Diabetes Care Services Research Articles

Supporting self management of type 2 diabetes: is there a role for the community pharmacist?

BackgroundEvidence supports the efficacy of pharmacy services in type 2 diabetes (T2D). However, little is known about consumer perspectives on the role of community pharmacists in diabetes care. The objectives of this study were to identify potential unmet needs and explore preferences for pharmacist-delivered support for T2D.MethodsA qualitative study using focus groups was conducted in Sydney, Australia. Patients with T2D who were members of the Australian Diabetes Council in Sydney, Australia, were recruited through a survey on medication use in T2D. Five focus groups with a total of 32 consumers with T2D were recorded, transcribed, and thematically analyzed.ResultsThe key themes were 1) the experiences of diabetes services received, 2) the potential to deliver self-management services, and 3) the suggested role of pharmacist in supporting diabetes management. Gaps in understanding and some degree of nonadherence to self-management signaled a potential for self-management support delivered by pharmacists. However, consumers still perceive that the main role of pharmacists in diabetes care centers on drug management services, with some enhancements to support adherence and continuity of supply. Barriers to diabetes care services included time constraints and a perceived lack of interest by pharmacists.ConclusionGiven the unmet needs in diabetes self-management, opportunities exist for pharmacists to be involved in diabetes care. The challenge is for pharmacists to upgrade their diabetes knowledge and skills, organize their workflow, and become proactive in delivering diabetes care support.

Care Management Medical Home Center Model: Preliminary Results of a Patient-Centered Approach to Improving Care Quality for Diabetic Patients.

This article presents preliminary findings of the impact of an innovative care management model for diabetic patients. The model was implemented by seven Federally Qualified Health Centers serving 10,000 diabetic patients in Miami-Dade County. A primary intervention of this model is a centralized care management team that makes previsit phone calls to diabetic patients who have scheduled appointments. These previsit phone calls optimize patient knowledge and self-management goals, and provide patient care coordinators with relevant clinical information to optimize the office visit and help to ensure completion of recommended diabetic preventive and chronic care services. Data suggest that following the implementation of this care management model, more diabetic patients are receiving regular care, and compliance with recommended tests and screenings has improved.

Inequitable Access to Health Services for Older Adults with Diabetes: Potential Solutions on a State Level

Diabetes is a serious global public health challenge. The cost for health services for diabetes care has increased 41% over the past 5 years. Despite escalating health expenditure, the United States continues to have higher rates of diabetes than many other developed countries. There is a need for health care reform in the United States not only in reducing health care costs but also in improving the quality of preventative care. This study presents the testing of a multilevel model investigating variables on the individual and state levels to develop a better understanding of the most important contextual pathways that can lead to providing older adults (50+) with type 2 diabetes with the recommended preventative quality care they require. The model was tested using a three-level repeated cross-sectional design with data from various existing data sources, using a national sample of 181,870 individuals aged 50 years and older. Results showed that differences in state health care systems contributed to inequitable access. Specifically, in a state where there was a higher percentage of adults 65 and older coupled with a shortage of health care professionals, the likelihood of receiving the recommended preventative quality care decreased. Also, older adults living in states with a higher percentage of people with diagnosed diabetes but with a lower-than-average annual per capita health care expenditure fared worse in receiving quality preventative care. Last, older adults in wealthy states with higher percentages of uninsured people had the lowest odds of receiving quality preventative care. Health care reform, similar to what is currently promoted by the Patient Protection and Affordable Care Act of 2010, is recommended to improve the performance of all health care systems in all states.

Podiatrists' perceptions of diabetic foot care services in a Scottish NHS health board area

The authors aimed to elicit podiatrists’ perceptions of NHS diabetic foot care services and to identify any perceived barriers to delivery of optimal care. A mixed-methods approach was adopted. A survey and focus groups were undertaken with podiatrists employed by NHS Greater Glasgow & Clyde. The majority of participants did not perceive that national care guidelines, screening targets and national diabetic foot care standards were being met.

Diabetes Research in Iran: a Scientometric Analysis of Publications Output.

