Disease Management Programs Research Articles

Digital disease management programme reduces chronic gastrointestinal symptoms among racially and socially vulnerable populations

ObjectiveConsiderable disparities exist in access to gastrointestinal (GI) care and digestive outcomes across gender, racial, and socioeconomic groups. We evaluated (1) whether adults with chronic GI symptoms from diverse demographic...

Prognostic impact of disease-related complications in asymptomatic mitral regurgitation: a health insurance claims analysis.

The impact of mitral regurgitation (MR) in asymptomatic patients is not well defined. We aimed to determine the prevalence of MR-related complications and their association with 10-year survival in a large unselected asymptomatic MR cohort. Health insurance claims data from Germany's second largest health insurance fund, BARMER, which maintains longitudinal data on 8.7 million German residents, were retrospectively analyzed. All patients with an outpatient diagnosis of MR in a minimum of two quarters during a calendar year and first recorded diagnosis between 2008 and 2011 were included. Patients with any complication attributable to MR or mitral valve intervention at index were excluded. Outcomes were compared between study group and age- and sex-matched controls (i.e., without known cardiac disease). MR-related complications of interest were new congestive heart failure, new-onset atrial fibrillation, pulmonary hypertension, or cardiac decompensation. A total of 56,577 individuals (median age 68 years, 67% female) with asymptomatic MR were identified. At 10 years, MR-related complications were more frequent in the study group vs. control group (46.5% vs. 20.8%, OR 3.31, P < 0.0001). Furthermore, MR-related complications were more common in male vs. female patients with an asymptomatic MR (OR 2.65, P < 0.0001). The occurrence of at least one MR-related complication was associated with a reduced 10-year survival (OR 1.80, P < 0.0001). Almost half of patients with asymptomatic MR experience complications during a 10 year follow-up which result in impaired survival. These results imply the necessity of long-term disease management program. Furthermore, decision-making process and timing for mitral valve intervention in asymptomatic patients should be reevaluated.

Nurses' Role in Obesity Management in Adults in Primary Healthcare Settings Worldwide: A Scoping Review.

Obesity is a chronic, prevalent, and complex health condition that adversely impairs physical and mental health. The World Health Organization calls for integrating obesity care into existing chronic disease management programs within primary healthcare services. This scoping review aimed to examine registered nurses' roles in the primary healthcare management of individuals with obesity. A scoping review was conducted using the Johanna Briggs Institute methodology framework. Thematic analysis was used to identify and categorize nurses' roles in primary healthcare obesity management of adults. Of 1142 documents included in this review, 15 papers met the inclusion criteria. Thematic analysis yielded the following six themes representing nurses' major roles: patient-centred care, patient assessments, therapeutic interventions, care management, patient education, and professional development. This review identified that the literature on nurses' roles primarily described their focus on lifestyle interventions (mainly nutrition and physical activity), anthropometric measurements, health planning, goal setting, supportive care, monitoring progress, and arranging follow-up. The Discussion highlights the importance of determining RN knowledge gaps and biases. More research is required to determine the need for additional RN pre-and or post-education related to obesity as a complex chronic disease.

