Chronic Disease Management Program Research Articles

Reframing Fall Prevention and Risk Management as a Chronic Condition through the Lens of the Expanded Chronic Care Model: Will Integrating Clinical Care and Public Health Improve Outcomes?

Falls are a leading cause of morbidity and mortality among adults aged 65 years and older (older adults) and are increasingly recognized as a chronic condition. Yet, fall-related care is infrequently provided in a chronic care context despite fall-related death rates increasing 41% between 2012 and 2021. One of the many challenges to addressing falls is the absence of fall-focused chronic disease management programs, which improve outcomes of other chronic conditions, like diabetes. Policies, information systems, and clinical-community connections help form the backbone of chronic disease management programs, yet these elements are often missing in fall prevention. Reframing fall prevention through the Expanded Chronic Care Model (ECCM) guided by implementation science to simultaneously support the uptake of evidence-based practices could help improve the care of older adults at risk for falling. The ECCM includes seven components: 1) self-management/develop personal skills, 2) decision support, 3) delivery system design/re-orient health services, 4) information systems, 5) build healthy public policy, 6) create supportive environments, and 7) strengthen community action. Applying the ECCM to falls-related care by integrating healthcare delivery system changes, community resources, and public policies to support patient-centered engagement for self-management offers the potential to prevent falls more effectively among older adults.

Client and clinician perspectives about a virtual education and exercise chronic disease management programme for people with hip and knee osteoarthritis.

Osteoarthritis (OA) is one of the most prevalent chronic conditions in Canada. Despite the established benefits of non-pharmacological management (education, exercise) for people with OA, many do not receive treatment, resulting in pain, decreased physical function, and poorer quality of life. Virtual programme options grew significantly during the recent pandemic and may provide longer-term opportunities for increased uptake by reaching individuals otherwise unable to participate. This study explored the experiences and perspectives of clients participating in and clinicians providing the Good Life with osteoArthritis: Denmark (GLA:DTM) Canada remote programme. This qualitative descriptive study recruited 10 clients with hip and/or knee OA and 11 clinicians across Canada using purposive sampling. An online pre-interview survey was completed, and individual interviews were conducted, audio-recorded, transcribed verbatim and analysed independently by two researchers using inductive thematic analysis. Coding and analyses were initially conducted separately by group and then compared and combined. Four overarching themes (and 11 subthemes) were identified: (1) Expected and unexpected benefits of virtual programs; (2) Drawbacks to virtual programs; (3) Programme delivery in a virtual world; (4) Shifting and non-shifting perspectives. Although initially sceptical, after completion of the programme, clients were in favour of virtual delivery with many benefits described. Clinicians' perspectives varied about feedback aimed to correct client movement patterns. Clients and clinicians identified important experiential and procedural elements for virtual chronic disease management programs that include education and exercise. Additional work is needed to understand if the GLA:DTM remote outcomes are equivalent to the in-person programme.

Patients Satisfaction with the Chronic Disease Management Program in Indonesia Using the Importance-Performance Matrix

Patients Satisfaction with the Chronic Disease Management Program in Indonesia Using the Importance-Performance Matrix

Employer Engagement Strategies to Promote and Add Evidence-Based Chronic Disease Prevention and Management Programs as a Covered Benefit

Employer Engagement Strategies to Promote and Add Evidence-Based Chronic Disease Prevention and Management Programs as a Covered Benefit

Education Influence Using Leaflet Media on the Level of Knowledge, Compliance, and Therapy Outcomes in Prolanis Hypertension Patients at X Clinic Surakarta


 Hypertension prevalence in Indonesia reached 34.4%. Chronic Disease Management Program or Program Pengelolaan Penyakit Kronis (PROLANIS) was one of the preventive and promotive strategies from BPJS, carried out to reduce or prevent complications of chronic diseases, including hypertension. Aim of this study was to determine education influence using leaflet media on the level of knowledge, compliance and therapy outcomes in prolanis hypertension patients at X Clinic, Surakarta. Method of this study used a quasi-experimental with pre-test and post-test design with 40 patients in each control and treatment group. Knowledge level assessed using HK-LS questionnaire, compliance assessed using MARS questionnaire, and therapy outcomes collected from medical record. The results of this study showed that education using leaflet media influenced level of knowledge with a value of p = 0.014, level of taking medication adherence with a value of p = 0.015 and results of systolic blood pressure therapy with a value of p = 0.000. There were an influence of education using leaflet media on the level of knowledge, compliance and therapy coutcome for prolanis hypertension patients at X Clinic, Surakarta.

