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Kanumilli N, Butler J, Makrilakis K, Rydén L, Vallis M, Wanner C, Zieroth S, Alhussein A, Cheng A. Guardians For Health: A Practical Approach to Improving Quality of Life and Longevity in People with Type 2 Diabetes. Diabetes Ther 2023:10.1007/s13300-023-01418-0. [PMID: 37199909 DOI: 10.1007/s13300-023-01418-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/28/2023] [Indexed: 05/19/2023] Open
Abstract
Type 2 diabetes is one of the fastest-growing health emergencies of the twenty-first century, in part due to its association with cardiovascular and renal disease. Successful implementation of evidence-based guidelines for the management of patients with diabetes and pre-diabetes has been shown to improve patient outcomes by controlling risk factors for cardiovascular and renal disease. Recommendations include the early introduction of lifestyle adjustments, supported by pharmacological tools. Despite the availability of regularly updated, evidence-based guidelines, guideline implementation in clinical practice is low. As a result, people living with type 2 diabetes are not consistently receiving ideal clinical care. Improving guideline adherence has the potential to improve quality of life and longevity in patients with type 2 diabetes. This article introduces Guardians For Health, a global initiative that aims to improve guideline adherence by simplifying patient management and encouraging patient participation in the implementation of guidelines for type 2 diabetes. Guardians For Health is supported by a global community of implementers, with tools to support decision-making and quality assurance. Through achieving better guideline adherence, Guardians For Health hopes to achieve its vision to "stop early mortality by reducing cardiovascular and kidney complications in people with type 2 diabetes".
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Affiliation(s)
- Naresh Kanumilli
- Northenden Group Practice, 489 Palatine Road, Northenden, Manchester, M22 4DH, UK.
| | | | | | - Lars Rydén
- Department for Medicine K2, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | - Ahmad Alhussein
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Alice Cheng
- University of Toronto Mississauga, Mississauga, Canada
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Nair D, Thekkur P, Fernando M, Kumar AMV, Satyanarayana S, Chandraratne N, Chandrasiri A, Attygalle DE, Higashi H, Bandara J, Berger SD, Harries AD. Outcomes and Challenges in Noncommunicable Disease Care Provision in Health Facilities Supported by Primary Health Care System Strengthening Project in Sri Lanka: A Mixed-Methods Study. Healthcare (Basel) 2023; 11:healthcare11020202. [PMID: 36673570 PMCID: PMC9859051 DOI: 10.3390/healthcare11020202] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/27/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
The Primary Healthcare System Strengthening Project in Sri Lanka focuses on improving noncommunicable disease (NCD) care provision at primary medical care institutions (PMCIs). We conducted an explanatory mixed-methods study to assess completeness of screening for NCD risk, linkage to care, and outcomes of diabetes/hypertension care at nine selected PMCIs, as well as to understand reasons for gaps. Against a screening coverage target of 50% among individuals aged ≥ 35 years, PMCIs achieved 23.3% (95% CI: 23.0-23.6%) because of a lack of perceived need for screening among the public and COVID-19-related service disruptions. Results of investigations and details of further referral were not documented in almost half of those screened. Post screening, 45% of those eligible for follow-up NCD care were registered at medical clinics. Lack of robust recording/tracking mechanisms and preference for private providers contributed to post-screening attrition. Follow-up biochemical investigations for monitoring complications were not conducted in more than 50% of diabetes/hypertension patients due to nonprescription of investigations by healthcare providers and poor uptake among patients because of nonavailability of investigations at PMCI, requiring them to avail services from the private sector, incurring out-of-pocket expenditure. Primary care strengthening needs to address these challenges to ensure successful integration of NCD care within PMCIs.
