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Li D, Pan E, Sun Z, Wen J, Su M, Wu M, Su J, Zhou J, Fan H, Shen C. Associations between perceived care quality, self-care behaviors, and glycemic control in Chinese adults with type 2 diabetes under the national essential public health services program. BMC Public Health 2024; 24:1964. [PMID: 39044169 PMCID: PMC11265356 DOI: 10.1186/s12889-024-19538-y] [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: 12/03/2023] [Accepted: 07/19/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND The rising prevalence of Type 2 diabetes (T2D) in China poses a critical health challenge, necessitating effective management strategies. The National Essential Public Health Services Program (NEPHSP), initiated in 2009, focuses on equitable access to health services, including T2D management. This study investigates the associations between perceived care quality, self-care behaviors, and glycemic control in Chinese adults with T2D under NEPHSP, particularly examining the mediating role of self-care behaviors. METHODS Conducted from April to November 2020 in Huai'an City, Jiangsu Province, this study involved 1,577 T2D patients enrolled in NEPHSP. We assessed perceived care quality using the Patient Assessment of Chronic Illness Care (PACIC) scale and developed a comprehensive self-care behavior score, covering nine essential health practices. Glycemic control was evaluated using HbA1c levels. Linear regression models were used to explore these associations, adjusting for demographic and clinical factors, while causal mediation analyses examined the role of intermediate variables. RESULTS Higher PACIC scores significantly correlated with improved self-care behaviors (β = 0.294, 95% CI: 0.233 to 0.354) and were negatively associated with HbA1c levels (β=-0.109, 95% CI: -0.192 to -0.026). The self-care behavior score inversely related to HbA1c levels (β=-0.197, 95% CI: -0.263 to -0.132). Notably, self-care behaviors mediated 50.41% (P < 0.05) of the effect of perceived care quality on HbA1c levels. CONCLUSIONS This study demonstrates a substantial association between perceived care quality and better glycemic control in Chinese adults with T2D under NEPHSP, with self-care behaviors playing a crucial mediating role. These findings suggest that patient-centered care and comprehensive self-care practices are essential for effective T2D management within NEPHSP.
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Affiliation(s)
- Dianjiang Li
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, China.
| | - Enchun Pan
- Department of Chronic Disease Prevention and Control, Huai'an City Center for Disease Control and Prevention, Huai'an, China
| | - Zhongming Sun
- Department of Chronic Disease Prevention and Control, Huai'an City Center for Disease Control and Prevention, Huai'an, China
| | - Jinbo Wen
- Department of Chronic Disease Prevention and Control, Huai'an City Center for Disease Control and Prevention, Huai'an, China
| | - Ming Su
- Huai'an District Center for Disease Control and Prevention, Huai'an, China
| | - Ming Wu
- Department of Chronic Disease Prevention and Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Jian Su
- Department of Chronic Disease Prevention and Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Jinyi Zhou
- Department of Chronic Disease Prevention and Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Hong Fan
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Chong Shen
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, China
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Yu C, Choi D, Bruno BA, Thorpe KE, Straus SE, Cantarutti P, Chu K, Frydrych P, Hoang-Kim A, Ivers N, Kaplan D, Leung FH, Maxted J, Rezmovitz J, Sale J, Sodhi-Helou S, Stacey D, Telner D. Impact of MyDiabetesPlan, a Web-Based Patient Decision Aid on Decisional Conflict, Diabetes Distress, Quality of Life, and Chronic Illness Care in Patients With Diabetes: Cluster Randomized Controlled Trial. J Med Internet Res 2020; 22:e16984. [PMID: 32996893 PMCID: PMC7557444 DOI: 10.2196/16984] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 05/04/2020] [Accepted: 08/11/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Person-centered care is critical for delivering high-quality diabetes care. Shared decision making (SDM) is central to person-centered care, and in diabetes care, it can improve decision quality, patient knowledge, and patient risk perception. Delivery of person-centered care can be facilitated with the use of patient decision aids (PtDAs). We developed MyDiabetesPlan, an interactive SDM and goal-setting PtDA designed to help individualize care priorities and support an interprofessional approach to SDM. OBJECTIVE This study aims to assess the impact of MyDiabetesPlan on decisional conflict, diabetes distress, health-related quality of life, and patient assessment of chronic illness care at the individual patient level. METHODS A two-step, parallel, 10-site cluster randomized controlled trial (first step: provider-directed implementation only; second step: both provider- and patient-directed implementation 6 months later) was conducted. Participants were adults 18 years and older with diabetes and 2 other