Patients' attitudes and intentions towards taking medical advice for type 2 diabetes mellitus: a theory of planned behaviour analysis

PURPOSE

A key component of effective diabetes care is understanding patients' perceptions about diabetes management. Patients' attitudes and intentions towards taking medical advice may predict the outcomes for effective diabetes care. This study aims to measure participants' attitudes, beliefs and intentions towards following medical advice to manage their diabetes using the Theory of Planned Behaviour (TPB). The domains of the TPB are correlated with clinical measures of diabetes to determine if these attitudes and intentions are predictive of better diabetes control.

METHODS

A pilot study was conducted. A 34-item survey was designed using the Theory of Planned Behaviour (TPB) framework and administered via mail by four general practice clinics. Included participants (N = 104; response rate 29.5%) had a diagnosis of type 2 diabetes and were taking medication for glycaemic control. Scores for each domain of the TPB survey were correlated with participants' clinical indicators for diabetes: HbA1c, blood pressure, lipid profile, cholesterol, and kidney health (eGFR and albumin: creatinine ratio) and BMI.

RESULTS

Participants surveyed generally reported positive attitudes and intention to follow medical advice. Medical advice was perceived to be beneficial and useful by the majority. However, in general, there was no correlation between positive intentions and improved clinical indicators of disease. Clinical indicators did not improve with duration of illness. The burden of illness is likely a mitigating factor for positive intention as participants perceive medical advice as difficult and inconvenient to follow.

CONCLUSIONS

Patients' individual capacity to implement medical advice should be addressed in shared-decision making models to potentially improve patient outcomes towards therapeutic targets.

Snacking cessation: It’s time to challenge this eating behaviour

Our habits have changed over the generations. In particular, our eating behaviours continue to adapt and are intrinsically linked with changing social norms and myriad other influences leading us to consume more. In light of the obesity epidemic that threatens to be our greatest health challenge, the race is on to find new ways to modify or alter our food choices to those considered more “healthful”. Somewhere along the way snacking has become an acceptable eating pattern. We are uncomfortable foregoing these readily available and hedonistic food rewards. It may be time to change more than our food choice and question the need to snack at all.

Doctors have a limited role in managing obesity

Obesity management is one of the greatest challenges in medicine. While the obesity epidemic continues to grow, there is increasing pressure on doctors to do more to curb these trends. National bodies offer guidelines and action plans; however, these miss the mark within the constraints of modern practice. While urgent change is needed to combat the health challenges that global obesity raises, medical practice is generally ill-equipped to make an effective change for patients. Significant innovation is needed to be able to deliver strategies that will work in a healthcare context.

Is snacking the new smoking?

The way we eat is changing. Incrementally, between-meal snacking has increased over time, and our busy, on-the-run lifestyles and changing social norms fuel the consumption of convenience foods and calorie-dense snacks. The societal normalising of snacking behaviour has myriad influences, but the marketing narrative that snacking is “good for you” needs to be challenged. Cigarette promotion of yesteryear seems unconscionable today, but the way snack foods are now pitched to the public has some eerie parallels. The pervasiveness of aggressive targeted marketing, celebrity endorsement, social normalisation narrative, and dismissal of health consequences should give us pause for thought.

Symptom profile of patients receiving antibiotics for upper respiratory tract infections in general practice: an observational study using smartphone technology

BACKGROUND

Upper respiratory tract infections (URTIs) are a common presentation in general practice and are linked to high rates of inappropriate antibiotic prescription. There is limited information about the trajectory of patients with this condition who have been prescribed antibiotics.

OBJECTIVE

To document the symptom profile of patients receiving antibiotics for URTIs in Australian general practice using smartphone technology and online surveys.

METHODS

In total, 8218 patients received antibiotics after attending one of the 32 general practice clinics in Australia from June to October 2017: 4089 were identified as URTI presentations and were the cohort studied. Patients completed the Wisconsin Upper Respiratory Symptom Survey (WURSS-24) 3 and 7 days after visiting their general practitioner (GP).

RESULTS

Six hundred fourteen URTI-specific patients responded to at least one symptom survey (RR 15%). The majority of patients reported moderate to mild symptoms at 72 hours [median global symptom severity score 37 (IQR 19, 59)] post-GP visit which reduced to very mild symptoms or not sick by day 7 [11 (IQR 4, 27)]. Patients receiving antibiotics for URTI reported the same level of symptom severity as patients in previous studies receiving no treatment.

CONCLUSIONS

The recovery of most patients within days of receiving antibiotics for URTI mimics the trajectory of patients with viral URTIs without treatment. Antibiotics did not appear to hasten recovery. Monitoring of patients in this context using smart phone technology is feasible but limited by modest response rates.

The profile of patients with chronic kidney disease who regularly present at an Australian general practice

BACKGROUND

Chronic kidney disease (CKD) is a common, serious and mostly asymptomatic condition that places considerable burden on the Australian healthcare system. Yet there is limited information on the patients with CKD who present to Australian primary care services, which represent the gateway to specialized care.

METHODS

Data pertaining to 31,897 patients who presented to a general practice in Western Australia, from 1 January 2013 to 30 June 2014 (inclusive), were extracted for review. Data included attendance records, comorbidities, diagnoses, and demographic details. Binary logistic regression was used to compare patients diagnosed with CKD by the consulting general practitioner with those without this diagnosis.

RESULTS

Of the 8629 patients who regularly attended the practice, 184 (2%) were diagnosed with CKD (mean age: 77.7 years; male: 57.1%). The stage of CKD was recorded in only 8.4% of cases. Patients with CKD averaged 11 more consultations in the past 18 months (mean difference 10.8, 95% CI [9.3, 12.3], p < .001). They were also more likely to: be male; be ex-smokers; be widowed; and to have a carer. Their most common comorbidities included acute infections, cerebrovascular or ischemic heart disease, osteopenia or osteoporosis, and cancer; 8.7% had died within the previous year.

CONCLUSIONS

Despite the prevalence of CKD, only one in five cases were recorded within this large practice. This reveals lost opportunities to monitor and manage patients with this chronic and common disease. Although this represents an important finding, this study is limited by the reliance on practice records, some of which were incomplete. Nevertheless, this study reveals two key findings. First, this disease is under-diagnosed and/or under-recorded. Second, patients with CKD have other, potentially unrelated, problems that may warrant attention.