve multiple outcomes such as behavioural and psychosocial outcomes in health services consumers. Due to varied telehealth interventions and follow-up durations, firm conclusions cannot be reached. As the research investigations studied in the present study were of different kinds and had used different follow-up periods, there is a need for further rigorous studies which consider socio-economic, cultural, and clinical differences.
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Affiliation(s)
- Mohammad Hossein Kaveh
- Research Center for Health Sciences, Department of Health Promotion, School of Health, Institute of Health, Shiraz University of Medical Sciences, Iran
| | | | - Sara Kaveh
- Research Center for Health Sciences, Institute of Health, Shiraz University of Medical Sciences, Iran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Iran
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Seaton J, Jones A, Johnston C, Francis K. Physiotherapy private practitioners' opinions regarding interprofessional collaborative practice: A qualitative study. J Interprof Care 2024; 38:10-21. [PMID: 37288950 DOI: 10.1080/13561820.2023.2221687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/26/2023] [Indexed: 06/09/2023]
Abstract
Physiotherapy private practitioners comprise a growing proportion of Australia's primary care workforce, yet their views and experiences of interprofessional collaborative practice (IPCP) are poorly documented. The aim of this study was to explore Australian physiotherapy private practitioners' opinions regarding IPCP. Twenty-eight semi-structured interviews were conducted with physiotherapists in 10 private practice sites in Queensland, Australia. Interviews were analyzed using reflexive thematic analysis. Data analysis produced five themes that characterized physiotherapists' perceptions of IPCP: (a) quality of care considerations; (b) not a one-size-fits-all approach; (c) the need for effective interprofessional communication; (d) fostering a positive work culture; and (e) fear of losing clientele. The findings from this study suggest that physiotherapy private practitioners value IPCP because it can deliver superior client outcomes, can strengthen interprofessional relationships, and has the potential to enhance the professional reputation of the organizations within which they work. Physiotherapists also claimed that IPCP can contribute to poor client outcomes when performed inappropriately, while some reported approaching interprofessional referrals with caution following instances of lost clientele. The mixed views toward IPCP in this study highlight the need to explore the facilitators and barriers to IPCP in the Australian physiotherapy private practice setting.
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Affiliation(s)
- Jack Seaton
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
| | - Anne Jones
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
| | - Catherine Johnston
- School of Health Sciences, University of Newcastle, Callaghan, New South Wales, Australia
| | - Karen Francis
- School of Nursing, Paramedicine and Healthcare Sciences, Wagga Wagga, New South Wales, Australia
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AGGARWAL MONICA, HUTCHISON BRIAN, ABDELHALIM REHAM, BAKER GROSS. Building High-Performing Primary Care Systems: After a Decade of Policy Change, Is Canada "Walking the Talk?". Milbank Q 2023; 101:1139-1190. [PMID: 37743824 PMCID: PMC10726918 DOI: 10.1111/1468-0009.12674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/29/2023] [Accepted: 08/15/2023] [Indexed: 09/26/2023] Open
Abstract
Policy Points Considerable investments have been made to build high-performing primary care systems in Canada. However, little is known about the extent to which change has occurred over the last decade with implementing programs and policies across all 13 provincial and territorial jurisdictions. There is significant variation in the degree of implementation of structural features of high-performing primary care systems across Canada. This study provides evidence on the state of primary care reform in Canada and offers insights into the opportunities based on changes that governments elsewhere have made to advance primary care transformation. CONTEXT Despite significant investments to transform primary care, Canada lags behind its peers in providing timely access to regular doctors or places of care, timely access to care, developing interprofessional teams, and communication across health care settings. This study examines changes over the last decade (2012 to 2021) in policies across 13 provincial and territorial jurisdictions that address the structural features of high-performing primary care systems. METHODS A multiple comparative case study approach was used to explore changes in primary care delivery across 13 Canadian jurisdictions. Each case consisted of (1) qualitative interviews with academics, provincial health care leaders, and health care professionals and (2) a literature review of policies and innovations. Data for each case were thematically analyzed within and across cases, using 12 structural features of high-performing primary care systems to describe each case and assess changes over time. FINDINGS The most significant changes include adopting electronic medical records, investments in quality improvement training and support, and developing interprofessional teams. Progress was more limited in implementing primary care governance mechanisms, system coordination, patient enrollment, and payment models. The rate of change was slowest for patient engagement, leadership development, performance measurement, research capacity, and systematic evaluation of innovation. CONCLUSIONS Progress toward building high-performing primary care systems in Canada has been slow and variable, with limited change in the organization and delivery of primary care. Canada's experience can inform innovation internationally by demonstrating how preexisting policy legacies constrain the possibilities for widespread primary care reform, with progress less pronounced in the attributes that impact physician autonomy. To accelerate primary care transformation in Canada and abroad, a national strategy and performance measurement framework is needed based on meaningful engagement of patients and other stakeholders. This must be accompanied by targeted funding investments and building strong data infrastructure for performance measurement to support rigorous research.
