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Affiliation(s)
- Chris van Weel
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Health Systems Research and Policy, Australian National University, Canberra, Australia
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Cuypers M, Tobi H, Huijsmans CAA, van Gerwen L, Ten Hove M, van Weel C, Kiemeney LALM, Naaldenberg J, Leusink GL. Disparities in cancer-related healthcare among people with intellectual disabilities: A population-based cohort study with health insurance claims data. Cancer Med 2020; 9:6888-6895. [PMID: 32710528 PMCID: PMC7520346 DOI: 10.1002/cam4.3333] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/29/2020] [Accepted: 07/08/2020] [Indexed: 01/07/2023] Open
Abstract
Background Concerns have been raised about the accessibility and quality of cancer‐related care for people with intellectual disabilities (ID). However, there is limited insight into cancer incidence and the utilization of cancer care at the ID population level to inform targeted cancer control strategies. Therefore, we aimed to examine differences in the utilization of cancer‐related care between people with and without ID, identified through diagnostic codes on health insurance claims. Methods In a population‐based cohort study, Dutch individuals of all ages who received residential care through the Chronic Care Act due to an ID (n = 65 183) and an age and sex‐matched sample of persons without ID (1:2 ratio), who were cancer‐free at enrollment in 2013 were followed through 2015. Incidence rates (IRs) of newly started cancer care and IR ratios (IRRs) with 95% CIs were used to compare groups. Separate analyses were performed per cancer type. Results Individuals with ID received less cancer‐related care than individuals without (IRR = 0.64, 95% CI 0.62‐0.66). Differences increased with age and were larger for females than for males. Utilization of care for cancers within the national screening program (female breast, cervical, and colon cancer) was lower for people with ID compared to people without ID. Conclusion Cancer may be underdiagnosed and/or undertreated in people with ID, or cancer is truly less prevalent in this population. In particular, the differences detected between males and females with ID, and the potential underutilization of national screening programs, require urgent follow‐up investigations.
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Affiliation(s)
- Maarten Cuypers
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hilde Tobi
- Biometris, Wageningen University & Research, Wageningen, The Netherlands
| | | | | | | | - Chris van Weel
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Health Services Research and Policy, Honorary Professor of Primary Health Care Research, Australian National University, Canberra, Australia
| | - Lambertus A L M Kiemeney
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jenneken Naaldenberg
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Geraline L Leusink
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Bonnie LHA, Visser MRM, Kramer AWM, van Dijk N. Insight in the development of the mutual trust relationship between trainers and trainees in a workplace-based postgraduate medical training programme: a focus group study among trainers and trainees of the Dutch general practice training programme. BMJ Open 2020; 10:e036593. [PMID: 32312728 PMCID: PMC7245404 DOI: 10.1136/bmjopen-2019-036593] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES Trust plays an important role in workplace-based postgraduate medical education programmes. Trainers must trust their trainees for granting them greater independence. Trainees must trust their trainer for a safe learning environment. As trainers' and trainees' trust in each other plays an important role in trainee learning and development, the authors aimed to explore the development of the mutual trust relationship between trainers and trainees. SETTING This study was performed in a general practice training department in the Netherlands. PARTICIPANTS All trainers and trainees of the general practice training department were invited to participate. Fifteen trainers and 34 trainees, voluntarily participated in focus group discussions. OUTCOME MEASURES The authors aimed to gain insight in the factors involved in the development of the mutual trust relationship between trainers and trainees, in order to be able to create a model for the development of a mutual trust relationship between trainers and trainees. The risk-based view of trust was adopted as leading conceptual framework. RESULTS In the first stage of trust development, trainers and trainees develop basic trust in each other. Basic trust forms the foundation of the trust relationship. In the second stage, trainers develop trust in trainees taking into account trainees' working and learning performance, and the context in which the work is performed. Trainees trust their trainer based on the trainer'savailability and accessibility and the personal relationship between the trainee and their trainer. Trainee self-confidence modifies the development of a trust relationship. CONCLUSION The development of a mutual trust relationship between trainers and trainees is a complex process that involves various stages, goals, factors and interactive aspects. As the mutual trust relationship influences the learning environment for trainees, greater emphasis on the mutual trust relationship may improve learning outcomes. Further research may explore the effect of long-term and short-term educational relationships on the trust relationship between trainers and trainees.
