Investigating discharge communication for chronic disease patients in three hospitals in India

Guideline adherence for cardiometabolic monitoring of patients prescribed antipsychotic medications in primary care: a retrospective observational study

BACKGROUND

Despite their known effectiveness, antipsychotics possess significant cardiometabolic adverse event profiles. Guidelines emphasise routine monitoring, however, practices are known to be suboptimal.

AIM

To investigate the level of cardiometabolic monitoring among people prescribed antipsychotic therapy in primary care, and patient-related factors that may influence monitoring patterns.

METHOD

Data were collected for patients with mental disorders and prescribed antipsychotics at two general practices in England (February 2016-February 2021). The main outcome measures were the proportion of patients with evidence of monitoring for cardiometabolic parameters (body composition, anthropometrics, lipids, glucose outcomes). Regression analysis was used to explore factors predicting monitoring practices.

RESULTS

Data from 497 patients were included. The proportion of patients receiving cardiometabolic monitoring at least once yearly varied across different parameters. Patients were mostly monitored for BP (92.0%), body weight (BMI > 85.0%) and HDL (72.0%), but to a lesser extent for other lipid parameters (non-HDL < 2.0%) and blood glucose (< 2.0%). Ageing (OR:2.0-7.0, p < 0.001) and chronic conditions (e.g., CVD and Type 2 DM, p < 0.05) were associated with frequent cardiometabolic monitoring. Conversely, antipsychotics with high metabolic risks (olanzapine), patients prescribed antipsychotic polypharmacy (≥ 2 antipsychotics) and cardiometabolic dysregulations (e.g., dyslipidaemias) did not improve monitoring frequencies.

CONCLUSION

Cardiometabolic health monitoring was generally infrequent, irregular, and did not change in response to abnormal test results or antipsychotic treatment with high cardiometabolic risks, suggesting more efforts need to be made to ensure the guidelines for cardiometabolic monitoring are followed. Future studies should investigate practices by using a large UK primary care database.

Hospital discharge intervention developed in a dialogical way with families to prepare them to care for children with chronic diseases at home: Mixed methods study

A convergent parallel mixed methods design with qualitative data collection embedded in a quasi-experimental study was developed to examine the potential of three modalities of preparation for hospital discharge of the families of children with chronic diseases in terms of uncertainty levels and management of the disease at home. Caregivers of these children were divided into three groups: two experimental groups and one control group. Two scales were applied: one measured family management, and the other evaluated uncertainties in relation to the disease. In addition, an in-depth interview was conducted. Wilcoxon's test and the integrated response index were used in data analysis to compare performance between the groups. Inductive thematic analysis was employed for the qualitative data. The data were integrated, comparing the groups before and after preparation for hospital discharge. Twenty-five family caregivers completed this study. Data integration showed that the intervention group, in which the families developed planning to prepare for discharge in a dialogical way with professionals, presented better perceptions regarding care management when compared to structured guide and usual care groups. Participation of families in planning for hospital discharge showed a reduction in uncertainties regarding the disease and better care management of children at home.

Health literacy and behaviors influencing blood sugar level control among type 2 diabetes patients in primary care units, Thailand: A cross-sectional study

Background: Type 2 Diabetes Mellitus (T2DM) remains a significant cause of death globally. In addition, T2DM is among the top five chronic diseases which leads to mortality in the Thai population. Patients with T2DM need a wide self-management protocol.  However, patients with low health literacy experience difficulty in recognizing health-related information and have difficulties in expressing their status to health care providers, resulting in poor self-management which results in worsening of the health condition. This study aimed to identify the health literacy among patients with type 2 diabetes to determine its association between factors with blood sugar level control in the patients who are treated in primary care units. Methods: A total of 605 subjects were randomly selected from four districts of Nakhon Ratchasima Province, Northeastern Thailand. Data were collected using a structured questionnaire and a review of their charts. A descriptive statistical analysis was used to describe characteristics of the subjects. In addition, multiple logistic regression was used for the association to estimate effect sizes in terms of an odds ratio with the 95% confidence interval. Results: Of the total 605 respondents, 90.90% of the subjects had a sufficient level of health literacy about diabetes. The present study found the subjects who had sufficient health literacy were significantly associated with blood sugar level control (Adjusted Odds Ratio, (AOR)=2.27; 95% CI: 1.10-4.74; p =0.026). A strongly significant association with blood sugar level control was found with diet behaviors (AOR = 9.71; 95% CI: 5.98-15.77; p<0.001) and exercise behaviors (AOR = 14.50; 95% CI: 8.66-24.27; p<0.001). Conclusions: Health literacy on the changing health related behaviors among the T2DM patients is significantly associated with controlling blood sugar level. Hence, health practitioners should enhance the health literacy on self-care among T2DM patients which will help to control T2DM in an effective manner.