1
|
Zhu X, Ren B, Liu W, Lei S, Lin S, Liu Q, Yin L, Feng B. The short- and long-term effects of community-family-doctor-based type 2 diabetes self-management interventions. Public Health 2024; 230:96-104. [PMID: 38521030 DOI: 10.1016/j.puhe.2024.02.014] [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: 12/04/2023] [Revised: 01/27/2024] [Accepted: 02/16/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVES The popularity of contracted family doctor services in China has been growing in recent years, but community-family-doctor-based type 2 diabetes mellitus (T2DM) intervention programs have yet to be adequately studied. This study was to evaluate the short- and long-term effects of community-family-doctor-based self-management interventions for T2DM and to explore strategies for long-term glycemic control. STUDY DESIGN This was a randomized controlled trial. METHODS A total of 144 eligible participants were randomly assigned to intervention and control groups. The control group received only routine community diabetes care, and the intervention group received community-family-doctor-based interventions involving the same standard of care. The interventions lasted for 3 months, and the follow-up was continued for 15 months. Intention-to-treat analysis and generalized estimation equations were then used to determine the short- and long-term effects of the interventions on glycated hemoglobin (HbA1c), diabetes self-management, and medication adherence. RESULTS There were statistically significantly greater improvements in all aspects of the intervention group after 3 months of intervention. Compared with baseline, changes in the attitude (β = 0.384, 95% confidence interval [CI; 0.194, 0.574], P < 0.001), practice (β = 1.751, 95% CI [0.762, 2.739], P = 0.001), and knowledge, attitudes, practice total scores (β = 2.338, 95% CI [0.682, 3.995], P = 0.006) of patients in the intervention group were statistically significant after 15 months, and the HbA1c (8.19 ± 1.73%), knowledge (16.42 ± 3.21), and medication adherence (5.53 ± 1.76) scores were slightly better than those at baseline, although not statistically significant (P > 0.05). CONCLUSIONS T2DM self-management interventions based on community family doctors improved patients' HbA1c, diabetes self-management, and medication adherence, did not do so significantly in the long term.
Collapse
Affiliation(s)
- Xiaoying Zhu
- The Department of Pharmacy Administration, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Biqi Ren
- The Department of Pharmacy Administration, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China; Xi'an People's Hospital (Xi'an Fourth Hospital), Xi'an, Shaanxi, China
| | - Wei Liu
- The Department of Pharmacy Administration, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Shuang Lei
- The Department of Pharmacy Administration, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Shuzhi Lin
- The Department of Pharmacy Administration, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Qian Liu
- The Department of Pharmacy Administration, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Lin Yin
- The Department of Pharmacy Administration, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Bianling Feng
- The Department of Pharmacy Administration, School of Pharmacy, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
| |
Collapse
|
2
|
Diriba DC, Leung DYP, Suen LKP. The effects of diabetes self-management interventions on physiological outcomes in people living with diabetes in Africa: A systematic review and meta-analysis. Diabet Med 2021; 38:e14501. [PMID: 33341999 DOI: 10.1111/dme.14501] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/19/2020] [Accepted: 12/16/2020] [Indexed: 12/26/2022]
Abstract
AIM To examine the effects of diabetes self-management interventions on physiological outcomes among people living with diabetes in Africa compared with patients receiving usual care. METHODS Relevant databases including PubMed, CINAHL Complete, Scopus, the Cochrane Library and Google Scholar were searched from inception to 28 September 2019, for randomised controlled trials (RCTs) involving adults living with diabetes in Africa. Nine RCTs were included in the review, and the quality of the studies was assessed using Cochrane's collaboration risk of bias tools. RESULTS A meta-analysis of the outcomes showed the significant effects of diabetes self-management interventions on blood pressure, total cholesterol and body mass index, whereas non-significant and inconclusive results were obtained for waist circumference and glycosylated haemoglobin, respectively. CONCLUSIONS The diabetes self-management interventions (DSM) effectively improved many physiological outcomes, but their effectiveness in HbA1c was inconclusive, suggesting a need for modifications in DSM interventions for African people living with diabetes.
Collapse
Affiliation(s)
| | - Doris Y P Leung
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Lorna K P Suen
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| |
Collapse
|
3
|
Alexandre K, Vallet F, Peytremann-Bridevaux I, Desrichard O. Identification of diabetes self-management profiles in adults: A cluster analysis using selected self-reported outcomes. PLoS One 2021; 16:e0245721. [PMID: 33481883 PMCID: PMC7822269 DOI: 10.1371/journal.pone.0245721] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 01/06/2021] [Indexed: 11/18/2022] Open
Abstract
The present study describes adult diabetes self-management (DSM) profiles using self-reported outcomes associated with the engagement in diabetes care activities and psychological adjustment to the disease. We used self-reported data from a community-based cohort of adults with diabetes (N = 316) and conducted a cluster analysis of selected self-reported DSM outcomes (i.e., DSM behaviors, self-efficacy and perceived empowerment, diabetes distress and quality of life). We tested whether clusters differed according to sociodemographic, clinical, and care delivery processes variables. Cluster analysis revealed four distinct DSM profiles that combined high/low levels of engagement in diabetes care activities and good/poor psychological adjustment to the disease. The profiles were differently associated with the variables of perceived financial insecurity, taking insulin treatment, having depression, and the congruence of the care received with the Chronic Care Model. The results could help health professionals gain a better understanding of the different realities facing people living with diabetes, identify patients at risk of poor outcomes related to their DSM, and lead to the development of profile-specific DSM interventions.
