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van Houtum W, Schrömbges P, Amadid H, van Bon AC, Braae UC, Hoogstraten C, Herrings H. Real-World Use of Oral Semaglutide in Adults with Type 2 Diabetes in the PIONEER REAL Netherlands Multicentre, Prospective, Observational Study. Diabetes Ther 2024:10.1007/s13300-024-01588-5. [PMID: 38861137 DOI: 10.1007/s13300-024-01588-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/11/2024] [Indexed: 06/12/2024] Open
Abstract
INTRODUCTION In this phase 4, multicentre, prospective, non-interventional PIONEER REAL Netherlands study, we assessed clinical outcomes associated with once-daily oral semaglutide use in real-world clinical practice in adults living with type 2 diabetes (T2D) naïve to injectable glucose-lowering medication. METHODS Participants initiated on oral semaglutide were followed for 34-44 weeks. Change in glycated haemoglobin (HbA1c) from baseline (BL) to end of study (EOS) was the primary endpoint; secondary endpoints included change in body weight (BW) from BL to EOS, the proportion of participants with HbA1c < 7.0% at EOS and the composite endpoints of HbA1c reduction ≥ 1.0%-points with BW reduction ≥ 3% or ≥ 5% at EOS. Treatment satisfaction was assessed using the Diabetes Treatment Satisfaction Questionnaire (DTSQ status/change). Safety was evaluated in all participants who initiated oral semaglutide treatment. RESULTS Oral semaglutide was initiated in 187 participants; 94.1% completed the study and 78.6% remained on treatment at EOS. At BL, 54.0% of participants were male, mean age was 58.8 years, mean duration of T2D was 8.7 years and mean body mass index was 35.1 kg/m2; mean HbA1c was 8.6% and mean BW was 103.1 kg. Significant improvements from BL to EOS were observed for HbA1c and BW (estimated change [95% confidence interval]: - 1.16%-points [- 1.48 to - 0.85]; p < 0.0001, and - 5.84 kg [- 6.88 to - 4.80]; p < 0.0001, respectively). At EOS, 47.5% of participants had an HbA1c level < 7.0%; 41.8% and 35.5% of participants achieved composite endpoints of HbA1c reduction ≥ 1.0%-points plus BW reduction ≥ 3% or ≥ 5%, respectively. DTSQ status and change scores improved by 2.1 (p = 0.0003) and 10.8 points (p < 0.0001), respectively. Oral semaglutide was easy or very easy to consume for 81.5% of participants. Adverse events were mostly mild/moderate, with gastrointestinal disorders being the most common. CONCLUSION In this real-world population, we reported clinically significant reductions in HbA1c and BW, improved treatment satisfaction and no new safety concerns. A graphical abstract is available with this article. CLINICAL TRIAL REGISTRATION NCT04601740.
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Affiliation(s)
- William van Houtum
- Department of Internal Medicine, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands.
| | | | | | | | | | | | - Hans Herrings
- Medisch Centrum Den Bosch Oost, Van Broeckhovenlaan, 's-Hertogenbosch, The Netherlands
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van der Poort EKJ, Kidanemariam M, Moriates C, Rakers MM, Tsevat J, Schroijen M, Atsma DE, van den Akker-van Marle ME, Bos WJW, van den Hout WB. How to Use Costs in Value-Based Healthcare: Learning from Real-life Examples. J Gen Intern Med 2024; 39:683-689. [PMID: 38135776 DOI: 10.1007/s11606-023-08423-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/07/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Healthcare organizations measure costs for business operations but do not routinely incorporate costs in decision-making on the value of care. AIM Provide guidance on how to use costs in value-based healthcare (VBHC) delivery at different levels of the healthcare system. SETTING AND PARTICIPANTS Integrated practice units (IPUs) for diabetes mellitus (DM) and for acute myocardial infarction (AMI) at the Leiden University Medical Center and a collaboration of seven breast cancer IPUs of the Santeon group, all in the Netherlands. PROGRAM DESCRIPTION AND EVALUATION VBHC aims to optimize care delivery to the patient by understanding how costs relate to outcomes. At the level of shared decision-making between patient and clinician, yearly check-up consultations for DM type I were analyzed for patient-relevant costs. In benchmarking among providers, quantities of cost drivers for breast cancer care were assessed in scorecards. In continuous learning, cost-effectiveness analysis was compared with radar chart analysis to assess the value of telemonitoring in outpatient follow-up. DISCUSSION Costs vary among providers in healthcare, but also between provider and patient. The joint analysis of outcomes and costs using appropriate methods helps identify and optimize the aspects of care that drive desired outcomes and value.
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Affiliation(s)
- Esmée K J van der Poort
- Department of Biomedical Data Sciences, Section of Medical Decision-Making, Leiden University Medical Center, Leiden, The Netherlands.