A rapid review to inform the policy and practice for the implementation of chronic disease prevention and management programs for Aboriginal and Torres Strait Islander people in primary care

BackgroundMore than 35% of Aboriginal and Torres Strait Islander adults live with cardiovascular disease, diabetes, or chronic kidney disease. There is a pressing need for chronic disease prevention and management among Aboriginal and Torres Strait Islander people in Australia. Therefore, this review aimed to synthesise a decade of contemporary evidence to understand the barriers and enablers of chronic disease prevention and management for Aboriginal and Torres Strait Islander People with a view to developing policy and practice recommendations.MethodsWe systematically searched for peer-reviewed published articles between January 2014 to March 2023 where the search was performed using subject headings and keywords related to “Aboriginal and Torres Strait Islander peoples,” “Chronic Disease,” and “Primary Health Care”. Quality assessment for all included studies was conducted using the Aboriginal and Torres Strait Islander Quality Appraisal Tool. The data were extracted and summarised using a conventional content analysis approach and applying strength-based approaches.ResultsDatabase searches identified 1653 articles where 26 met inclusion criteria. Studies varied in quality, primarily reporting on 14 criteria of the Aboriginal and Torres Strait Islander Quality Appraisal Tool. We identified six key domains of enablers and barriers of chronic disease prevention and management programs and implied a range of policy and practice options for improvement. These include culturally acceptable and safe services, patient-provider partnerships, chronic disease workforce, primary health care service attributes, clinical care pathways, and accessibility to primary health care services. This review also identified the need to address social and cultural determinants of health, develop the Aboriginal and Torres Strait Islander and non-Indigenous chronic disease workforce, support multidisciplinary teams through strengthening clinical care pathways, and engage Aboriginal and Torres Strait Islander communities in chronic disease prevention and management program design and delivery.ConclusionEnabling place-based partnerships to develop contextual evidence-guided strategies that align with community priorities and aspirations, with the provision of funding mechanisms and models of care through policy and practice reforms will strengthen the chronic disease prevention and management program for Aboriginal and Torres Strait Islander people.

Dental and Oral Health Promotion Video Media on the Knowledge of Prolanis Patients

Dental and oral health is a top priority for everyone, including prolanis patients. Prolanis is a proactive and integrated chronic disease management program involving participants, health facilities, especially community health centers and BPJS Health, aimed at encouraging chronic disease patients to achieve optimal quality of life services, one of which is dental and oral health. Education about dental and oral health needs to be provided to prolanis patients. This education needs to use media so that targets can more quickly understand the education provided, such as video and non-video media (flipcharts). The aim of this research is to analyze changes in knowledge before and after being given counseling using video media to prolanis patients, in the work area of the Mangkubumi Health Center, Tasikmalaya City in 2023. This research method uses a quantitative approach with a Quasi-Experimental research type with a Two Group Pretest and Posttest Design. Based on the results of statistical knowledge tests in the experimental group and control group, it was found that there was no significant difference between the results of dental and oral health knowledge before and after being given intervention using video and non-video with a significance value of 0.910, meaning p > 0.05. The results of the Mann-Whitney statistical test showed that the knowledge of the experimental group was an average of 20.30 and the control group had an average of 20.70. p=value of 0.910 is greater than the significance level of p > 0.05. This means that there is no significant difference between the results of dental and oral health knowledge using video and non-video. In conclusion, it was found that flipcharts were more effective than videos in increasing dental and oral health knowledge in Prolanis with a difference of 0.5 more effective in increasing flipchart media.

New Approach to Equitable Intervention Planning to Improve Engagement and Outcomes in a Digital Health Program: Simulation Study.