STRATEGIES FOR THE PREVENTION AND CONTROL OF HYPERTENSION IN RURAL COMMUNITIES

Hypertension is a prevalent chronic condition that can lead to serious complications such as cardiovascular disease, stroke and kidney failure. The prevalence of hypertension is especially high in rural communities, where factors such as limited access to health care, lack of health information and socioeconomic conditions can contribute to a lack of control of the disease. Prevention and control strategies tailored to these communities are crucial to reducing the burden of hypertension and improving the overall health of the rural population. This brief explores effective strategies for the prevention and control of hypertension in rural communities, highlighting innovative approaches and associated challenges. The aim of this paper is to review and analyze strategies for the prevention and control of hypertension in rural communities. It aims to identify the main interventions that have proved effective, discuss approaches adapted to the needs and resources of rural communities, and address the challenges faced in implementing these strategies. This is a literature review, using qualitative and quantitative assumptions, using the PubMed, Scopus and Google Scholar databases. The health descriptors “Hypertension”, “Hypertension Management in Rural Areas”, “Telemedicine”, “Community Interventions” and “Rural Health Policies” were used to refine the research. The time frame covers the years 2018 to 2022. The focus is to promote a comprehensive understanding of best practices and areas that need more attention to improve the management of hypertension in rural contexts. Preventing and controlling hypertension in rural communities requires a multifaceted approach that takes into account the particularities of these areas, including barriers to accessing healthcare, resource limitations and specific cultural needs. Education is key to preventing hypertension. Awareness programs about risk factors, the importance of regular blood pressure monitoring and lifestyle changes can have a significant impact. Community initiatives such as workshops, lectures and local media campaigns can help raise awareness of hypertension and promote healthy habits. Improving access to healthcare is crucial for hypertension control in rural areas. This can include the implementation of mobile health units, telemedicine and partnerships with health organizations to provide regular medical services and blood pressure monitoring. Community screening programs and regular consultations can help identify and treat cases of hypertension early. Interventions that encourage a healthy diet, rich in fruit, vegetables and low in sodium, as well as regular physical activity, are essential for the prevention and control of hypertension. Nutritional education programs and the promotion of community physical activities, such as walking groups or sports, can be effective in promoting a healthy lifestyle. Thus, many people with hypertension also have other health conditions, such as diabetes or obesity. Integrated strategies that address hypertension alongside other health conditions can improve overall outcomes. This includes chronic disease management programs that provide support for managing multiple health conditions simultaneously. Involving the community in the planning and implementation of prevention and control strategies can increase the acceptance and effectiveness of interventions. Community groups, local leaders and non-governmental organizations can play an important role in promoting health programs and mobilizing resources. The effective implementation of hypertension control strategies in rural communities faces several challenges. Barriers can include a lack of adequate health infrastructure, a shortage of health professionals, limited access to medicines and treatments, and cultural factors that can affect the acceptance of interventions. In addition, logistical and financial difficulties can limit the ability to implement and maintain health programs in remote areas. Therefore, the approach to preventing and controlling hypertension in rural communities must be adapted to the specific needs and characteristics of these areas. Effective strategies include community education and awareness, improving access to health care, promoting a healthy lifestyle and integrated management of comorbidities. Involving the community and overcoming challenges related to infrastructure and resources are critical aspects for the success of these strategies. With a multifaceted and collaborative approach, it is possible to reduce the prevalence and impact of hypertension in rural communities, promoting better health and an improved quality of life for their inhabitants.

New and Emerging Therapies: Review the Latest Advancements in Rheumatology Treatments, Including Biologic Therapies, Targeted Therapies, Regenerative Medicine, and Novel Drug Development, Assessing their Potential Benefits and Limitations

This study was contributed to assess clinical outcomes related to the role of biologic therapies, targeted therapies, regenerative medicine, and novel drug development in the treatment of rheumatology patients. Patients and methods: A cross-sectional study of 80 rheumatology different hospitals in Iraq analyzed demographic and clinical data from February 2022 to September 2023. The study included 80 cases who underwent modern treatments and methods within the disease management program. The patients were categorized into remission, low, moderate, and high disease severity. Common symptoms included joint pain, swelling, decreased range of motion, fatigue, muscle weakness, fever, numbness, skin rash, weight loss, and difficulty with daily activities. Treatment data included corticoids, cDMARD, bDMARD, and cDMARD combined bDMARD. The study also assessed patients' quality of life, ranging from 0 to 100, based on physical function, psychological function, emotional and social aspects, and daily activity. A multivariate analysis of risk factors affecting patients with rheumatic diseases was performed. Results: Our results shown that males were 16 cases and females were 64 cases, the smoking rate were 30%, obesity was 50%, hypertension was 80%, diabetes was 55%, and cerebrovascular disease was 30%, and the most common symptoms of rheumatic disease which distribute into patients swelling and tenderness in the joints was 80%, joint pain, and stiffness was 85%, and fatigue was 60%, types of treatments used in patients with rheumatology which contain corticoids included 8 cases, cDMARD included 56 cases, bDMARD included 4 cases, and cDMARD combined bDMARD included 12 cases, and we identify activity rheumatic disease which classified into remission got 36 cases, low got 20 cases, moderate got 16 cases, and high got 8 cases. Conclusion: Patients with rheumatic diseases have benefited from biological therapies, targeted therapies, regenerative medicine, and novel drug development.

