Chronic Disease Clinic Research Articles

How to Follow up on Unexplained Hyperferritinemia in Primary Care

50-years-old Bahraini male came to local health center as follow up in chronic disease clinic for his medical problems as he is a known case of good controlled DM type 2 {FBS 6.4 (3.6-5.6 mmol/l)}, HBA1c 48 FBS mmol/L (20-39 mmol/mol) on oral hypoglycemic treatment [Glucophage 500 mg twice daily], and dyslipidemia mainly elevated triglyceridemia {Total cholesterol 4.9 mmol/L; mean HDL cholesterol 1 mmol/L (0.83-1.86 mmol/l); mean LDL cholesterol 2.85 mmol/L (1.68-3.367 mmol/l); mean Triglycerides 2.3 mmol/L (0.2-1.8 mmol/l)} on fibrates [Bezalip 400 mg daily]. The patient was found to have high serum ferritin level incidentally. His mean serum ferritin was 561 mcq/l {S. ferritin range from 502 to 600 mcq/l. (normal range in male 12-300 mcq/l)}. The patient's investigation showed abnormal liver function test {alanine aminotransferase 53 IU/L (normal range 10-40 IU/L) and γ-glutamyltransferase 66 IU/L (normal range 0-37 IU/L). Patient's CBC, ESR and renal function test were normal. He was otherwise obese, his weight was 104 kg, and height 175 cm (BMI = 33.9), and waist circumferences was 110 cm in diameter, blood pressure was 160/100 mmHg.

Effect of Implementation of Electronic File System and the Completeness of Clinical Evaluation in Chronic Non-Communicable Diseases Clinic

Effect of Implementation of Electronic File System and the Completeness of Clinical Evaluation in Chronic Non-Communicable Diseases Clinic

Patient satisfaction with nurse-led chronic kidney disease clinics: A multicentre evaluation.

There is growing international evidence that nurse-led chronic kidney disease (CKD) clinics provide a comprehensive approach to achieving clinical targets effective in slowing the progression of CKD. Across Queensland, Australia, these clinics have been established in many renal outpatient departments although patient satisfaction with these clinics is unknown. To measure patient satisfaction levels with CKD nurse-led clinics. This was a cross-sectional study undertaken at five clinics located in metropolitan, regional and remote hospitals in Queensland. Participants were >18 years of age (no upper age limit) with CKD (non-dialysis) who attended CKD nurse-led clinics over a six month period (N = 873). They completed the Nurse Practitioner Patient Satisfaction questionnaire which was modified for CKD. The response rate was 64.3 % (n = 561); half of the respondents were male (55.5 %), there was a median age range of 71-80 years (43.5 %) and most respondents were pensioners or retired (84.2 %). While the majority reported that they were highly satisfied with the quality of care provided by the nurse (83.8 %), we detected differences in some aspects of satisfaction between genders, age groups and familiarity with the nurse. Overall, patients' comments were highly positive with a few improvements to the service being suggested; these related to car-parking, providing more practical support, and having accessible locations. In an era of person-centred care, it is important to measure patient satisfaction using appropriate and standardised questionnaires. Our results highlight that, to improve services, communication strategies should be optimised in nurse-led clinics.

Primary Healthcare-based Diabetes Registry in Puducherry: Design and Methods.

Background:Diabetes registries monitor the population prevalence and incidence of diabetes, monitor diabetes control program, provide information of quality of care to health service providers, and provide a sampling frame for interventional studies. This study documents the process of establishing a prospective diabetes registry in a primary health-care setting in Puducherry.Methods:This is a facility-based prospective registry conducted in six randomly selected urban health centers in Puducherry, with enrollment of all known patients with diabetes attending chronic disease clinics. Administrative approvals were obtained from Government Health Services. Manuals for training of medical officers, health-care workers, and case report forms were developed. Diabetes registry was prepared using Epi Info software.Results:In the first phase, demographic characteristics, risk factors, complications, coexisting chronic conditions, lifestyle and medical management, and clinical outcomes were recorded. Around 2177 patients with diabetes have been registered in six Primary Health Centres out of a total of 2948 participants seeking care from chronic disease clinic. Registration coverage ranges from 61% to 105% in these centers.Conclusion:This study has documented methodological details, and learning experiences gained while developing a diabetes registry at the primary health care level and the scope for upscaling to a Management Information System for Diabetes and a State-wide Registry. Improvement in patient care through needs assessment and quality assurance in service delivery is an important theme envisioned by this registry.