Digital health programs provide individualized support to patients with chronic diseases and their effectiveness is measured by the extent to which patients achieve target individual clinical outcomes and the program's ability to sustain patient engagement. However, patient dropout and inequitable intervention delivery strategies, which may unintentionally penalize certain patient subgroups, represent challenges to maximizing effectiveness. Therefore, methodologies that optimize the balance between success factors (achievement of target clinical outcomes and sustained engagement) equitably would be desirable, particularly when there are resource constraints. Our objectives were to propose a model for digital health program resource management that accounts jointly for the interaction between individual clinical outcomes and patient engagement, ensures equitable allocation as well as allows for capacity planning, and conducts extensive simulations using publicly available data on type 2 diabetes, a chronic disease. We propose a restless multiarmed bandit (RMAB) model to plan interventions that jointly optimize long-term engagement and individual clinical outcomes (in this case measured as the achievement of target healthy glucose levels). To mitigate the tendency of RMAB to achieve good aggregate performance by exacerbating disparities between groups, we propose new equitable objectives for RMAB and apply bilevel optimization algorithms to solve them. We formulated a model for the joint evolution of patient engagement and individual clinical outcome trajectory to capture the key dynamics of interest in digital chronic disease management programs. In simulation exercises, our optimized intervention policies lead to up to 10% more patients reaching healthy glucose levels after 12 months, with a 10% reduction in dropout compared to standard-of-care baselines. Further, our new equitable policies reduce the mean absolute difference of engagement and health outcomes across 6 demographic groups by up to 85% compared to the state-of-the-art. Planning digital health interventions with individual clinical outcome objectives and long-term engagement dynamics as considerations can be both feasible and effective. We propose using an RMAB sequential decision-making framework, which may offer additional capabilities in capacity planning as well. The integration of an equitable RMAB algorithm further enhances the potential for reaching equitable solutions. This approach provides program designers with the flexibility to switch between different priorities and balance trade-offs across various objectives according to their preferences.

Frequency of walking physical exercise reduces blood sugar levels in diabetic

Diabetes mellitus is a global public health threat characterized by increasing morbidity and mortality rates. An unhealthy lifestyle causes this and has an impact on various kinds of disease complications and even death. One of the complementary interventions that can be carried out is physical exercise on foot. The research aimed to analyze the effect of physical walking exercise on blood sugar levels. Pre and post-test quasi-experimental research design without a control group. The study was conducted in January-February 2024 in the Ngembalrejo Community Health Center Working Area, Kudus Regency. The sample was 20 clients for each of the two intervention groups. Inclusion criteria were diagnosed diabetes mellitus, age 20-59 years, following all interventions, and no complications. Intervention group 1 did physical exercise three times a week, and intervention group 2 did physical exercise walking every day. The research instrument used an observation sheet and a glucometer—data analysis using paired t-tests and independent t-tests. The study's results showed a significant effect of physical walking exercise on blood sugar levels with a value of p=0.000 (p<0.05). Physical walking exercises can be carried out regularly by Diabetics, either independently or integrated with chronic disease management programs (PROLANIS), non-communicable disease patients, and elderly patients.

Diabetic Self-Management and Correlated Factors: A Cross-Sectional Study

Prevention of diabetes complications has an important role in decreasing mortality and morbidity in diabetes patients. Self-management in diabetic patients (DSM) is a recommended strategy to increase the quality of life in diabetes patients. Several factors are related to self-management in diabetic patients. This study aims to discover factors related to self-management in diabetic patients. This is a cross-sectional study performed on 42 diabetic patients. Respondents were given a Diabetes Knowledge Questionnaire (DKQ-24) and a self-management behaviour questionnaire in Diabetes Mellitus (SMDM). Data was analyzed using SPSS version 26. This study had no significant relation between age and self-management (p = 0.987). There was also no statistically significant relationship between gender, education level, and knowledge level with p-value of 0.651, 0.559, and 0.558, respectively. Moreover, there was no correlation between participation in chronic disease management programs and self-management with p = 0.559. This study concluded no correlation between age, gender, education level, knowledge level, and participation in chronic disease management programs with self-management of diabetic patients.