comorbidities at 10 family health teams (FHTs) in Southwestern Ontario. FHTs were randomly assigned to MyDiabetesPlan (n=5) or control (n=5) through a computer-generated algorithm. MyDiabetesPlan was integrated into intervention practices, and clinicians (first step) followed by patients (second step) were trained on its use. Control participants received static generic Diabetes Canada resources. Patients were not blinded. Participants completed validated questionnaires at baseline, 6 months, and 12 months. The primary outcome at the individual patient level was decisional conflict; secondary outcomes were diabetes distress, health-related quality of life, chronic illness care, and clinician intention to practice interprofessional SDM. Multilevel hierarchical regression models were used. RESULTS At the end of the study, the intervention group (5 clusters, n=111) had a modest reduction in total decisional conflicts compared with the control group (5 clusters, n=102; -3.5, 95% CI -7.4 to 0.42). Although there was no difference in diabetes distress or health-related quality of life, there was an increase in patient assessment of chronic illness care (0.7, 95% CI 0.4 to 1.0). CONCLUSIONS Use of goal-setting decision aids modestly improved decision quality and chronic illness care but not quality of life. Our findings may be due to a gap between goal setting and attainment, suggesting a role for optimizing patient engagement and behavioral support. The next steps include clarifying the mechanisms by which decision aids impact outcomes and revising MyDiabetesPlan and its delivery. TRIAL REGISTRATION ClinicalTrials.gov NCT02379078; https://clinicaltrials.gov/ct2/show/NCT02379078.
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Affiliation(s)
- Catherine Yu
- St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada
| | - Dorothy Choi
- St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada
| | - Brigida A Bruno
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kevin E Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada
| | - Sharon E Straus
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada
| | | | - Karen Chu
- Bridgepoint Active Healthcare (Sinai Health System), Toronto, ON, Canada
| | - Paul Frydrych
- Mount Dennis Weston Health Centre, Humber River Family Health Team, Toronto, ON, Canada
| | - Amy Hoang-Kim
- St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada
| | - Noah Ivers
- Department of Family and Community Medicine, Women's College Hospital, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - David Kaplan
- University of Toronto, Toronto, ON, Canada
- North York General Hospital, Toronto, ON, Canada
| | - Fok-Han Leung
- St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada
| | - John Maxted
- Markham Stouffville Hospital, Markham, ON, Canada
| | | | - Joanna Sale
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada
| | - Sumeet Sodhi-Helou
- Toronto Western Family Health Team, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Deanna Telner
- South East Toronto Family Health Team (Toronto East Health Network), Toronto, ON, Canada
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Mo R, Shi R, Hu Y, Hu F. Nomogram-Based Prediction of the Risk of Diabetic Retinopathy: A Retrospective Study. J Diabetes Res 2020; 2020:7261047. [PMID: 32587869 PMCID: PMC7298262 DOI: 10.1155/2020/7261047] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/15/2020] [Accepted: 04/28/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES This study is aimed at developing a risk nomogram of diabetic retinopathy (DR) in a Chinese population with type 2 diabetes mellitus (T2DM). METHODS A questionnaire survey, biochemical indicator examination, and physical examination were performed on 4170 T2DM patients, and the collected data were used to evaluate the DR risk in T2DM patients. By operating R software, firstly, the least absolute shrinkage and selection operator (LASSO) regression analysis was used to optimize variable selection by running cyclic coordinate descent with 10 times K cross-validation. Secondly, multivariable logistic regression analysis was applied to build a predicting model introducing the predictors selected from the LASSO regression analysis. The nomogram was developed based on the selected variables visually. Thirdly, calibration plot, receiver operating characteristic (ROC) curve, and decision curve analysis were used to validate the model, and further assessment was running by external validation. RESULTS Seven predictors were selected by LASSO from 19 variables, including age, course of disease, postprandial blood glucose (PBG), glycosylated haemoglobin A1c (HbA1c), uric creatinine (UCR), urinary microalbumin (UMA), and systolic blood pressure (SBP). The model built by these 7 predictors displayed medium prediction ability with the area under the ROC curve of 0.700 in the training set and 0.715 in the validation set. The decision curve analysis curve showed that the nomogram could be applied clinically if the risk threshold is between 21% and 57% and 21%-51% in external validation. CONCLUSION Introducing age, course of disease, PBG, HbA1c, UCR, UMA, and SBP, the risk nomogram is useful for prediction of DR risk in T2DM individuals.
