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Santana CR, de Oliveira MGG, Camargo MS, Moreira PMB, de Castro PR, Aguiar EC, Mistro S. Improving pharmaceutical practice in diabetes care using point-of-care glycated haemoglobin testing in the community pharmacy. Int J Pharm Pract 2024; 32:46-51. [PMID: 37936510 DOI: 10.1093/ijpp/riad072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 10/16/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVES To evaluate the use of point-of-care testing to detect new cases of diabetes mellitus at a Brazilian public community pharmacy. METHODS This cross-sectional study included individuals without a previous diagnosis of diabetes mellitus who met the criteria for screening according to the Brazilian Diabetes Society, which were identified during their presence at a Brazilian public community pharmacy. The measurements of HbA1c were performed using a Cobas b101 device (Roche Diagnostics) and were categorized according to the following classification established by the Brazilian Society of Diabetes: HbA1c <5.7%, normal; HbA1c between 5.7% and 6.4%, pre-diabetes; and HbA1c >6.4%, new diagnosis of T2DM. KEY FINDINGS One hundred and eight users met the inclusion criteria. The patients' mean age was 54.4 (± 15.4) years old, ranging from 22 to 80 years old. Eighty (74.1%) participants presented with glycated haemoglobin levels over the standard threshold, of which 58 (72.5%) were in the pre-diabetes range (glycated haemoglobin levels between 5.7% and 6.4%), and 22 (27.5%) had glycated haemoglobin levels >6.4%, which corresponds to a new diagnosis of type 2 diabetes mellitus. CONCLUSIONS The use of point-of-care glycated haemoglobin testing allowed community pharmacists at a Brazilian public community pharmacy to identify health system users with glycated haemoglobin alterations that corresponded to the pre-diabetes state or a new diagnosis of type 2 diabetes mellitus. This presented a good opportunity to refer these users to diabetes diagnosis and treatment services.
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Affiliation(s)
| | | | | | | | | | | | - Sóstenes Mistro
- Faculty of Pharmacy, Federal University of Bahia, Salvador, Bahia, Brazil
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Madela SLM, Harriman NW, Sewpaul R, Mbewu AD, Williams DR, Sifunda S, Manyaapelo T, Nyembezi A, Reddy SP. Area-level deprivation and individual-level socioeconomic correlates of the diabetes care cascade among black south africans in uMgungundlovu, KwaZulu-Natal, South Africa. PLoS One 2023; 18:e0293250. [PMID: 38079422 PMCID: PMC10712896 DOI: 10.1371/journal.pone.0293250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 10/09/2023] [Indexed: 12/18/2023] Open
Abstract
South Africa is experiencing a rapidly growing diabetes epidemic that threatens its healthcare system. Research on the determinants of diabetes in South Africa receives considerable attention due to the lifestyle changes accompanying South Africa's rapid urbanization since the fall of Apartheid. However, few studies have investigated how segments of the Black South African population, who continue to endure Apartheid's institutional discriminatory legacy, experience this transition. This paper explores the association between individual and area-level socioeconomic status and diabetes prevalence, awareness, treatment, and control within a sample of Black South Africans aged 45 years or older in three municipalities in KwaZulu-Natal. Cross-sectional data were collected on 3,685 participants from February 2017 to February 2018. Individual-level socioeconomic status was assessed with employment status and educational attainment. Area-level deprivation was measured using the most recent South African Multidimensional Poverty Index scores. Covariates included age, sex, BMI, and hypertension diagnosis. The prevalence of diabetes was 23% (n = 830). Of those, 769 were aware of their diagnosis, 629 were receiving treatment, and 404 had their diabetes controlled. Compared to those with no formal education, Black South Africans with some high school education had increased diabetes prevalence, and those who had completed high school had lower prevalence of treatment receipt. Employment status was negatively associated with diabetes prevalence. Black South Africans living in more deprived wards had lower diabetes prevalence, and those residing in wards that became more deprived from 2001 to 2011 had a higher prevalence diabetes, as well as diabetic control. Results from this study can assist policymakers and practitioners in identifying modifiable risk factors for diabetes among Black South Africans to intervene on. Potential community-based interventions include those focused on patient empowerment and linkages to care. Such interventions should act in concert with policy changes, such as expanding the existing sugar-sweetened beverage tax.