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Affiliation(s)
| | - BRIAN HUTCHISON
- Centre for Health Economics and Policy AnalysisMcMaster University
| | - REHAM ABDELHALIM
- Institute of Health PolicyManagement and EvaluationUniversity of Toronto
| | - G. ROSS BAKER
- Dalla Lana School of Public HealthUniversity of Toronto
- Institute of Health PolicyManagement and EvaluationUniversity of Toronto
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Schneiders J, Telo GH, Lavinsky D, Dos Reis MA, Corrêa BG, Schaan BD. Organizational intervention to improve access to retinopathy screening for patients with diabetes mellitus: health care service improvement project in a tertiary public hospital. Prim Care Diabetes 2023:S1751-9918(23)00101-8. [PMID: 37328386 DOI: 10.1016/j.pcd.2023.05.007] [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: 06/22/2022] [Revised: 03/27/2023] [Accepted: 05/28/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION The aim of this study was to improve the access to diabetic retinopathy (DR) screening with retinographies in a tertiary care center through a process conducted by an interdisciplinary group driven by a nurse. MATERIALS AND METHODS This is a quality improvement study that evaluated the flow for DR screening conducted by an interdisciplinary group using the Plan-Do-Study-Act methodology. As a result measure, we assessed the quantity of retinographies performed after the project implementation, the proportion of patients who presented abnormal retinographies, and the proportion of patients referred to a specialist. RESULTS The new patient screening flow and the reinforcement of available human resources led to an increase in the number of retinographies performed and screened patients. A total of 1184 retinographies were conducted, and it was possible to observe DR alterations in 37.8 % patients, of which only 6 % needed to be referred to the DR reference center. CONCLUSIONS This study showed a significant increase in the number of retinographies performed. The Plan-Do-Study-Act methodology was an important tool to improve the flow of patient access to fundus images, helping to consistently and continuously improve these processes.
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Affiliation(s)
| | - Gabriela H Telo
- Graduate Program, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Internal Medicine Department, Hospital São Lucas, Porto Alegre, Brazil
| | - Daniel Lavinsky
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | | | - Beatriz D Schaan
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Prabhath S, Handady G, Herle G, Kamath MG, Ramanathan HP. Importance of interprofessional collaboration in teaching diabetic foot self-management: Perceptions of health care professionals. Med J Armed Forces India 2023. [DOI: 10.1016/j.mjafi.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Hao R, Myroniuk T, McGuckin T, Manca D, Campbell-Scherer D, Lau D, Yeung RO. Underuse of cardiorenal protective agents in high-risk diabetes patients in primary care: a cross-sectional study. BMC PRIMARY CARE 2022; 23:124. [PMID: 35606699 PMCID: PMC9128222 DOI: 10.1186/s12875-022-01731-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 05/10/2022] [Indexed: 12/03/2022]
Abstract
Background Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) have shown benefits in patients with diabetes and cardiovascular disease (CVD), heart failure (HF), and chronic kidney disease (CKD). Objective We assessed benchmark outcomes (Hemoglobin A1c, LDL-C, and blood pressure), identified the prevalence of cardiorenal indications for SGLT2i and GLP-1RA, and compared prescribing rates of GLP1-RA and SGLT2i in those with and without cardiorenal indications. Methods We analyzed data from January 2018–June 2019 for 7168 patients with diabetes using electronic medical records from the Northern Alberta Primary Care Research Network, a regional network of the Canadian Primary Sentinel Surveillance Network (CPCSSN). Patients with and without cardiorenal comorbidities were compared using descriptive statistics and two proportion Z tests. Results Hemoglobin A1c ≤ 7.0% was met by 56.8%, blood pressure < 130/80 mmHg by 62.1%, LDL-C ≤ 2.0 mmol/L by 45.3% of patients. There were 4377 patients on glucose lowering medications; metformin was most common (77.7%), followed by insulin (24.6%), insulin secretagogues (23.6%), SGLT2i (19.7%), dipeptidyl peptidase-4 inhibitor (19.3%), and GLP-1RA (9.4%). A quarter of patients had cardiorenal indications for SGLT2i or GLP-1RA. Use of SGLT2i in these patients was lower than in patients without cardiorenal comorbidities (14.9% vs 21.2%, p < 0.05). GLP-1RA use in these patients was 4.6% compared with 11% in those without cardiorenal comorbidities (p < 0.05). Discussion Contrary to current evidence and recommendations, SGLT2i and GLP1-RA were less likely to be prescribed to patients with pre-existing CVD, HF, and/or CKD, revealing opportunities to improve prescribing for patients with diabetes at high-risk for worsening cardiorenal complications. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01731-w.
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Torti JMI, Szafran O, Kennett SL, Bell NR. Interprofessional care of patients with type 2 diabetes mellitus in primary care: family physicians’ perspectives. BMC PRIMARY CARE 2022; 23:74. [PMID: 35395729 PMCID: PMC8990268 DOI: 10.1186/s12875-022-01688-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/05/2022] [Indexed: 11/10/2022]
Abstract
Background There is a lack of understanding of the team processes and factors that influence teamwork and medication management practices in the care of patients with type 2 diabetes mellitus (T2DM). The purpose of the study was to explore physicians’ perspectives of barriers and facilitators to interprofessional care of patients with T2DM within team-based family practice settings. Methods This was a qualitative, descriptive study. Participants included physicians affiliated with a primary care network providing care to patients with T2DM in an interprofessional team-based primary care setting in Edmonton, Alberta, Canada. Participants’ contact information was obtained from the publicly available College of Physicians and Surgeons of Alberta and respective primary care network websites. Interview questions addressed physicians’ perspectives on factors or processes that facilitated and hindered the care and medication management of adult patients with T2DM in primary care team-based clinical practice. Interviews were audio-recorded, transcribed, and analyzed using qualitative content analysis and a constant comparative approach. Results A total of 15 family physicians participated in individual interviews. Family physicians identified facilitators of interprofessional team-based care and medication management of patients with T2DM in three theme areas—access to team members and programs, knowledgeable and skilled health professionals, and provision of patient education by other health professionals. Two themes emerged as barriers to interprofessional care – lack of provider continuity and the loss of skills from delegation of tasks. Conclusion Family physicians perceive both benefits and risks to interprofessional team-based care in caring for patients with T2DM. Successful functioning of team-based care in family practice will require overcoming traditional professional roles.
Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01688-w.
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Vrkatić A, Grujičić M, Jovičić-Bata J, Novaković B. Nutritional Knowledge, Confidence, Attitudes towards Nutritional Care and Nutrition Counselling Practice among General Practitioners. Healthcare (Basel) 2022; 10:2222. [PMID: 36360563 PMCID: PMC9691229 DOI: 10.3390/healthcare10112222] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/30/2022] [Accepted: 11/03/2022] [Indexed: 08/04/2023] Open
Abstract
Nutritional care represents any practice provided by a health professional, aimed to improve the patient's health outcomes by influencing patient's dietary habits. Clearly, dietitians are the ones supposed to provide top-quality nutrition care, but their services are often inaccessible to many for various reasons. This obliges general practitioners (GPs) in primary health care to provide nutritional counselling to their patients to a certain extent. Preconditions to successful nutritional counselling are GPs with adequate nutritional knowledge, positive attitudes towards nutrition and nutritional care, self-confident and competent in nutritional counselling. Therefore, the aim of this review is to summarise currently available information on nutritional knowledge, confidence and attitudes towards nutritional care and nutrition counselling practice of GPs, as well as barriers towards provision of nutritional counselling. GPs do not consistently obtain satisfying results in nutrition knowledge assessments and their self-confidence in nutrition counselling skills varies. Studies suggest that nutritional counselling practice still has not met its full potential, and GPs frequently report various barriers that impair nutritional counselling practice. Thus, health policies that help overcome barriers and create stimulating environment for GPs to implement nutrition counselling strategies efficiently are the key to improving quality and quantity of nutritional counselling.
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Affiliation(s)
- Aleksandra Vrkatić
- Department of Pharmacy, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
| | - Maja Grujičić
- Department of General Education Subjects, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
| | - Jelena Jovičić-Bata
- Department of Pharmacy, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
| | - Budimka Novaković
- Department of Pharmacy, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
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Castillo-Laborde C, Hirmas-Adauy M, Matute I, Jasmen A, Urrejola O, Molina X, Awad C, Frey-Moreno C, Pumarino-Lira S, Descalzi-Rojas F, Ruiz TJ, Plass B. Barriers and Facilitators in Access to Diabetes, Hypertension, and Dyslipidemia Medicines: A Scoping Review. Public Health Rev 2022; 43:1604796. [PMID: 36120091 PMCID: PMC9479461 DOI: 10.3389/phrs.2022.1604796] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 07/27/2022] [Indexed: 12/03/2022] Open
Abstract
Objective: Identify barriers and facilitators in access to medicines for diabetes, hypertension, and dyslipidemia, considering patient, health provider, and health system perspectives. Methods: Scoping review based on Joanna Briggs methodology. The search considered PubMed, Cochrane Library, CINAHL, Academic Search Ultimate, Web of Science, SciELO Citation Index, and grey literature. Two researchers conducted screening and eligibility phases. Data were thematically analyzed. Results: The review included 219 documents. Diabetes was the most studied condition; most of the evidence comes from patients and the United States. Affordability and availability of medicines were the most reported dimension and specific barrier respectively, both cross-cutting concerns. Among high- and middle-income countries, identified barriers were cost of medicines, accompaniment by professionals, long distances to facilities, and cultural aspects; cost of transportation emerges in low-income settings. Facilitators reported were financial accessibility, trained health workers, medicines closer to communities, and patients’ education. Conclusion: Barriers and facilitators are determined by socioeconomic and cultural conditions, highlighting the role of health systems in regulatory and policy context (assuring financial coverage and free medicines); providers’ role bringing medicines closer; and patients’ health education and disease management.