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Affiliation(s)
- Ruohui Mo
- School of Public Health, Shanghai University of Traditional Chinese Medicine, 201203, China
| | - Rong Shi
- School of Public Health, Shanghai University of Traditional Chinese Medicine, 201203, China
| | - Yuhong Hu
- School of Public Health, Shanghai University of Traditional Chinese Medicine, 201203, China
| | - Fan Hu
- School of Public Health, Shanghai University of Traditional Chinese Medicine, 201203, China
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Bruno BA, Choi D, Thorpe KE, Yu CH. Relationship Among Diabetes Distress, Decisional Conflict, Quality of Life, and Patient Perception of Chronic Illness Care in a Cohort of Patients With Type 2 Diabetes and Other Comorbidities. Diabetes Care 2019; 42:1170-1177. [PMID: 31048410 DOI: 10.2337/dc18-1256] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 03/31/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The primary outcome is to evaluate the relationship between diabetes distress and decisional conflict regarding diabetes care in patients with diabetes and two or more comorbidities. Secondary outcomes include the relationships between diabetes distress and quality of life and patient perception of chronic illness care and decisional conflict. RESEARCH DESIGN AND METHODS This was a cross-sectional study of 192 patients, ≥18 years of age, with type 2 diabetes and two or more comorbidities, recruited from primary care practices in the Greater Toronto Area. Baseline questionnaires were completed using validated scales: Diabetes Distress Scale (DDS), Decisional Conflict Scale (DCS), Short-Form Survey 12 (SF-12), and Patient Assessment of Chronic Illness Care (PACIC). Multiple linear regression models evaluated associations between summary scores and subscores, adjusting for age, education, income, employment, duration of diabetes, and social support. RESULTS Most participants were >65 years old (65%). DCS was significantly and positively associated with DDS (β = 0.0139; CI 0.00374-0.0246; P = 0.00780). DDS-emotional burden subscore was significantly and negatively associated with SF-12-mental subscore (β =-3.34; CI -4.91 to -1.77; P < 0.0001). Lastly, DCS was significantly and negatively associated with PACIC (β = -6.70; CI -9.10 to -4.32; P < 0.0001). CONCLUSIONS We identified a new positive relationship between diabetes distress and decisional conflict. Moreover, we identified negative associations between emotional burden and mental quality of life and patient perception of chronic illness care and decisional conflict. Understanding these associations will provide valuable insights in the development of targeted interventions to improve quality of life in patients with diabetes.
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Affiliation(s)
- Brigida A Bruno
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Dorothy Choi
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Kevin E Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Catherine H Yu
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada .,Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
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Arditi C, Iglesias K, Peytremann-Bridevaux I. The use of the Patient Assessment of Chronic Illness Care (PACIC) instrument in diabetes care: a systematic review and meta-analysis. Int J Qual Health Care 2019; 30:743-750. [PMID: 29733366 DOI: 10.1093/intqhc/mzy091] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 04/13/2018] [Indexed: 02/05/2023] Open
Abstract
Purpose The Patient Assessment of Chronic Illness Care (PACIC) was created to assess whether provided care is congruent with the Chronic Care Model, according to patients. We aimed to identify all studies using the PACIC in diabetic patients to explore (i) how overall PACIC scores varied across studies and (ii) whether scores varied according to healthcare delivery, patient and instrument characteristics. Data sources MEDLINE, Embase, PsycINFO, CINAHL and PubMed Central (PMC), from 2005 to 2016. Study selection Studies of any design using the PACIC in diabetic patients. Data extraction and synthesis We extracted data on healthcare delivery, patient, and instrument characteristics, and overall PACIC score and standard deviation. We performed random-effects meta-analyses and meta-regressions. Results We identified 34 studies including 25 942 patients from 13 countries, mostly in North America and Europe, using different versions of the PACIC in 11 languages. The overall PACIC score fluctuated between 1.7 and 4.2, with a pooled score of 3.0 (95% confidence interval 2.8-3.2, 95% predictive interval 1.9-4.2), with very high heterogeneity (I2 = 99%). The PACIC variance was not explained by healthcare delivery or patient characteristics, but by the number of points on the response scale (5 vs. 11) and the continent (Asia vs. others). Conclusion The PACIC is a widely used instrument, but the direct comparison of PACIC scores between studies should be performed with caution as studies may employ different versions and the influence of cultural norms and language on the PACIC score remains unknown.