| | - Martha Kidanemariam
- Department of Biomedical Data Sciences, Section of Medical Decision-Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Christopher Moriates
- Department of Internal Medicine, Dell Medical School, University of Texas, Austin, TX, USA
- Department of Medical Education, Dell Medical School, University of Texas, Austin, TX, USA
| | - Margot M Rakers
- National eHealth Living Lab, Leiden University Medical Center, Leiden, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Joel Tsevat
- Department of Medicine and ReACH Center, Joe R. & Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Marielle Schroijen
- Department of Internal Medicine, Section of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
| | - Douwe E Atsma
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - M Elske van den Akker-van Marle
- Department of Biomedical Data Sciences, Section of Medical Decision-Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Willem Jan W Bos
- Department of Internal Medicine, Section of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Wilbert B van den Hout
- Department of Biomedical Data Sciences, Section of Medical Decision-Making, Leiden University Medical Center, Leiden, The Netherlands
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Tichler A, Hertroijs DFL, Ruwaard D, Brouwers MCGJ, Hiligsmann M, de Jong JD, Elissen AMJ. Preferred Conversation Topics with Respect to Treatment Decisions Among Individuals with Type 2 Diabetes. Patient Prefer Adherence 2023; 17:719-729. [PMID: 36960182 PMCID: PMC10029372 DOI: 10.2147/ppa.s397647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/14/2023] [Indexed: 03/19/2023] Open
Abstract
PURPOSE Greater knowledge of individuals' needs and preferences can enhance shared decision-making, which is associated with improved quality of decisions and increased satisfaction. This study aimed to identify and prioritize the attributes (ie conversation topics) that individuals with type 2 diabetes find it most important to discuss with their healthcare provider regarding treatment decisions. PATIENTS AND METHODS First, small group interviews were organized with adults with type 2 diabetes (N=8) treated in primary care to identify the attributes that they find important to discuss regarding treatment decisions. A five-step nominal group technique was applied during the interviews. An object best-worst scaling (BWS) survey was subsequently distributed to individuals with self-reported diabetes participating in the Dutch Health Care Consumer Panel of the Netherlands Institute for Health Services Research (N=600) to determine the relative importance score (RIS) of the identified attributes. A higher RIS indicates a higher level of perceived importance. Subgroup and latent class analyses were performed to explore whether individuals' demographic and disease characteristics influenced their attribute preferences. RESULTS A total of 21 attributes were identified during three small group interviews with individuals with type 2 diabetes. Respondents in the BWS survey (N=285) viewed "quality of life" (RIS=11.97), "clinical outcomes" (RIS=10.40), "long-term diabetes complications" (RIS=9.83) and "short-term adverse medication" (RIS=7.72) as the most important in the decision-making process for the treatment of type 2 diabetes. Some differences in attribute preferences were identified according to demographic and disease characteristics. CONCLUSION In general, individuals with type 2 diabetes not only want to discuss the biological effects of treatments, but also the impact of treatment on their quality of life. Healthcare providers should be aware that attributes are viewed differently by different individuals. This emphasizes the need for tailor-made healthcare decisions, which means eliciting and responding to individual preferences in the decision-making process.
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Affiliation(s)
- Anna Tichler
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, the Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
- Correspondence: Anna Tichler, Department of Health Services Research, Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, P.O. Box 616, Maastricht, 6200 MD, the Netherlands, Tel +31433882193, Email
| | - Dorijn F L Hertroijs
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, the Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, the Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Martijn C G J Brouwers
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
- Department of Internal Medicine, Division of Endocrinology and Metabolic Disease, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Mickaël Hiligsmann
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, the Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Judith D de Jong
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, the Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
- The Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands
| | - Arianne M J Elissen
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, the Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
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Lim LL, Lau ESH, Ozaki R, So TTY, Wong RYM, Chow EYK, Ma RCW, Luk AOY, Chan JCN, Kong APS. Team-based multicomponent care improved and sustained glycaemic control in obese people with type 2 diabetes (T2D) in a Diabetes Centre setting: A quality improvement program with quasi-experimental design. Diabetes Res Clin Pract 2022; 194:110138. [PMID: 36328212 DOI: 10.1016/j.diabres.2022.110138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 10/19/2022] [Accepted: 10/25/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the effect of a team-based multi-component intervention care (MIC) program in obese patients with type 2 diabetes (T2D) and poor glycemic control. METHODS Patients with T2D and HbA1c ≥ 8 % and body mass index (BMI) ≥ 27 kg/m2 and/or waist circumference ≥ 80 cm in women and ≥90 cm in men were recruited. The intervention in Diabetes Centre included 1) nurse-led, group-based workshops; 2) review by endocrinologists; 3) telephone reminders by healthcare assistants and 4) peer support during visits. The usual care (UC) group received consultations at outpatient clinic without workshops or peer support. The MIC group received UC after 1-year of intervention. The primary outcome was change of HbA1c from baseline at 1- and 3-year. RESULTS Of 207 eligible patients [age (mean ± standard deviation): 56.9 ± 8.8 years, 47.4 % men, disease duration: 13.5 ± 8.2 years, HbA1c: 9.6 ± 1.3 %, BMI: 28.8 ± 4.3 kg/m2, waist circumference: 101.5 ± 9.9 cm (men), 95.3 ± 9.8 cm (women)], 104 received MIC and 103 received UC. 95 % patients had repeat assessments at 1- and 3-year. After adjustment for confounders, MIC had greater HbA1c reduction (β -0.51, 95 % confidence interval [CI] -1.00 to -0.01; P = 0.045) than UC at 1-year, with sustained improvement at 3-year (β -0.56, CI -1.10 to -0.02; P = 0.044). CONCLUSION Team-based MIC for 1 year improved glycemic control in obese T2D which was sustained at 3-year.
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Affiliation(s)
- Lee-Ling Lim
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), Hong Kong Special Administrative Region; Asia Diabetes Foundation, Hong Kong Special Administrative Region; Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Eric S H Lau
- Asia Diabetes Foundation, Hong Kong Special Administrative Region
| | - Risa Ozaki
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), Hong Kong Special Administrative Region
| | - Tammy T Y So
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), Hong Kong Special Administrative Region
| | - Rebecca Y M Wong
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), Hong Kong Special Administrative Region
| | - Elaine Y K Chow
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), Hong Kong Special Administrative Region
| | - Ronald C W Ma
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), Hong Kong Special Administrative Region; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, CUHK, Hong Kong Special Administrative Region
| | - Andrea O Y Luk
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), Hong Kong Special Administrative Region; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, CUHK, Hong Kong Special Administrative Region
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), Hong Kong Special Administrative Region; Asia Diabetes Foundation, Hong Kong Special Administrative Region; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, CUHK, Hong Kong Special Administrative Region
| | - Alice P S Kong
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), Hong Kong Special Administrative Region; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, CUHK, Hong Kong Special Administrative Region.