Correlation of Urinary Foam with Proteinuria in Patients with Chronic Kidney Disease

Background: Foamy urine is often reported to be associated with proteinuria and kidney diseases. There is no objective measure on the nature and correlation of this relationship. Literature reviews revealed very few studies that can confirm or refute this relationship. This study hypothesized that the severity and persistence of urinary foam were associated with the degree of proteinuria (as determined by urine protein-creatinine ratio and dipstick). Methods: We analyzed urine samples of patients from our chronic kidney disease (CKD) clinics for urine protein and foam. The urine samples were shaken in a standardized way and heights of resting foam (in millimeters) were measured after a pre-determined resting time. The foam heights were correlated with clinical variables including proteinuria, stages of CKD, gender, age, co-morbidities and urine specific gravity. Results: A total of 160 urine samples were analyzed. Greater foam height was significantly associated with advanced CKD stages (p=0.015), urine dipstick protein (p<0.001), urine PCR (p=0.005) and diabetes mellitus (p=0.013). Urine specific gravity (p=0.053) and hypertension (p=0.91) did not achieve statistically significant results with foam height. Further analyses were performed on 54 urine samples with no or low protein level (defined as urine PCR of less than <100 mg/mmol AND urine protein dipstick result of ≤ 1+). In these samples, there was no statistically significant relationship between foam height and CKD stages (p=0.403), specific gravity (p=0.564), diabetes mellitus (p=0.909) and hypertension (p=0.08). Conclusion: Our study showed that urinary foam can be used as a rudimentary surrogate marker for proteinuria in patients with CKD. It provides extra leverage to the age-long assumptions that urinary foam is associated with kidney disease and proteinuria. More research will be needed to ascertain and investigate the nature of this relationship.

Self-care practices among diabetes patients registered in a chronic disease clinic in Puducherry, South India

Abstract Background: In management of diabetes, self-care plays an important role in prevention of complications. This study aims to find the proportion of diabetic patients following the recommended self-care practices in an urban area of Puducherry. Materials and Methods: Consecutive eligible patients registered in chronic disease clinic were interviewed using Summary of Diabetes Self Care Activities Score (SDSCA) questionnaire. Self-care practices were evaluated in domains of diet, physical activity, foot-care, adherence to medications and blood glucose monitoring. All domains were scored from the range of 0 to 7. Results: Totally 162 diabetic patients were interviewed. The mean (SD) age of participants was 57 (11.1) yrs. Among all domains, adherence to medication was the highest (95.6 %) followed by avoidance of selected food items (99.4%). Almost 78% of patients had their blood sugar checked at least once in the last three months. Only half of them (50.6%) had followed at least 20 minutes of leisure time physical activity. Except washing of foot (83.3%) all other foot care practices were less commonly (35-57%) followed. Conclusion: The study shows that higher level of compliance to self-care practices in terms of taking drugs and diet but self-care in other domains such as foot care is alarmingly low.