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Affiliation(s)
- Chantal Arditi
- Health Care Evaluation Unit (UES), Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Biopôle 2, Lausanne, Switzerland
| | - Katia Iglesias
- Applied Research and Development Unit, School of Health Sciences Fribourg (HEdS‑FR), University of Applied Sciences and Arts Westrn Switzerland (HES-SO), Route des Cliniques 15, Fribourg, Switzerland.,Center for the Understanding of Social Processes University of Neuchâtel, Breguet 1, Neuchâtel, Switzerland
| | - Isabelle Peytremann-Bridevaux
- Health Care Evaluation Unit (UES), Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Biopôle 2, Lausanne, Switzerland
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Kong JX, Zhu L, Wang HM, Li Y, Guo AY, Gao C, Miao YY, Wang T, Lu XY, Zhu HH, Patrick DL. Effectiveness of the Chronic Care Model in Type 2 Diabetes Management in a Community Health Service Center in China: A Group Randomized Experimental Study. J Diabetes Res 2019; 2019:6516581. [PMID: 30719455 PMCID: PMC6335771 DOI: 10.1155/2019/6516581] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/17/2018] [Accepted: 11/20/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The Chronic Care Model, based on core elements of team-centered care in chronic diseases, has widely been accepted. This study was aimed at evaluating the effectiveness of the Chronic Care Model in type 2 diabetes management. METHODS A group randomized experimental study was conducted. Twelve communities of the Zhaohui Community Health Service Center in Hangzhou, China, were randomly assigned into an intervention group (n = 6) receiving the Chronic Care Model-based intervention and a control group (n = 6) receiving conventional care. A total of three hundred patients, twenty-five for each community, aged ≥18 years with type 2 diabetes for at least 1-year duration, were recruited. Data of health behaviors, clinical outcomes, and health-related quality of life (Short-Form 36-item questionnaire) were collected before and after a 9-month intervention and analyzed using descriptive statistics, t-test, chi-square test, binary logistic regression, and linear mixed regression. A total of 258 patients (134 in intervention and 124 in control) who completed the baseline and follow-up evaluations and the entire intervention were included in the final analyses. RESULTS Health behaviors such as drinking habit (OR = 0.07, 95% CI: 0.01, 0.75), physical activity (OR = 2.92, 95% CI: 1.18, 7.25), and diet habit (OR = 4.30, 95% CI: 1.49, 12.43) were improved. The intervention group had a remarkable reduction in glycated hemoglobin (from 7.17% to 6.60%, P < 0.001). The quality of life score changes of the role limitation due to physical problems (mean = 9.97, 95% CI: 3.33, 16.60), social functioning (mean = 6.50, 95% CI: 2.37, 10.64), role limitation due to emotional problems (mean = 8.06, 95% CI: 2.15, 13.96), and physical component summary score (mean = 3.31, 95% CI: 1.22, 5.39) were improved in the intervention group compared to the control group. CONCLUSION The Chronic Care Model-based intervention helped improve some health behaviors, clinical outcomes, and quality of life of type 2 diabetes patients in China in a short term.