Collapse
Affiliation(s)
- Ketia Alexandre
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Fanny Vallet
- Faculté de Psychologie et des Sciences de l’Education, University of Geneva, Geneva, Switzerland
| | | | - Olivier Desrichard
- Faculté de Psychologie et des Sciences de l’Education, University of Geneva, Geneva, Switzerland
| |
Collapse
|
4
|
Shen H, Wang Y, Edwards H. Can a community-based peer-led diabetic self-management programme be effective: 12-week evaluation. J Clin Nurs 2017; 26:1621-1631. [PMID: 27535118 DOI: 10.1111/jocn.13526] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Huixia Shen
- School of Medicine; Tongji University; Shanghai China
| | - Yanbo Wang
- School of Medicine; Tongji University; Shanghai China
| | - Helen Edwards
- Faculty of Health; Queensland University of Technology; Brisbane Qld Australia
| |
Collapse
|
5
|
Harris ML, Dolja-Gore X, Kendig H, Byles JE. End of life hospitalisations differ for older Australian women according to death trajectory: a longitudinal data linkage study. BMC Health Serv Res 2016; 16:484. [PMID: 27613597 PMCID: PMC5017050 DOI: 10.1186/s12913-016-1729-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 08/30/2016] [Indexed: 11/12/2022] Open
Abstract
Background Hospitalisations are the prime contributor to healthcare expenditure, with older adults often identified as high hospital users. Despite the apparent high use of hospitals at the end of life, limited evidence currently exists regarding reasons for hospitalisation. Understanding complex end of life care needs is required for future health care planning as the global population ages. This study aimed to investigate patterns of hospitalisation in the last year of life by cause of death (COD) as well as reasons for admission and short-term predictors of hospital use. Methods Survey data from 1,205 decedents from the 1921–1926 cohort of the Australian Longitudinal Study on Women’s Health were matched with the state-based hospital records and the National Death Index. Hospital patterns based on COD were graphically summarised and multivariate logistic regression models examined the impact of short-term predictors of length of stay (LOS). Results 85 % of women had at least one admission in the last year of life; and 8 % had their first observed admission during this time. Reasons for hospitalisation, timing of admissions and LOS differed by COD. Women who died of cancer, diabetes and ‘other’ causes were admitted earlier than women who died of organ failure, dementia and influenza. Women who died of organ failure overall spent the longest time in hospital, and women with cancer had the highest median LOS. Longer LOS was associated with previous short- and medium-term- hospitalisations and type of hospital separation. Conclusions Reducing acute care admissions and LOS at the end of life is complex and requires a shift in perceptions and treatment regarding end of life care and chronic disease management. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1729-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Melissa L Harris
- Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
| | - Xenia Dolja-Gore
- Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Hal Kendig
- Centre for Research on Ageing, Health and Wellbeing, College of Medicine, Biology and Environment, Australian National University, Mills Road, Acton, ACT, Australia.,ARC Centre of Excellence in Population Ageing Research, Sydney, NSW, 2033, Australia
| | - Julie E Byles
- Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,ARC Centre of Excellence in Population Ageing Research, Sydney, NSW, 2033, Australia
| |
Collapse
|
6
|
Alhabib S, Aldraimly M, Alfarhan A. An evolving role of clinical pharmacists in managing diabetes: Evidence from the literature. Saudi Pharm J 2016; 24:441-6. [PMID: 27330374 PMCID: PMC4908050 DOI: 10.1016/j.jsps.2014.07.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 07/19/2014] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Diabetes mellitus is a rapidly growing disease world-wide that is estimated to be present in 6.6% of the international population and projected to be increased by 7.8% in 2030. Treating diabetic patients is multifaceted in all aspects and they require objectives and optimum information in order to obtain the maximum benefits of their treatment and avoid complications. Pharmacists are increasingly considered as a part of the health care system. Hence, the aim of this review is to address and summarize the effectiveness of clinical pharmacists in managing diabetic patients. METHOD This is a narrative review of the evidence from the literature in order to answer the present question of what is the evidence of the role of clinical pharmacists in managing diabetic patients. We searched five databases including: the Cochrane library, MEDLINE, EMBASE, TRIP, and Science Direct. We will also try to look for other potentially eligible trials or ancillary publications by searching the reference lists of retrieved included trials, (systematic) reviews, meta-analyses and health technology assessment reports. Outcomes included short-term and long-term measures. RESULTS Final search revealed nine studies. They were heterogeneous in terms of interventions, participants, settings and outcomes. Studies varied in their quality and/or reporting of their findings conducted in several settings. Majority of the studies were conducted in Western countries, one in Hong Kong and one in South India. In majority of the studies, pharmacists' role was mainly to specify all drug-related problems including poor drug compliance and side effects and communicating these to the physician. We found that those who received the pharmacist care had a statistically significant reduction in coronary heart disease, blood pressure, HA1c, quality of life and lipid profile. CONCLUSION Our review demonstrated the important role of clinical pharmacists in managing diabetic patients at diverse settings worldwide. There is an urgent need to recognize and change regulations to allow shared practice agreements among physicians, pharmacists, and other allied health professionals. These mutual agreements would allow more streamlined provision of health care delivery from non-physician health professionals to participants with common health conditions.