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Affiliation(s)
| | - Nigel Walsh Harriman
- Social and Behavioral Sciences Department, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Ronel Sewpaul
- Human and Social Capabilities Division, Human Sciences Research Council, Cape Town, South Africa
| | - Anthony David Mbewu
- Department of Internal Medicine, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - David R Williams
- Social and Behavioral Sciences Department, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of African and American Studies, Harvard University, Cambridge, Massachusetts, United States of America
| | - Sibusiso Sifunda
- Human and Social Capabilities Division, Human Sciences Research Council, Cape Town, South Africa
| | | | - Anam Nyembezi
- School of Public Health, University of the Western Cape, Cape Town, South Africa
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Schelde-Olesen B, Bjørsum-Meyer T, Koulaouzidis A, Buijs MM, Herp J, Kaalby L, Baatrup G, Deding U. Interobserver agreement on landmark and flexure identification in colon capsule endoscopy. Tech Coloproctol 2023; 27:1219-1225. [PMID: 37036637 PMCID: PMC10638147 DOI: 10.1007/s10151-023-02789-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/14/2023] [Indexed: 04/11/2023]
Abstract
PURPOSE When an optical colonoscopy is carried out, Scope Guide can assist the endoscopist in determining the localization. In colon capsule endoscopy (CCE), this support is not available. To our knowledge, the interobserver agreement on landmark identification has never been studied. This study aims to investigate the interobserver agreement on landmark identification in CCE. METHODS An interobserver study was carried out comparing the landmark identification (the ileocecal valve, hepatic flexure, splenic flexure, and anus) in CCE investigations between an external private contractor and three in-house CCE readers with different levels of experience. All CCE investigations analyzed in this study were carried out as a part of the Danish screening program for colorectal cancer. Patients were between 50 and 74 years old with a positive fecal immunochemical test (FIT). A random sample of 20 CCE investigations was taken from the total sample of more than 800 videos. RESULTS Overall interobserver agreement on all landmarks was 51%. Interobserver agreement on the first cecal image (ileocecal valve), hepatic flexure, splenic flexure, and last rectal image (anus) was 72%, 29%, 22%, and 83%, respectively. The overall interobserver agreement, including only examinations with adequate bowel preparation (n = 16), was 54%, and for individual landmarks, 73%, 32%, 24%, and 85%. CONCLUSION Overall interobserver agreement on all four landmarks from CCE was poor. Measures are needed to improve landmark identification in CCE investigations. Artificial intelligence could be a possible solution to this problem.
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Affiliation(s)
- B Schelde-Olesen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
- Department of Surgery, Odense University Hospital, Baagoes Alle 31, 5700, Svendborg, Denmark.