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Peeters MAC, de Haan HG, Bal RA, van Staa A, Sattoe JNT. Active involvement of young people with T1DM during outpatient hospital consultations: Opportunities and challenges in transitional care services. PATIENT EDUCATION AND COUNSELING 2022; 105:1510-1517. [PMID: 34649751 DOI: 10.1016/j.pec.2021.09.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/23/2021] [Accepted: 09/27/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Little is known about active involvement of young people (YP) with type 1 diabetes (T1DM) in transitional care. This study aims to gain insight into patient-provider interactions during outpatient hospital consultations. METHODS Semi-structured observations (n = 61) of outpatient consultations with YP with T1DM (15-25 years) treated in 12 hospitals in the Netherlands. The consultations concerned pediatric care (n = 23), adult care (n = 17), and joint consultations (n = 21). Thematic data analysis focused on whether professionals engaged in open, in-depth conversations; used motivational interviewing techniques; involved YP in shared decision-making; and addressed non-medical topics. RESULTS Apart from some good examples, the healthcare professionals generally had difficulty interacting adequately with YP. They paid little attention to the YP's individual attitudes and priorities regarding disease management; non-medical topics remained generally underexposed. Conversations about daily life often remained shallow, as YP's cues were not taken up. Furthermore, decisions about personal and health-related goals were often not made together. CONCLUSION By adopting a more person-centered approach, professionals could empower YP to take an active role in their diabetes management. PRACTICE IMPLICATIONS Using a structured conversation model combined with a tool to encourage YP's agenda-setting and shared decision-making is recommended for more person-centered transitional care in T1DM.
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Affiliation(s)
- Mariëlle A C Peeters
- Research Centre (American English) Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Hielke G de Haan
- Nutrition and Dietetics, Hanze University of Applied Sciences, Groningen, The Netherlands.
| | - Roland A Bal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - AnneLoes van Staa
- Research Centre (American English) Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Jane N T Sattoe
- Research Centre (American English) Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
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Seidu S, Cos X, Brunton S, Harris SB, Jansson SPO, Mata-Cases M, Neijens AMJ, Topsever P, Khunti K. 2022 update to the position statement by Primary Care Diabetes Europe: a disease state approach to the pharmacological management of type 2 diabetes in primary care. Prim Care Diabetes 2022; 16:223-244. [PMID: 35183458 DOI: 10.1016/j.pcd.2022.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 01/25/2022] [Accepted: 02/02/2022] [Indexed: 12/12/2022]
Abstract
Type 2 diabetes and its associated comorbidities are growing more prevalent, and the complexity of optimising glycaemic control is increasing, especially on the frontlines of patient care. In many countries, most patients with type 2 diabetes are managed in a primary care setting. However, primary healthcare professionals face the challenge of the growing plethora of available treatment options for managing hyperglycaemia, leading to difficultly in making treatment decisions and contributing to treatment and therapeutic inertia. This position statement offers a simple and patient-centred clinical decision-making model with practical treatment recommendations that can be widely implemented by primary care clinicians worldwide through shared-decision conversations with their patients. It highlights the importance of managing cardiovascular disease and elevated cardiovascular risk in people with type 2 diabetes and aims to provide innovative risk stratification and treatment strategies that connect patients with the most effective care.
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Affiliation(s)
- S Seidu
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, United Kingdom.
| | - X Cos
- Sant Marti de Provenҫals Primary Care Centres, Institut Català de la Salut, University Research Institute in Primary Care (IDIAP Jordi Gol), Barcelona, Spain
| | - S Brunton
- Primary Care Metabolic Group, Winnsboro, SC, USA
| | - S B Harris
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - S P O Jansson
- School of Medical Sciences, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - M Mata-Cases
- La Mina Primary Care Centre, Institut Català de la Salut, University Research Institute in Primary Care (IDIAP Jordi Gol), CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - A M J Neijens
- Praktijk De Diabetist, Nurse-Led Case Management in Diabetes, QOL-consultancy, Deventer, The Netherlands
| | - P Topsever
- Department of Family Medicine, Acibadem Mehmet Ali Aydinlar University School of Medicine, Kerem Aydinlar Campus, 34752 Atasehir, Istanbul, Turkey
| | - K Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, United Kingdom
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Lafontaine S, Bourgault P, Ellefsen E. Acceptability of a self-management support intervention for people living with type 2 diabetes to promote a person-centered approach by nurses: A qualitative study. Collegian 2022. [DOI: 10.1016/j.colegn.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Cha E, Shin MH, Smart M, Jang H, Lee J, Joung KH, Kim HJ, Faulkner MS. Q-Methodology and Psychological Phenotyping to Design Patient-Centered Diabetes Education for Persons With Type 2 Diabetes on Insulin Therapy. Sci Diabetes Self Manag Care 2022; 48:98-110. [PMID: 35118919 DOI: 10.1177/26350106221076035] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of this study was to identify the psychological phenotypes of persons with type 2 diabetes (T2D) on insulin therapy to better inform personalized diabetes education strategies to improve self-management behaviors. METHODS Q-methodology, a research approach combining the quantitative rigor of statistical analysis with qualitative data on perception of diabetes self-management by persons with T2D on insulin therapy, was used. The Summary of Diabetes Self-Care Activity measure and A1C in the past 6 months were used to further describe self-management behaviors of each P-sample, Q-sorter. Of 160 statements, 33 Q-sample statements were selected as Q-set. Then, 37 P-samples (24 men; 13 women) were recruited from a university-affiliated diabetes clinic in South Korea. Data obtained from each P-sample with a Q-set and a Q-sorting table, a forced-choice normal distribution table, were analyzed using varimax rotation. RESULTS Forty-one percent of the variance was explained with 5 factors represented by 27 Q-sorters, explaining variance ranging from 5% to 17% for each factor: Factor A (n = 6): those showing self-management education need but possessing inadequate health literacy; Factor B (n = 4): those valuing lifestyle modification to control diabetes; Factor C (n = 5): those valuing antidiabetic medication to control diabetes; Factor D (n = 6): carpe diem, accepting diabetes as destiny; and Factor E (n = 6): those overestimating their competencies to control diabetes. Ten Q-sorters fell into either confounded or nonsignificant. CONCLUSIONS Tailoring messages and educational approaches based on patients' psychological phenotypes are necessary to promote optimal self-management behaviors.