Introduction:In the developing countries, diabetes mellitus as a chronic diseases, have replaced infectious diseases as the main causes of morbidity and mortality. International Diabetes Federation (IDF) recently estimates 382 million people have diabetes globally and more than 34.6 million people in the Middle East Region and this number will increase to 67.9 million by 2035. The aim of this study was to analyze Iran’s research performance on diabetes in national and international context.Methods:This Scientometric analysis is based on the Iranian publication data in diabetes research retrieved from the Scopus citation database till the end of 2014. The string used to retrieve the data was developed using “diabetes” keyword in title, abstract and keywords, and finally Iran in the affiliation field was our main string.Results:Iran’s cumulative publication output in diabetes research consisted of 4425 papers from 1968 to 2014, with an average number of 96.2 papers per year and an annual average growth rate of 25.5%. Iran ranked 25th place with 4425 papers among top 25 countries with a global share of 0.72 %. Average of Iran’s publication output was 6.19 citations per paper. The average citation per paper for Iranian publications in diabetes research increased from 1.63 during 1968-1999 to 10.42 for 2014.Conclusions:Although diabetic population of Iran is increasing, number of diabetes research is not remarkable. International Diabetes Federation suggested increased funding for research in diabetes in Iran for cost-effective diabetes prevention and treatment. In addition to universal and comprehensive services for diabetes care and treatment provided by Iranian health care system, Iranian policy makers should invest more on diabetes research.

Impact of a chronic care coordinator intervention on diabetes quality of care in a community health center.

To evaluate the impact of a clinic-based chronic care coordinator (CCC) intervention on quality of diabetes care, health outcomes and health service utilization within six community health centers serving predominantly low-income Hispanic and non-Hispanic white patients. We used a retrospective cohort study design with a 12-month pre- and 12-month postintervention analysis to evaluate the effect of the CCC intervention and examined: (1) the frequency of testing for glycated hemoglobin (HbAIC), cholesterol LDL level, and microalbumin screen and frequency of retinal and foot exam; (2) outcomes for HbAIC levels, lipid, and blood pressure control; and (3) health care service utilization. Patients with diabetes who received the CCC intervention (n = 329) were compared to a propensity score adjusted control group who are not exposed to the CCC intervention (n = 329). All of the data came from Electronic Medical Record. Four separate sets of analyses were conducted to demonstrate the effect of propensity score matching on results. The CCC intervention led to improvements in process measures, including more laboratory checks for HbAIC levels, microalbuminuria screens, retinal and foot exams and also increased primary care visits. However, the intervention did not improve metabolic control. CCC interventions offer promise in improving process measures within community health centers but need to be modified to improve metabolic control.

A simple method for introducing care planning into specialist diabetes clinics. The WICKED project

AbstractDiabetes care planning is a systematic way of establishing a partnership between people with diabetes and health care services. We piloted a systematic patient‐driven care planning consultation process in our routine specialist diabetes clinics.A document based on all key care processes was given to and completed by patients prior to their consultation. The completed document was used to structure the clinic consultation. Patient and doctor outcomes were assessed by post consultation questionnaires.Of 148 patients, 101 responded; 55 male, age 60 ± 12 years, duration of diabetes 12 ± 9 years, 67 on insulin, 3 new and 98 review patients; 63% were Caucasian, 14% Asian, 4% Afro Caribbean and 19% unknown ethnicity. In global assessment by patients, the process scored ‘good’ or ‘very good’ in 80%, as it did in the other more specific domains (n = 7). Among doctors, 10 of 12 rated the structured patient‐driven consultation process good or very good, reporting increased patient engagement, shared decision making and communication; they felt it was more time consuming though worthwhile. Crucially, it increased insight into patients’ needs.In patient‐centric consultations: patients did use the opportunity to assess, categorise and prioritise their health concerns with a high degree of satisfaction; health professionals found that of benefit; this was implementable within busy routine specialist diabetes clinics. Copyright © 2014 John Wiley & Sons, Ltd.