| | - T Bjørsum-Meyer
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Surgery, Odense University Hospital, Baagoes Alle 31, 5700, Svendborg, Denmark
| | - A Koulaouzidis
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Social Medicine and Public Health, Pomeranian Medical University, 70-204, Szczecin, Poland
- Department of Medicine, Odense University Hospital, Svendborg, Denmark
| | - M M Buijs
- Department of Surgery, Odense University Hospital, Baagoes Alle 31, 5700, Svendborg, Denmark
| | - J Herp
- Applied AI and Data Science Group, Mærsk-Mc-Kinney Møller Institute, Faculty of Engineering, University of Southern Denmark, Odense, Denmark
- CAI-X (Centre for Clinical Artificial Intelligence) University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - L Kaalby
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Surgery, Odense University Hospital, Baagoes Alle 31, 5700, Svendborg, Denmark
| | - G Baatrup
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Surgery, Odense University Hospital, Baagoes Alle 31, 5700, Svendborg, Denmark
| | - U Deding
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Surgery, Odense University Hospital, Baagoes Alle 31, 5700, Svendborg, Denmark
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Nunes Oliveira C, Galvão Oliveira M, Wildes Amorim W, Nicolaevna Kochergin C, Mistro S, de Medeiros DS, Oliveira Silva K, Moraes Bezerra V, Honorato Dos Santos de Carvalho VC, Bispo Júnior JP, Louzado JA, Lopes Cortes M, Arruda Soares D. Physicians' and nurses' perspective on chronic disease care practices in Primary Health Care in Brazil: a qualitative study. BMC Health Serv Res 2022; 22:673. [PMID: 35590417 PMCID: PMC9121587 DOI: 10.1186/s12913-022-08078-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 05/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary health care-oriented systems provide better healthcare, especially for chronic diseases. This study analyzed the perspectives of physicians and nurses performing care for patients with chronic diseases in Primary Health Care in a Brazilian city. METHODS A qualitative study was conducted in Vitória da Conquista, Bahia, Brazil, using semi-structured interviews with five physicians and 18 nurses. The interview included questions from an analytical matrix based on three dimensions of healthcare practices: organizational, technical care, and biopsychosocial, following a deductive approach. The interviews were fully transcribed and analyzed using a thematic categorical approach. RESULTS The results indicated that the provision of chronic care occurs in a comprehensive way. Potentialities were identified in the diversification of access, offer of care actions and technologies, integration of teamwork, and bringing together social networks to foster autonomy and self-care. Weaknesses were mostly related to the high number of people in the teams, follow-up of several cases, high turnover of support teams, low integration of Primary Health Care with other levels, difficulties in intersectoral articulation and family participation in care. CONCLUSION The multidimensional assessment of health care practices aimed at individuals with chronic noncommunicable diseases was useful to portray the strengths and weaknesses of the services. It also ratifies the need to consider the importance of and investment in primary health care by offering the necessary technical, political, logistical and financial support to the units, to ensure the sustainability of the actions by nurses, doctors and entire team.
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Affiliation(s)
- Carolinny Nunes Oliveira
- Master's Program in Collective Health, Multidisciplinary Health Institute, Federal University of Bahia, Vitória da Conquista, Bahia, Brazil
| | - Marcio Galvão Oliveira
- Epidemiology and Collective Health Nucleus, Multidisciplinary Health Institute, Federal University of Bahia, Hormindo Barros Street, 58 - Candeias, Vitória da Conquista, Bahia, 45029-094, Brazil
| | - Welma Wildes Amorim
- Departament of Natural Science, State University of Southwest of Bahia, Vitória da Conquista, Bahia, Brazil
| | - Clavdia Nicolaevna Kochergin
- Epidemiology and Collective Health Nucleus, Multidisciplinary Health Institute, Federal University of Bahia, Hormindo Barros Street, 58 - Candeias, Vitória da Conquista, Bahia, 45029-094, Brazil
| | - Sóstenes Mistro
- Epidemiology and Collective Health Nucleus, Multidisciplinary Health Institute, Federal University of Bahia, Hormindo Barros Street, 58 - Candeias, Vitória da Conquista, Bahia, 45029-094, Brazil
| | - Danielle Souto de Medeiros
- Epidemiology and Collective Health Nucleus, Multidisciplinary Health Institute, Federal University of Bahia, Hormindo Barros Street, 58 - Candeias, Vitória da Conquista, Bahia, 45029-094, Brazil
| | - Kelle Oliveira Silva
- Epidemiology and Collective Health Nucleus, Multidisciplinary Health Institute, Federal University of Bahia, Hormindo Barros Street, 58 - Candeias, Vitória da Conquista, Bahia, 45029-094, Brazil
| | - Vanessa Moraes Bezerra
- Epidemiology and Collective Health Nucleus, Multidisciplinary Health Institute, Federal University of Bahia, Hormindo Barros Street, 58 - Candeias, Vitória da Conquista, Bahia, 45029-094, Brazil
| | - Vivian Carla Honorato Dos Santos de Carvalho
- Epidemiology and Collective Health Nucleus, Multidisciplinary Health Institute, Federal University of Bahia, Hormindo Barros Street, 58 - Candeias, Vitória da Conquista, Bahia, 45029-094, Brazil
| | - José Patrício Bispo Júnior
- Epidemiology and Collective Health Nucleus, Multidisciplinary Health Institute, Federal University of Bahia, Hormindo Barros Street, 58 - Candeias, Vitória da Conquista, Bahia, 45029-094, Brazil
| | - José Andrade Louzado
- Epidemiology and Collective Health Nucleus, Multidisciplinary Health Institute, Federal University of Bahia, Hormindo Barros Street, 58 - Candeias, Vitória da Conquista, Bahia, 45029-094, Brazil
| | - Matheus Lopes Cortes
- Epidemiology and Collective Health Nucleus, Multidisciplinary Health Institute, Federal University of Bahia, Hormindo Barros Street, 58 - Candeias, Vitória da Conquista, Bahia, 45029-094, Brazil
| | - Daniela Arruda Soares
- Epidemiology and Collective Health Nucleus, Multidisciplinary Health Institute, Federal University of Bahia, Hormindo Barros Street, 58 - Candeias, Vitória da Conquista, Bahia, 45029-094, Brazil.