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Affiliation(s)
- Carla Castillo-Laborde
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- *Correspondence: Carla Castillo-Laborde,
| | - Macarena Hirmas-Adauy
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Isabel Matute
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Anita Jasmen
- Biblioteca Biomédica, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Oscar Urrejola
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Xaviera Molina
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Camila Awad
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Catalina Frey-Moreno
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Sofia Pumarino-Lira
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Fernando Descalzi-Rojas
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Tomás José Ruiz
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Barbara Plass
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
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Matsunaga M, Horiuchi S, Kataoka Y, Igarashi Y, Porter SE, Fukui T. Continuous interprofessional collaboration for women with gestational diabetes mellitus: A cross-sectional survey in Japan. Jpn J Nurs Sci 2021; 18:e12438. [PMID: 34235854 DOI: 10.1111/jjns.12438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/28/2021] [Accepted: 05/20/2021] [Indexed: 11/26/2022]
Abstract
AIM This study aimed to identify the current situation of interprofessional collaboration for gestational diabetes mellitus (GDM) management in Japan including the professionals involved, the collaboration methods employed, and the barriers perceived by nurses and midwives. METHODS This nationwide cross-sectional survey of 1,046 total hospitals facilitating childbirth in Japan used an original 60-item questionnaire to investigate GDM management practice through interprofessional collaboration. The questionnaire required one responder to be a midwife or nurse who was familiar with the management practices for GDM women in their respective hospitals. Quantitative data were analyzed using descriptive statistics, and framework analysis was conducted for qualitative data collected by open-ended questions. RESULTS All 308 respondents (response rate 29.4%) were included. The professionals included in interprofessional collaboration were limited, and the only strategy used for interprofessional collaboration by a majority (91.5%) of hospitals was medical charts. There were 50.8% of hospitals that provided postpartum GDM follow-ups and 54.5% of hospitals that did not engage in external collaboration for GDM management. The barriers to interprofessional collaboration extracted were seven categories and 23 subcategories, which were aligned within the following units of analysis: individual, team, organization, and community. CONCLUSIONS This survey shows that interprofessional collaboration, including support for GDM postpartum follow-up in Japan remains insufficient. Furthermore, nurses and midwives perceive numerous barriers to interprofessional collaboration for continuous GDM management at the individual, team, organizational and community levels.
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Affiliation(s)
- Mayumi Matsunaga
- Women's Health and Midwifery, St. Luke's International University-Graduate School, Tokyo, Japan
| | - Shigeko Horiuchi
- Women's Health and Midwifery, St. Luke's International University-Graduate School, Tokyo, Japan
| | - Yaeko Kataoka
- Women's Health and Midwifery, St. Luke's International University-Graduate School, Tokyo, Japan.,Midwifery Policy Committee, Japan Academy of Midwifery, Tokyo, Japan
| | - Yumiko Igarashi
- Women's Health and Midwifery, St. Luke's International University-Graduate School, Tokyo, Japan
| | - Sarah E Porter
- Educational Advisor, St. Luke's International University, Tokyo, Japan
| | - Toshiko Fukui
- Japanese Nursing Association, Executive Board, Tokyo, Japan
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Damiani G, Pascucci D, Sindoni A, Mete R, Ricciardi W, Villari P, De Vito C. The bigger, the better? A systematic review on the impact of mergers on primary care organizations. Eur J Public Health 2021; 31:244-252. [PMID: 33624788 PMCID: PMC8071597 DOI: 10.1093/eurpub/ckaa248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Primary care services are the first point of contact in a healthcare system; in the last years, many mergers and reconfigurations have taken place in this setting. The aim of this study is to summarize the literature evidence on the relationship between the increase in the size of these organizations and their performance. METHODS A systematic review of the literature was carried out querying EMBASE, MEDLINE and Web of Science databases, from their inception to January 2020. Articles which quantitatively assessed outcomes and process indicators of merger/structural reorganization of primary care organizations and qualitative articles that assessed staff perception and satisfaction were included in the review. RESULTS A total of 3626 articles was identified and another study was retrieved through snowball search; 11 studies were included in the systematic review. Studies about lipid profile evaluation and emergency admissions for chronic conditions showed moderate evidence in supporting the merging of primary care organizations; conversely, clinical outcome studies did not reach a sufficient level of evidence to support merging actions. A moderate evidence of a negative effect on patient's perspective was found. CONCLUSION Actually, there is no strong evidence in favour or against merging of primary care organizations without equivocation. This review supports the possibility to identify indicators for evaluating a merging process of primary care organizations and for adopting eventual remedies during this process. Further efforts should be made to identify additional indicators to assess merge actions among primary care organizations.
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Affiliation(s)
- Gianfranco Damiani
- Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Domenico Pascucci
- Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Sindoni
- Dipartimento di Sanità Pubblica e Malattie Infettive, Sapienza Università di Roma, Rome, Italy
| | | | - Walter Ricciardi
- Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Paolo Villari
- Dipartimento di Sanità Pubblica e Malattie Infettive, Sapienza Università di Roma, Rome, Italy
| | - Corrado De Vito
- Dipartimento di Sanità Pubblica e Malattie Infettive, Sapienza Università di Roma, Rome, Italy
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Kiles TM, Hall EA, Scott D, Cernasev A. Enhancing Student Knowledge of Diabetes through Virtual Choose Your Own Adventure Patient Case Format. PHARMACY 2021; 9:pharmacy9020087. [PMID: 33924071 PMCID: PMC8167788 DOI: 10.3390/pharmacy9020087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 04/05/2021] [Accepted: 04/14/2021] [Indexed: 11/16/2022] Open
Abstract
Educational strategies to teach pharmacy students about diabetes are necessary to prepare future pharmacists to manage complex patients. The Choose Your Own Adventure (CYOA) patient case format is an innovative activity that presents a patient case in an engaging way. The objectives of this study were (1) to describe the development of the innovative teaching activity and (2) to assess its effect on student knowledge and confidence in outpatient management of diabetes. The CYOA patient case activity was designed by transforming a traditional paper patient case involving outpatient diabetes management into an interactive format utilizing an online platform. The activity was conducted with 186 second-year pharmacy students in a skills-based course. This activity was administered virtually through a combination of small group work and large group discussion. After completion of the activity, students completed an online self-assessment questionnaire. Of 178 completed questionnaires, there was a statistically significant difference in students’ self-ratings after versus before the activity for all survey items (p < 0.001). The CYOA activity improved self-reported knowledge of outpatient diabetes management and increased self-reported confidence in clinical decision-making skills. This format shows promise as an educational tool that may be adapted for other disease states to enhance clinical decision-making skills.