Audit of healthy lifestyle behaviors among patients with diabetes and hypertension attending ambulatory health care services in the United Arab Emirates

Knowledge is limited on healthy lifestyle behaviors and their associations with glycemic and blood pressure control among patients with diabetes and hypertension in the United Arab Emirates (UAE). To examine healthy lifestyle behaviors and their associations with glycemic and blood pressure control among patients with hypertension and diabetes, and improvement after the implementation of an intervention in a Chronic Disease Program. All patients with diabetes or hypertension attending seven primary health care centers in Al Ain, UAE during a designated three-week period in July and August 2009. Nurses conducted an audit of patients' adherence to health lifestyle behaviors related to meal planning, smoking, exercise, blood glucose and blood pressure monitoring at home, and foot and eye exams in the Chronic Disease Program clinics after a self-management intervention. A perceived knowledge score and discussion scores (based on the frequency the patients discuss diabetes and hypertension management issues with their providers) were calculated. Data were analyzed using linear regression and odds ratios. Patients reported acceptable rates of adherence to healthy lifestyle behaviors, including a low smoking rate (6% in males), following a meal plan and exercising (88.6% and 78.7%, respectively). Among patients with diabetes, 59% tested their blood glucose levels at least once a week compared to only 15.3% of those with hypertension monitoring their blood pressure levels at home. Only 33% of the participants were following the current physical activity recommendations. Healthy lifestyle behaviors fell into the following clusters: meal planning with exercise (odds ratio (OR): 8.9 [3.3-23.7]), meal planning with foot exams (OR: 10.6 [3.4-32.9]) and exercising and foot exams (OR: 5.2 [1.9-14.2]). This practice-based audit provides an essential assessment for future interventions to improve adherence to healthy life style behaviors among patients with diabetes and hypertension attending primary health clinics in the UAE.

The Relationship Between County-Level Contextual Characteristics and Use of Diabetes Care Services

To examine the relationship between county-level measures of social determinants and use of preventive care among US adults with diagnosed diabetes. To inform future diabetes prevention strategies. Data are from the Behavioral Risk Factor Surveillance System (BRFSS) 2004 and 2005 surveys, the National Diabetes Surveillance System, and the Area Resource File. Use of diabetes care services was defined by self-reported receipt of 7 preventive care services. Our study sample included 46 806 respondents with self-reported diagnosed diabetes. Multilevel models were run to assess the association between county-level characteristics and receipt of each of the 7 preventive diabetes care service after controlling for characteristics of individuals. Results were considered significant if P < .05. Controlling for individual-level characteristics, our analyses showed that 7 of the 8 county-level factors examined were significantly associated with use of 1 or more preventive diabetes care services. For example, people with diabetes living in a county with a high uninsurance rate were less likely to have an influenza vaccination, visit a doctor for diabetes care, have an A1c test, or a foot examination; people with diabetes living in a county with a high physician density were more likely to have an A1c test, foot examination, or an eye examination; and people with diabetes living in a county with more people with less than high-school education were less likely to have influenza vaccination, pneumococcal vaccination, or self-care education (all P < .05). Many of the county-level factors examined in this study were found to be significantly associated with use of preventive diabetes care services. County policy makers may need to consider local circumstances to address the disparities in use of these services.

Developing the diabetes team: practical issues of skill-mix change

There has been minimal research into the role of health care assistants (HCAs) in general practice. Polly Smith shares her reflections on expanding the role of an HCA to provide a better diabetes care service

P85 Collaborative diabetes care services in Nigeria – the Talabi Diabetes Centre experience in primary care

P85 Collaborative diabetes care services in Nigeria – the Talabi Diabetes Centre experience in primary care

Cultural barriers impeding ethnic minority groups from accessing effective diabetes care services: a systematic review of observational studies

A number of reports indicate that cultural barriers may prevent members of ethnic minority groups from accessing diabetes services, but little is known about the specific nature of these barriers. This systematic review of observational studies aimed to identify and explore cultural barriers as a basis for improvements in care. Articles published from inception to September 2011 were retrieved from four databases (Medline, CINAHL, Cochrane and DARE), two National Health Service specialist libraries (Diabetes, and Ethnicity and Health), Warwick Medical School publications and reference lists. Inclusion criteria were qualitative or quantitative studies involving ethnic minority groups with diabetes. Two reviewers independently conducted paper selection and appraisal. A total of 316 studies

An ICT-Based Diabetes Management System Tested for Health Care Delivery in the African Context.