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Ospelt E, Noor N, Sanchez J, Nelson G, Rioles N, Malik FS, Basina M, Indyk J, Vendrame F, Schmitt J, Scott ML, Ebekozien O. Facilitators and Barriers to Smart Insulin Pen Use: A Mixed-Method Study of Multidisciplinary Stakeholders From Diabetes Teams in the United States. Clin Diabetes 2022; 41:56-67. [PMID: 36714258 PMCID: PMC9845084 DOI: 10.2337/cd22-0068] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This study sought to identify barriers and facilitators to successful smart insulin pen (SIP) use and gauge prescribing practices and integration into clinical practice by assessing provider and care team perspectives at participating endocrinology clinics within the T1D Exchange Quality Improvement Collaborative. The identified provider-related, patient-related, and clinic- and operational-level barriers and facilitators varied based on clinic knowledge, capacity, and resources. High-impact barriers included insurance coverage and prescribing processes; high-impact facilitators included improved diabetes clinic visit quality and use of SIPs as an alternative to insulin pump therapy. Findings indicated the need for provider and care team education and training on proper SIP features, use, and prescribing.
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Affiliation(s)
- Emma Ospelt
- T1D Exchange, Boston, MA
- Corresponding author: Emma Ospelt,
| | | | - Janine Sanchez
- University of Miami Miller School of Medicine, Miami, FL
| | | | | | | | | | | | | | | | | | - Osagie Ebekozien
- T1D Exchange, Boston, MA
- University of Mississippi School of Population Health, Jackson, MS
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Telford LH, Abdullahi LH, Ochodo EA, Zuhlke LJ, Engel ME. Standard echocardiography versus handheld echocardiography for the detection of subclinical rheumatic heart disease: a systematic review and meta-analysis of diagnostic accuracy. BMJ Open 2020; 10:e038449. [PMID: 33122317 PMCID: PMC7597508 DOI: 10.1136/bmjopen-2020-038449] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To summarise the accuracy of handheld echocardiography (HAND) which, if shown to be sufficiently similar to that of standard echocardiography (STAND), could usher in a new age of rheumatic heart disease (RHD) screening in endemic areas. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, Scopus, EBSCOHost and ISI Web of Science were initially searched on 27 September 2017 and again on 3 March 2020 for studies published from 2012 onwards. ELIGIBILITY CRITERIA Studies assessing the accuracy of HAND compared with STAND when performed by an experienced cardiologist in conjunction with the 2012 World Heart Federation criteria among populations of children and adolescents living in endemic areas were included. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted data and assessed the methodological quality of included studies against review-specific Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 criteria. A meta-analysis using the hierarchical summary receiver operating characteristic model was conducted to produce summary results of sensitivity and specificity. Forest plots and scatter plots in receiver operating characteristic space in combination with subgroup analyses were used to investigate heterogeneity. Publication bias was not investigated. RESULTS Six studies (N=4208) were included in the analysis. For any RHD detection, the pooled results from six studies were as follows: sensitivity: 81.56% (95% CI 76.52% to 86.61%) and specificity: 89.75% (84.48% to 95.01%). Meta-analytical results from five of the six included studies were as follows: sensitivity: 91.06% (80.46% to 100%) and specificity: 91.96% (85.57% to 98.36%) for the detection of definite RHD only and sensitivity: 62.01% (31.80% to 92.22%) and specificity: 82.33% (65.15% to 99.52%) for the detection of borderline RHD only. CONCLUSIONS HAND displayed good accuracy for detecting definite RHD only and modest accuracy for detecting any RHD but demonstrated poor accuracy for the detection of borderline RHD alone. Findings from this review provide some evidence for the potential of HAND to increase access to echocardiographic screening for RHD in resource-limited and remote settings; however, further research into feasibility and cost-effectiveness of wide-scale screening is still needed. PROSPERO REGISTRATION NUMBER CRD42016051261.