Comparison of Fast and Time Blood Glucose Levels in Chronic Disease Management Program Patients (Proalnic) and Non-Prolanic with Diabetes Mellitus in Praya Health Center

Glucose is the most important carbohydrate which is mostly absorbed into the bloodstream as glucose and other sugars are converted into glucose in the liver. Blood glucose levels are closely related to DM. Prolanic (Chronic Disease Management Program) is a health service system that involves participants from Health Facilities and BPJS health in the context of health care for participants suffering from chronic diseases including diabetes mellitus to achieve optimal quality of life with cost-effective and efficient health services. To determine the comparison of fasting and intermittent blood glucose levels in prolanic and non-prolanic patients suffering from DM at Praya Health Center. : This type of research is Analytical Observation, the sample is taken purposively. A sample of 30 respondents, in this study were 15 respondents who took prolanis and 15 respondents who did not follow prolanis who had a history of diabetes mellitus and underwent blood glucose level checks at the UPTD BLUD Laboratory of Praya Health Center. Based on research that has been done, the average fasting blood glucose level in prolanis is 158 mg/dl and fasting glucose is 204 mg/dl. Meanwhile, non-prolanic fasting glucose levels are 156 mg/dl and fasting glucose levels are 204 mg/dl.

Increasing Awareness of Diabetes Mellitus in The Elderly in Lamongan Regency Through Community Service

Purpose – The Indonesian government had a chronic disease management program, PROLANIS, targeted for diabetes and hypertension since 2010 to prevent chronic disease patients from severe complications through monitoring and control measures. The purpose of this community service was to improve the health status of diabetic patients who participate in PROLANIS in Sukodadi and Sukolilo Villages, Lamongan Regency, through analysis of blood glucose levels. Design/methodology/approach – To overcome the problems previously mentioned, community service has been proposed. This service includes educating participants about metabolic syndrome and health checks. The main aim of this educational program is to increase public awareness about diabetes mellitus. The blood examination aims to determine the prevalence of diabetes mellitus in these villages. This educational program involves direct mentoring and outreach methods, such as the creation of booklets, educational videos, and PPTs. Findings and Discussions – In Sukodadi and Sukolilo Villages, community service was organized as a response to the high prevalence of diabetes mellitus. The program included blood tests and educational sessions for participants enrolled in the PROLANIS initiative. Analysis of the data revealed that the average blood sugar level of the participants was 143.1 mg/dl, slightly above the normal blood sugar level tolerance limit of 140 mg/dl. Nevertheless, the results indicate that the blood sugar levels of the participants can be effectively managed and kept below the diabetes tolerance threshold of <200 mg/dl. Originality/value – Our community services in Sukodadi and Sukolilo Village, Lamongan Regency, showed that most elderly women with diabetes mellitus are retired. As people age, their risk of high blood glucose levels increases. Despite the average glucose level of PROLANIS participants being higher than normal, it can still be controlled. Our findings can guide the government to organize diabetes management programs and help service providers carry out prevention measures.

Prevention and control of diabetes mellitus complications in productive population in rural

In Pekalongan Regency, Central Java, Indonesia, cases of productive population with diabetes mellitus have rapidly increased over the past three years. With regard to individual-based problems prevention and management, this is not sufficiently balanced. From the standpoint of the provider, this study examines attempts to prevent and control diabetes mellitus in productive population, including obstacles and limitations. With a focus on three rural areas (Wiradesa, Tirto I and Kedungwuni I Sub-Districts), qualitative study included 75 productive-age diabetics and 30 breadwinners. In-depth interviews and focus group discussions were used to gather data, which was then thematically analyzed. Three rural locus with the highest prevalence of diabetes mellitus in productive population were found in the results. Through screening for non-communicable diseases at integrated service post (Posyandu), chronic disease management programs and cross-sectoral activities, there are numerous initiatives for the prevention and management of complications. The challenges include constantly changing programmers, programmers with many assignments, inadequate target awareness and low motivation, as well as a worse recording and reporting system. Such that fundamental information on both individual and public health cannot be accessed. Based on individual emphasis, recording and reporting, several programs for complication prevention and management are required to identify the range of non-communicable diseases.