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Affiliation(s)
- Jing-Xia Kong
- Department of Social Medicine and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
- Department of Investment and Insurance, Zhejiang Financial College, Hangzhou, Zhejiang Province, China
| | - Lin Zhu
- Department of Social Medicine, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Hong-Mei Wang
- Department of Social Medicine and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Ying Li
- Department of Social Medicine, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - An-Ying Guo
- Department of Social Medicine, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Chao Gao
- Department of Social Medicine, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Yan-Yao Miao
- Department of Social Medicine, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Ting Wang
- Department of Social Medicine, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Xiao-Yang Lu
- Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Hong-Hong Zhu
- Preventive Medicine Institute, Louisiana, MO 63353, USA
| | - Donald L. Patrick
- Department of Health Services, University of Washington, H670 Health Sciences Building, Box 357660, Seattle, WA 98195-7660, USA
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Pilipovic-Broceta N, Vasiljevic N, Marinkovic J, Todorovic N, Jankovic J, Ostric I, Kalimanovska-Ostric D, Racic M. Assessment of hypertension chronic care model: Pacic application in Bosnia and Herzegovina. PLoS One 2018; 13:e0202250. [PMID: 30106998 PMCID: PMC6091945 DOI: 10.1371/journal.pone.0202250] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 07/08/2018] [Indexed: 12/04/2022] Open
Abstract
The objectives of this study were to evaluate patients' attitudes towards hypertension treatment according to the chronic care model and to assess the implementation of hypertension clinical guidelines in family medicine. The cross-sectional study was carried out in two randomly selected primary health care centers (Bijeljina and Prijedor), respectively in Bosnia and Herzegovina, covering the period between March and April 2016. This study sample consists of 791 respondents with hypertension purposing to measure specific actions and quality of care for hypertensive patients. The Patient Assessment of Chronic Illness Care (PACIC) was used. Treatment for the indicators of hypertension was assessed by analyzing patients' medical charts according to the recommendations of clinical guidelines. More than half of the evaluated indicators of treatment for hypertension were documented in medical charts of 84.07% patients. The average overall PACIC score was 4.18 (SD 0.59), being an average of the separate scores of 4.19 (SD 0.57) in men and 4.17 (SD 0.60) in women. Subscale means of PACIC were as follows: patient activation 4.33, delivery system design 4.36; goal setting 4.03; problem solving 4.51; follow-up and co-ordination 3.67. No statistically significant correlations in the overall score and subscale scores were found by demographic characteristics. Non-smokers had a significantly higher overall score compared to smokers (p = 0.001). As implementation of the guidelines became stronger, the reported PACIC scores rose. Continuing the education of patients in order to achieve better health care outcomes is imperative.
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Affiliation(s)
- Natasa Pilipovic-Broceta
- Family Medicine Department, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
- Family Medicine Teaching Centre, Primary Health Care Banja Luka, Bosnia and Herzegovina
| | - Nadja Vasiljevic
- Institute of Hygiene and Medical Ecology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jelena Marinkovic
- Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nevena Todorovic
- Family Medicine Department, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
- Family Medicine Teaching Centre, Primary Health Care Banja Luka, Bosnia and Herzegovina
| | - Janko Jankovic
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Irena Ostric
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dimitra Kalimanovska-Ostric
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Institute for Cardiovascular Diseases, Clinical Center of Serbia, Belgrade, Serbia
| | - Maja Racic
- Department for Primary Health Care and Public Health, Faculty of Medicine, University of East Sarajevo, Foca, Bosnia and Herzegovina
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Nurjono M, Shrestha P, Lee A, Lim XY, Shiraz F, Tan S, Wong SH, Foo KM, Wee T, Toh SA, Yoong J, Maria Vrijhoef HJ. Realist evaluation of a complex integrated care programme: protocol for a mixed methods study. BMJ Open 2018; 8:e017111. [PMID: 29500199 PMCID: PMC5855239 DOI: 10.1136/bmjopen-2017-017111] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The lack of understanding of how complex integrated care programmes achieve their outcomes due to the lack of acceptable methods leads to difficulties in the development, implementation, adaptation and scaling up of similar interventions. In this study, we evaluate an integrated care network, the National University Health System (NUHS) Regional Health System (RHS), consisting of acute hospitals, step down care, primary care providers, social services and community partners using a theory-driven realist evaluation approach. This study aims to examine how and for whom the NUHS-RHS works to improve healthcare utilisations, outcomes, care experiences and reduce healthcare costs. By using a realist approach that balances the needs of context-specific evaluation with international comparability, this study carries the potential to address current research gaps. METHODS AND ANALYSIS This evaluation will be conducted in three research phases: (1) development of initial programme theory (IPT) underlying the NUHS-RHS; (2) testing of programme theory using empirical data; and (3) refinement of IPT. IPT was elicited and developed through reviews of programme documents, informal discussions and in-depth interviews with relevant stakeholders. Then, a convergent parallel mixed method study will be conducted to assess context (C), mechanisms (M) and outcomes (O) to test the IPT. Findings will then be analysed according to the realist evaluation formula of CMO in which findings on the context, mechanisms will be used to explain the outcomes. Finally, based on findings gathered, IPT will be refined to highlight how to improve the NUHS-RHS by detailing what works (outcome), as well as how (mechanisms) and under what conditions (context). ETHICS AND DISSEMINATION The National Healthcare Group, Singapore, Domain Specific Review Board reviewed and approved this study protocol. Study results will be published in international peer-reviewed journals and presented at conferences and internally to NUHS-RHS and Ministry of Health, Singapore.