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Affiliation(s)
- Lisa Helen Telford
- Department of Medicine, Groote Schuur Hospital, University of Cape Town Faculty of Health Sciences, Cape Town, Western Cape, South Africa
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town Faculty of Health Sciences, Cape Town, Western Cape, South Africa
| | - Leila Hussein Abdullahi
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town Faculty of Health Sciences, Cape Town, Western Cape, South Africa
- Department of Policy and Research, African Institute for Development Policy (AFIDEP), Nairobi, Kenya
| | - Eleanor Atieno Ochodo
- Department of Global Health, Faculty of Medicine and Health Sciences, University of Stellenbosch Centre for Evidence-Based Health Care, Cape Town, Western Cape, South Africa
| | - Liesl Joanna Zuhlke
- Division of Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town Faculty of Health Sciences, Cape Town, Western Cape, South Africa
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital, University of Cape Town Faculty of Health Sciences, Cape Town, Western Cape, South Africa
| | - Mark Emmanuel Engel
- Department of Medicine, Groote Schuur Hospital, University of Cape Town Faculty of Health Sciences, Cape Town, Western Cape, South Africa
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7
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Flor LS, Wilson S, Bhatt P, Bryant M, Burnett A, Camarda JN, Chakravarthy V, Chandrashekhar C, Chaudhury N, Cimini C, Colombara DV, Narayanan HC, Cortes ML, Cowling K, Daly J, Duber H, Ellath Kavinkare V, Endlich P, Fullman N, Gabert R, Glucksman T, Harris KP, Loguercio Bouskela MA, Maia J, Mandile C, Marcolino MS, Marshall S, McNellan CR, Medeiros DSD, Mistro S, Mulakaluri V, Murphree J, Ng M, Oliveira JAQ, Oliveira MG, Phillips B, Pinto V, Polzer Ngwato T, Radant T, Reitsma MB, Ribeiro AL, Roth G, Rumel D, Sethi G, Soares DA, Tamene T, Thomson B, Tomar H, Ugliara Barone MT, Valsangkar S, Wollum A, Gakidou E. Community-based interventions for detection and management of diabetes and hypertension in underserved communities: a mixed-methods evaluation in Brazil, India, South Africa and the USA. BMJ Glob Health 2020; 5:e001959. [PMID: 32503887 PMCID: PMC7279660 DOI: 10.1136/bmjgh-2019-001959] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 03/25/2020] [Accepted: 04/15/2020] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION As non-communicable disease (NCD) burden rises worldwide, community-based programmes are a promising strategy to bridge gaps in NCD care. The HealthRise programme sought to improve hypertension and diabetes management for underserved communities in nine sites across Brazil, India, South Africa and the USA between 2016 and 2018. This study presents findings from the programme's endline evaluation. METHODS The evaluation utilises a mixed-methods quasi-experimental design. Process indicators assess programme implementation; quantitative data examine patients' biometric measures and qualitative data characterise programme successes and challenges. Programme impact was assessed using the percentage of patients meeting blood pressure and A1c treatment targets and tracking changes in these measures over time. RESULTS Almost 60 000 screenings, most of them in India, resulted in 1464 new hypertension and 295 new diabetes cases across sites. In Brazil, patients exhibited statistically significant reductions in blood pressure and A1c. In Shimla, India, and in South Africa, country with the shortest implementation period, there were no differences between patients served by facilities in HealthRise areas relative to comparison areas. Among participating patients with diabetes in Hennepin and Ramsey counties and hypertension patients in Hennepin County, the percentage of HealthRise patients meeting treatment targets at endline was significantly higher relative to comparison group patients. Qualitative analysis identified linking different providers, services, communities and information systems as positive HealthRise attributes. Gaps in health system capacities and sociodemographic factors, including poverty, low levels of health education and limited access to nutritious food, are remaining challenges. CONCLUSIONS Findings from Brazil and the USA indicate that the HealthRise model has the potential to improve patient outcomes. Short implementation periods and strong emphasis on screening may have contributed to the lack of detectable differences in other sites. Community-based care cannot deliver its full potential if sociodemographic and health system barriers are not addressed in tandem.