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Affiliation(s)
- Linda H A Bonnie
- Department of General Practice/GP Speciality Training, Amsterdam UMC - Locatie AMC, Amsterdam, North Holland, The Netherlands
| | - Mechteld R M Visser
- Department of General Practice/GP Speciality Training, Amsterdam UMC - Locatie AMC, Amsterdam, North Holland, The Netherlands
| | - Anneke W M Kramer
- Department of General Practice/GP Specialty Training, Leiden University, Leiden, South Holland, The Netherlands
| | - Nynke van Dijk
- Department of General Practice/GP Speciality Training, Amsterdam UMC - Locatie AMC, Amsterdam, North Holland, The Netherlands
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Samal M, Sahoo KC, Pati S, Tripathy SR, Parida MK, Das BK. Use of Animal and Animal Products for Rheumatoid Arthritis Treatment: An Explorative Study in Odisha, India. Front Med (Lausanne) 2020; 6:323. [PMID: 31993436 PMCID: PMC6970967 DOI: 10.3389/fmed.2019.00323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/18/2019] [Indexed: 11/13/2022] Open
Abstract
Severe fatigue, pain, deformity, and disability, are the major concerns for rheumatoid arthritis (RA). The extreme pain experienced by the patients often force them to experiment with various indigenous substances including animals and animal products. However, there is little evidence on the use of animals or animal products as traditional medicine in RA. Hence, this study was aimed to explore the experience and perception of patients toward the use of animals and animal products for the treatment of RA. A qualitative, explorative study was conducted at the out-patient-department of Rheumatology of a tertiary care medical college and hospital at Cuttack, Odisha, India. Out of 113 patients with RA, 18 patients gave history of use of animal and/or animal products and were selected for in-depth interviews. The content analysis methods were used for data analysis. Four major categories emerged: (1) prevailing patterns of traditional treatment of RA using animals, (2) beliefs and values behind the traditional treatment of RA, (3) sources and traditional learning pathway of indigenous practices on RA, and (4) ethical aspects of the indigenous practice of using animals and/or animal products in the treatment of RA. This study revealed the practice of eating dead animals to get relief from RA. However, there was hardly any perceived positive outcome of the practice; which indicates the lack of awareness of rational, scientific, treatment, and prevalence of irrational and unethical practices for the treatment of RA. Hence, community awareness, social mobilization, and newer screening tools are necessary to improve the timely detection and prevention of irrational treatment practices among RA patients.
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Affiliation(s)
- Mousumi Samal
- Regional Medical Research Centre, Indian Council of Medical Research, Bhubaneswar, India
| | - Krushna Chandra Sahoo
- Regional Medical Research Centre, Indian Council of Medical Research, Bhubaneswar, India
| | - Sanghamitra Pati
- Regional Medical Research Centre, Indian Council of Medical Research, Bhubaneswar, India
| | - Saumya Ranjan Tripathy
- Clinical Immunology and Rheumatology, Department of Medicine, Srirama Chandra Bhanja Medical College and Hospital, Cuttack, India
| | - Manoj Kumar Parida
- Clinical Immunology and Rheumatology, Department of Medicine, Srirama Chandra Bhanja Medical College and Hospital, Cuttack, India
| | - Bidyut Kumar Das
- Clinical Immunology and Rheumatology, Department of Medicine, Srirama Chandra Bhanja Medical College and Hospital, Cuttack, India
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de Brún T, O’Reilly - de Brún M, Van Weel-Baumgarten E, Burns N, Dowrick C, Lionis C, O’Donnell C, Mair FS, Papadakaki M, Saridaki A, Spiegel W, Van Weel C, Van den Muijsenbergh M, MacFarlane A. Using Participatory Learning & Action (PLA) research techniques for inter-stakeholder dialogue in primary healthcare: an analysis of stakeholders' experiences. RESEARCH INVOLVEMENT AND ENGAGEMENT 2017; 3:28. [PMID: 29225922 PMCID: PMC5718138 DOI: 10.1186/s40900-017-0077-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 11/06/2017] [Indexed: 05/12/2023]
Abstract