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Affiliation(s)
- Divya Nair
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), 75001 Paris, France
| | - Pruthu Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), 75001 Paris, France
- Correspondence:
| | - Manoj Fernando
- Department of Health Promotion, Rajarata University of Sri Lanka, Mihintale, Anuradhapura 50300, Sri Lanka
| | - Ajay M. V. Kumar
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), 75001 Paris, France
- The Union-South East Asia (USEA) Office, New Delhi 110016, India
- Yenepoya Medical College, Yenepoya (Deemed to be University), Mangalore 575018, India
| | - Srinath Satyanarayana
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), 75001 Paris, France
- The Union-South East Asia (USEA) Office, New Delhi 110016, India
| | - Nadeeka Chandraratne
- The Foundation for Health Promotion, 21/1 Kahawita Road, Dehiwala 10350, Sri Lanka
- Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo 00300, Sri Lanka
| | - Amila Chandrasiri
- The Foundation for Health Promotion, 21/1 Kahawita Road, Dehiwala 10350, Sri Lanka
| | | | | | - Jayasundara Bandara
- Project Management Unit, Primary Health Care System Strengthening Project (PSSP), Colombo 00300, Sri Lanka
| | - Selma Dar Berger
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), 75001 Paris, France
| | - Anthony D. Harries
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), 75001 Paris, France
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
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Ramya S, Anand A, Bhaskar S, Prasad S. Clinical audit on assessment of non-glycemic parameters in diabetic patients by physicians. J Family Med Prim Care 2021; 10:1917-1921. [PMID: 34195125 PMCID: PMC8208193 DOI: 10.4103/jfmpc.jfmpc_2305_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/24/2020] [Accepted: 01/04/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is a major health problem in family practice causing multiple micro and macrovascular complications; the prevention of which should be the main aim of treating physicians. Lack of proper assessment can hasten the complications and a meticulous screening system is a prerequisite in every diabetic patient's evaluation. OBJECTIVE The aim of this study was to assess the pattern of screening for non-glycemic parameters in type 2 DM patients by physicians in an outpatient setting. METHODS A cross-sectional study was conducted in a teaching hospital during December 2019. A total of 254 patients with type 2 DM without any complications were randomly selected for screening as per the criteria developed by RSSDI [Research Society for the Study of Diabetes in India]. RESULTS Complete history and physical examination were done by physicians in all the participants. Measurement of blood pressure at every visit was done in about 95% of patients and 90% of them were counseled for cessation of smoking. But only about 60% or less of patients were screened for microalbuminuria, diabetic retinopathy, and peripheral neuropathy. Advice on comprehensive foot care was also not a regular practice among physicians. CONCLUSION This clinical audit showed that 90% of the patients had undergone only 4 of the 9 RSSDI recommended screening. The other parameters had been carried out in only among 40 to 60% of the patients. Thus, primary care physicians have to emphasize on the subtle but important criteria like ophthalmic examination, peripheral neuropathy and microalbuminuria during regular outpatient visits.
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Affiliation(s)
- S Ramya
- Department of Family Medicine, St Philomena's Hospital, Bangalore, Karnataka, India
| | - Arjun Anand
- Final Year MBBS, Basaweshwara Medical College, Chitradurga, Karnataka, India
| | - Swapna Bhaskar
- Department of Family Medicine, St Philomena's Hospital, Bangalore, Karnataka, India
| | - Shankar Prasad
- Department of Internal Medicine, St Philomena's Hospital, Bangalore, Karnataka, India
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Correia JC, Lachat S, Lagger G, Chappuis F, Golay A, Beran D. Interventions targeting hypertension and diabetes mellitus at community and primary healthcare level in low- and middle-income countries:a scoping review. BMC Public Health 2019; 19:1542. [PMID: 31752801 PMCID: PMC6873661 DOI: 10.1186/s12889-019-7842-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 10/24/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Hypertension (HTN) and diabetes mellitus (DM) are highly prevalent in low- and middle-income countries (LMIC) and a leading cause of morbidity and mortality. Recent evidence on effectiveness of primary care interventions has attracted renewed calls for their implementation. This review aims to synthesize evidence pertaining to primary care interventions on these two diseases, evaluated and tested in LMICs. METHODS Two reviewers conducted an electronic search of three databases (Pubmed, EMBASE and Web of Science) and screened for eligible articles. Interventions covering health promotion, prevention, treatment, or rehabilitation activities at the PHC or community level were included. Studies published in English, French, Portuguese and Spanish, from January 2007 to January 2017, were included. Key extraction variables included the 12 criteria identified by the Template for Intervention Description and Replication (TIDieR) checklist and guide. The Innovative Care for Chronic Conditions Framework (ICCCF) was used to guide analysis and reporting of results. RESULTS 198 articles were analyzed. The strategies focused on healthcare service organization (76.5%), community level (9.7 %), creating a positive policy environment (3.6%) and strategies covering multiple domains (10.2%). Studies included related to the following topics: description or testing of interventions (n=81; 41.3%), implementation or evaluation projects (n=42; 21.4%), quality improvement initiatives (n=15; 7.7%), screening and prevention efforts (n=26; 13.2%), management of HTN or DM (n=13; 6.6%), integrated health services (n=10; 5.1%), knowledge and attitude surveys (n=5; 2.5%), cost-effective lab tests (n=2; 1%) and policy making efforts (n=2; 1%). Most studies reported interventions by non-specialists (n=86; 43.4%) and multidisciplinary teams (n=49; 25.5%). CONCLUSION Only 198 articles were found over a 10 year period which demonstrates the limited published research on highly prevalent diseases in LMIC. This review shows the variety and complexity of approaches that have been tested to address HTN and DM in LMICs and highlights the elements of interventions needed to be addressed in order to strengthen delivery of care. Most studies reported little information regarding implementation processes to allow replication. Given the need for multi-component complex interventions, study designs and evaluation techniques will need to be adapted by including process evaluations versus simply effectiveness or outcome evaluations.