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Affiliation(s)
- Luisa S Flor
- Department of Health Metrics Sciences, University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - Shelley Wilson
- Department of Health Metrics Sciences, University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - Paurvi Bhatt
- Medtronic Foundation, Minneapolis, Minnesota, USA
| | - Miranda Bryant
- Department of Health Metrics Sciences, University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - Aaron Burnett
- Department of Emergency Medicine, University of Minnesota, Minneapolis, Minnesota, USA
- Regions Hospital, Saint Paul, Minnesota, USA
| | - Joseph N Camarda
- Department of Health Metrics Sciences, University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | | | | | | | - Christiane Cimini
- School of Medicine, Federal University of Jequitinhonha and Mucuri Valleys, Teofilo Otoni, MG, Brazil
| | | | | | - Matheus Lopes Cortes
- Anisio Teixeira Campus, Federal University of Bahia Multidisciplinary Institute in Health, Vitoria da Conquista, Bahia, Brazil
| | - Krycia Cowling
- Department of Health Metrics Sciences, University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - Jessica Daly
- Medtronic Foundation, Minneapolis, Minnesota, USA
| | - Herbert Duber
- Department of Health Metrics Sciences, University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
- Department of Emergency Medicine, University of Washington, Seattle, Washington, USA
| | | | - Patrick Endlich
- School of Medicine, Federal University of Jequitinhonha and Mucuri Valleys, Teofilo Otoni, MG, Brazil
| | - Nancy Fullman
- Department of Health Metrics Sciences, University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - Rose Gabert
- School of Medicine, University of Washington, Seattle, Washington, USA
| | - Thomas Glucksman
- Department of Health Metrics Sciences, University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - Katie Panhorst Harris
- Department of Health Metrics Sciences, University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | | | - Junia Maia
- Telehealth Department, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Milena S Marcolino
- Telehealth Department, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Claire R McNellan
- National CASA/GAL Association for Children, Seattle, Washington, USA
| | - Danielle Souto de Medeiros
- Anisio Teixeira Campus, Federal University of Bahia Multidisciplinary Institute in Health, Vitoria da Conquista, Bahia, Brazil
| | - Sóstenes Mistro
- Anisio Teixeira Campus, Federal University of Bahia Multidisciplinary Institute in Health, Vitoria da Conquista, Bahia, Brazil
| | - Vasudha Mulakaluri
- Department of Health Metrics Sciences, University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | | | - Marie Ng
- IBM Watson Health, San Jose, California, USA
| | - J A Q Oliveira
- Telehealth Department, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Márcio Galvão Oliveira
- Anisio Teixeira Campus, Federal University of Bahia Multidisciplinary Institute in Health, Vitoria da Conquista, Bahia, Brazil
| | - Bryan Phillips
- Health Policy and Management, University of California Los Angeles, Los Angeles, California, USA
| | - Vânia Pinto
- School of Medicine, Federal University of Jequitinhonha and Mucuri Valleys, Teofilo Otoni, MG, Brazil
| | | | - Tia Radant
- Regions Hospital, Saint Paul, Minnesota, USA
| | - Marissa B Reitsma
- Department of Health Metrics Sciences, University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - Antonio Luiz Ribeiro
- Telehealth Department, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Gregory Roth
- Department of Health Metrics Sciences, University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - Davi Rumel
- Research and Teaching Institute, Hospital Sirio-Libanes, Sao Paulo, São Paulo, Brazil
- School of Medicine, Municipal University Sao Caetano do Sul, Sao Caetano do Sul, Sao Paulo, Brazil