PLAIN ENGLISH SUMMARY It is important for health care workers to know the needs and expectations of their patients. Therefore, service users have to be involved in research. To achieve a meaningful dialogue between service users, healthcare workers and researchers, participatory methods are needed. This paper describes how the application of a specific participatory methodology, Participatory Learning and Action (PLA) can lead to such a meaningful dialogue. In PLA all stakeholders are regarded as equal partners and collaborators in research.During 2011-2015, a European project called RESTORE used PLA in Austria, Greece, Ireland, The Netherlands and the UK to investigate how communication between primary health care workers and their migrant patients could be improved.Seventy eight migrants, interpreters, doctors, nurses and other key stakeholders (see Table 2) participated in 62 PLA sessions. These dialogues (involving discussions, activities, PLA techniques and evaluations) were generally 2-3 h long and were recorded and analysed by the researchers.Participants reported many positive experiences about their dialogues with other stakeholders. There was a positive, trusting atmosphere in which all stakeholders could express their views despite differences in social power. This made for better understanding within and across stakeholder groups. For instance a doctor changed her view on the use of interpreters after a migrant explained why this was important. Negative experiences were rare: some doctors and healthcare workers thought the PLA sessions took a lot of time; and despite the good dialogue, there was disappointment that very few migrants used the new interpreting service. ABSTRACT Background In order to be effective, primary healthcare must understand the health needs, values and expectations of the population it serves. Recent research has shown that the involvement of service users and other stakeholders and gathering information on their perspectives can contribute positively to many aspects of primary healthcare. Participatory methodologies have the potential to support engagement and dialogue between stakeholders from academic, migrant community and health service settings. This paper focuses on a specific participatory research methodology, Participatory Learning and Action (PLA) in which all stakeholders are regarded as equal partners and collaborators in research.Our research question for this paper was: "Does the application of PLA lead to meaningful engagement of all stakeholders, and if so, what elements contribute to a positive and productive inter-stakeholder dialogue?". Methods We explored the use of PLA in RESTORE, a European FP7-funded project, during 2011-2015 in 5 countries: Austria, Greece, Ireland, the Netherlands and the UK. The objective of RESTORE was to investigate and support the implementation of guidelines and training initiatives (G/TIs) to enhance communication in cross-cultural primary care consultations with migrants.Seventy eight stakeholders (migrants, interpreters, doctors, nurses and others - see Table 2) participated in a total of 62 PLA sessions (discussions, activities, evaluations) of approximately 2-3 h' duration across the five sites. During the fieldwork, qualitative data were generated about stakeholders' experiences of engagement in this dialogue, by means of various methods including participatory evaluations, researchers' fieldwork reports and researcher interviews. These were analysed following the principles of thematic analysis. Results Stakeholders involved in PLA inter-stakeholder dialogues reported a wide range of positive experiences of engagement, and very few negative experiences. A positive atmosphere during early research sessions helped to create a sense of safety and trust. This enabled stakeholders from very different backgrounds, with different social status and power, to offer their perspectives in a way that led to enhanced learning in the group - they learned with and from each other. This fostered shifts in understanding - for example, a doctor changed her view on interpreted consultations because of the input of the migrant service-users. Conclusion PLA successfully promoted stakeholder involvement in meaningful and productive inter-stakeholder dialogues. This makes it an attractive approach to enhance the further development of health research partnerships to advance primary healthcare.