The demand for new healthcare services is growing rapidly. Improving accessibility of the African population to diabetes care seems to be a big challenge in most countries where the number of care centers and medical staff is reduced. Information and communication technologies (ICT) have great potential to address some of these challenges faced by several countries in providing accessible, cost-effective, and high-quality health care services. This paper presents the Mobil Diab system which is a telemedical approach proposed for the management of long-term diseases. The system applies modern mobile and web technologies which overcome geographical barriers, and increase access to health care services. The idea of the system is to involve patients in the therapy process and motivate them for an active participation. For validation of the system in African context, a trial was conducted in the Democratic Republic of Congo. 40 Subjects with diabetes divided randomly into control and intervention groups were included in the test. Results show that Mobil Diab is suitable for African countries and presents a number of benefits for the population and public health care system. It improves clinical management and delivery of diabetes care services by enhancing access, quality, motivation, reassurance, efficiency, and cost-effectiveness.

Cohort monitoring – As a tool to improve diabetes care services

The need to stem the rising tide of non-communicable diseases (NCDs) including diabetes has been recognised at the highest levels through the UN political declaration. Diabetes care services are largely unavailable in the primary care setting in most developing countries and where available the services are unstructured, with poor record keeping, stock outs and frequent disruption in supplies. With no systematic monitoring of care and programme implementation, treatment outcomes are poor and are consequently associated with a high economic burden. Systematic evaluation of programmes through cohort monitoring has been shown to be effective in large-scale interventions for two chronic infectious diseases-tuberculosis and HIV/AIDS. Can the same simple tool of cohort monitoring be applied to improve diabetes care delivery in the developing world? Pilot projects show it is possible, but scale up and expansion would require investment in information technology. In a scenario where systems for NCD are just beginning to be set up, it makes sense to learn from and build further on the initial pilot programmes.

Diabetes care provision: barriers, enablers and service needs of young adults with Type 1 diabetes from a region of social disadvantage

To determine the barriers to and enablers of engaging with specialist diabetes care and the service requirements of young adults with Type 1 diabetes mellitus from a low socio-economic, multicultural region. A cross-sectional survey targeted 357 young adults with Type 1 diabetes, aged 18-30 years. Participants completed questions about barriers/enablers to accessing diabetes care and service preferences, self-reported HbA(1c), plus measures of diabetes-related distress (Problem Areas in Diabetes), depression/anxiety (Hospital Anxiety and Depression Scale), and illness perceptions (Brief Illness Perceptions Questionnaire). Eighty-six (24%) responses were received [55 (64%) female; mean ± sd age 24 ± 4 years; diabetes duration 12 ± 7 years; HbA(1c) 68 ± 16 mmol/mol (8.4 ± 1.5%)]. Logistical barriers to attending diabetes care were reported; for example, time constraints (30%), transportation (26%) and cost (21%). However, 'a previous unsatisfactory diabetes health experience' was cited as a barrier by 27%. Enablers were largely matched to overcoming these barriers. Over 90% preferred a multidisciplinary team environment, close to home, with after-hours appointment times. Forty per cent reported severe diabetes-related distress, 19% reported moderate-to-severe depressive symptoms and 50% reported moderate-to-severe anxiety. Among these young adults with Type 1 diabetes, glycaemic control was suboptimal and emotional distress common. They had identifiable logistical barriers to accessing and maintaining contact with diabetes care services, which can be addressed with flexible service provision. A substantial minority were discouraged by previous unsatisfactory experiences, suggesting health providers need to improve their interactions with young adults. This research will inform the design of life-stage-appropriate diabetes services targeting optimal engagement, access, attendance and ultimately improved healthcare outcomes in this vulnerable population.