Collapse
Affiliation(s)
- Samia Alhabib
- National Guard Health Affairs, Department of Family and Community Medicine, P.O. Box 246913, Riyadh 11312, Saudi Arabia
| | - Maha Aldraimly
- National Guard Health Affairs, Department of Family and Community Medicine, P.O. Box 270436, Riyadh 11352, Saudi Arabia
| | - Ali Alfarhan
- National Guard Health Affairs, Department of Family and Community Medicine, P.O. Box 5301, Riyadh 11422, Saudi Arabia
| |
Collapse
|
7
|
Markle-Reid M, Ploeg J, Fisher K, Reimer H, Kaasalainen S, Gafni A, Gruneir A, Kirkconnell R, Marzouk S, Akhtar-Danesh N, Thabane L, Rojas-Fernandez C, Upshur R. The Aging, Community and Health Research Unit-Community Partnership Program for older adults with type 2 diabetes and multiple chronic conditions: a feasibility study. Pilot Feasibility Stud 2016; 2:24. [PMID: 27965843 PMCID: PMC5154077 DOI: 10.1186/s40814-016-0063-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 04/20/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Few studies have examined the effectiveness of community-based self-management interventions in older adults with type 2 diabetes mellitus (T2DM) and multiple chronic conditions (MCC). The objectives of this study were to examine the feasibility of implementation in practice (primary) and the feasibility of study methods and potential effectiveness (secondary) of the Aging, Community and Health-Community Partnership Program, a new 6-month interprofessional, nurse-led program to promote diabetes self-management in older adults (>65 years) with T2DM and MCC. METHODS This study used a prospective one-group pre-test/post-test design. Participants were recruited from a specialized diabetes clinic. They received a median of three in-home/clinic visits by certified diabetes educators (CDEs) and attended a median of three group wellness sessions provided by the CDEs in partnership with a community-based seniors' association. The primary outcome was the feasibility of the program (acceptability, fidelity, implementation barriers/facilitators). Secondary outcomes included the feasibility of the study methods (recruitment/retention rates and procedures, eligibility criteria, data collection and analysis methods) and potential effectiveness of the program based on 6-month changes in self-reported outcomes including self-management behavior (diet, exercise, self-monitoring), health status (quality of life, mental health), and costs of service use. Analysis of feasibility outcomes was primarily based on descriptive statistics. The potential effectiveness of the program was explored using different tests, with the results expressed using descriptive statistics and effect estimates (95 % confidence intervals). RESULTS In total, 45 (88 %) of 51 eligible persons consented to participate. Of these, 37 (82 %) completed the 6-month follow-up. Participants and providers viewed the program as acceptable and feasible. Participants had a higher SF-12 physical component summary score at 6 months compared with baseline (mean score difference 3.0, 95 % CI 0.2-5.8). Median costs for diabetes care increased over 6 months (reflecting inclusion of program costs), while other service costs either decreased or remained unchanged. CONCLUSIONS This study offers preliminary evidence that the program was feasible to deliver and acceptable to participants and providers. Initial results suggest that the program may improve physical functioning. A randomized controlled trial is feasible, with some adaptations to the program and study methods that were identified from this feasibility study. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT01880476.
Collapse
Affiliation(s)
- Maureen Markle-Reid
- School of Nursing, Health Sciences Centre, McMaster University, 1280 Main Street West, Room 3N25B, Hamilton, ON L8S 4 K1 Canada
| | - Jenny Ploeg
- School of Nursing, Health Sciences Centre, McMaster University, 1280 Main Street West, Room 3N25C, Hamilton, ON L8S 4 K1 Canada
| | - Kathryn Fisher
- School of Nursing, Health Sciences Centre, McMaster University, 1280 Main Street West, Room 2J34A, Hamilton, ON L8S 4 K1 Canada
| | - Holly Reimer
- School of Nursing, Health Sciences Centre, McMaster University, 1280 Main Street West, Room 3N25B, Hamilton, ON L8S 4 K1 Canada
| | - Sharon Kaasalainen
- School of Nursing, Health Sciences Centre, McMaster University, 1280 Main Street West, Room 3N25B, Hamilton, ON L8S 4 K1 Canada
| | - Amiram Gafni
- Department of Clinical Epidemiology and Biostatistics, Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main Street West, Room CRL-208, Hamilton, ON L8S 4 K1 Canada
| | - Andrea Gruneir
- University Department of Family Medicine, University of Alberta, 6-40 University Terrace, Edmonton, AB T6G 2T4 Canada
| | - Ross Kirkconnell
- Guelph Family Health Team, Dawson Road Family Medical Centre, 83 Dawson Rd, Guelph, ON N1H 1B1 Canada
| | - Sam Marzouk
- Diabetes Care Guelph, Dawson Road Family Medical Centre, 83 Dawson Rd, Guelph, ON N1H 1B1 Canada
| | - Noori Akhtar-Danesh
- School of Nursing, Health Sciences Centre, McMaster University, 1280 Main Street West, Room 3N28B, Hamilton, ON L8S 4 K1 Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, St. Joseph’s Healthcare Hamilton, 3rd Floor, Martha Wing, Room H-325, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - Carlos Rojas-Fernandez
- School of Pharmacy, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
| | - Ross Upshur
- Division of Clinical Public Health, Dalla Lana School of Public Health, 155 College Street, 6th floor, Toronto, ON M5T 3M7 Canada
| |
Collapse
|
8
|
Shen H, Edwards H, Courtney M, McDowell J, Wei J. Barriers and facilitators to diabetes self-management: perspectives of older community dwellers and health professionals in China. Int J Nurs Pract 2013; 19:627-35. [PMID: 24330214 DOI: 10.1111/ijn.12114] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Little is known about self-management among people with Type 2 diabetes living in mainland China. Understanding the experiences of this target population is needed to provide socioculturally relevant education to effectively promote self-management. The aim of this study was to explore perceived barriers and facilitators to diabetes self-management for both older community dwellers and health professionals in China. Four focus groups, two for older people with diabetes and two for health professionals, were conducted. All participants were purposively sampled from two communities in Shanghai, China. Six barriers were identified: overdependence on but dislike of western medicine, family role expectations, cuisine culture, lack of trustworthy information sources, deficits in communication between clients and health professionals, and restriction of reimbursement regulations. Facilitators included family and peer support, good relationships with health professionals, simple and practical instruction and a favourable community environment. The findings provide valuable information for diabetes self-management intervention development in China, and have implications for programmes tailored to populations in similar sociocultural circumstances.