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Affiliation(s)
- T. de Brún
- Centre for Participatory Strategies (CPS), Galway, Ireland
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
| | - M. O’Reilly - de Brún
- Centre for Participatory Strategies (CPS), Galway, Ireland
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
| | - E. Van Weel-Baumgarten
- Department of Primary and Community Care, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - N. Burns
- Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YW UK
| | - C. Dowrick
- Department of Psychological Sciences, B121 Waterhouse Buildings University of Liverpool, Liverpool, UK
| | - C. Lionis
- University of Crete, Faculty of Medicine, Clinic of Social and Family Medicine, Heraklion, Greece
| | - C. O’Donnell
- General Practice & Primary Care, Institute of Health and Wellbeing, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - F. S. Mair
- General Practice & Primary Care, Institute of Health and Wellbeing, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - M. Papadakaki
- Technological Educational Institute of Crete, School of Health and Social Welfare, Department of Social Work, Heraklion, Greece
| | - A. Saridaki
- University of Crete, Faculty of Medicine, Clinic of Social and Family Medicine, Heraklion, Greece
| | - W. Spiegel
- Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1st floor, A-1090, Vienna, Austria
| | - C. Van Weel
- Department of Primary and Community Care, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - M. Van den Muijsenbergh
- Department of Primary and Community Care, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
- Pharos, centre of expertise on health disparities, Utrecht, The Netherlands
| | - A. MacFarlane
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
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Case finding for COPD in general practice. THE LANCET RESPIRATORY MEDICINE 2016; 4:679-681. [DOI: 10.1016/s2213-2600(16)30181-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 06/20/2016] [Indexed: 11/24/2022]
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Sturgiss EA, Elmitt N, van Weel C, Haesler E, Sargent G, Stevenson A, Harris M, Douglas K. The role of the family doctor in the management of adults who are obese: a scoping review protocol. SPRINGERPLUS 2015; 4:820. [PMID: 26753108 PMCID: PMC4695474 DOI: 10.1186/s40064-015-1647-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 12/21/2015] [Indexed: 11/16/2022]
Abstract
Background The role of family doctors in the management of obesity in primary care will become increasingly important as more of the adult population become overweight or obese. Having a solid understanding of the family doctor’s role as a sole practitioner is important for supporting practitioners in providing patient care and for informing future research. Objective The purpose of this paper is to describe a protocol for a scoping review that aims to examine and map the current research base for the role of the family doctor in managing adults who are overweight or obese. Methods This scoping review is based on the methodology as described by the Joanna Briggs Institute which involves final consultation with stakeholders. Two reviewers (ES, NE) will be responsible for the iterative development of a search strategy based on the basic initial search terms obesity, doctor and primary care. Black and grey literature will be searched to elucidate any manuscripts involving the family doctor in the management of adults who are overweight or obese. A customised data extraction tool will be used to collect relevant items from each manuscript. Results Data extraction will expose the role family doctors are playing in obesity management in all stages of research including recruitment, intervention or as a control group. By looking at a broad scope of manuscripts we will discover the family doctor’s role as portrayed in research, in international guidelines and by peak bodies. We will also determine if there are any gaps in the research base. Conclusion This protocol describes a scoping review that will illustrate the supporting international research for the role family doctors are playing in the management of adults who are overweight or obese. Scoping of the international literature will then be translated for Australian primary care.
