WellDoc mobile diabetes management randomized controlled trial: change in clinical and behavioral outcomes and patient and physician satisfaction

BACKGROUND

Less than 63% of individuals with diabetes meet professional guidelines target of hemoglobin A1c <7.0%, and only 7% meet combined glycemic, lipid, and blood pressure goals. The primary study aim was to assess the impact on A1c of a cell phone-based diabetes management software system used with web-based data analytics and therapy optimization tools. Secondary aims examined health care provider (HCP) adherence to prescribing guidelines and assessed HCPs' adoption of the technology.

METHODS

Thirty patients with type 2 diabetes were recruited from three community physician practices for a 3-month study and evenly randomized. The intervention group received cell phone-based software designed by endocrinologists and CDEs (WellDoc Communications, Inc., Baltimore, MD). The software provided real-time feedback on patients' blood glucose levels, displayed patients' medication regimens, incorporated hypo- and hyperglycemia treatment algorithms, and requested additional data needed to evaluate diabetes management. Patient data captured and transferred to secure servers were analyzed by proprietary statistical algorithms. The system sent computer-generated logbooks (with suggested treatment plans) to intervention patients' HCPs.

RESULTS

The average decrease in A1c for intervention patients was 2.03%, compared to 0.68% (P < 0.02, one-tailed) for control patients. Of the intervention patients, 84% had medications titrated or changed by their HCP compared to controls (23%, P = 0.002). Intervention patients' HCPs reported the system facilitated treatment decisions, provided organized data, and reduced logbook review time.

CONCLUSIONS

Adults with type 2 diabetes using WellDoc's software achieved statistically significant improvements in A1c. HCP and patient satisfaction with the system was clinically and statistically significant.

Hospital Performance Reports: Impact On Quality, Market Share, And Reputation

This study builds on earlier work by assessing the long-term impact of a public hospital performance report on both consumers and hospitals. In doing so, we shed light on the relative importance of alternative assumptions about what stimulates quality improvements. The findings indicate that making performance data public results in improvements in the clinical area reported upon. An earlier investigation indicated that hospitals included in the public report believed that the report would affect their public image. Indeed, consumer surveys suggest that inclusion did affect hospitals' reputations.

Use of social media in health promotion: purposes, key performance indicators, and evaluation metrics

Despite the expanding use of social media, little has been published about its appropriate role in health promotion, and even less has been written about evaluation. The purpose of this article is threefold: (a) outline purposes for social media in health promotion, (b) identify potential key performance indicators associated with these purposes, and (c) propose evaluation metrics for social media related to the key performance indicators. Process evaluation is presented in this article as an overarching evaluation strategy for social media.

The effects of pharmaceutical firm enticements on physician prescribing patterns. There's no such thing as a free lunch

We examined the impact on physician prescribing patterns of pharmaceutical firms offering all-expenses-paid trips to popular sunbelt vacation sites to attend symposia sponsored by a pharmaceutical company. The impact was assessed by tracking the pharmacy inventory usage reports for two drugs before and after the symposia. Both drugs were available only as intravenous preparations and could be used only on hospitalized patients. The usage patterns were tracked for 22 months preceding each symposium and for 17 months after each symposium. Ten physicians invited to each symposium were interviewed about the likelihood that such an enticement would affect their prescribing patterns. A significant increase in the prescribing pattern of both drugs occurred following the symposia. The usage of drug A increased from a mean of 81 +/- 44 units before the symposium to a mean of 272 +/- 117 after the symposium (p less than 0.001). The usage of drug B changed from 34 +/- 30 units before the symposium to 87 +/- 24 units (p less than 0.001) after the symposium. These changed prescribing patterns were also significantly different from the national usage patterns of the two drugs by hospitals with more than 500 beds and major medical centers over the same period of time. These alterations in prescribing patterns occurred even though the majority of physicians who attended the symposia believed that such enticements would not alter their prescribing patterns.

Does publicizing hospital performance stimulate quality improvement efforts?

This study evaluates the impact on quality improvement of reporting hospital performance publicly versus privately back to the hospital. Making performance information public appears to stimulate quality improvement activities in areas where performance is reported to be low. The findings from this Wisconsin-based study indicate that there is added value to making this information public.

Constructing "sound science" and "good epidemiology": tobacco, lawyers, and public relations firms

The tobacco industry has attacked "junk science" to discredit the evidence that secondhand smoke-among other environmental toxins-causes disease. Philip Morris used public relations firms and lawyers to develop a "sound science" program in the United States and Europe that involved recruiting other industries and issues to obscure the tobacco industry's role. The European "sound science" plans included a version of "good epidemiological practices" that would make it impossible to conclude that secondhand smoke-and thus other environmental toxins-caused diseases. Public health professionals need to be aware that the "sound science" movement is not an indigenous effort from within the profession to improve the quality of scientific discourse, but reflects sophisticated public relations campaigns controlled by industry executives and lawyers whose aim is to manipulate the standards of scientific proof to serve the corporate interests of their clients.