Collapse
Affiliation(s)
- Huixia Shen
- Department of Nursing, School of Medicine, Tongji University, Shanghai, China
| | | | | | | | | |
Collapse
|
9
|
Jack L. Toward a Men's Health Research Agenda in Health Education: Examining Gender, Sex Roles, and Health-seeking Behaviors in Context. AMERICAN JOURNAL OF HEALTH EDUCATION 2013. [DOI: 10.1080/19325037.2005.10608201] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Leonard Jack
- a Behavioral and Community Health Sciences Program , School of Public Health, Louisiana State University Health Sciences Center , 1600 Canal Street, Suite 713, New Orleans , Louisiana , 70112 , USA
| |
Collapse
|
10
|
Critchley CR, Hardie EA, Moore SM. Examining the psychological pathways to behavior change in a group-based lifestyle program to prevent type 2 diabetes. Diabetes Care 2012; 35:699-705. [PMID: 22338102 PMCID: PMC3308314 DOI: 10.2337/dc11-1183] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine the psychological process of lifestyle change among adults at risk for type 2 diabetes. RESEARCH DESIGN AND METHODS A randomized control trial in which 307 volunteers (intervention, n = 208; wait control, n = 99) diagnosed with prediabetes completed a six-session group-based intervention to promote healthier living. Participants' motivation to change, diet and exercise self-efficacy, mood, knowledge about diabetes, activity levels, healthy eating, waist circumference, and weight were assessed before and after the program. RESULTS Participation in the program was associated with significant increases in healthy eating and physical activity, reductions in waist and weight, and improvements in motivation, positive mood, self-efficacy, and knowledge. Examination of the pathways to lifestyle change showed that the educational aspect of the program increased activity levels because it increased diabetes knowledge and improved mood. Eating behavior was not mediated by any of the psychological variables. Improvements in diet and physical activity were, in turn, directly associated with changes in weight and waist circumference. CONCLUSIONS Although the program significantly improved motivation, self-efficacy, and mood, its impact on knowledge uniquely explained the increase in physical activity. Group-based programs that are tailored to lifestyle behaviors may provide a cost-effective method of diabetes prevention, but more research is needed to explain why they improve healthy eating.
Collapse
Affiliation(s)
- Christine R Critchley
- Faculty of Life and Social Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia.
| | | | | |
Collapse
|
11
|
Psychosocial Impacts of Type 2 Diabetes Self-Management in a Rural African-American Population. J Immigr Minor Health 2012; 14:1071-81. [DOI: 10.1007/s10903-012-9585-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
12
|
Funnell MM, Brown TL, Childs BP, Haas LB, Hosey GM, Jensen B, Maryniuk M, Peyrot M, Piette JD, Reader D, Siminerio LM, Weinger K, Weiss MA. National standards for diabetes self-management education. Diabetes Care 2012; 35 Suppl 1:S101-8. [PMID: 22187467 PMCID: PMC3632167 DOI: 10.2337/dc12-s101] [Citation(s) in RCA: 158] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
13
|
Taveira TH, Dooley AG, Cohen LB, Khatana SAM, Wu WC. Pharmacist-Led Group Medical Appointments for the Management of Type 2 Diabetes with Comorbid Depression in Older Adults. Ann Pharmacother 2011; 45:1346-55. [DOI: 10.1345/aph.1q212] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background:: Depression is associated with poor glycemic control, increased number of microvascular and macrovascular complications, functional impairment, mortality, and 4.5 times higher total health care costs in patients with diabetes. Shared medical appointments (SMAs) may be an effective method to attain national guideline recommendations for glycemic control in diabetes for patients with depression through peer support, counseling, problem solving, and improved access to care. Objective: To test the efficacy as assessed by attainment of a hemoglobin A1c (A1C) <7% of pharmacistted group SMA visits, Veterans Affairs Multidisciplinary Education in Diabetes and Intervention for Cardiac Risk Reduction in Depression (VA-MEDIC-D), in patients with type 2 diabetes mellitus. Methods: This was a randomized controlled trial of VA-MEDIC-D added to standard care versus standard care alone in depressed patients with diabetes with A1C >6.5%. VA-MEDIC-D consisted of 4 once-weekly, 2-hour sessions followed by 5 monthly 90-minute group sessions. Each SMA session consisted of multidisciplinary education and pharmacist-led behavioral and pharmacologic interventions for diabetes, lipids, smoking, and blood pressure. No pharmacologic interventions for depression were provided. The change in the proportion of participants who achieved an A1C <7% at 6 months was compared. Results: Compared to standard care (n = 44), a lower proportion of patients in VA-MEDIC-D (n = 44) had systolic blood pressure (SBP) <130 mm Hg at baseline, but were similar in other cardiovascular risk factors and psychiatric comorbidity. The change in the proportion of participants achieving an A1C <7% was greater in the VA-MEDIC-D arm than in the standard care arm (29.6% vs 11.9%), with odds ratio 3.6 (95% CI 1.1 to 12.3). VA-MEDIC-D participants also achieved significant reductions in SBP, low-density lipoprotein cholesterol, and non–high-density lipoprotein (HDL) cholesterol from baseline, whereas significant reductions were attained only in non–HDL cholesterol with standard care. There was no significant change in depressive symptoms for either arm. Conclusions: Pharmacist-led group SMA visits are efficacious in attainment of glycemic control in patients with diabetes and depression without change in depression symptoms.