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Affiliation(s)
- Tyler Marie Kiles
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, The University of Tennessee Health Science Center, Memphis, TN 38163, USA;
- Correspondence:
| | - Elizabeth A. Hall
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, The University of Tennessee Health Science Center, Memphis, TN 38163, USA;
| | - Devin Scott
- Teaching and Learning Center, College of Pharmacy, The University of Tennessee Health Science Center, Memphis, TN 38163, USA;
| | - Alina Cernasev
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, The University of Tennessee Health Science Center, Nashville, TN 37211, USA;
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Abdulrhim S, Sankaralingam S, Ibrahim MIM, Diab MI, Hussain MAM, Al Raey H, Ismail MT, Awaisu A. Collaborative care model for diabetes in primary care settings in Qatar: a qualitative exploration among healthcare professionals and patients who experienced the service. BMC Health Serv Res 2021; 21:192. [PMID: 33653324 PMCID: PMC7927378 DOI: 10.1186/s12913-021-06183-z] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 02/16/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Diabetes mellitus is highly prevalent and associated with huge economic burden globally. The conventional care and management of diabetes mellitus is highly fragmented and complex, warranting the need for a comprehensive Collaborative Care Model (CCM). Little is known about the perception of patients with diabetes and their healthcare providers about CCM, its barriers and facilitators. This study aimed to explore the value of CCM in diabetes care at a primary healthcare (PHC) setting from the perspective of patients with diabetes and healthcare professionals (HCPs), in an effort to expand our current knowledge on collaborative care in diabetes at primary care level for the purpose of quality improvement and service expansion. METHODS Using an exploratory case study approach, semi-structured interviews were conducted among patients and HCPs who encountered CCM in Qatar during 2019 and 2020. The semi-structured interviews were transcribed verbatim and the data were analysed and interpreted using a deductive-inductive thematic analysis approach. RESULTS Twelve patients and 12 HCPs at a diabetes clinic participated in one-to-one interviews. The interviews resulted in five different themes: the process and components of collaborative care model (four subthemes), current organizational support and resources (three subthemes), impact of collaborative care model on diabetes outcomes (three subthemes), enablers of collaborative care model (three subthemes), and barriers to collaborative care model (three subthemes). The participants indicated easy access to and communication with competent and pleasant HCPs. The patients appreciated the extra time spent with HCPs, frequent follow-up visits, and health education, which empowered them to self-manage diabetes. HCPs believed that successful CCM provision relied on their interest and commitment to care for patients with diabetes. Generally, participants identified barriers and facilitators that are related to patients, HCPs, and healthcare system. CONCLUSIONS The providers and users of CCM had an overall positive perception and appreciation of this model in PHC settings. Barriers to CCM such as undesirable attributes of HCPs and patients, unsupportive hospital system, and high workload must be addressed before implementing the model in other PHC settings.
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Affiliation(s)
- Sara Abdulrhim
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | | | | | - Mohammed Issam Diab
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | | | - Hend Al Raey
- Qatar Petroleum Healthcare Center, Dukhan, Qatar
| | | | - Ahmed Awaisu
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar.
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15
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Siopis G, Colagiuri S, Allman-Farinelli M. Doctors identify regulatory barriers for their patients with type 2 diabetes to access the nutritional expertise of dietitians. Aust J Prim Health 2021; 27:312-318. [PMID: 33352088 DOI: 10.1071/py20228] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/07/2020] [Indexed: 11/23/2022]
Abstract
Diet is central to the management of type 2 diabetes (T2D) and better outcomes are achieved when the dietary intervention is delivered by a dietitian. Yet, many people with T2D never see a dietitian. It has been proposed that doctors prefer to provide the dietary advice themselves or rely on medication to treat their patients instead of referring them to a dietitian. This study aimed to collect the opinions and perspectives of doctors with regard to the dietary management of people with T2D in Australia. GPs and physicians treating people with T2D were recruited to participate in semistructured interviews conducted over the telephone. Inductive thematic analysis of content was conducted. Five GPs and seven physicians participated in the study. The qualitative analysis identified four main themes: the importance and role of diet in the management of T2D; the perceived value of dietetic care; access to dietetic services; and patients' motivation to consult a dietitian. All participants acknowledged the importance of diet in the treatment of T2D and all but one preferred to refer patients to a dietitian for nutritional management. Among the reported barriers to accessing dietetic services were: specialist physicians' lack of access to the national referral scheme for chronic conditions; patients' financial circumstances; and inadequacy of the number of subsidised sessions. It is important to facilitate and subsidise access to dietetic services through existing mechanisms by increasing the number of visits on the chronic disease management scheme and providing referral rights to specialist physicians.