Cardiovascular risk profiling of patients of an Urban Health Centre of a tertiary care teaching hospital in South India

Abstract Background Addressing all modifiable risk factors in a composite manner, instead of treating individual risk factors is the current approach in the management of cardiovascular diseases. In patients, attending chronic disease clinic in Urban Health Centre (UHC) functioning under a tertiary care teaching hospital, this study aims to assess 10-year cardiovascular risk using ‘WHO/ISH Cardiovascular Risk Prediction Charts’ and ‘Framingham General Cardiovascular Risk Profile using lipid levels’ and compare the level of agreement between the results obtained. Methodology A retrospective record review was carried out in urban chronic disease clinic during the months of May and June 2013. Records of 280 patients attending the Urban Health Centre were screened using a structured proforma and 180 of them were included subject to selection criteria. The analysis was carried out using IBM SPSS v 21. 10-year cardiovascular risk was calculated using the joint WHO/ISH charts and the General Framingham Cardiovascular Risk Profile charts. Level of agreement between the risk scores was compared using kappa statistics. Institution ethics committee approval was obtained before starting the project. Results 81.7% of the patients were women with a median age of 58 years. Less than half of the patients (45%) had hypertension and another 37.2% had both diabetes and hypertension. 71.6% of the patients had a Conclusion Framingham Risk Profile was found to identify more patients as belonging to the higher risk category as compared to WHO/ISH charts.

Perspectives on optimizing care of patients in multidisciplinary chronic kidney disease clinics.

Purpose of reviewTo summarize a jointly held symposium by the Canadian Society of Nephrology (CSN), the Canadian Association of Nephrology Administrators (CANA), and the Canadian Kidney Knowledge Translation and Generation Network (CANN-NET) entitled “Perspectives on Optimizing Care of Patients in Multidisciplinary Chronic Kidney Disease (CKD) Clinics” that was held on April 24, 2015, in Montreal, Quebec.Sources of informationThe panel consisted of a variety of members from across Canada including a multidisciplinary CKD clinic patient (Randall Russell), nephrology fellow (Dr. David Collister), geriatrician (Dr. Josee Verdon), and nephrologists (Dr. Monica Beaulieu, Dr. Adeera Levin).FindingsThe objectives of the symposium were (1) to gain an understanding of the goals of care for CKD patients, (2) to gain an appreciation of different perspectives regarding optimal care for patients with CKD, (3) to examine the components required for optimal care including education strategies, structures, and tools, and (4) to describe a framework and metrics for CKD care which respect patient and system needs. This article summarizes the key concepts discussed at the symposium from a patient and physician perspectives. Key messages include (1) understanding patient values and preferences is important as it provides a framework as to what to prioritize in multidisciplinary CKD clinic and provincial renal program models, (2) barriers to effective communication and education are common in the elderly, and adaptive strategies to limit their influence are critical to improve adherence and facilitate shared decision-making, (3) the use of standardized operating procedures (SOPs) improves efficiency and minimizes practice variability among health care practitioners, and (4) CKD scorecards with standardized system processes are useful in approaching variability as well as measuring and improving patient outcomes.LimitationsThe perspectives provided may not be applicable across centers given the differences in patient populations including age, ethnicity, culture, language, socioeconomic status, education, and multidisciplinary CKD clinic structure and function.ImplicationsKnowledge transmission by collaborative interprovincial and interprofessional networks may play a role in facilitating optimal CKD care. Validation of system and clinic models that improve outcomes is needed prior to disseminating these best practices.

The prevalence of metabolic syndrome among chronic disease patients in Alwazarat health center at Prince Sultan Military Medical City, Riyadh, Saudi Arabia, 2014