Hubungan Keikutsertaan Kegiatan Prolanis dengan Kualitas Hidup Lansia di Wilayah Kerja Puskesmas Bangkala

<p align="justify"><em>Chronic diseases cause disability in sufferers, so the Government, through BPJS Health, collaborates with health facilityservices to design a program known as “Chronic Disease Management Program” which is a system that combines management and communication if health services for participants with certain diseases through efforts to treat the disease independently. This research aims to determine the relationship between participation in Prolanis activitiesand the quality of life of the elderly. The type of research used is an analytical survey method using a Cross Sectional Study. The population in this study were 63 elderly who participated in Prolanis in the Bangkala Community Health Center working area. The sampling technique used was Exhaustive sampling. Data was collected through questionnaires and analysis using univariate and bivariate test, with a confidence level of    α = 0.05. The research result show that reminders do not have a significant relationship with the elderly where the p value is 0.229. Monitoring health status has a significant relationship with the quality of life of the elderly where the p value is 0.033. Drug services do not have a significant relationship with the quality of life of the elderly where the p value is 0.214. Club activities have a significant relationship with the quality of life of the elderly where the p value is 0.047 based on the results of the chi-square test. Therefore, Bangkala Health Center Health officers are expected to pay more attention to reminder activities. Participants are also expected to carry out health status monitoring activities, drug services and club activities more regularly.</em><em></em></p>

Participants' perspectives of "NeuroSask: Active and Connect"-a virtual chronic disease management program for individuals with a neurological condition.

Neurological conditions account from more than half of Canadians requiring chronic care. Both physical activity and the development of a self-management skillset are critical components supporting individuals with chronic health conditions. "NeuroSask: Active and Connected" is a virtual chronic disease management program offering twice weekly neuro-physiotherapist directed "active" exercise sessions, followed by weekly knowledge-exchange "connect" sessions with invited guest experts. NeuroSask was launched April 2020 in response to the restricted services and supports for people with neurological conditions. The program aimed to provide seated physical activity, social interaction, and access to expertise in neurological conditions and neurorehabilitation. A program evaluation of NeuroSask was conducted to gain participants' perspectives. All participants registered for the NeuroSask program were invited to complete optional online surveys (SurveyMonkey) circulated by email at 3 occasions post-program launch: 10 weeks, 1 year, and 2 years. Participants could complete any one or all of the surveys, at their discretion. The number of potential respondents changed dependent on the total number of participants registered for NeuroSask at the time the survey was circulated. Questions were co-designed by multi-stakeholder team members. Descriptive statistics were used for closed-ended questions and a reflexive thematic analysis was completed with coding conducted in NVivo 12 Plus for open-ended text. Response rates (participants/registrants) were as follows: 10-week survey 260/793, one year survey 326/1224, and 2-year survey 434/1989. 90% of participants reported being in either the age categories of 40-59 years or above 60 years. 75% of both survey respondents and program registrants were female. 70% of both survey respondents and program registrants reported a diagnosis of multiple sclerosis and 30% reported other neurological conditions. Survey respondents were from all ten Canadian provinces, with 45% reporting living outside of large cities. Respondents reported preferring online vs. in person format for this type of programming. Three main themes, and eight corresponding subthemes were identified highlighting the perceived impact and key components of the NeuroSask program: Theme 1 "together in a positive and encouraging environment" (subthemes 1a: connection, 1b: empowerment); Theme 2 "access to enthusiastic qualified leaders from home" (subthemes 2a: leader characteristics, 2b: accessibility, 2c: program logistics); Theme 3 "being able to enjoy everyday life" (subthemes 3a: symptom benefits and beyond, 3b: carry-over, 3c: keep going, please do not cancel). NeuroSask is an example of an accessible and meaningful virtual approach to providing ongoing support for some individuals with neurological conditions. It was perceived as beneficial for fostering community and connection in a positive environment with perceived benefits extending beyond symptom management to participant reported improvements in function, daily life, and disease experience.

Real-World Cost-Consequence Analysis of an Integrated Chronic Disease Management Program in Saskatchewan, Canada.