| | - Gaurav Sethi
- MAMTA Health Institute for Mother and Child, New Delhi, Delhi, India
| | - Daniela Arruda Soares
- Anisio Teixeira Campus, Federal University of Bahia Multidisciplinary Institute in Health, Vitoria da Conquista, Bahia, Brazil
| | - Tsega Tamene
- Pillsbury United Communities, Minneapolis, Minnesota, USA
| | - Blake Thomson
- Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Harsha Tomar
- MAMTA Health Institute for Mother and Child, New Delhi, Delhi, India
| | - Mark Thomaz Ugliara Barone
- Medtronic Foundation, Minneapolis, Minnesota, USA
- Global Health Leaders, Public Health Institute, Sao Paulo, Sao Paulo, Brazil
| | - Sameer Valsangkar
- Research and Monitoring Systems, The Catholic Health Association of India, Hyderabad, Telangana, India
| | | | - Emmanuela Gakidou
- Department of Health Metrics Sciences, University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
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8
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Wollum A, Gabert R, McNellan CR, Daly JM, Reddy P, Bhatt P, Bryant M, Colombara DV, Naidoo P, Ngongo B, Nyembezi A, Petersen Z, Phillips B, Wilson S, Gakidou E, Duber HC. Identifying gaps in the continuum of care for cardiovascular disease and diabetes in two communities in South Africa: Baseline findings from the HealthRise project. PLoS One 2018; 13:e0192603. [PMID: 29538420 PMCID: PMC5851537 DOI: 10.1371/journal.pone.0192603] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 01/28/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The HealthRise initiative seeks to implement and evaluate innovative community-based strategies for diabetes, hypertension and hypercholesterolemia along the entire continuum of care (CoC)-from awareness and diagnosis, through treatment and control. In this study, we present baseline findings from HealthRise South Africa, identifying gaps in the CoC, as well as key barriers to care for non-communicable diseases (NCDs). METHODS This mixed-methods needs assessment utilized national household data, health facility surveys, focus group discussions, and key informant interviews in Umgungundlovu and Pixley ka Seme districts. Risk factor and disease prevalence were estimated from the South Africa National Health and Nutrition Examination Survey. Health facility surveys were conducted at 86 facilities, focusing on essential intervention, medications and standard treatment guidelines. Quantitative results are presented descriptively, and qualitative data was analyzed using a framework approach. RESULTS 46.8% of the population in Umgungundlovu and 51.0% in Pixley ka Seme were hypertensive. Diabetes was present in 11.0% and 9.7% of the population in Umgungundlovu and Pixley ka Seme. Hypercholesterolemia was more common in Pixley ka Seme (17.3% vs. 11.1%). Women and those of Indian descent were more likely to have diabetes. More than half of the population was found to be overweight, and binge drinking, inactivity and smoking were all common. More than half of patients with hypertension were unaware of their disease status (51.6% in Pixley ka Seme and 51.3% in Umgungundlovu), while the largest gap in the diabetes CoC occurred between initiation of treatment and achieving disease control. Demand-side barriers included lack of transportation, concerns about confidentiality, perceived discrimination and long wait times. Supply-side barriers included limited availability of testing equipment, inadequate staffing, and pharmaceutical stock outs. CONCLUSION In this baseline assessment of two South African health districts we found high rates of undiagnosed hypercholesterolemia and hypertension, and poor control of hypercholesterolemia, hypertension, and diabetes. The HealthRise Initiative will need to address key supply- and demand-side barriers in an effort to improve important NCD outcomes.