Background: The presence of metabolic syndrome (MS) results in heart attacks twice the time in people with MS and in thrice the time the chances of experiencing a heart attack or stroke in those with MS when compared with normal individuals. Identifying individuals with MS appropriately and managing them at early stages are important. Objective: To measure the prevalence of MS using the NECP/ATP III and the WHO criteria and compare the differences between the two criteria in assessing the prevalence of disease in addition to identifying the different factors associated with MS among chronic disease patients in primary health care. Materials and Methods: A cross-sectional study was carried out at chronic disease clinics in Alwazarat primary care center during the period between February and March 2014. It included a sample of 250 patients attending the chronic disease clinics. A questionnaire was designed to interview the patients and collect the information regarding their socioeconomic status, smoking habits, physical activity, and history of diabetes mellitus (DM), hypertension, and dyslipidemia. Information about their body mass index, blood pressure measurement, and the laboratory tests were recorded in a different checklist. Result: The prevalence of MS among the patients based on the NECP/ATP III and the WHO criteria was 36% and 39.1%, respectively. On the basis of both the criteria together (NECP/ATP III and the WHO), the prevalence of MS was 29.3%. High fasting blood sugar was the highest prevalent component of MS based on the NECP/ATP III criteria (96.3%), followed by low HDL-cholesterol level (82.7%) and abdominal obesity (76.5%), while the highest prevalent component of MS based on the WHO criteria, in addition to impaired glucose level, was obesity (59.1%), followed by high triglycerides level (53.2%), and low HDL-cholesterol level (40.9%). Obesity, ex-smoking, and history of DM, hypertension, and dyslipidemia together were significantly associated with MS. Conclusion: This study showed that there is no significant difference between the WHO criteria and NECP/ATP III criteria for the diagnosis of MS. The approach to the management of all cardiovascular risk factors as MS must be considered.

Knowledge Translation Interventions to Improve the Timing of Dialysis Initiation: Protocol for a Cluster Randomized Trial.

Background:Early initiation of chronic dialysis (starting dialysis with higher vs lower kidney function) has risen rapidly in the past 2 decades in Canada and internationally, despite absence of established health benefits and higher costs. In 2014, a Canadian guideline on the timing of dialysis initiation, recommending an intent-to-defer approach, was published.Objective:The objective of this study is to evaluate the efficacy and safety of a knowledge translation intervention to promote the intent-to-defer approach in clinical practice.Design:This study is a multicenter, 2-arm parallel, cluster randomized trial.Setting:The study involves 55 advanced chronic kidney disease clinics across Canada.Patients:Patients older than 18 years who are managed by nephrologists for more than 3 months, and initiate dialysis in the follow-up period are included in the study.Measurements:Outcomes will be measured at the patient-level and enumerated within a cluster. Data on characteristics of each dialysis start will be determined by linkages with the Canadian Organ Replacement Register. Primary outcomes include the proportion of patients who start dialysis early with an estimated glomerular filtration rate greater than 10.5 mL/min/1.73 m2 and start dialysis in hospital as inpatients or in an emergency room setting. Secondary outcomes include the rate of change in early dialysis starts; rates of hospitalizations, deaths, and cost of predialysis care (wherever available); quarterly proportion of new starts; and acceptability of the knowledge translation materials.Methods:We randomized 55 multidisciplinary chronic disease clinics (clusters) in Canada to receive either an active knowledge translation intervention or no intervention for the uptake of the guideline on the timing of dialysis initiation. The active knowledge translation intervention consists of audit and feedback as well as patient- and provider-directed educational tools delivered at a comprehensive in-person medical detailing visit. Control clinics are only exposed to guideline release without active dissemination. We hypothesize that the clinics randomized to the intervention group will have a lower proportion of early dialysis starts.Limitations:Limitations include passive dissemination of the guideline through publication, and lead-time and survivor bias, which favors delayed dialysis initiation.Conclusions:If successful, this active knowledge translation intervention will reduce early dialysis starts, lead to health and economic benefits, and provide a successful framework for evaluating and disseminating future guidelines.Trial Registration:ClinicalTrials.gov, NCT02183987

Factors Associated with Unplanned Dialysis Starts in Patients followed by Nephrologists: A Retropective Cohort Study.