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Affiliation(s)
- Milawaty Nurjono
- Centre for Health Services Research and Policy Research, Saw Swee Hock School of Public Health, National University Health System, Singapore
| | - Pami Shrestha
- Regional Health System Planning Office, National University Health System, Singapore
| | - Alice Lee
- Regional Health System Planning Office, National University Health System, Singapore
| | - Xin Ya Lim
- Centre for Health Services Research and Policy Research, Saw Swee Hock School of Public Health, National University Health System, Singapore
| | - Farah Shiraz
- Regional Health System Planning Office, National University Health System, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Shermin Tan
- Regional Health System Planning Office, National University Health System, Singapore
| | - Shing Hei Wong
- Regional Health System Planning Office, National University Health System, Singapore
| | - Kah Mun Foo
- Regional Health System Planning Office, National University Health System, Singapore
| | - Thomas Wee
- Regional Health System Planning Office, National University Health System, Singapore
| | - Sue-Anne Toh
- Regional Health System Planning Office, National University Health System, Singapore
| | - Joanne Yoong
- Centre for Health Services Research and Policy Research, Saw Swee Hock School of Public Health, National University Health System, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Center for Economic and Social Research, University of Southern California, California, USA
| | - Hubertus Johannes Maria Vrijhoef
- Vrije Universiteit Brussels, Brussels, Belgium
- Panaxea B.V., Amsterdam, The Netherlands
- Department of Patient and Care, University Hospital Maastricht, Maastricht, The Netherlands
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Relevant patient characteristics for guiding tailored integrated diabetes primary care: a systematic review. Prim Health Care Res Dev 2018; 19:424-447. [PMID: 29405097 PMCID: PMC6452927 DOI: 10.1017/s146342361800004x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Aim To identify which patient-related effect modifiers influence the outcomes of integrated care programs for type 2 diabetes in primary care. Background Integrated care is a widespread management strategy for the treatment of type 2 diabetes. However, most integrated care programs are not tailored to patients’ needs, preferences and abilities. There is increasing consensus that such a patient-centered approach could improve the management of type 2 diabetes. Thus far, it remains unclear which patient-related effect modifiers should guide such an approach. Methods PubMed, CINAHL and EMBASE were searched for empirical studies published after 1998. A systematic literature review was conducted according to the PRISMA guidelines. Findings In total, 23 out of 1015 studies were included. A total of 21 studies measured the effects of integrated diabetes care programs on hemoglobin A1c (HbA1c) and three on low-density lipoprotein cholesterol, systolic blood pressure and health-care utilization. In total, 49 patient characteristics were assessed as potential effect modifiers with HbA1c as an outcome, of which 46 were person or health-related and only three were context-related. Younger age, insulin therapy and longer disease duration were associated with higher HbA1c levels in cross-sectional and longitudinal studies. Higher baseline HbA1c was associated with higher HbA1c at follow-up in longitudinal studies. Information on context- and person-related characteristics was limited, but is necessary to help identify the care needs of individual patients and implement an effective integrated type 2 diabetes tailored care program.