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Affiliation(s)
- George Siopis
- Charles Perkins Centre, School of Life and Environmental Sciences, The University of Sydney, Sydney, NSW 2006, Australia; and Corresponding author.
| | - Stephen Colagiuri
- Charles Perkins Centre, Boden Collaboration, The University of Sydney, Sydney, NSW 2006, Australia
| | - Margaret Allman-Farinelli
- Charles Perkins Centre, School of Life and Environmental Sciences, The University of Sydney, Sydney, NSW 2006, Australia
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16
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Bari B, Corbeil MA, Farooqui H, Menzies S, Pflug B, Smith BK, Vasquez A, Berard L. Insulin Injection Practices in a Population of Canadians with Diabetes: An Observational Study. Diabetes Ther 2020; 11:2595-2609. [PMID: 32893337 PMCID: PMC7475025 DOI: 10.1007/s13300-020-00913-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Proper insulin injection technique has demonstrated positive clinical outcomes in patients with diabetes. A Canadian-based practice reflective was undertaken to evaluate the current state of understanding of injection technique practices by patients administering insulin, and the importance physicians place on proper injection technique. METHODS Twenty-four sites across Canada completed a practice profile survey and enrolled adult non-pregnant patients with either type 1 or type 2 diabetes injecting insulin using an insulin pen. Seven areas of proper injection technique to be evaluated were identified by the study steering committee: size of injection site, use of a skin lift, needle reuse, length of the needle, duration of the needle in the skin, injection into lipohypertrophic tissue, and applied injection force. During a scheduled visit, each patient filled out the Injection Technique Survey and the physician documented the answers via an electronic database. RESULTS Almost all physicians surveyed agreed (96%) that proper insulin injection technique is important or very important and 80% indicated they were either completely confident or fairly confident in discussing overall insulin injection technique. All patients surveyed were making at least one insulin injection technique error within the following categories: applied injection force (76%), area size of injection site (64%), duration of pen needle in skin (61%), pen needle reuse (39%), performs a skin lift with a 4 or 5 mm needle (38%), uses a longer pen needle than required (34%), and injection of insulin into lipohypertrophic tissue (37%). CONCLUSION Patients commonly make insulin injection errors. Patient and physician education on optimal insulin injection technique continues to be an unmet medical need for the treatment of patients with diabetes. Prospective trials examining the impact of new technology, diabetes educational teams, and e-learning as educational interventions are potential avenues to explore in future studies to support improved insulin injection technique.
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Affiliation(s)
- Basel Bari
- Markham HealthPlex Medical Centre, Markham, ON, Canada
| | | | - Hena Farooqui
- Medical Division, CTC Communications, Mississauga, ON, Canada
| | - Stuart Menzies
- Medical Division, CTC Communications, Mississauga, ON, Canada
| | - Brian Pflug
- Becton, Dickinson and Company, Franklin Lakes, NJ, USA
| | - Brennan K Smith
- Medical Division, CTC Communications, Mississauga, ON, Canada
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Family physician perceptions of barriers and enablers to integrating a co-located clinical pharmacist in a medical clinic: A qualitative study. J Am Pharm Assoc (2003) 2020; 60:1021-1028. [PMID: 32900606 DOI: 10.1016/j.japh.2020.08.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/04/2020] [Accepted: 08/10/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Pharmacists from The University of British Columbia Pharmacists Clinic provide comprehensive medication management services once to twice a month through the co-location model at multiple general practice clinics beginning from 2014 and consistently since 2016. For some of the clinics, this was the first experience with a co-located allied health professional. The objective of this study was to examine the perspectives of physicians who had a relatively long-standing relationship with a co-located pharmacist to identify barriers and facilitators to integrating a clinical pharmacist. METHODS A qualitative research methodology was used to gain the perspectives of physicians. Data were collected through convenience sampling and one-on-one semistructured interviews. In-person or telephone interviews were conducted from August 12, 2019, to September 10, 2019, and audio was recorded with the participants' consent. The recorded interviews were transcribed, and a thematic analysis with an inductive approach was used to analyze the data. RESULTS Eight physicians from 4 general practice clinics were interviewed. Analysis of the interviews identified 6 themes that contained barriers or enablers to the integration of a co-located pharmacist: (1) electronic medical record (EMR) use, (2) identifying patients and the referral process, (3) workload and logistics, (4) patients' willingness, (5) impact of in-person communication, and (6) shifting physicians' perspectives. The enablers included the use of an EMR to proactively identify patient referrals, a dedicated pharmacist workspace, a physician champion, and intentional scheduling of in-person physician-pharmacist case conferences. The barriers included identifying patients for referral, the lack of EMR interoperability, pharmacist availability, physician colleagues who were less committed to team-based care, and financial implications despite externally funded pharmacists. CONCLUSION The physician participants perceived several barriers and enablers to the integration of a pharmacist into their practice. The themes identified can be used to inform physicians and pharmacists on the integration process for team-based primary care.
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Artaza O, Santacruz J, Girard J, Alvarez D, Barría S, Tetelboin C, Tomasina F, Medina A. [Training of human resources for universal health: strategic actions from academic institutions]. Rev Panam Salud Publica 2020; 44:e83. [PMID: 32733545 PMCID: PMC7384700 DOI: 10.26633/rpsp.2020.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 06/11/2020] [Indexed: 11/24/2022] Open
Abstract
El desafío de avanzar hacia la materialización del derecho a la salud para todos a través de la estrategia para el acceso y la cobertura universal de salud (salud universal) requiere de múltiples condiciones y acciones. Una de ellas es contar con trabajadores de la salud suficientes, bien distribuidos y con las competencias y motivación que hagan posible la transformación de los servicios de salud y proporcionen respuestas integrales y de calidad a las personas y sus comunidades. Este artículo, producto del diálogo de académicos de diversos centros universitarios de las Américas, reflexiona y enfatiza cuatro dimensiones esenciales: la planificación, la formación interprofesional, la misión o responsabilidad social de los centros formadores y el uso de modelos de docencia-servicio-investigación. Estas dimensiones deben ser atendidas para una formación integral de profesionales de salud que contribuyan a hacer factible la salud universal.