The number of patients starting dialysis is increasing world wide. Unplanned dialysis starts (patients urgently starting dialysis in hospital) is associated with increased costs and high morbidity and mortality. Risk factors for starting dialysis urgently in hospital have not been well studied. The primary objective of this study was to identify risk factors for unplanned dialysis starts in patients followed in a multidisciplinary chronic kidney disease (CKD) clinic. We performed a retrospective cohort study of 649 advanced CKD patients followed in a multidisciplinary CKD clinic at a tertiary care hospital from January 01, 2010 to April 30, 2013. Patients were classified as unplanned start (in hospital) or elective start. Multivariable logistic regression was used to identify variables associated with unplanned dialysis initiation. 184 patients (28.4%) initiated dialysis, of which 76 patients (41.3%) initiated dialysis in an unplanned fashion and 108 (58.7%) starting electively. Unplanned start patients were more likely to have diabetes (68.4% versus 51.9%; p = 0.04), CAD (42.1% versus 24.1%; p = 0.02), congestive heart failure (36.8% versus 17.6%; p = 0.01), and were less likely to receive modality education (64.5% vs 89.8%; p < 0.01) or be assessed by a surgeon for access creation (40.8% vesrus78.7% p < 0.01). On multivariable analysis, higher body mass index (OR 1.07, 95% CI 1.02, 1.13), and a history of congestive heart failure (OR 2.41, 95% CI 1.09, 5.41) were independently associated with an unplanned start. Unplanned dialysis initiation is common among advanced CKD patients, even if they are followed in a multidisciplinary chronic kidney disease clinic. Timely education and access creation in patients at risk may lead to lower costs and less morbidity and mortality.

An assessment of the supply chain management for HIV/AIDS care and treatment in Kilombero and Ulanga districts in southern Tanzania

Background: The Chronic Diseases Clinic Ifakara (CDCI) has been providing HIV care and treatment in Kilombero and Ulanga districts in Tanzania since 2005. Over time, several drug-refilling stations were created through the Tanzanian National AIDS Control Programme (NACP) to provide antiretroviral therapy (ART). Without any specific performance and outcome evaluation, these refilling stations were upgraded to comprehensive HIV care and treatment centres (CTCs). The objectives of this study were to evaluate the supply chain of the CTCs, key aspects of patient management and the coping strategies of theCTC staff andART patients during stock-outs of drugs and test kits. Methods: This explorative and cross-sectional study was undertaken in September 2011 and involved CDCI and all 11 peripheral CTCs in Kilombero and Ulanga districts in Tanzania. Data were collected through structured interviews with staff in charge of 12 sites and patients onART during un-announced visits. Results: All sites reported shortage of rapid tests to diagnose HIV. Seven (59%) CTCs experienced stock-outs of co-trimoxazole drugs. The CDCI and all but one peripheral CTC reported stock-outs of ARV medication. CD4 + T cell count service and second line drugs were available at the CDCI and in two CTCs only. To cope with the stock-out situation CTCs staff had to stop testing for HIV, substitute the treatment regimen depending on drug availability or close the CTC temporarily. Patients coped by skipping ARVs and co-trimoxazole medications. Conclusion: Access toART in Kilombero and Ulanga districts has some critical imbalances in the supply chain and management for HIV/AIDS care and treatment. Potential strategies to overcome the barriers are discussed in relation to routine health management information system, investments into mobile-health and human resource capacity strengthening.

Patient Enablement in Chronic Diseases in Primary Health Care, Riyadh City, KSA

Background: Chronic diseases continue to cause high morbidity and mortality in Saudi Arabia. Patients severing from diabetes mellitus, hypertension and associated complications have recently increased and most of these patients find it extremely difficult to understand or cope with their illness. The objective of this study is to determine the level of patients’ enablement in chronic disease and its predictors. Methods: A community based cross-sectional study was conducted between December 2014 and January 2015. Six hundred and four (604) Patients attending the Chronic Disease Clinic in Alwazarat Health center were randomly selected to participate in the study. Patients aged 18 years and above, who willingly agreed to participate, were included in the study. Self-reported questionnaire was used to determine patient level of enablement. Descriptive statistics such as mean and median were calculated and binary logistic regression was employed to determine the predictors of patient’s enablement to chronic disease. Results: Our results show that five hundred and sixty five (565) out of (604) patients participated in the study with 86.6% response rate. Type 2 diabetes mellitus affecting 40.65% while hypertension affecting 37.79% of the patients in Al wazarat health center. Patient’s enablement to chronic disease was very low and ranged between 2.41 and 1.53 out of 5.0. Binary logistic regression shows that age (male: OR; 0.84, 95% CI, 0.72 - 1.04, female. OR; 1.04, 95% CI 0.88 - 1.39), marital status (male: OR; 0.72, 95% CI 0.54 - 1.11, female: OR 1.01; 95% CI 0.82 - 1.29), patient educational level and number of problems discussed with physician and consultation length between male patients and their physician were statistically significant and correlated with patients enablement to chronic disease (P < 0.05). Conclusion: This study shows that patient’s enablement in chronic disease is very low but constitutes an important arm in patients care management. It should be considered as a measurable patient outcome from healthcare services. More prospective studies on this important topic are highly recommended.