Collapse
Affiliation(s)
- Tracey H Taveira
- Systems Outcomes and Quality in Chronic Disease and Rehabilitation, Research Enhancement Award Program, Providence Veterans Administration (VA) Medical Center, Providence, RI; Associate Professor of Pharmacy, Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, RI; Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI
| | - Andrea G Dooley
- Systems Outcomes and Quality in Chronic Disease and Rehabilitation, Research Enhancement Award Program, Providence VA Medical Center; Clinical Assistant Professor of Pharmacy, Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island
| | - Lisa B Cohen
- Systems Outcomes and Quality in Chronic Disease and Rehabilitation, Research Enhancement Award Program, Providence VA Medical Center; Assistant Professor of Pharmacy, Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island
| | - Sameed Ahmed M Khatana
- Systems Outcomes and Quality in Chronic Disease and Rehabilitation, Research Enhancement Award Program, Providence VA Medical Center
| | - Wen-Chih Wu
- Systems Outcomes and Quality in Chronic Disease and Rehabilitation, Research Enhancement Award Program, Providence VA Medical Center; Associate Professor of Medicine, Department of Medicine, Warren Alpert Medical School of Brown University; Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island
| |
Collapse
|
14
|
Cohen LB, Taveira TH, Khatana SAM, Dooley AG, Pirraglia PA, Wu WC. Pharmacist-Led Shared Medical Appointments for Multiple Cardiovascular Risk Reduction in Patients With Type 2 Diabetes. DIABETES EDUCATOR 2011; 37:801-12. [DOI: 10.1177/0145721711423980] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose To assess whether VA MEDIC-E (Veterans Affairs Multi-disciplinary Education and Diabetes Intervention for Cardiac risk reduction[EM DASH] Extended for 6 months), a pharmacist-led shared medical appointments program, could improve attainment of target goals for hypertension, hyperglycemia, hyperlipidemia, and tobacco use in patients with type 2 diabetes compared to standard primary care after 6 months of intervention. Methods A randomized, controlled trial of VA MEDIC-E (n = 50) versus standard primary care (n = 49) in veterans with type 2 diabetes, hemoglobin A1c (A1C) > 7%, blood pressure (BP) > 130/80 mmHg, and low density lipoprotein cholesterol (LDL-C) > 100mg/dl (2.59 mmol/l) in the previous 6 months was conducted. The VA MEDIC-E intervention consisted of 4 weekly group sessions followed by 5 monthly booster group sessions. Each 2-hour session included 1 hour of multidisciplinary diabetes specific healthy lifestyle education and 1 hour of pharmacotherapeutic interventions performed by a clinical pharmacist. Evaluation measures included lab values of A1C, LDL cholesterol, BP, and goal attainment of these values, and diabetes self-care behavior questionnaires at 6 months. Results The randomization groups were similar at baseline in all cardiovascular risk factors except for LDL, which was significantly lower in the MEDIC-E arm. At 6 months, significant improvements from baseline were found in the intervention arm for exercise, foot care, and goal attainment of A1C, LDL-C, and BP but not in the control arm. Conclusions The results of this study demonstrate that the pharmacist-led group intervention program for 6 months was an efficacious and sustainable collaborative care approach to managing diabetes and reducing associated cardiovascular risk.
Collapse
Affiliation(s)
- Lisa B. Cohen
- Systems Outcomes and Quality in Chronic Disease and Rehabilitation, Research Enhancement Award Program, Providence VA Medical Center, Providence, Rhode Island (Dr Cohen, Dr Taveira, Dr Dooley, Dr Pirraglia, Dr Wu)
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island (Dr Cohen, Dr Taveira, Dr Dooley)
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island (Dr Taveira, Dr Pirraglia, Dr Wu)
| | - Tracey H. Taveira
- Systems Outcomes and Quality in Chronic Disease and Rehabilitation, Research Enhancement Award Program, Providence VA Medical Center, Providence, Rhode Island (Dr Cohen, Dr Taveira, Dr Dooley, Dr Pirraglia, Dr Wu)
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island (Dr Cohen, Dr Taveira, Dr Dooley)
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island (Dr Taveira, Dr Pirraglia, Dr Wu)
| | - Sameed Ahmed M. Khatana
- Systems Outcomes and Quality in Chronic Disease and Rehabilitation, Research Enhancement Award Program, Providence VA Medical Center, Providence, Rhode Island (Dr Cohen, Dr Taveira, Dr Dooley, Dr Pirraglia, Dr Wu)
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island (Dr Cohen, Dr Taveira, Dr Dooley)
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island (Dr Taveira, Dr Pirraglia, Dr Wu)
| | - Andrea G. Dooley
- Systems Outcomes and Quality in Chronic Disease and Rehabilitation, Research Enhancement Award Program, Providence VA Medical Center, Providence, Rhode Island (Dr Cohen, Dr Taveira, Dr Dooley, Dr Pirraglia, Dr Wu)
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island (Dr Cohen, Dr Taveira, Dr Dooley)
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island (Dr Taveira, Dr Pirraglia, Dr Wu)
| | - Paul A. Pirraglia
- Systems Outcomes and Quality in Chronic Disease and Rehabilitation, Research Enhancement Award Program, Providence VA Medical Center, Providence, Rhode Island (Dr Cohen, Dr Taveira, Dr Dooley, Dr Pirraglia, Dr Wu)
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island (Dr Cohen, Dr Taveira, Dr Dooley)
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island (Dr Taveira, Dr Pirraglia, Dr Wu)
| | - Wen-Chih Wu