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Affiliation(s)
- EunSeok Cha
- College of Nursing, Chungnam National University, Daejeon, South Korea.,Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Myoung Hwan Shin
- School of Communication and Media, Sookmyung Women's University, Seoul, South Korea
| | - Michael Smart
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, Georgia
| | - Hyesun Jang
- College of Nursing, Chungnam National University, Daejeon, South Korea
| | - Jooseon Lee
- College of Nursing, Chungnam National University, Daejeon, South Korea
| | - Kyong Hye Joung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Hyun Jin Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Melissa Spezia Faulkner
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia.,Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, Georgia
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Ruissen MM, Sont JK, van Vugt HA, Kunneman M, Rutten GEHM, de Koning EJP. Key Factors Relevant for Healthcare Decisions of Patients with Type 1 and Type 2 Diabetes in Secondary Care According to Healthcare Professionals. Patient Prefer Adherence 2022; 16:809-819. [PMID: 35370405 PMCID: PMC8974434 DOI: 10.2147/ppa.s354686] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 03/11/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Understanding which factors are important for healthcare decisions of patients with diabetes in clinical practice is important to personalise diabetes care strategies and tailor care plans to the individual. The main drivers for these healthcare decisions remain unclear. This study assessed which key factors are relevant for healthcare decisions during clinical consultations for patients with type 1 diabetes (T1DM) and type 2 diabetes (T2DM), according to healthcare professionals. MATERIALS AND METHODS Annual diabetes reviews were performed as part of a trial assessing the impact of a consultation model facilitating person-centred diabetes care in six hospital outpatient clinics. After each consultation, we asked healthcare professionals to choose a maximum of three out of 20 factors that were most relevant for healthcare decisions about treatment goals and the professional support needed during the upcoming year. Factors were characterised as either person or disease-related. Percentages reflect the number of annual diabetes reviews in which the key factor was reported. RESULTS Seventeen physicians and eight diabetes specialist nurses reported the key factors relevant for healthcare decisions in 285 annual diabetes reviews (T1DM n = 119, T2DM n = 166). Healthcare professionals most often reported quality of life (31.9%), motivation (27.0%) and diabetes self-management (25.6%), and to a lesser extent glycaemic control (24.2%), to be important for decisions about treatment goals. For decisions about the professional support needed during the upcoming year patient's preferences (33.7%), diabetes self-management (33.3%), quality of life (27.0%) and motivation (25.6%) were most often considered relevant by healthcare professionals. CONCLUSION According to healthcare professionals, person-related factors such as quality of life, diabetes self-management and motivation are predominantly relevant for healthcare decisions about treatment goals and the professional support needed during the upcoming year.
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Affiliation(s)
- Merel M Ruissen
- Department of Medicine, Leiden University Medical Centre, Leiden, the Netherlands
- Department of Biomedical Data Sciences, Section of Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Jacob K Sont
- Department of Biomedical Data Sciences, Section of Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| | - Heidi A van Vugt
- Julius Centre for Health Sciences and Primary Care, Department of General Practice, University Medical Centre Utrecht, Utrecht, the Netherlands
- Dutch Diabetes Federation, Amersfoort, the Netherlands
| | - Marleen Kunneman
- Department of Biomedical Data Sciences, Section of Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Guy E H M Rutten
- Julius Centre for Health Sciences and Primary Care, Department of General Practice, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Eelco J P de Koning
- Department of Medicine, Leiden University Medical Centre, Leiden, the Netherlands
- Correspondence: Eelco JP de Koning, Department of Medicine, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands, Tel +31 71 52 62085, Fax +31 71 52 66881, Email
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10
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Daly BM, Arroll B, Scragg RKR. Trends in diabetes care and education by primary health care nurses in Auckland, New Zealand. Diabetes Res Clin Pract 2021; 177:108903. [PMID: 34102248 DOI: 10.1016/j.diabres.2021.108903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 05/04/2021] [Accepted: 06/03/2021] [Indexed: 11/24/2022]
Abstract
AIMS To examine trends in the management of patients with diabetes by primary health care nurses, its association with diabetes education and how valued and supported nurses feel in Auckland, New Zealand. METHODS Two representative cross-sectional surveys of all nurses providing community-based care, and patients with diabetes they consult, were conducted in 2006-8 and 2016. All participants completed a self-administered questionnaire on biographical details and a telephone interview on their provision of diabetes care. RESULTS Significantly more nurses discussed serum glucose and medications with patients, planned follow-up and scheduled practice nurse appointments in 2016 compared with 2006-8, and fewer specialist diabetologist appointments were made (12% versus 2%). Fewer nurses in 2016 than in 2006-8 felt valued (62% versus 75%) and supported (78% versus 89%) when managing patients (p-values = 0.0004). Nurses diabetes education was associated with recommended practice and feeling valued. Significantly more patients were prescribed metformin (81%) and insulin (46%) in 2016 compared with 58% and 30% in 2006-8. Despite this, HbA1c levels remained unchanged. CONCLUSIONS Prescribed glycaemic-related medications increased, and more nurses engaged with patients about glycaemic control and medications in 2016 compared with 2006-8. Nurses undertaking diabetes education was strongly associated with best management practices and nurses feeling valued.