An integrated disease management program otherwise called a clinical pathway was recently implemented in Saskatchewan, Canada for patients living with chronic obstructive pulmonary disease (COPD). This study compared the real-world costs and consequences of the COPD clinical pathway program with 2 control treatment programs. The study comprised adult COPD patients in Regina (clinical pathway group, N = 759) matched on propensity scores to 2 independent control groups of similar adults in (1) Regina (historical controls, N = 759) and (2) Saskatoon (contemporaneous controls, N = 759). The study measures included patient-level healthcare costs and acute COPD exacerbation outcomes, both tracked in population-based administrative health data over a one-year follow-up period. Analyses included Cox proportional hazards models and differences in means between groups. The bias-corrected and accelerated bootstrap method was used to calculate 95% confidence intervals (CI). The COPD pathway patients had lower risks of moderate (hazard ratio [HR] =0.57, 95% CI [0.40-0.83]) and severe (HR = 0.43, 95% CI [0.28-0.66]) exacerbations compared to the historical control group, but similar risks compared with the contemporaneous control group. The COPD pathway patients experienced fewer episodes of exacerbations compared with the historical control group (mean difference = -0.30, 95% CI [-0.40, -0.20]) and the contemporaneous control group (mean difference = -0.12, 95% CI [-0.20, -0.03]). Average annual healthcare costs in Canadian dollars were marginally higher among patients in the COPD clinical pathway (mean = $10 549, standard deviation [SD] =$18 149) than those in the contemporaneous control group ($8841, SD = $17 120), but comparable to the historical control group ($10 677, SD = $21 201). The COPD pathway provides better outcomes at about the same costs when compared to the historical controls, but only slightly better outcomes and at a marginally higher cost when compared to the contemporaneous controls.

Promoting effective interprofessional collaborative practice in the primary care setting: recommendations from Queensland physiotherapy private practitioners.

Physiotherapy private practitioners represent a growing proportion of Australia's primary care workforce; however, they face significant barriers in integrating seamlessly within interprofessional teams. Historically, the landscape of primary care in Australia has been one where many physiotherapists work in monoprofessional private practice facilities at dispersed locations, potentially limiting collaborative and coordinated care. The aim of this study was to investigate strategies recommended by physiotherapists to promote effective interprofessional collaborative practice (IPCP) within the Australian private practice setting. Using interpretive description as the guiding methodological framework, semi-structured interviews were conducted with 28 physiotherapists in 10 private practice sites in Queensland, Australia. Data analysis produced three themes that characterised physiotherapy private practitioners' recommendations to improve IPCP: (a) the need for improved funding and compensation, particularly addressing the limitations of the Medicare Chronic Disease Management program; (b) the development of integrated and secure digital communication systems to facilitate better information exchange; and (c) prioritising professional development and training to enhance collaboration. This research lays the groundwork for informed policy making to advance person-centred care and support the integration of services in the Australian healthcare system. The findings from this study indicate that promoting effective IPCP in physiotherapy private practice requires a comprehensive strategy that addresses systemic funding and compensation issues, enhances digital communication systems and optimises interprofessional education and training.

A Real-World Precision Medicine Program Including the KidneyIntelX Test Effectively Changes Management Decisions and Outcomes for Patients With Early-Stage Diabetic Kidney Disease.

The KidneyIntelX is a multiplex, bioprognostic, immunoassay consisting of 3 plasma biomarkers and clinical variables that uses machine learning to predict a patient's risk for a progressive decline in kidney function over 5 years. We report the 1-year pre- and post-test clinical impact on care management, eGFR slope, and A1C along with engagement of population health clinical pharmacists and patient coordinators to promote a program of sustainable kidney, metabolic, and cardiac health. The KidneyIntelX in vitro prognostic test was previously validated for patients with type 2 diabetes and diabetic kidney disease (DKD) to predict kidney function decline within 5 years was introduced into the RWE study (NCT04802395) across the Health System as part of a population health chronic disease management program from [November 2020 to April 2023]. Pre- and post-test patients with a minimum of 12 months of follow-up post KidneyIntelX were assessed across all aspects of the program. A total of 5348 patients with DKD had a KidneyIntelX assay. The median age was 68 years old, 52% were female, 27% self-identified as Black, and 89% had hypertension. The median baseline eGFR was 62 ml/min/1.73 m2, urine albumin-creatinine ratio was 54 mg/g, and A1C was 7.3%. The KidneyIntelX risk level was low in 49%, intermediate in 40%, and high in 11% of cases. New prescriptions for SGLT2i, GLP-1 RA, or referral to a specialist were noted in 19%, 33%, and 43% among low-, intermediate-, and high-risk patients, respectively. The median A1C decreased from 8.2% pre-test to 7.5% post-test in the high-risk group (P < .001). UACR levels in the intermediate-risk patients with albuminuria were reduced by 20%, and in a subgroup treated with new scripts for SGLT2i, UACR levels were lowered by approximately 50%. The median eGFR slope improved from -7.08 ml/min/1.73 m2/year to -4.27 ml/min/1.73 m2/year in high-risk patients (P = .0003), -2.65 to -1.04 in intermediate risk, and -3.26 ml/min/1.73 m2/year to +0.45 ml/min/1.73 m2/year in patients with low-risk (P < .001). Deployment and risk stratification by KidneyIntelX was associated with an escalation in action taken to optimize cardio-kidney-metabolic health including medications and specialist referrals. Glycemic control and kidney function trajectories improved post-KidneyIntelX testing, with the greatest improvements observed in those scored as high-risk.