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Affiliation(s)
- Osvaldo Artaza
- Universidad de las Américas Santiago de Chile Chile Universidad de las Américas, Santiago de Chile, Chile
| | - Javier Santacruz
- Universidad Nacional Autónoma de México Ciudad de México México Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Jacques Girard
- Universidad Laval Quebec Canadá Universidad Laval, Quebec, Canadá
| | - Daniela Alvarez
- Universidad Nacional Arturo Jauretche Florencio Varela Argentina Universidad Nacional Arturo Jauretche, Florencio Varela, Argentina
| | - Soledad Barría
- Universidad de Chile Santiago de Chile Chile Universidad de Chile, Santiago de Chile, Chile
| | - Carolina Tetelboin
- Universidad Autónoma Metropolitana Ciudad de México México Universidad Autónoma Metropolitana, Ciudad de México, México
| | - Fernando Tomasina
- Universidad de la República Montevideo Uruguay Universidad de la República, Montevideo, Uruguay
| | - Arnaldo Medina
- Universidad de las Américas Santiago de Chile Chile Universidad de las Américas, Santiago de Chile, Chile.,Universidad Nacional Autónoma de México Ciudad de México México Universidad Nacional Autónoma de México, Ciudad de México, México.,Universidad Laval Quebec Canadá Universidad Laval, Quebec, Canadá.,Universidad Nacional Arturo Jauretche Florencio Varela Argentina Universidad Nacional Arturo Jauretche, Florencio Varela, Argentina.,Universidad de Chile Santiago de Chile Chile Universidad de Chile, Santiago de Chile, Chile.,Universidad Autónoma Metropolitana Ciudad de México México Universidad Autónoma Metropolitana, Ciudad de México, México.,Universidad de la República Montevideo Uruguay Universidad de la República, Montevideo, Uruguay
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Mao Y, Fu H, Feng Z, Feng D, Chen X, Yang J, Li Y. Could the connectedness of primary health care workers involved in social networks affect their job burnout? A cross-sectional study in six counties, Central China. BMC Health Serv Res 2020; 20:557. [PMID: 32552752 PMCID: PMC7302340 DOI: 10.1186/s12913-020-05426-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 06/12/2020] [Indexed: 11/24/2022] Open
Abstract
Background This study aimed to reveal the effects of the connectedness of primary health care (PHC) workers in social networks on their job burnout. Methods Cross-sectional survey data of rural PHC workers in China were analyzed. A total of 663 respondents were enrolled. Chi-square and cumulative logistic regression were used to determine the effects of the connectedness of PHC workers in social networks on their job burnout. Results PHC workers in rural China had high levels of emotional exhaustion (24.1%), depersonalization (15.7%), and lack of personal accomplishment (34.7%). More than half of the participants were in the middle connectedness level in terms of their advisory (70.4%) and friendship (70.3%) networks. The degree of emotional exhaustion seemed to increase when participants had a low connectedness in their friendship networks (β = 0.769, 95% CI = 0.080–1.458, P = 0.029). Respondents with the middle level of connectedness in advisory networks had higher levels of depersonalization (β = 0.739, 95% CI = 0.130–1.348, P = 0.017) and lack of personal accomplishment (β = 0.583, 95% CI = 0.111–1.055, P = 0.015) than those with the high degree of connectedness in advisory networks. Conclusions The connectedness of PHC workers in social networks influenced their job burnout. Thus, organizations should establish an informal communication platform and information feedback mechanism, promote and manage friendship networks, and help PHC workers overcome emotional exhaustion. Managers should also encourage individuals with a high level of connectedness in advisory networks play the role of “opinion leader” so that they can help others mitigate burnout.
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Affiliation(s)
- Yiqing Mao
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.,Research center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, 430030, Hubei, China
| | - Hang Fu
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Zhanchun Feng
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China. .,Research center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, 430030, Hubei, China.