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Affiliation(s)
- Barbara M Daly
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland 1142, New Zealand.
| | - Bruce Arroll
- School of Population Health, University of Auckland, New Zealand
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Hu X, Zhang Y, Lin S, Guo X, Yang D, Cai M, Gao L. Dietary Knowledge, Attitude and Practice (KAP) Among the Family Members of Patients with Type 2 Diabetes Mellitus (T2DM) and Its Influence on the KAP of T2DM Patients. Diabetes Metab Syndr Obes 2021; 14:205-213. [PMID: 33488108 PMCID: PMC7815068 DOI: 10.2147/dmso.s290639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 12/30/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To investigate the dietary knowledge, attitude and practice (KAP) among the family members (FMs) of Chinese type 2 diabetes mellitus (T2DM) patients and its influence on the KAP of T2DM patients. PATIENTS AND METHODS Two hundred thirty-six pairs of hospitalized T2DM patients and their FMs (472 in total) in our hospital were enrolled. A pair of self-designed questionnaires on dietary KAP (Cronbach's α ≥ 0.763, I-CVI ≥ 0.857, S-CVI = 0.964, 0.958) were used to collect data and assess the KAP towards diabetes diets. RESULTS The mean score for dietary KAP of T2DM patients was 2.33 ± 0.60, 3.03 ± 0.44 and 2.77 ± 0.38, whereas that of their FMs was 2.37 ± 0.55, 3.08 ± 0.48 and 2.82 ± 0.61, respectively. Pearson's correlation analysis showed that the glycosylated hemoglobin (HbA1c) of T2DM patients was negatively correlated to their dietary practice (r = -0.218, P < 0.01). There was a positive correlation between T2DM patients and their FMs for dietary KAP (r = 0.306, P < 0.05). The dietary practice of T2DM patients was positively correlated with the dietary KAP of their FMs (r = 0.305, 0.252 and 0.136, respectively, P < 0.01). Logistic regression analysis revealed that the score for dietary knowledge and attitude, occupation, residence, family history, complications of the T2DM patient, and the sex and dietary knowledge score of the FM were significantly associated with dietary practice for T2DM patients. CONCLUSION The dietary attitude of FMs was moderate but dietary knowledge and practice were poor. Dietary KAP was positively correlated with T2DM patients and their FMs.
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Affiliation(s)
- Xiling Hu
- Department of Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Yao Zhang
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Shuo Lin
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Xiaodi Guo
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Dan Yang
- School of Nursing, Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Mengyin Cai
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of China
- Correspondence: Mengyin Cai Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, Guangdong510630, People’s Republic of ChinaTel +86 13922131451 Email
| | - Lingling Gao
- School of Nursing, Sun Yat-Sen University, Guangzhou, People’s Republic of China
- Lingling Gao School of Nursing, Sun Yat-Sen University, No. 74, Zhongshan Er Road, Guangzhou, Guangdong510085, People’s Republic of ChinaTel +86 13539965693 Email
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Rutten GEHM, Van Vugt H, de Koning E. Person-centered diabetes care and patient activation in people with type 2 diabetes. BMJ Open Diabetes Res Care 2020; 8:8/2/e001926. [PMID: 33323460 PMCID: PMC7745339 DOI: 10.1136/bmjdrc-2020-001926] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/19/2020] [Accepted: 11/21/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The American Diabetes Association and the European Association for the Study of Diabetes advocate a person-centered approach to enhance patient engagement in self-care activities. To that purpose, people with diabetes need adequate diabetes knowledge, motivation, skills and confidence. These prerequisites are captured by the concept 'patient activation'. The Dutch Diabetes Federation implemented a person-centered consultation model for the annual diabetes review. To assess its relationship with patient activation, we measured the change in patient activation, and in person and disease-related factors in people with type 2 diabetes after their second person-centered annual review. RESEARCH DESIGN AND METHODS Observational study in 47 primary care practices and six outpatient hospital clinics. FOLLOW-UP 1 year. From 2.617 people with diabetes and capable of completing questionnaires (no additional exclusion criteria) 1.487 (56.8%) participated, 1366 with type 2 diabetes. MAIN OUTCOME patient activation (13-item Patient Activation Measure, score 0-100). Before the first and after the second review, participants completed questionnaires. Medical data were retrieved from electronic records. We performed a repeated measure analysis using a linear mixed model in 1299 participants, who completed the first set of questionnaires. RESULTS In 1299 participants (41.6% female, mean age 66 years, median diabetes duration 10 years, median glycated hemoglobin (HbA1c) 6.8%/51 mmol/mol), the mean baseline activation level was 58.9 (SD 11.7). Independent of actual diabetes care, activation levels increased 1.53 units (95% CI 0.67 to 2.39, p=0.001). Several diabetes perceptions improved significantly; diabetes distress level decreased significantly. Body mass index (-0.22, 95% CI -0.33 to -0.10, p<0.001) and low-density lipoprotein cholesterol (-2.71 mg/dL, 95% CI -4.64 to -0.77, p=0.004) decreased, HbA1c increased 0.08% (95% CI 0.03 to 0.12) (p=0.001). CONCLUSIONS Person-centered diabetes care was associated with a slightly higher patient activation level, improved diabetes perception and small improvements in clinical outcomes. Person-centered care may enhance patient engagement, but one should not expect substantial improvement in patient outcomes in the short term.
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Affiliation(s)
- Guy E H M Rutten
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Heidi Van Vugt
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Eelco de Koning
- Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Netherlands
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13
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Hertroijs DFL, Elissen AMJ, Brouwers MCGJ, Hiligsmann M, Schaper NC, Ruwaard D. Preferences of people with Type 2 diabetes for diabetes care: a discrete choice experiment. Diabet Med 2020; 37:1807-1815. [PMID: 31001855 PMCID: PMC7586937 DOI: 10.1111/dme.13969] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2019] [Indexed: 01/05/2023]
Abstract
AIMS Limited knowledge exists on the preferences of people with Type 2 diabetes towards diabetes care. Consequently, these care preferences cannot yet be considered in the development of tailored diabetes care approaches. Therefore, this study aimed to assess care preferences and their determinants in people with Type 2 diabetes. METHODS A discrete choice experiment was conducted to elicit people's preferences. People with Type 2 diabetes, treated in 30 Dutch primary care practices, were asked to choose repeatedly between two hypothetical diabetes care packages, which differed in six attributes: role division in daily diabetes care planning, lifestyle education method, type of medication management support, consultation frequency, emotional support and time spend on self-management. A mixed-logit model was used to estimate the relative importance of the included attributes. Preference heterogeneity among people with different person- and disease-related characteristics was investigated. RESULTS In total, 288 participants completed the experiment. They preferred to plan their daily diabetes care together with a healthcare provider, to receive individual lifestyle education, medication and emotional support from a healthcare provider, one consultation visit every 3 months and to spend less time on self-management. Participants did not prefer to receive emotional support from a psychologist. Heterogeneity in preferences could partly be explained by differences in sex, education level and glucose-lowering drug use. CONCLUSION People with Type 2 diabetes show a preference for traditional care models. Emotional support was identified by participants as the most important attribute. It is therefore important to adequately guide them when changes in diabetes care organization are implemented.