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Gu M, Ma Y, Zhou T, Xia Y. Evaluation of a Community Health Service Center-Based Intervention Program for Managing Chronic Heart Failure. Balkan Med J 2016; 33:45-51. [PMID: 26966617 DOI: 10.5152/balkanmedj.2015.150023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 07/03/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Although the role of primary care for the management of patients with chronic heart failure (CHF) has been highly recommended, structural involvement of primary care in heart failure (HF) management programs is extremely limited. AIMS To examine the feasibility and applicability of two most recommended forms of care delivery mode, home visit and telephone support, for CHF management in the setting of community health service center (CHSC). STUDY DESIGN Prospective study. METHODS This study was conducted in two CHSCs in Beijing, China. Care delivery was led by trained general practitioners or community nurses via home visits in one CHSC and telephone support in the other. Data regarding the change in mortality and hospitalization rate during 12 months and self-care level at 6 months were prospectively collected and compared across the intervention groups. RESULTS A total of 329 patients were included, with 142 in the home visit group and 187 in the telephone support group. Patients in both groups had frequent visits to CHSC (8.1±5.9 in the home visit and 7.7±4.1 in the telephone support group, p=0.45) during the follow-up period. Compared to the telephone support group, patients in the home visit group showed a reduction in all-cause mortality (14.1% versus 20.3%, p=0.14), one or more hospitalizations due to any cause (33.8% versus 44.2%, p=0.12) and one or more hospitalizations due to cardiac cause (17.6% versus 24.6%, p=0.13) in the home visit group. The absolute differences were 6.2% (95% CI: 1.9%, 14.3%), 8.4% (95% CI: 2.1%, 18.9%) and 7.3% (95% CI: 1.5%, 16.1%), respectively, although the results were not statistically significant. After 6 months of intervention, patients in both groups achieved marked improvement in self-care with reference to their own baseline values. CONCLUSION Although no statistical difference was observed between the two care delivery approaches regarding the clinical outcomes of interest, given the high participation rates, the acceptable rate of adverse events, frequent CHSC visits and patients' preferences in the current study, it was concluded that CHSC might be the optimal setting for delivering care to CHF patients in China.
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Affiliation(s)
- Moli Gu
- Department of Nursing, No. 1 Hospital affiliated to General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Yanlan Ma
- Department of Nursing, No. 1 Hospital affiliated to General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Ti Zhou
- Department of Nursing, No. 1 Hospital affiliated to General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Yunfeng Xia
- The Cadre Ward, No. 1 Hospital affiliated to General Hospital of the Chinese People's Liberation Army, Beijing, China
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Aung E, Donald M, Coll JR, Williams GM, Doi SAR. Association between patient activation and patient-assessed quality of care in type 2 diabetes: results of a longitudinal study. Health Expect 2015; 19:356-66. [PMID: 25773785 DOI: 10.1111/hex.12359] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Previous research using cross-sectional data has shown a positive relationship between patient activation and quality of care. The quantitative relationships in the same patients over time, however, remain undefined. OBJECTIVE To examine the relationship between changes in activation over time and patient-assessed quality of chronic illness care. DESIGN Prospective cohort study. PARTICIPANTS The study used data reported annually from 2008 (N = 3761) to 2010 (N = 3040), using self-report survey questionnaires, completed by patients with type 2 diabetes in a population-based cohort in Queensland, Australia. MAIN MEASURES Principal measures were the 13-item Patient Activation Measure (PAM), and the 20-item Patient Assessment of Chronic Illness Care (PACIC) instrument. METHODS Nonparametric anova was used to determine the association between patient activation and patient-assessed quality of care in low and high patient activation groups at baseline (2008), and in 2009 and 2010, when patients had changed group membership. The Wilcoxon signed ranks test was used to compare the PACIC scores between baseline and each follow-up survey for the same patient activation level. RESULTS Patient activation was positively associated with the median PACIC score within each survey year and within each of the groups defined at baseline (high- and low-activation groups; P < 0.001). CONCLUSIONS Patient activation and the PACIC change in the same direction and should be considered together in the interpretation of patient care assessment. This can be carried out by interpreting PACIC scores within strata of PAM.
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Affiliation(s)
- Eindra Aung
- School of Population Health, University of Queensland, Brisbane, Qld, Australia
| | - Maria Donald
- School of Medicine, University of Queensland, Brisbane, Qld, Australia
| | - Joseph R Coll
- School of Population Health, University of Queensland, Brisbane, Qld, Australia
| | - Gail M Williams
- School of Population Health, University of Queensland, Brisbane, Qld, Australia
| | - Suhail A R Doi
- School of Population Health, University of Queensland, Brisbane, Qld, Australia
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Joint influence of patient-assessed chronic illness care and patient activation on glycaemic control in type 2 diabetes. Int J Qual Health Care 2015; 27:117-24. [DOI: 10.1093/intqhc/mzv001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2014] [Indexed: 01/25/2023] Open
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