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Affiliation(s)
- Alexandra Wollum
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Rose Gabert
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Claire R. McNellan
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Jessica M. Daly
- Medtronic Foundation, Minneapolis, Minnesota, United States of America
| | | | - Paurvi Bhatt
- Medtronic Foundation, Minneapolis, Minnesota, United States of America
| | - Miranda Bryant
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Danny V. Colombara
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Pamela Naidoo
- Human Sciences Reseach Council, Cape Town, South Africa
| | - Belinda Ngongo
- Medtronic Foundation, Minneapolis, Minnesota, United States of America
- Public Health Institute, Global Health Fellows Program, Washington, DC, United States of America
| | - Anam Nyembezi
- Human Sciences Reseach Council, Cape Town, South Africa
| | | | - Bryan Phillips
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Shelley Wilson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Emmanuela Gakidou
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Herbert C. Duber
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
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Gabert R, Ng M, Sogarwal R, Bryant M, Deepu RV, McNellan CR, Mehra S, Phillips B, Reitsma M, Thomson B, Wilson S, Wollum A, Gakidou E, Duber HC. Identifying gaps in the continuum of care for hypertension and diabetes in two Indian communities. BMC Health Serv Res 2017; 17:846. [PMID: 29282052 PMCID: PMC5746011 DOI: 10.1186/s12913-017-2796-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 12/13/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) represent the largest, and fastest growing, burden of disease in India. This study aimed to quantify levels of diagnosis, treatment, and control among hypertensive and diabetic patients, and to describe demand- and supply-side barriers to hypertension and diabetes diagnosis and care in two Indian districts, Shimla and Udaipur. METHODS We conducted household and health facility surveys, as well as qualitative focus group discussions and interviews. The household survey randomly sampled individuals aged 15 and above in rural and urban areas in both districts. The survey included questions on NCD knowledge, history, and risk factors. Blood pressure, weight, height, and blood glucose measurements were obtained. The health facility survey was administered in 48 health care facilities, focusing on NCD diagnosis and treatment capacity, including staffing, equipment, and pharmaceuticals. Qualitative data was collected through semi-structured key informant interviews with health professionals and public health officials, as well as focus groups with patients and community members. RESULTS Among 7181 individuals, 32% either reported a history of hypertension or were found to have a systolic blood pressure ≥ 140 mmHg and/or diastolic ≥90 mmHg. Only 26% of those found to have elevated blood pressure reported a prior diagnosis, and just 42% of individuals with a prior diagnosis of hypertension were found to be normotensive. A history of diabetes or an elevated blood sugar (Random blood glucose (RBG) ≥200 mg/dl or fasting blood glucose (FBG) ≥126 mg/dl) was noted in 7% of the population. Among those with an elevated RBG/FBG, 59% had previously received a diagnosis of diabetes. Only 60% of diabetics on treatment were measured with a RBG <200 mg/dl. Lower-level health facilities were noted to have limited capacity to measure blood glucose as well as significant gaps in the availability of first-line pharmaceuticals for both hypertension and diabetes. CONCLUSIONS We found high rates of uncontrolled diabetes and undiagnosed and uncontrolled hypertension. Lower level health facilities were constrained by capacity to test, monitor and treat diabetes and hypertension. Interventions aimed at improving patient outcomes will need to focus on the expanding access to quality care in order to accommodate the growing demand for NCD services.
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Affiliation(s)
- Rose Gabert
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98121, USA
| | - Marie Ng
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98121, USA
| | - Ruchi Sogarwal
- MAMTA Health Institute for Mother and Child, New Delhi, India
| | - Miranda Bryant
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98121, USA
| | - R V Deepu
- MAMTA Health Institute for Mother and Child, New Delhi, India
| | - Claire R McNellan
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98121, USA
| | - Sunil Mehra
- MAMTA Health Institute for Mother and Child, New Delhi, India
| | - Bryan Phillips
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98121, USA
| | - Marissa Reitsma
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98121, USA
| | - Blake Thomson
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98121, USA
| | - Shelley Wilson
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98121, USA
| | - Alexandra Wollum
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98121, USA
| | - Emmanuela Gakidou
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98121, USA
| | - Herbert C Duber
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98121, USA.
- Department of Emergency Medicine, University of Washington, Seattle, WA, USA.
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