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Affiliation(s)
- Elizabeth Ann Sturgiss
- Academic Unit of General Practice, Australian National University Medical School, Canberra, Australia
| | - Nicholas Elmitt
- Academic Unit of General Practice, Australian National University Medical School, Canberra, Australia
| | - Chris van Weel
- Radboud University Nijmegen, Nijmegen, The Netherlands ; Primary Health Care Research, Australian Primary Health Care Research Institute, Research School of Population Health, ANU College of Medicine, Canberra, Australia
| | - Emily Haesler
- Academic Unit of General Practice, Australian National University Medical School, Canberra, Australia
| | - Ginny Sargent
- National Centre for Epidemiology and Population Health (NCEPH), Research School of Population Health, ANU College of Medicine, Biology and Environment, The Australian National University, Canberra, Australia
| | - Alex Stevenson
- Academic Unit of General Practice, Australian National University Medical School, Canberra, Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), UNSW, Sydney, Australia
| | - Kirsty Douglas
- Academic Unit of General Practice, Australian National University Medical School, Canberra, Australia
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Malterud K, Guassora AD, Graungaard AH, Reventlow S. Understanding medical symptoms: a conceptual review and analysis. THEORETICAL MEDICINE AND BIOETHICS 2015; 36:411-424. [PMID: 26597868 DOI: 10.1007/s11017-015-9347-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The aim of this article is to present a conceptual review and analysis of symptom understanding. Subjective bodily sensations occur abundantly in the normal population and dialogues about symptoms take place in a broad range of contexts, not only in the doctor's office. Our review of symptom understanding proceeds from an initial subliminal awareness by way of attribution of meaning and subsequent management, with and without professional involvement. We introduce theoretical perspectives from phenomenology, semiotics, social interactionism, and discourse analysis. Drew Leder's phenomenological perspectives deal with how symptom perception occurs when any kind of altered balance brings forward a bodily attention. Corporeality is brought to explicit awareness and perceived as sensations. Jesper Hoffmeyer's biosemiotic perspectives provide access to how signs are interpreted to attribute meaning to the bodily messages. Symptom management is then determined by the meaning of a symptom. Dorte E. Gannik's concept "situational disease" explains how situations can be reviewed not just in terms of their potential to produce signs or symptoms, but also in terms of their capacity to contain symptoms. Disease is a social and relational phenomenon of containment, and regulating the situation where the symptoms originate implies adjusting containment. Discourse analysis, as presented by Jonathan Potter and Margaret Wetherell, provides a tool to notice the subtle ways in which language orders perceptions and how language constructs social interaction. Symptoms are situated in culture and context, and trends in modern everyday life modify symptom understanding continuously. Our analysis suggests that a symptom can only be understood by attention to the social context in which the symptom emerges and the dialogue through which it is negotiated.
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Affiliation(s)
- Kirsti Malterud
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
- Research Unit for General Practice, Uni Research Health, Kalfarveien 31, 5018, Bergen, Norway.
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Ann Dorrit Guassora
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anette Hauskov Graungaard
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Reventlow
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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van Weel C. Research and clinical practice: How to better answer the needs of patient care. J Clin Epidemiol 2015; 68:1244-6. [PMID: 26092289 DOI: 10.1016/j.jclinepi.2015.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 05/28/2015] [Accepted: 06/02/2015] [Indexed: 11/28/2022]
Abstract
This article analyzes the translation of research to clinical practice. Clinical practice is focused on a concrete context in which patients are encountered. This follows from the population under care in terms of their health status, socioeconomic circumstances, cultural and religious features, and social determinants of health but also from the actual function in which the encounter between patient and professional takes place. An understanding of this contextual complexity is as important in the translation of research into practice, as is an understanding of research. This asks for a partnership between practice and research, and the closer to the practice setting research data are collected, the more straightforward the translation is.
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Affiliation(s)
- Chris van Weel
- Department of Primary and Community Care, Radboud University Nijmegen Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands; Australian Primary Health Care Research Institute, Building 63, Crn Mills and Eggleston Roads, The Australian National University, Acton ACT 2601, Canberra, Australia.
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de Jonge A, de Vries R, Lagro-Janssen ALM, Malata A, Declercq E, Downe S, Hutton EK. The importance of evaluating primary midwifery care for improving the health of women and infants. Front Med (Lausanne) 2015; 2:17. [PMID: 25853136 PMCID: PMC4369669 DOI: 10.3389/fmed.2015.00017] [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: 02/05/2015] [Accepted: 03/09/2015] [Indexed: 11/13/2022] Open
Abstract
In most countries, maternal and newborn care is fragmented and focused on identification and treatment of pathology that affects only the minority of women and babies. Recently, a framework for quality maternal and newborn care was developed, which encourages a system-level shift to provide skilled care for all. This care includes preventive and supportive care that works to strengthen women's capabilities and focuses on promotion of normal reproductive processes while ensuring access to emergency treatment when needed. Midwifery care is pivotal in this framework, which contains several elements that resonate with the main dimensions of primary care. Primary health care is the first level of contact with the health system where most of the population's curative and preventive health needs can be fulfilled as close as possible to where people live and work. In this paper, we argue that midwifery as described in the framework requires the application of a primary care philosophy for all childbearing women and infants. Evaluation of the implementation of the framework should therefore include tools to monitor the performance of primary midwifery care.