| | - Da Feng
- School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Xiaoyu Chen
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.,Research center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, 430030, Hubei, China
| | - Jian Yang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.,Research center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, 430030, Hubei, China
| | - Yuanqing Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.,Research center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, 430030, Hubei, China
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van Bruggen S, Rauh SP, Bonten TN, Chavannes NH, Numans ME, Kasteleyn MJ. Association between GP participation in a primary care group and monitoring of biomedical and lifestyle target indicators in people with type 2 diabetes: a cohort study (ELZHA cohort-1). BMJ Open 2020; 10:e033085. [PMID: 32345697 PMCID: PMC7213889 DOI: 10.1136/bmjopen-2019-033085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Whether care group participation by general practitioners improves delivery of diabetes care is unknown. Using 'monitoring of biomedical and lifestyle target indicators as recommended by professional guidelines' as an operationalisation for quality of care, we explored whether (1) in new practices monitoring as recommended improved a year after initial care group participation (aim 1); (2) new practices and experienced practices differed regarding monitoring (aim 2). DESIGN Observational, real-life cohort study. SETTING Primary care registry data from Eerstelijns Zorggroep Haaglanden (ELZHA) care group. PARTICIPANTS Aim 1: From six new practices (n=538 people with diabetes) that joined care group ELZHA in January 2014, two practices (n=211 people) were excluded because of missing baseline data; four practices (n=182 people) were included. Aim 2: From all six new practices (n=538 people), 295 individuals were included. From 145 experienced practices (n=21 465 people), 13 744 individuals were included. EXPOSURE Care group participation includes support by staff nurses on protocolised diabetes care implementation and availability of a system providing individual monitoring information. 'Monitoring as recommended' represented minimally one annual registration of each biomedical (HbA1c, systolic blood pressure, low-density lipoprotein) and lifestyle-related target indicator (body mass index, smoking behaviour, physical exercise). PRIMARY OUTCOME MEASURES Aim 1: In new practices, odds of people being monitored as recommended in 2014 were compared with baseline (2013). Aim 2: Odds of monitoring as recommended in new and experienced practices in 2014 were compared. RESULTS Aim 1: After 1-year care group participation, odds of being monitored as recommended increased threefold (OR 3.00, 95% CI 1.84 to 4.88, p<0.001). Aim 2: Compared with new practices, no significant differences in the odds of monitoring as recommended were found in experienced practices (OR 1.21, 95% CI 0.18 to 8.37, p=0.844). CONCLUSIONS We observed a sharp increase concerning biomedical and lifestyle monitoring as recommended after 1-year care group participation, and subsequently no significant difference between new and experienced practices-indicating that providing diabetes care within a collective approach rapidly improves registration of care.
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Affiliation(s)
- Sytske van Bruggen
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Chronical Care, Hadoks, The Hague, The Netherlands
| | - Simone P Rauh
- Department of Epidemiology and Biostatistics, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Tobias N Bonten
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Niels H Chavannes
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Mattijs E Numans
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Marise J Kasteleyn
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
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Seaton JA, Jones AL, Johnston CL, Francis KL. The characteristics of Queensland private physiotherapy practitioners' interprofessional interactions: a cross-sectional survey study. Aust J Prim Health 2020; 26:500-506. [PMID: 33239149 DOI: 10.1071/py20148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/09/2020] [Indexed: 11/23/2022]
Abstract
Effective interprofessional collaboration (IPC) contributes to superior patient outcomes, facilitates cost-efficient health care, and increases patient and practitioner satisfaction. However, there is concern that IPC may be difficult to implement in clinical settings that do not conform to formal team-based processes, such as mono-professional physiotherapy private practice facilities. The aim of this study was to describe the characteristics of private physiotherapy practitioners' interprofessional interactions, including their experiences and perceptions regarding IPC. A custom developed cross-sectional online survey instrument was used to collect data from physiotherapists employed in private practice facilities in Queensland, Australia. In all, 49 (20% response rate) physiotherapists completed the survey. Only a small proportion (14%) indicated that their interprofessional interactions were a daily occurrence, and less than one-third of all respondents (31%) participated in formal, multi-professional face-to-face planned meetings. Most participants (76%) reported a moderate-to-high level of satisfaction regarding their interprofessional interactions. Despite low self-reported levels of interprofessional activity and other data indicating that IPC is necessary for holistic patient care, this study shows that physiotherapists were predominately satisfied when interacting with health practitioners from various professional backgrounds. Further research is required to inform the implementation of robust strategies that will support sustainable models of IPC in physiotherapy private practice.
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Affiliation(s)
- Jack A Seaton
- College of Healthcare Sciences, James Cook University, 1 James Cook Drive, Townsville, Qld 4811, Australia; and College of Public Health, Medical and Veterinary Sciences, James Cook University, 1 James Cook Drive, Townsville, Qld 4811, Australia; and Corresponding author.
| | - Anne L Jones
- College of Healthcare Sciences, James Cook University, 1 James Cook Drive, Townsville, Qld 4811, Australia
| | - Catherine L Johnston
- College of Public Health, Medical and Veterinary Sciences, James Cook University, 1 James Cook Drive, Townsville, Qld 4811, Australia
| | - Karen L Francis
- School of Health Sciences, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
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22
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Engel J, Prentice D, Hicks R. Where Does the Patient Fit? An Analysis of Word Use Within the Context of Interprofessional Collaborative Care. Glob Qual Nurs Res 2019; 6:2333393619889353. [PMID: 31840037 PMCID: PMC6900618 DOI: 10.1177/2333393619889353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 10/17/2019] [Accepted: 10/24/2019] [Indexed: 11/15/2022] Open
Abstract
Patient-centeredness is considered central to interprofessional collaborative patient care as a participatory, partnered approach between health care professionals and patients. Content analysis of 501 articles from the 1986, 1987, 1988, 1996, 2006, 2013, 2014, and 2018 volumes of a selected journal was undertaken. The purposes were to identify contexts in which the term patient was used in articles with a primary focus on interprofessional care and to identify trends in its usage. With Dilthey's ideas on language as a framework, patient and its variations in the articles were coded under five categories. Findings suggest that the term patient appears predominantly as a modifier for activities enacted by experts and a platform for the discussion of relationships among professionals. There is limited evidence that use of the term patient fits within the context of partnership, suggesting that the language in published interprofessional collaborative research and discussion is currently largely expert, not patient-centered.
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Affiliation(s)
- Joyce Engel
- Brock University, St. Catharines, Ontario, Canada
| | | | - Rachel Hicks
- Brock University, St. Catharines, Ontario, Canada
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