- Systems Outcomes and Quality in Chronic Disease and Rehabilitation, Research Enhancement Award Program, Providence VA Medical Center, Providence, Rhode Island (Dr Cohen, Dr Taveira, Dr Dooley, Dr Pirraglia, Dr Wu)
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island (Dr Cohen, Dr Taveira, Dr Dooley)
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island (Dr Taveira, Dr Pirraglia, Dr Wu)
| |
Collapse
|
15
|
Comans TA, Clark MJ, Cartmill L, Ash S, Sheppard LA. How do Allied Health Professionals Evaluate New Models of Care? What Are We Measuring and Why? J Healthc Qual 2011; 33:19-28. [DOI: 10.1111/j.1945-1474.2011.00152.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
16
|
Funnell MM, Brown TL, Childs BP, Haas LB, Hosey GM, Jensen B, Maryniuk M, Peyrot M, Piette JD, Reader D, Siminerio LM, Weinger K, Weiss MA. National Standards for diabetes self-management education. Diabetes Care 2011; 34 Suppl 1:S89-96. [PMID: 21193633 PMCID: PMC3006053 DOI: 10.2337/dc11-s089] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Martha M Funnell
- Department of Medical Education, Diabetes Research and Training Center, University of Michigan, Ann Arbor, Michigan, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Hopkinson JB, Fenlon DR, Okamoto I, Wright DNM, Scott I, Addington-Hall JM, Foster C. The deliverability, acceptability, and perceived effect of the Macmillan approach to weight loss and eating difficulties: a phase II, cluster-randomized, exploratory trial of a psychosocial intervention for weight- and eating-related distress in people with advanced cancer. J Pain Symptom Manage 2010; 40:684-95. [PMID: 20678895 DOI: 10.1016/j.jpainsymman.2010.02.015] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2009] [Revised: 02/12/2010] [Accepted: 02/17/2010] [Indexed: 01/11/2023]
Abstract
CONTEXT Up to 80% of people with cancer will develop weight loss and anorexia during the advanced stages of the disease. The Macmillan Weight and Eating Studies (2000-2009) have used the Medical Research Council complex interventions framework to develop the first psychosocial intervention for weight- and eating-related distress (WRD and ERD) in people with advanced cancer and their carers: The Macmillan Approach to Weight and Eating (MAWE). OBJECTIVES This article reports the findings of a Phase II trial of MAWE that investigated its deliverability, acceptability, and patient-perceived effect on WRD and ERD. METHODS The Phase II trial, conducted in 2006-2007, was of cluster-randomized design, with two community palliative care teams randomized to different arms. It used mixed methods to compare an intervention group (n=25), the MAWE group, which was supported by MAWE-trained clinical nurse specialists, with a group that received usual care (n=25), the control group. RESULTS MAWE was deliverable in clinical practice and acceptable to patients. Unplanned exposure of the MAWE group to the intervention before an initial measure of WRD and ERD proved problematic to the trial process. Despite this, quantitative and qualitative analyses indicate that MAWE does not exacerbate WRD and ERD and may help patients with advanced cancer live with the weight loss and anorexia that are the symptoms of cancer cachexia syndrome. CONCLUSION A follow-on randomized controlled trial of MAWE is warranted but should be of a revised design.
Collapse
Affiliation(s)
- Jane B Hopkinson
- School of Health Sciences, University of Southampton, Southampton, United Kingdom.
| | | | | | | | | | | | | |
Collapse
|
18
|
Funnell MM, Brown TL, Childs BP, Haas LB, Hosey GM, Jensen B, Maryniuk M, Peyrot M, Piette JD, Reader D, Siminerio LM, Weinger K, Weiss MA. National standards for diabetes self-management education. Diabetes Care 2010; 33 Suppl 1:S89-96. [PMID: 20042780 PMCID: PMC2797385 DOI: 10.2337/dc10-s089] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Martha M Funnell
- Department of Medical Education, Diabetes Research and Training Center, University of Michigan, Ann Arbor, Michigan, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Taveira TH, Friedmann PD, Cohen LB, Dooley AG, Khatana SAM, Pirraglia PA, Wu WC. Pharmacist-Led Group Medical Appointment Model in Type 2 Diabetes. DIABETES EDUCATOR 2009; 36:109-17. [DOI: 10.1177/0145721709352383] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this study was to assess whether the VA-MEDIC (Veterans Affairs Multi-disciplinary Education and Diabetes Intervention for Cardiac risk reduction), a pharmacist-led group medical visit program, could improve achievement of target goals in hypertension, hyperglycemia, hyperlipidemia, and tobacco use in patients with type 2 diabetes compared to usual care. Methods This was a randomized controlled trial of VA-MEDIC intervention in addition to usual care versus usual care alone in diabetic patients to reduce cardiac risk factors. VA-MEDIC consisted of a 40- to 60-minute educational component by nurse, nutritionist, physical therapist, or pharmacist followed by pharmacist-led behavioral and pharmacological interventions over 4 weekly sessions. Measures The attainment of target goals in hemoglobin A1C (A1C), blood pressure, fasting lipids, and tobacco use recommended by the American Diabetes Association. Results Of 118 participants, 109 completed the study. VA-MEDIC (n = 58) participants were younger and had greater tobacco use at baseline than usual care but were similar in other cardiovascular risk factors. After 4 months, a greater proportion of VA-MEDIC participants versus controls achieved an A1C of less than 7% and a systolic blood pressure less than 130 mm Hg. No significant change was found in lipid control or tobacco use between the 2 study arms. Conclusion Pharmacist-led group medical visits are feasible and efficacious for improving cardiac risk factors.