Opportunities for reducing morbidity and mortality due to leading cancers in a developing country.

Malignancies are a leading cause of chronic non-communicable disease deaths in Jamaica. However, little or no data is available on integration of cancer screening guidelines in clinics. A cross-sectional survey of 88 consecutive patients with diabetes mellitus (DM) and/or hypertension (HTN) was conducted at major health centers in Jamaica between September and December 2011. Eighty percent respondents were women; 20% were men. The mean age was 57 years old. Forty persons (45.5%) had high cholesterol, 62 (71%) had DM and 62 (71%) had HTN. Of 66 women, 27% reported never having a pap smear and 66% had no pap smear within the last 12 months. 49% women over 40 years never had a mammogram and 74% did not have a mammogram in the last 12 months. Among men over 40 years old, at least 25% never had a prostate examination and 19% never had a prostate-specific antigen blood test. Most participants (>90%) received counseling about diet and exercise, but self-reported compliance with recommendations was low. Cancer screening among chronic disease patients is suboptimal in our population. Improved implementation of guidelines for cancer in chronic disease clinics have the potential to impact on morbidity and mortality.

Impact of nursing care in Australian general practice on the quality of care: A pilot of the Patient Enablement and Satisfaction Survey (PESS)

Nursing roles in general practice have undergone significant expansion, but as yet there are few tools to measure the quality of nursing care in general practice. This study piloted the Patient Enablement and Satisfaction Survey (PESS) to evaluate two aspects of quality of care in this setting. Participants were patients attending nurse-led general and chronic-disease clinics in two general practices The survey was posted to 180 consecutive patients attending these clinics over one week (response rate, 28% for general clinic, 40% chronic diseases clinic; n = 57). Scores were calculated for enablement and satisfaction and free text comments were analysed. Comparisons were made between patients who had attended the general clinic for influenza vaccination and for other conditions, and those who attended the chronic diseases clinic. Overall results indicate high levels of satisfaction (M = 68.3/75 SD = 8.1) and moderate enablement (M = 4.7/8 SD = 3.2). Significant differences were observed between satisfaction scores for patients attending the chronic disease clinic and the general clinic for influenza vaccinations alone, and between those attending the general clinic for influenza vaccinations versus treatment of other conditions. Patients attending the chronic disease clinic had higher enablement scores than patients receiving influenza vaccinations at the general clinic. Analysis of free-text comments in the survey supported these findings. All patients reported satisfaction with nursing care. Patients receiving chronic disease management reported high levels of enablement. This pilot indicated that the PESS can distinguish between two aspects of the quality of nursing care that may impact on patient outcomes.

Boundaries, gaps, and overlaps: defining roles in a multidisciplinary nephrology clinic.