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Affiliation(s)
- Jorge César Correia
- Division of Tropical and Humanitarian Medicine, Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | - Sarah Lachat
- Division of Tropical and Humanitarian Medicine, Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | - Grégoire Lagger
- Division of Therapeutic Patient Education for Chronic Diseases. Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | - Alain Golay
- Division of Therapeutic Patient Education for Chronic Diseases. Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | - David Beran
- Division of Tropical and Humanitarian Medicine, Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
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Basu S, Sharma N. Diabetes self-care in primary health facilities in India - challenges and the way forward. World J Diabetes 2019; 10:341-349. [PMID: 31231457 PMCID: PMC6571487 DOI: 10.4239/wjd.v10.i6.341] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/10/2019] [Accepted: 05/14/2019] [Indexed: 02/05/2023] Open
Abstract
India has approximately 73 million people living with diabetes and another 37 million with prediabetes while nearly 47% of the diabetes cases are undiagnosed. The high burden of poor glycemic control and early onset of complications with associated economic costs indicates a high prevalence of poor self-management practices. It is well-established that achieving patient-centered primary care consistent with a chronic care model ensures optimum diabetes self-management support and improves long-term clinical and health outcomes in diabetes patients. The public sector primary care system in India provides services free of cost to beneficiaries but lacks patient-centered care that undermines diabetes self-management education and support. Furthermore, factors like poor patient knowledge of diabetes, suboptimal medication adherence, persistent clinical inertia, lack of data for monitoring and evaluation through clinical audit worsens the standards of diabetes care in primary care settings of India. There is a need for government initiatives to be directed towards the provision of comprehensive outpatient care that is inclusive of uninterrupted supply of drugs, provision of essential laboratory investigators, training and availability of qualified diabetes educators and availability of specialist support when required. Furthermore, the integration of depression screening and smoking cessation services at the primary care level is warranted.
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Affiliation(s)
- Saurav Basu
- Department of Community Medicine, Maulana Azad Medical College, New Delhi 110002, India
| | - Nandini Sharma
- Department of Community Medicine, Maulana Azad Medical College, New Delhi 110002, India
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Al Mutairi AS, Al Dheshe A, Al Gahtani A, Al Mutairi F, Al Ghofaili M, Al Sawayyed S, Heena H. Audit of diabetes mellitus among patients attending an employee health clinic at a tertiary care centre in Riyadh, Saudi Arabia. J Family Med Prim Care 2019; 8:972-975. [PMID: 31041235 PMCID: PMC6482748 DOI: 10.4103/jfmpc.jfmpc_182_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Purpose: To assess the clinical practices in the management of patients with type 2 diabetes mellitus (T2DM) as a basis for establishing a guideline that focuses on risk factors and complications. Methods: We conducted a retrospective audit of the medical records of 450 patients (aged 20–65 years) diagnosed with T2DM attending an employee health clinic at King Fahad Medical City, Riyadh (Saudi Arabia) during the period from 1 January to 1 July 2016. All patients requiring emergency treatment were excluded. A checklist of demographic variables, co-morbidities, clinical examinations, and laboratory investigations was used for collecting data. Results: In total, 303 (67.3%) were women and 312 (69.3%) were Saudis. Forty-five (10%) patients were not receiving current treatment for diabetes and body mass index was not calculated for 117 (26%). Retinal and neurological examinations were not performed in 363 (80.7%) and 109 (24.2%) patients, respectively. Cardiovascular and peripheral vascular system examinations were not conducted for 112 (24.9%) and 114 (25.3%) patients, respectively. For laboratory investigations, 2-h glucose tolerance tests and vitamin B12 tests were not performed for 473 (97.1%) and 436 (96.9%) patients, respectively. Moreover, TSH/T4 and eGFR tests were not performed for 220 (48.9%) and 135 patients (30%), respectively. Conclusions: We concluded that current clinical practice for management of T2DM patients is not comprehensive and that the quality of healthcare should be improved with continuous checking of patient records.
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Affiliation(s)
- Almas S Al Mutairi
- Employee Health Clinic, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | | | | | | | - Mooj Al Ghofaili
- Medical Student, AlMarefa Colleges, Riyadh, Kingdom of Saudi Arabia
| | - Sara Al Sawayyed
- Medical Student, King Saudi University, Riyadh, Kingdom of Saudi Arabia
| | - Humariya Heena
- Research Center, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
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