Innovative hypoglycaemia care pathway for admission avoidance: a partnership approach with a local ambulance trust

AbstractIn 2010, Leicester City Primary Care Trust commissioned an Intermediate Care Diabetes Service. One aspect of the service plan was to work with the local ambulance trust to gather data around patients using ambulance services for hypoglycaemia, and to provide an advisory service for individuals post ambulance call‐out.This audit identified 388 diabetic emergency ambulance call‐outs locally (for the period 1 September 2010 to 31 March 2011) including those for hypoglycaemia in the Leicester City area.The new service commissioned by Leicester City included diabetes specialist nurse assessment within two working days for all hypoglycaemic individuals accessing ambulance services. A care pathway was drawn up and agreed over a series of meetings between the Intermediate Care Diabetes Service and ambulance service leads. Copyright © 2013 John Wiley &amp; Sons. Practical Diabetes 2013; 30(4): 151–153

The Transition From Pediatric to Adult Diabetes Care Services

A systematic review of the literature was conducted to identify the level of evidence and to describe the evidence on the transition from pediatric to adult healthcare services among youth with diabetes. The transition from pediatric to adult healthcare services is an expectation of youth with diabetes; however, little is known to guide policy and procedures on such transitions. The literature was first searched and screened according to predetermined criterion and then evaluated for level of evidence. There were 16 mixed qualitative and/or quantitative studies, 23 quantitative studies, and 2 expert opinion articles reviewed. Most of the evidence was from uncontrolled studies. Youth report challenges in making the transition in services. Delay in seeking adult services and poor clinic attendance are issues for these youth. However, it is unclear if these problems are a result of the transition in services. Several promising transition programs have been evaluated and, overall, are found acceptable and useful by youth. In general, evidence suggests that these programs improve glycemic control. More research is needed in this challenging area to guide policies and procedures. Expert opinion is a guide for policy and procedures at this point in time.

Utilisation of multidisciplinary services for diabetes care in the rural setting

To quantify utilisation of allied health care services by diabetics in rural NSW and explore reasons for any underutilisation. Self-administered mail survey of 268 patients with diagnosed diabetes identified from practice registers. Two rural general practices. One hundred seventeen respondents with diabetes. Annual frequency of visits to allied health practitioners. In the last year, 40.2% of patients had seen a diabetes educator (DE), 21.4% a dietitian and 47% a podiatrist. However, 25-40% of patients had never used each of the services. Reasons for nonutilisation were non-referral (35.9-68.0%) and lack of perceived need (40.6-59.0%). One third of patients who had not seen a DE in the last year thought their 'general practitioner (GP) provides a similar service'. However, mean annual GP visits (5.6) were significantly lower than urban and rural comparisons. Patients with formal management plans were, in the last year, twice as likely to have seen a DE and podiatrist, and reported two extra visits to their GP compared to those without. Rates of allied health service utilisation were not significantly lower than urban rates; however, there is room for increased uptake of multidisciplinary services. Patients who do not access these services may expect their GP to fulfil multiple roles within a limited number of visits and may not understand the role of other practitioners. Where allied health services are available locally, utilisation may be improved by increasing use of management plans and fostering awareness of the role of allied health practitioners in diabetes management.

Comforter in chief in our towns

Comforter in chief in our towns

Using Computer Adaptive Assessment Tool to Evaluate High Cost Anti-Diabetic Drug Utilization in the Medical Insurance for Government Employees in Thailand

Diabetes knowledge was generally limited. While most participants reported being adherent to pharmacotherapy, some unintentional dosing errors were reported. Self-monitoring of blood glucose monitoring (SMBG) was common; however, the results were not used in any meaningful way. Most undertook regular physical activity, however, adherence to diet varied and was cultural influenced. Cultural enablers included attitudes towards financial independence and social integration. Lack of linguistic support was perceived as a barrier. Nurturers included family and community support. Participants expressed interest in accessing more support from their community pharmacy. Conclusions: Maltese patients experience barriers to care, such as poor health literacy and limited access to diabetes education, many of which are unrecognised. Culturally they are strongly influenced by social norms and this may impact on adherence to dietary control and other self-management behaviours. There are opportunities for pharmacists to fill in gaps in knowledge and there appears to be some level of interest in such support. Pharmacists must develop cultural competence and take initiatives to deliver diabetes care services that will meet the needs of these groups of patients.