Public reporting of surgical mortality: a survey of New York State cardiothoracic surgeons

BACKGROUND

Public disclosure of individual surgeons mortality following coronary artery bypass (CAB) is part of the New York State Department of Health Cardiac Surgery Reporting System (CSRS). The effects on the practice of cardiac surgery, as perceived by surgeons, remain unknown.

METHODS

All 150 New York State cardiac surgeons were sent an anonymous mail survey in 1997. Data was analyzed to determine the dominant opinion regarding the CSRS.

RESULTS

One hundred and four surgeons (69.3%) responded. The majority (70%) did not experience a change in practice. Data reporting was performed by the surgeon or an employee (58%). Many picked the incorrect definition of chronic obstructive pulmonary disease (COPD) (45%) or statistical method (60%). The aspect of CSRS most in need of improvement was gaming with risk factors (40%). Most surgeons (62%) refused to operate on at least one high-risk CAB patient over the prior year, primarily because of public reporting. Refusal was more common in surgeons in practice less than 10 years, those with less than 100 cases per year, and those with a mixed cardiothoracic practice (p < 0.05, Pearson's chi2 test). A significantly higher percentage of high-risk CAB patients were treated non-operatively, when compared with ascending aortic dissection patients (not disclosed) (p < 0.001, Wilcoxon signed ranks test).

CONCLUSIONS

The public disclosure of surgical results may be based on imperfect data and appears to have resulted in denial of surgical treatment to high-risk patients.

Effects of public and professional education on reducing the delay in presentation and referral of stroke patients

BACKGROUND AND PURPOSE

Several emerging stroke therapies require patients to be treated within several hours of symptom onset. Past studies have documented a significant delay between symptom onset and hospital presentation. As part of an experimental treatment study using tissue-type plasminogen activator, we began a multifaceted program of public and professional education to reduce the delay in presentation and referral of acute stroke patients.

METHODS

The educational efforts focused on improving the recognition of stroke symptoms, the study enrollment criteria, and the need for rapid treatment of stroke patients. This program included 1) interviews on television and radio, 2) newspaper articles, 3) lectures to local and regional primary care and emergency department physicians, 4) mailings to several thousand local physicians, 5) having neurologists on-call for referrals 24 hrs/day, and 6) use of the Duke Life-Flight helicopter.

RESULTS

Since starting our program, 139 of 159 (86%) patients with cerebral infarction presented primarily to our were referred to our facility within 24 hours of symptom onset, compared with 70 of 187 (37%) before our educational efforts (p less than 0.00001). No significant change was seen in patients with intracerebral hemorrhage (23 of 30 +AD77%+BD within 24 hours after program, compared with 25 of 40 +AD63%+BD before educational efforts; p = 0.30).

CONCLUSIONS

These findings suggest that educational efforts aimed at the public and health professionals may increase recognition of stroke symptoms and reduce the delay in presentation and referral of stroke patients.

Public reporting on quality in the United States and the United Kingdom

The public reporting of comparative information about health care quality is becoming an accepted way of improving accountability and quality. Quality report cards have been prominent in the United States for more than a decade and are a central feature of British health system reform. In this paper we examine the common challenges and differences in implementation of the policy in the two countries. We use this information to explore some key questions relating to the content, target audience, and use of published information. We end by making specific recommendations for maximizing the effectiveness of public reporting.

The impact of emotional dissonance on organizational commitment and intention to turnover

In the workplace, emotional dissonance is the conflict between experienced emotions and emotions expressed to conform to display rules. This study is an empirical examination of the impact of emotional dissonance on organizational criteria and its moderation by self-monitoring and social support. Emotional dissonance was theorized to stimulate turnover intentions, either solely through job dissatisfaction or through both job dissatisfaction and reduced organizational commitment. Job dissatisfaction was found to be the sole mediator. Emotional dissonance resulted in job dissatisfaction, which, in turn, stimulated withdrawal intentions. Self-monitoring and social support exerted moderator effects, albeit in opposing directions. Emotional dissonance aroused feelings of job dissatisfaction and reduced organizational commitment among high self-monitors. In contrast, social support lessened the negative impact of emotional dissonance on organizational commitment.

Marketing to the marginalised: tobacco industry targeting of the homeless and mentally ill

OBJECTIVES

To describe the tobacco industry's relationships with and influence on homeless and mentally ill smokers and organisations providing services to them.

METHODS

Analysis of internal tobacco industry documents and journal articles.

RESULTS

The tobacco industry has marketed cigarettes to the homeless and seriously mentally ill, part of its "downscale" market, and has developed relationships with homeless shelters and advocacy groups, gaining positive media coverage and political support.

DISCUSSION

Tobacco control advocates and public health organisations should consider how to target programmes to homeless and seriously mentally ill individuals. Education of service providers about tobacco industry efforts to cultivate this market may help in reducing smoking in these populations.