This study aims to explore how health care professionals in a multidisciplinary chronic kidney disease clinic interact with one another, patients, families, and caregivers to expand understanding of how this increasingly common form of chronic disease management functions in situ. Nonparticipatory observations were conducted of 64 consultations between patients and health care professionals and end-of-day rounds at a multidisciplinary chronic kidney disease clinic. Key themes in our findings revolved around the question of boundaries between the health professions that were expected to work cooperatively within the clinic, between medical specialties in the management of complex patients, and between caregivers and patients. Understanding the importance of various professional roles and how they are allocated, either formally as part of care design or organically as a clinical routine, may help us understand how multidisciplinary care teams function in real life and help us identify gaps in practice. This study highlights two areas for further study and reflection: the effect of discrepancies in health information and the role of caregivers in patient care.

Urinary CYP eicosanoid excretion correlates with glomerular filtration in African-Americans with chronic kidney disease

Previous studies have indicated that cytochrome P450 (CYP) metabolites of arachidonic acid (AA), i.e., 20-hydroxyeicosatetraenoic acid (20-HETE) and epoxyeicosatrienoic acids (EETs), play an important role in the regulation of renal tubular and vascular function. The present study for the first time profiled HETEs and epoxygenase derived dihydroxyeicosatetraenoic acid diHETEs levels in spot urines and plasma in 262 African American patients from the University of Mississippi Chronic Kidney Disease Clinic and 31 African American controls. Significant correlations in eGFR and urinary 20-HETE/creatinine and 19-HETE/creatinine levels were observed. The eGFR increased by 17.47 [p=0.001] and 60.68 [(p=0.005]ml/min/for each ng/mg increase in 20-HETE and 19-HETE levels, respectively. Similar significant positive associations were found between the other urinary eicosanoids and eGFR and also with 19-HETE/urine creatinine concentration and proteinuria. We found that approximately 80% of plasma HETEs and 30% diHETEs were glucuronidated and the fractional excretion of 20-HETE was less than 1%. These results suggest that there is a significant hepatic source of urinary 20-HETE glucuronide and EETs with extensive renal biotransformation to metabolites which may play a role in the pathogenesis of CKD.

SP0156 Improving Access to Rheumatologist for Patients with Inflammatory Arthritis: What Role Should the GP Play?

Primary care is a key partner in the successful diagnosis and management of patients with inflammatory arthritis. Not only do general practitioners (GPs) have a critical role in the early...

Experiences from an interprofessional student-assisted chronic disease clinic

Faced with significant health and workforce challenges in the region, the Central Queensland Health Service District (CQHSD) commenced a student-assisted clinical service. The Capricornia Allied Health Partnership (CAHP) is an interprofessional clinical placement program in which pre-entry students from exercise physiology, nutrition and dietetics, occupational therapy, pharmacy, podiatry and social work are embedded in a collaborative chronic disease service delivery model. The model coordinates multiple student clinical placements to: address service delivery gaps for previously underserved people with chronic disease in need of early intervention and management; provide an attractive clinical placement opportunity for students that will potentially lead to future recruitment success, and demonstrate leadership in developing future health workforce trainees to attain appropriate levels of interprofessional capacity. The CAHP clinic commenced student placements and client services in February 2010. This report provides early evaluative information regarding student experiences included self-reported changes in practice.

Determinants of diabetes and hypertension control in ambulatory healthcare in Al ain, United arab emirates.

This study aims to study determinants for the control of diabetes and hypertension in Al Ain Ambulatory Healthcare patients. This is a cross sectional observational study of patients attending ambulatory healthcare centers in Al Ain, United Arab Emirates in 2009. From a yearly audit evaluating the care of patients with diabetes and hypertension, the determinants for improved diabetes and hypertension outcomes were identified from a total of 512 patients and its association with glycemic and blood pressure control were studied. From all variables studied, only the clinic where the patient was treated helped predict both improved blood sugar and blood pressure control. For patients with diabetes, poor control the year before (p<0.001), the number of chronic disease clinic visits (p=0.042) and triglyceride levels (p=0.007) predicted worse control of diabetes. A predictor of poor control of blood pressure (p<0.001) for patients with hypertension was poor control of blood pressure in the year before. In this population, the healthcare system and the team played major roles as determinants in the control of patient's diabetes and blood pressure more than any of the other factors examined.