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Affiliation(s)
- Ank de Jonge
- Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands
| | - Raymond de Vries
- Center for Bioethics and Social Sciences in Medicine, School of Medicine, University of Michigan, Ann Arbor, MI, USA
- Midwifery Academy Maastricht, Maastricht, Netherlands
| | - Antoine L. M. Lagro-Janssen
- Gender and Women’s Health Unit, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands
| | - Address Malata
- Kamuzu College of Nursing, University of Malawi, Zomba, Malawi
| | | | - Soo Downe
- Research in Childbirth and Health (ReaCH) Group, School of Health, University of Central Lancashire, Preston, UK
| | - Eileen K. Hutton
- Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands
- Midwifery Education Program, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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Furler J, Blackberry I, Manski-Nankervis JA, O'Neal D, Best J, Young D. Optimizing care and outcomes for people with type 2 diabetes - lessons from a translational research program on insulin initiation in general practice. Front Med (Lausanne) 2015; 1:60. [PMID: 25688345 PMCID: PMC4310321 DOI: 10.3389/fmed.2014.00060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 12/19/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Clinical inertia, failure to intensify treatment according to evidence-based guidelines, leads to prolonged, avoidable hyperglycemia in people with type 2 diabetes (T2D). This is a challenge for General Practice and Primary Care, where most people with T2D receive most of their care. Sustained, integrated translational research programs are needed to embed effective treatments in routine practice, yet many challenges exist for developing such programs. OBJECTIVES To explore challenges and facilitators to implementing a translational research program focused on insulin initiation and titration among people with T2D in general practice and to identify key factors important to support and sustain such translation research in primary care. Operationalizing a program of translational work in primary care: We describe a series of studies on insulin initiation and titration in general practice including theory and qualitative work (Phase 1), a small feasibility and acceptability pilot (Phase 2), a large scale pilot (Phase 3), and a pragmatic cluster randomized trial currently under way (Phase 4). We used mixed methods to explore practice level implementation issues, and reflective investigator discussions to explore broader research program sustainability. Challenges for translational research in primary care: Key facilitators and barriers at practice and research program levels, include: Appropriate funding structures to secure long-term capacity building and people support; Building and maintaining linkages between communities of practice, primary and secondary/tertiary care researchers, institutions, and industry partners; Strategies for engagement and support for practitioners and participants. CONCLUSION Building effective and sustainable translational research programs are critical for developing evidence-based policy that drives improved outcomes at a population level. Diverse sources of funding that support extensive and sustained trans-mural collaboration as well as engagement with practitioners, patients, and policymakers in the field are crucial.
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Affiliation(s)
- John Furler
- General Practice and Primary Health Care Academic Centre, The University of Melbourne , Carlton, VIC , Australia
| | - Irene Blackberry
- General Practice and Primary Health Care Academic Centre, The University of Melbourne , Carlton, VIC , Australia ; John Richards Initiative, School of Nursing and Midwifery, La Trobe University , Wodonga, VIC , Australia
| | - Jo-Anne Manski-Nankervis
- General Practice and Primary Health Care Academic Centre, The University of Melbourne , Carlton, VIC , Australia
| | - David O'Neal
- Department of Medicine, St Vincent's Hospital, The University of Melbourne , Fitzroy, VIC , Australia
| | - James Best
- Melbourne Medical School, The University of Melbourne , Parkville, VIC , Australia
| | - Doris Young
- General Practice and Primary Health Care Academic Centre, The University of Melbourne , Carlton, VIC , Australia
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