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Affiliation(s)
- D. F. L. Hertroijs
- Department of Health Services ResearchCAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - A. M. J. Elissen
- Department of Health Services ResearchCAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - M. C. G. J. Brouwers
- Department of Internal MedicineMaastricht University Medical CentreMaastrichtThe Netherlands
| | - M. Hiligsmann
- Department of Health Services ResearchCAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - N. C. Schaper
- Department of Internal MedicineMaastricht University Medical CentreMaastrichtThe Netherlands
| | - D. Ruwaard
- Department of Health Services ResearchCAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
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14
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Lafontaine S, Bourgault P, Girard A, Ellefsen E. Dimensions, application, and outcomes of person-centered self-management interventions for those living with type 2 diabetes: A scoping review. PATIENT EDUCATION AND COUNSELING 2020; 103:1961-1982. [PMID: 32624328 DOI: 10.1016/j.pec.2020.06.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 06/17/2020] [Accepted: 06/20/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To explore which dimensions of the person-centered approach (PCA) are adopted in self-management interventions, how they are applied, and its outcomes. METHODS A review team carried out a scoping review using the methodology of Arksey and O'Malley on diabetes mellitus type 2, person-centered care, and self-management. RESULTS Of the 364 titles identified, 22 articles were included in this review. No study contained all five dimensions described by the person-centered framework. Some dimensions seemed difficult to assess, mainly having a sympathetic presence and engagement. The application of the five PCA dimensions are presented. Although the authors claimed their intervention to be person-centered, none used a specific tool to measure person-centered care in a holistic way. CONCLUSION Although the guidelines recommend a PCA to professionals, there is a gap with practice, professionals having difficulty adopting and measuring this approach. PRACTICE IMPLICATIONS Some strategies to facilitate the adoption of a PCA with people living with type 2 diabetes are proposed. These can help researchers and clinicians develop a PCA, by identifying the care delivery processes necessary to provide it. It seems important for researchers to measure whether their intervention is truly person-centered, using holistic tools and combining different methods (observation, questionnaire, interview).
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Affiliation(s)
- S Lafontaine
- School of Nursing, University of Sherbrooke, Longueuil, Québec, J4K 0A8, Canada.
| | - P Bourgault
- School of Nursing, University of Sherbrooke, Sherbrooke, Québec, J1H 5N4, Canada.
| | - A Girard
- School of Nursing, University of Sherbrooke, Sherbrooke, Québec, J1H 5N4, Canada.
| | - E Ellefsen
- School of Nursing, University of Sherbrooke, Longueuil, Québec, J4K 0A8, Canada.
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15
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van Vugt HA, Heijmans MJWM, de Koning EJP, Rutten GEHM. Factors that influence the intended intensity of diabetes care in a person-centred setting. Diabet Med 2020; 37:1167-1175. [PMID: 31278874 DOI: 10.1111/dme.14072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/05/2019] [Indexed: 12/15/2022]
Abstract
AIMS To assess the intended intensity of Type 2 diabetes care and the factors associated with that intensity of care after the annual monitoring visit in which a new person-centred diabetes consultation model including shared decision making was used. METHODS We conducted an observational study in 1284 people from 47 general practices and six hospital outpatient clinics. Intensity of care (more, no/minimal change, less) was based on monitoring frequency and referral to other care providers. We used multivariable analyses to determine the factors that were independently associated with intensity of care. Care providers also reported three factors which, in their opinion, determined the intensity of care. RESULTS After the consultation, 22.8% of people chose more intensive care, 70.6% chose no/minimal change and 6.6% chose less intensive care. Whether care became more intensive vs not/minimally changed was associated with a high educational level (odds ratio 1.65, CI 1.07 to 2.53; P=0.023), concern about illness (odds ratio 1.08; CI 1.00 to 1.17; P=0.045), goal-setting (odds ratio 6.53, CI 3.79 to 11.27; P<0.001), comorbidities (odds ratio 1.12, CI 1.00 to 1.24; P=0.041) and use of oral blood glucose lowering medication (odds ratio 0.59, CI 0.39 to 0.89; P=0.011). Less intensive care vs no/minimal change was associated with lower diabetes distress levels (odds ratio 0.87, CI 0.79 to 0.97; P=0.009). According to care providers, quality of life, lifestyle, person's preferences and motivation, glycaemic control, and self-management possibilities most frequently determined the intended care. CONCLUSIONS In person-centred diabetes care, the intended intensity of care was associated with both disease- and person-related factors.