Nursing shortage in China: State, causes, and strategy

This article describes the nursing shortage situation in China and the causes for it. China is a major donor of nurses to other parts of the world and this article discusses the solutions China has implemented to address its nursing shortage, and the challenges that it is currently facing. The strategies that have been employed include: improving the health care system, improving work cultures for increased retention through policy and regulation, making greater investments in nursing education to build sustainable nursing education infrastructures, and enhancing the image of the nursing profession. These solutions may serve as a reference to other countries to deal with the crisis of a nursing shortage.

Factors affecting African-American participation in AIDS research

BACKGROUND

Although African Americans are disproportionately affected by the AIDS epidemic, they are underrepresented in AIDS research, particularly in AIDS clinical trials. This study examines a multidimensional construct of distrust and other factors that may affect willingness to participate in AIDS research.

METHODS

A total of 301 African Americans (aged >/=18 years) in Durham, North Carolina participated in a cross-sectional survey. In-person interviews, 20 to 25 minutes in length, were conducted with participants. Structural equation modeling was used to develop models exploring distrust and other factors affecting willingness to participate in AIDS research among African Americans.

RESULTS

Distrust was the strongest inverse predictor of willingness to participate in AIDS clinical trials. Distrust was not significantly associated with willingness to participate in AIDS surveys and educational interventions. Altruism, facilitators/barriers, religiosity, and economic group membership were also significantly associated with willingness to participate in AIDS clinical trials. Only altruism was significantly associated with willingness to participate in AIDS surveys and educational interventions.

CONCLUSIONS

Distrust about research institutions is a significant barrier to recruiting African Americans in AIDS clinical trials. Issues of distrust need to be acknowledged by researchers to develop better recruitment and retention strategies when conducting AIDS clinical trials in African-American communities.

A controlled study of the effect of television messages on safety belt use

Images

Biofantasies: genetics and medicine in the print news media

The contemporary news media is an important site for exploring the diverse and complex cultural images of genetics and its medical possibilities, and of the mechanisms by which these images are (re) produced and sustained. This article investigates how the print news media 'frames' stories on genetics and medicine. It is based on a discourse analysis of articles appearing in three Australian newspapers in the late 1990s. Gene stories were found to be prominent in each of the newspapers, and to emphasise the medical benefits of genetic research. Stories frequently cite and quote scientists, who explain the nature and significance of the research and/or its implications for treatment or prevention. Many stories focus on new genetic discoveries, and portray genetic researchers as involved in a quest to unlock nature's secrets. Stories of hope, and depictions of geneticists as warriors or heroes, appear regularly. The positive vision of genetics is supported by the use of particular metaphors, accompanying illustrative material, 'human interest' stories, and reference to credible sources. There is rarely mention of the influence of non-genetic factors and 'multifactorial' interactions on disorders, or questioning of the goals, direction, methods, or value of genetic research. Scientists made extensive use of the media in their efforts to maintain a positive image of research in the face of public concerns about scientists 'going too far', following the announcement of the cloning of Dolly. Boundaries were drawn between 'therapeutic cloning'--implicitly defined as 'good', useful, and legitimate--and 'reproductive cloning'--seen as 'bad', dangerous, and illegitimate. By framing news stories as they do, the print news media are likely to exert a powerful influence on public responses to health problems. With new genetic technologies becoming more integrated in preventive medicine and public health, it is important to investigate how news stories help shape the agenda for public debate.

An uneasy relationship: the tensions between medicine and the media

The enduring tensions between medicine and the media are largely due to the different perspectives of biomedical scientists and journalists, as this final essay in the series on medicine and the media underscores. These tensions arise because of perceived differences in defining science news, conflicts over styles of science reporting, and most of all disagreement about the role of the media. In the 1990s, scientists are especially concerned by media messages that question their credibility. Since scientists and journalists depend on each other in the communication of science and the shaping of the public meaning of science and medicine, the tensions are likely to increase.

Advocacy for public health: a primer

Public health advocacy is the strategic use of news media to advance a public policy initiative, often in the face of opposition.

Naming and framing occupational therapy: a lecture dedicated to the life of Nancy B

The case of Nancy B. is testimony to the importance of occupation to living and hence the importance of occupational therapy. Yet the importance of the discipline is poorly recognized. It is argued that the failure of occupational therapy to gain wide recognition is due to a problem in communicating its importance simply, easily and clearly and that the discipline needs to be named and framed in positive and powerful terms. The values on which to base this naming and framing are articulated. Based on the Occupational Therapy Values Statement, it is proposed that the discipline be framed in an Enablement Model and that, accordingly, occupational therapy be described as the discipline concerned with enabling occupational competence guided by an understanding of the individual, the environment and their interaction in determining occupational competence.

Corporate social responsibility and the tobacco industry: hope or hype?

Corporate social responsibility (CSR) emerged from a realisation among transnational corporations of the need to account for and redress their adverse impact on society: specifically, on human rights, labour practices, and the environment. Two transnational tobacco companies have recently adopted CSR: Philip Morris, and British American Tobacco. This report explains the origins and theory behind CSR; examines internal company documents from Philip Morris showing the company's deliberations on the matter, and the company's perspective on its own behaviour; and reflects on whether marketing tobacco is antithetical to social responsibility.