Collapse
Affiliation(s)
- Tracey H. Taveira
- Systems Outcomes and Quality in Chronic disease and
Rehabilitation (SOQCR), Research Enhancement Award Program (REAP) Providence
VA Medical Center, Providence, Rhode Island,
| | - Peter D. Friedmann
- Department of Medicine, Warren Alpert Medical School
of Brown University, Providence, Rhode Island
| | - Lisa B. Cohen
- Department of Pharmacy Practice, College of Pharmacy,
University of Rhode Island, Kingston
| | - Andrea G. Dooley
- Department of Pharmacy Practice, College of Pharmacy,
University of Rhode Island, Kingston
| | - Sameed Ahmed M. Khatana
- Department of Medicine, Warren Alpert Medical School
of Brown University, Providence, Rhode Island
| | - Paul A. Pirraglia
- Department of Medicine, Warren Alpert Medical School
of Brown University, Providence, Rhode Island
| | - Wen-Chih Wu
- Department of Medicine, Warren Alpert Medical School
of Brown University, Providence, Rhode Island
| |
Collapse
|
20
|
Funnell MM, Brown TL, Childs BP, Haas LB, Hosey GM, Jensen B, Maryniuk M, Peyrot M, Piette JD, Reader D, Siminerio LM, Weinger K, Weiss MA. National standards for diabetes self-management education. Diabetes Care 2009; 32 Suppl 1:S87-94. [PMID: 19118294 PMCID: PMC2613581 DOI: 10.2337/dc09-s087] [Citation(s) in RCA: 191] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Martha M Funnell
- 1Department of Medical Education, Diabetes Research and Training Center, University of Michigan, Ann Arbor, Michigan, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Kavookjian J, Elswick BM, Whetsel T. Interventions for being active among individuals with diabetes: a systematic review of the literature. DIABETES EDUCATOR 2008; 33:962-88; discussion 989-90. [PMID: 18057265 DOI: 10.1177/0145721707308411] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this systematic review is to assess and summarize evidence and gaps in the literature regarding the intervention for being active (exercise) among individuals with diabetes. METHODS Twelve electronic databases were searched. Publications eligible for inclusion specifically studied learning, behavioral, clinical, and humanistic outcomes for exercise interventions in adult patients with type 1 and type 2 diabetes. RESULTS Seven reviews (2 systematic reviews, 3 meta-analyses, 2 technical reviews) and 34 individual, nonreview studies (18 randomized controlled trials, 16 nonrandomized trials) met inclusion criteria. For type 2 diabetes, findings suggested that exercise had a positive effect on glycemic control and decreased cardiovascular risk, but the impact of exercise on behavioral and humanistic outcomes was unclear; long-term outcomes and adherence to exercise interventions is unknown because most studies were of short duration. The overall impact of varied types of exercise in type 1 diabetes was unclear, especially regarding glycemic control. Potential benefits of exercise in type 1 may include improved cardiovascular health. CONCLUSION The review did not identify specific successful intervention details because of the heterogeneity of studies, subjects, and research gaps. General findings suggest that physical activity is better than no exercise at all; intensive regimens, if tolerated by patients, achieved better clinical outcomes than less intensive regimens. Reviewed studies using structured exercise regimens exhibited a more significant impact on outcomes. Substantial gaps in the literature include studies measuring direct effects of exercise in the US minority populations most affected by type 2 diabetes and economic evaluations of exercise interventions. Interventions must be tailored to individual patient needs to succeed.
Collapse
Affiliation(s)
- Jan Kavookjian
- The Department of Pharmacy Care Systems, Harrison School of Pharmacy, Auburn, Alabama (Dr Kavookjian)
| | - Betsy M Elswick
- The Clinical Pharmacy Department, West Virginia University School of Pharmacy, Morgantown (Dr Elswick, Dr Whetsel)
| | - Tara Whetsel
- The Clinical Pharmacy Department, West Virginia University School of Pharmacy, Morgantown (Dr Elswick, Dr Whetsel)
| |
Collapse
|
22
|
Funnell MM, Brown TL, Childs BP, Haas LB, Hosey GM, Jensen B, Maryniuk M, Peyrot M, Piette JD, Reader D, Siminerio LM, Weinger K, Weiss MA. National standards for diabetes self-management education. Diabetes Care 2008; 31 Suppl 1:S97-104. [PMID: 18165344 PMCID: PMC2797381 DOI: 10.2337/dc08-s097] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Martha M Funnell
- Department of Medical Education, Diabetes Research and Training Center, University of Michigan, Ann Arbor, Michigan 48109-0489, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Goodman RM, Yoo S, Jack L. Applying comprehensive community-based approaches in diabetes prevention: rationale, principles, and models. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2007; 12:545-55. [PMID: 17041303 DOI: 10.1097/00124784-200611000-00008] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The literature regarding the prevention of diabetes provides few standards for community-based initiatives. The present article offers four principles for engaging communities in comprehensive community approaches to diabetes prevention including (1) facilitating meaningful and central roles for communities, (2) giving primary attention to participatory processes rather than to best practices, (3) emphasizing cultural relevance in designing interventions particularly in racial and ethnic communities, and (4) incorporating social ecology approaches that are holistic and that address larger environmental influences rather than individual behavioral change alone. In order that community public health practitioners may operationalize the principles, models are provided for each.
Collapse
Affiliation(s)
- Robert M Goodman
- Department of Behavioral and Community Health, Sciences, Graduate School of Public Health, University of Pittsburgh, Pennsylvania, USA.
| | | | | |
Collapse
|
24
|
Funnell MM, Brown TL, Childs BP, Haas LB, Hosey GM, Jensen B, Maryniuk M, Peyrot M, Piette JD, Reader D, Siminerio LM, Weinger K, Weiss MA. National standards for diabetes self-management education. DIABETES EDUCATOR 2007; 33:599-600, 602-4, 606 passim. [PMID: 17684162 DOI: 10.1177/0145721707305880] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
25
|
Lenz M, Steckelberg A, Richter B, Mühlhauser I. Meta-analysis does not allow appraisal of complex interventions in diabetes and hypertension self-management: a methodological review. Diabetologia 2007; 50:1375-83. [PMID: 17520239 DOI: 10.1007/s00125-007-0679-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2007] [Accepted: 02/20/2007] [Indexed: 10/23/2022]
Abstract
Common methodologies used in systematic reviews do not allow adequate appraisal of complex interventions. The aim of the present study was to describe and critically appraise current methods of systematic reviews on complex interventions, using diabetes and hypertension patient education as examples. PubMed, the Cumulative Index to Nursing and Allied Health (CINAHL), the Cochrane Library and Health Technology Assessment databases were searched. Systematic reviews focusing on diabetes or hypertension patient education were included. Authors were contacted. Two investigators independently evaluated the reviews. The available evidence of three patient education programmes of diabetes and hypertension self-management implemented in Germany was used as a reference. We included 14 reviews; 12 reviews mentioned that the included education programmes were multidimensional. Reviews on comparable topics identified different publications of the same programme. Identical programmes were classified differently within and between reviews. Education programmes were dissected to analyse effects of single components. Different components of identical programmes were used. Interdependencies between components were not explored. Six reviews performed meta-analysis across programmes with heterogeneous educational or organisational approaches. The complexity of efficacy measures was disregarded: e.g. HbA(1c) was used as an isolated outcome variable without considering treatment goals, effects on hypoglycaemia, body weight or quality of life. Our results indicate that methods of current systematic reviews are not fully equipped to appraise patient education and self-management programmes. Since these are complex and heterogeneous interventions, consideration of aggregated evidence is necessary.