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Affiliation(s)
- H A van Vugt
- Julius Centre for Health Sciences and Primary Care, Department of General Practice, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - M J W M Heijmans
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - E J P de Koning
- Department of Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - G E H M Rutten
- Julius Centre for Health Sciences and Primary Care, Department of General Practice, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
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Brickley B, Sladdin I, Williams LT, Morgan M, Ross A, Trigger K, Ball L. A new model of patient-centred care for general practitioners: results of an integrative review. Fam Pract 2020; 37:154-172. [PMID: 31670759 DOI: 10.1093/fampra/cmz063] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND GPs providing patient-centred care (PCC) is embedded in international health care policies due to its positive impact on patients and potential to lower health care costs. However, what is currently known about GP-delivered PCC is unknown. OBJECTIVE To synthesize literature investigating GP-delivered PCC and address 'what is currently known about GP-delivered PCC?' METHOD A systematic literature search was conducted between June and July 2018. Eligible articles were empirical, full-text studies published in English between January 2003 and July 2018, related to at least three of the four dimensions of PCC described by Hudon et al. (2011), and related to preventative, acute, and/or chronic care by GPs. Following screening, full-text articles were independently assessed for inclusion by two investigators. Data were extracted and quality assessed by two researchers. Findings on PCC were analysed thematically (meta-synthesis). RESULTS Thirty medium- to high-quality studies met the inclusions criteria. Included studies utilized varied designs, with the most frequent being quantitative, cross-sectional. A theoretical model of PCC was synthesized from included studies and contained four major components: (i) understanding the whole person, (ii) finding common ground, (iii) experiencing time and (iv) aiming for positive outcomes. Harms of PCC were rarely reported. CONCLUSIONS Four overarching theoretical components of PCC relate to elements of the consultation and experience of time. These components can be used to inform the development of toolkits to support GPs and general practice organizations in pursuit of PCC as well as tools to measure patient-centredness.
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Affiliation(s)
- Bryce Brickley
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Ishtar Sladdin
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Lauren T Williams
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Mark Morgan
- Bond University, Gold Coast, Queensland, Australia
| | - Alyson Ross
- Gold Coast Primary Health Network, Gold Coast, Queensland, Australia
| | - Kellie Trigger
- Gold Coast Primary Health Network, Gold Coast, Queensland, Australia
| | - Lauren Ball
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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Hertroijs DFL, Brouwers MCGJ, Elissen AMJ, Schaper NC, Ruwaard D. Relevant patient characteristics for estimating healthcare needs according to healthcare providers and people with type 2 diabetes: a Delphi survey. BMC Health Serv Res 2019; 19:575. [PMID: 31419980 PMCID: PMC6698036 DOI: 10.1186/s12913-019-4371-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 07/25/2019] [Indexed: 01/02/2023] Open
Abstract
Background Recently, there has been growing interest in providing more tailored, patient-centered care for the treatment of type 2 diabetes mellitus (T2DM). Yet it remains unclear which patient characteristics should be determined to guide such an approach. Therefore, the opinions of healthcare providers (HCP) and people with T2DM about relevant patient characteristics for estimating healthcare needs of people with T2DM were assessed and compared. Methods Two separate online Delphi studies were conducted according to the RAND-UCLA Appropriateness Method: one with HCPs (n = 22) from Dutch primary and secondary care and one with people with T2DM treated in Dutch primary care (n = 46). The relevance of patient characteristics for estimating healthcare needs, defined as the number of yearly consultations, was assessed on a 5-point Likert scale. Characteristics with a median of 4 or 5 and an interquartile range ≤ 1.5 were considered relevant with consensus. Participants were also asked to select the top 5 of most relevant patient characteristics. To determine the overall top 5, the mean relative importance score of each characteristic was calculated. Results In two Delphi rounds, 28 and 15 patient characteristics were rated by HCPs and people with T2DM, respectively. Both HCPs and people with T2DM found health-related characteristics relevant for estimating healthcare needs of people with T2DM. However, HCPs preferred to estimate healthcare needs using person- and context-related characteristics. They ranked self-efficacy as the most relevant estimator. In contrast, people with T2DM were more in favor of health-related characteristics and ranked HbA1c as the most relevant estimator. Conclusions The findings show that there is discrepancy in opinions on relevant patient characteristics for estimating healthcare needs between HCPs and people with T2DM. To achieve more tailored, patient-centered care, it is important that both groups agree on the topics to be discussed during patient consultations. Electronic supplementary material The online version of this article (10.1186/s12913-019-4371-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dorijn F L Hertroijs
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229, GT, Maastricht, the Netherlands.
| | - Martijn C G J Brouwers
- Department of Internal Medicine, Division of Endocrinology and Metabolic Diseases, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
| | - Arianne M J Elissen
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229, GT, Maastricht, the Netherlands
| | - Nicolaas C Schaper
- Department of Internal Medicine, Division of Endocrinology and Metabolic Diseases, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229, GT, Maastricht, the Netherlands
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Hambling CE, Khunti K, Cos X, Wens J, Martinez L, Topsever P, Del Prato S, Sinclair A, Schernthaner G, Rutten G, Seidu S. Factors influencing safe glucose-lowering in older adults with type 2 diabetes: A PeRsOn-centred ApproaCh To IndiVidualisEd (PROACTIVE) Glycemic Goals for older people: A position statement of Primary Care Diabetes Europe. Prim Care Diabetes 2019; 13:330-352. [PMID: 30792156 DOI: 10.1016/j.pcd.2018.12.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/17/2018] [Accepted: 12/28/2018] [Indexed: 12/23/2022]
Abstract
Diabetes in later life is associated with a range of factors increasing the complexity of glycaemic management. This position statement, developed from an extensive literature review of the subject area, represents a consensus opinion of primary care clinicians and diabetes specialists. It highlights many challenges facing older people living with type 2 diabetes and aims to support primary care clinicians in advocating a comprehensive, holistic approach. It emphasises the importance of the wishes of the individual and their carers when determining glycaemic goals, as well as the need to balance intended benefits of treatment against the risk of adverse treatment effects. Its ultimate aim is to promote consistent high-quality care for older people with diabetes.