Analysis of determinant diabetic neuropathy symptom score factors in diabetes mellitus patients

Background: Diabetes peripheral neuropathy (DPN) is a set of signs and symptoms of peripheral nervous system dysfunction in diabetes mellitus patients. Abdominal obesity is one of the main risk factors for DPN. Diabetic neuropathy symptom (DNS) is a reliable instrument with consistent results for the diagnosis of neuropathy. Objective: This study aimed to determine the correlation of abdominal obesity with scores. Methods: This research was a quantitative study with a cross-sectional approach. The sample of this study was 92 type 2 diabetes mellitus (T2DM) patients aged range 30-60 years who participated in the chronic disease management program (Prolanis) and the integrated healthcare center (Posbindu) for people in the area of three public health centers (Puskesmas) in Pekalongan Regency which purposively selected. Instruments used to measure DPN were DNS sheets, and abdominal obesity was measured by waist circumference using a midline. The bivariate analysis was performed using the Pearson correlation and linear regression tests. Results: There was a correlation between abdominal obesity and DNS scores with a p value of 0.043 with a correlation coefficient of 0.212. The DNS score was influenced by age, gender, duration of diabetes, and body mass index by 13.4%. Conclusion: There was a correlation between abdominal obesity and DNS scores. It indicated that the higher the value of abdominal obesity was, the higher DNS scores increased.

Increasing Awareness Of Sustainable Oral Health In The Elderly With The Peer Group Methods At Klinic Pratama 'Aisyiyah Moyudan Sleman Yogyakarta 2023

Introduction - The link between disease and age is extremely complicated. Age explains more variation in disease incidence than any other known factor, including oral diseases. Periodontal infections and dental caries are the most frequent human diseases and the leading causes of tooth loss. Both disorders can impair nutrition and have a detrimental impact on self-esteem and quality of life. The aim of this study is to maximize self-efficacy and health literacy through health empowerment, elderly adults with Diabetes Mellitus (DM), hypertension, or other systemic disorders require dental health promotion by creating dental and oral health cadres, the goal is to raise elderly's awareness of dental and oral health through peer groups.&#x0D; Method - Forming and educating cadres in oral health was one of the tasks done. Two men and two women who were patients at the Klinic Pratama ‘Aisyiyah Moyudan Sleman Yogyakarta Indonesia and also members of chronic disease management Program (PROLANIS), were chosen as cadres. The cadres were given tooth brushing aids and dental and oral health posters, which were then used to train 30 elderly participants on how to brush their teeth properly and correctly. The training participants worked on pre-test and post-test questions before and after the training.&#x0D; Result – Oral health cadres have been selected and trained to provide education to fellow elderly and participants. The education conducted by the cadres for 30 other participants generated very good results, where the average post-test score experienced a high increase (90) compared to the pre-test average score (60). In the second and third month after the program's execution, cadres' activities were independently monitored. Dental and oral health cadres could teach the people how to brush their teeth effectively.&#x0D; Implications – Promotive and preventive efforts carried out by cadres who were fellow elders employing peer group methods get excellent results, whereas education carried out from and by the internal community was more targeted and achieved excellent results.&#x0D;