Collapse
Affiliation(s)
- M Lenz
- Unit of Health Sciences and Education, University of Hamburg, Martin-Luther-King Platz 6, 20146, Hamburg, Germany.
| | | | | | | |
Collapse
|
26
|
Abstract
AIM This paper is a report of a study to explore the management of changing eating habits in people with advanced cancer. BACKGROUND Internationally there is interest in supporting self-management as a way of helping people to live with illness. It is unknown if promoting self-management in people with cancer can lead to beneficial health outcomes. In order to develop and test interventions that promote self-management in cancer patients, it is first important to understand ways in which they can help themselves. METHOD A mixed-methods exploratory case study of the meaning, management and manifestations of weight loss and change in eating habits was conducted with 30 patients receiving palliative home care in England in 2003. Semi-structured interview data were analysed using both content and thematic approaches. FINDINGS Participants described a total of 141 different self-actions, each of which formed a component of up to four self-action strategies that were used to aid life with advanced cancer. The strategies were 'Taking control', 'Promoting self-worth', 'Relationship work', and 'Distraction'. Employing these strategies led to changes in thinking and behaviour that were motivated by a desire to sustain or enhance well-being. The pattern of self-action strategies adopted by each individual is theorized to be dependent on the personal and contextual resources available. CONCLUSION Patients can and do find their own solutions to eating problems and nurses should support this self-action. The proposed theory of self-management of eating change provides an understanding that can inform the provision of this support.
Collapse
Affiliation(s)
- Jane B Hopkinson
- Macmillan Research Unit, School of Nursing and Midwifery, University of Southampton, Southampton, Hampshire, UK.
| |
Collapse
|
27
|
Funnell MM, Brown TL, Childs BP, Haas LB, Hosey GM, Jensen B, Maryniuk M, Peyrot M, Piette JD, Reader D, Siminerio LM, Weinger K, Weiss MA. National standards for diabetes self-management education. Diabetes Care 2007; 30:1630-7. [PMID: 17526822 DOI: 10.2337/dc07-9923] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Martha M Funnell
- Department of Medical Education, Diabetes Research and Training Center, University of Michigan, Ann Arbor, Michigan 48109-0489, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Wolf J. The Benefits of Diabetes Self-Management Eduction of the Elderly Veteran in the Home Care Setting. ACTA ACUST UNITED AC 2006; 24:645-51; quiz 652-3. [PMID: 17135842 DOI: 10.1097/00004045-200611000-00009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Jacquelyn Wolf
- Home Based Primary Care, VACT Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA.
| |
Collapse
|
29
|
Liburd LC, Jack L, Williams S, Tucker P. Intervening on the social determinants of cardiovascular disease and diabetes. Am J Prev Med 2005; 29:18-24. [PMID: 16389121 DOI: 10.1016/j.amepre.2005.07.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2004] [Revised: 06/20/2005] [Accepted: 07/07/2005] [Indexed: 02/08/2023]
Abstract
Heart disease, cerebrovascular diseases, and type 2 diabetes ranked first, third, and sixth, respectively, among the leading causes of death and disability in the United States in 2000. Racial and ethnic communities (i.e., African Americans, Hispanic-Latino Americans, Native Americans and Alaska Natives, and Asian Americans and Pacific Islanders) disproportionately suffer from these chronic conditions. Traditional behavior change strategies have had some positive, but limited effects and will not likely be sufficient to eliminate these health disparities at the population level. In this commentary, the authors argue for greater intervention research directed at the social determinants of cardiovascular disease and diabetes if we are to reverse current trends in chronic disease prevalence in communities of color. The authors also call for new research questions and study designs that will increase our understanding of the social, policy, and historic context in which disparities are created as a necessary first step in developing interventions aimed at social-contextual and psychosocial risk factors. Promising programs supported by the Centers for Disease Control and Prevention's Racial and Ethnic Approaches to Community Health (REACH 2010) program and the Division of Diabetes Translation are highlighted.
Collapse
Affiliation(s)
- Leandris C Liburd
- Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
| | | | | | | |
Collapse
|
30
|
Marks R, Allegrante JP, Lorig K. A review and synthesis of research evidence for self-efficacy-enhancing interventions for reducing chronic disability: implications for health education practice (part I). Health Promot Pract 2005; 6:37-43. [PMID: 15574526 DOI: 10.1177/1524839904266790] [Citation(s) in RCA: 289] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Disability and poor quality of life attributable to chronic diseases such as arthritis, diabetes, and heart disease constitute challenging public health problems for American society. In the absence of any effective cure for these conditions, the secondary prevention of complications and improving quality of life and functional capacity through better disease self-management becomes critical and are key objectives of Healthy People 2010. The organizing focus of such disease self-management should be on improving coping, communication, and control by enhancing self-efficacy. Part I of this two-part article describes the common clinical features of chronic diseases and the diverse disease management strategies used for alleviating pain and preventing disability associated with these and reviews the role of self-efficacy as a theoretical framework for successful self-management interventions. Part II identifies and synthesizes the key research evidence for educational interventions designed to enhance individual self-efficacy perceptions and presents implications for practice in patient education.
Collapse
Affiliation(s)
- Ray Marks
- Teachers College, Columbia University, New York, NY, USA
| | | | | |
Collapse
|