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Affiliation(s)
- C E Hambling
- Department of Public Health and Primary Care, School of Clinical Medicine, Box 285, Cambridge Biomedical Campus, Cambridge, CB2 0SR, United Kingdom; Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, United Kingdom.
| | - K Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, United Kingdom
| | - X Cos
- Sant Marti de Provençals Primary Care Centres, Institut Català de la Salut, University Research Institute in Primary Care (IDIAP Jordi Gol), Barcelona, Spain
| | - J Wens
- Department of Medicine and Health Sciences, Primary and Interdisciplinary Care Antwerp, University of Antwerp, Antwerp, Belgium
| | - L Martinez
- Department of General Medicine, Pierre and Marie Curie University, Paris, France
| | - P Topsever
- Department of Family Medicine, Acibadem Mehmet Ali Aydinlar University School of Medicine, Kerem Aydinlar Campus, 34752 Atasehir, Istanbul, Turkey
| | - S Del Prato
- Department of Clinical and Experimental Medicine, Section of Diabetes, University of Pisa, Pisa, Italy
| | - A Sinclair
- Foundation for Diabetes Research in Older People (FDROP), Diabetes Frail, Luton, United Kingdom
| | - G Schernthaner
- Department of Medicine 1, Rudolfstiftung Hospital, Juchgasse 25, 1030 Vienna, Austria
| | - G Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, University, Utrecht, the Netherlands
| | - S Seidu
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, United Kingdom
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Association between person and disease related factors and the planned diabetes care in people who receive person-centered type 2 diabetes care: An implementation study. PLoS One 2019; 14:e0219702. [PMID: 31339929 PMCID: PMC6655662 DOI: 10.1371/journal.pone.0219702] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 06/29/2019] [Indexed: 11/20/2022] Open
Abstract
AIMS To assess the planned diabetes care for the coming year and its associated factors in patients with Type 2 diabetes who have a person-centered annual consultation. METHODS Implementation study of a new consultation model in 47 general practices (primary care) and 6 outpatient clinics (secondary care); 1200 patients from primary and 166 from secondary care participated. Data collection took place between November 2015 and February 2017. Outcomes: preferred monitoring frequency; referral to other health care provider(s); medication change. One measurement at the end of the consultation. We performed logistic regression analyses. Differences between primary and secondary care were analyzed. RESULTS Many patients arranged a monitoring frequency <4 times per year (general practices 19.5%, outpatient clinics 40%, p < .001). Type of provider (physician/nurse, OR 3.83, p < .001), baseline HbA1c (OR 1.02, p = .017), glucose lowering medication; and setting treatment goals (OR .65, p = .048) were associated with the chosen frequency. Independently associated with a referral were age (OR .99, p = .039), baseline glucose lowering medication and patients' goal setting (OR 1.52, p = .016). Medication change was associated with type of provider, baseline HbA1c, blood glucose lowering medication, quality of life (OR .80, p = .037) and setting treatment goals (OR 2.64, p = .001). CONCLUSIONS Not only disease but also person related factors, especially setting treatment goals, are independently associated with planned care use in person-centered diabetes care.
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Fisher L, Polonsky WH, Hessler D. Addressing diabetes distress in clinical care: a practical guide. Diabet Med 2019; 36:803-812. [PMID: 30985025 DOI: 10.1111/dme.13967] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2019] [Indexed: 01/09/2023]
Abstract
Addressing the emotional side of diabetes and its management has received considerable attention in recent years. At the centre of most of these efforts is the concept of 'diabetes distress', a generic term that captures the primary sources and intensity of emotional distress associated with diabetes and its management over time. As interest in diabetes distress has grown, however, it has been difficult to integrate and translate the various strands of clinical research in a manner that can guide diabetes distress intervention efforts in the real world of clinical care. The aim of this paper is to fill this gap by outlining practical strategies for intervention in clinical settings and to assist diabetes healthcare professionals in thinking through how diabetes distress might be addressed practically in their clinics. To address these goals, this review is divided into five sections: a definition of diabetes distress, ways diabetes distress can be assessed and monitored, information about diabetes distress for use in intervention planning, topics to be considered for inclusion in diabetes distress interventions, and alternatives for where in the care process a diabetes distress intervention might be considered. We focus on diabetes distress experienced by adults with both Type 1 and Type 2 diabetes.
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Affiliation(s)
- L Fisher
- Department of Family & Community Medicine, University of California, San Francisco, Ca, USA
| | - W H Polonsky
- University of California, San Diego, Behavioral Diabetes Institute, San Diego, Ca, USA
| | - D Hessler
- Department of Family & Community Medicine, University of California, San Francisco, Ca, USA
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van Vugt HA, Boels AM, de Weerdt I, de Koning EJ, Rutten GE. Patient activation in individuals with type 2 diabetes mellitus: associated factors and the role of insulin. Patient Prefer Adherence 2018; 13:73-81. [PMID: 30643392 PMCID: PMC6314047 DOI: 10.2147/ppa.s188391] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIM This study explored the relationship between insulin use and patient activation (a person's internal readiness and capabilities to undertake health-promoting actions) in individuals with type 2 diabetes mellitus and aimed to identify demographic, clinical and psychosocial factors involved in patient activation. METHODS In this cross-sectional study, baseline data from a Dutch nationwide study were analyzed. Patient activation was assessed with the Patient Activation Measure 13. A linear mixed model was used to take clustering into account. RESULTS In total, 1,189 persons were included (310 of whom were on insulin), enrolled via 47 general practices and six hospitals. Their mean Patient Activation Measure 13 score was 59±12. We found no association between insulin therapy and patient activation. In the multivariable analysis, individuals with a better health status, very good or very poor social support (vs good social support), individuals who felt they had greater control over their illness and those with a better subjective understanding of their illness showed higher patient activation. Individuals with a lower educational level and those who expected their illness to continue showed a lower activation level. CONCLUSION Patient activation does not differ between individuals with type 2 diabetes mellitus on insulin therapy and those on other therapies.
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Affiliation(s)
- Heidi A van Vugt
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, Utrecht, the Netherlands,
- Dutch Diabetes Federation, Amersfoort 3818 LE, the Netherlands
| | - Anne Meike Boels
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, Utrecht, the Netherlands,
| | - Inge de Weerdt
- Dutch Diabetes Federation, Amersfoort 3818 LE, the Netherlands
| | - Eelco Jp de Koning
- Department of Medicine, Leiden University Medical Center, 2300 RC Leiden, the Netherlands
| | - Guy Ehm Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3508 GA Utrecht, Utrecht, the Netherlands,
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