Proportion and factors influencing healthcare-seeking behavior among older people in Motta town, East Gojjam: a community-based cross-sectional study, Ethiopia, 2023

BackgroundIn resource-limited countries, older people who are at risk and face numerous health problems, often receive insufficient attention regarding their healthcare-seeking behavior. Assessing the proportion of healthcare-seeking behavior and associated factors among older people in Motta town, was the aim of the study.MethodA community-based cross-sectional study was carried out from April 22 to May 22, 2023. The study subjects were chosen using a systematic random sampling technique. To identify candidate variables for multivariable analysis, a bivariable logistic regression analysis was performed. Variables having a P-value of < 0.05 were considered statistically significant.ResultsFrom the total, 161 (39.3%) of respondents had good healthcare-seeking behavior with 95% CI [35%, 44%]. Secondary school [AOR = 2.69, 95% CI = 1.27, 5.68], Education college and above [AOR = 4.6, 95% CI = 2.27, 9.33], Family support during their illness [AOR = 1.39, 95% CI = 1.05, 3.09], Members of CBHI [AOR = 2.02, 95% CI = 1.21, 3.36], and presence of chronic illness [AOR = 2.55, 95%, CI = 1.64, 3.97] were significantly associated with good healthcare-seeking behavior.Conclusion and recommendationThis study found that good healthcare-seeking behavior among older people is significantly associated with higher education, strong family support, Community-Based Health Insurance (CBHI) membership, and chronic illnesses. Improving health literacy through education, strengthening family support systems, expanding CBHI participation for better healthcare access, and developing targeted chronic disease management programs to enhance this behavior is recommended. These strategies can collectively improve healthcare utilization and outcomes for older people.

Improvements in Digestive Symptoms After Participation in an App-Based Chronic Digestive Disease Management Program: A Prospective Cohort Evaluation.

Fewer than 20% of adults with chronic gastrointestinal (GI) symptoms have accessed care to evaluate or manage their symptoms. We sought to characterize whether adults with chronic GI symptoms would use an app for symptom monitoring and the effects of participation in a digitally delivered GI chronic care program. We provided a digital digestive care management app to adults via their employer-sponsored benefits. We evaluated participants' self-reported GI symptoms at baseline and between 30 and 90 days post-registration. GI symptoms (e.g., abdominal pain and constipation) were rated on a scale of 0 (no symptoms) to 4 (very severe symptoms). A total of 1936 participants were enrolled (75% female; 67% White, 11% Asian/Pacific Islander, 6% Hispanic, 7% Black; mean age: 43 years). Their most common GI conditions were irritable bowel syndrome (IBS), gastroesophageal reflux disease (GERD), and acid reflux. Participants of all genders and races reported statistically significant improvements in all symptoms between baseline and the end of the intervention (P< 0.05). At baseline, 79.5% of participants reported at least moderate GI symptom severity for at least one symptom. In contrast, at the end of the intervention, only 47.8% of participants reported moderate or severe symptoms, and 310 (16.0%) participants reported no symptoms. Participants who were scheduled with their care team reported greater symptom improvement than those who were not scheduled (P = 0.004). Participants reported feeling greater control of their health (83%), better management of their digestive symptoms (83%), increased happiness (76%), and greater productivity at work (54%). Demographically diverse participants engaged with a digital digestive chronic care program and reported significant improvements in digestive symptom severity.

Identifying Predictors of Heart Failure Readmission in Patients From a Statutory Health Insurance Database: Retrospective Machine Learning Study.

Patients with heart failure (HF) are the most commonly readmitted group of adult patients in Germany. Most patients with HF are readmitted for noncardiovascular reasons. Understanding the relevance of HF management outside the hospital setting is critical to understanding HF and factors that lead to readmission. Application of machine learning (ML) on data from statutory health insurance (SHI) allows the evaluation of large longitudinal data sets representative of the general population to support clinical decision-making. This study aims to evaluate the ability of ML methods to predict 1-year all-cause and HF-specific readmission after initial HF-related admission of patients with HF in outpatient SHI data and identify important predictors. We identified individuals with HF using outpatient data from 2012 to 2018 from the AOK Baden-Württemberg SHI in Germany. We then trained and applied regression and ML algorithms to predict the first all-cause and HF-specific readmission in the year after the first admission for HF. We fitted a random forest, an elastic net, a stepwise regression, and a logistic regression to predict readmission by using diagnosis codes, drug exposures, demographics (age, sex, nationality, and type of coverage within SHI), degree of rurality for residence, and participation in disease management programs for common chronic conditions (diabetes mellitus type 1 and 2, breast cancer, chronic obstructive pulmonary disease, and coronary heart disease). We then evaluated the predictors of HF readmission according to their importance and direction to predict readmission. Our final data set consisted of 97,529 individuals with HF, and 78,044 (80%) were readmitted within the observation period. Of the tested modeling approaches, the random forest approach best predicted 1-year all-cause and HF-specific readmission with a C-statistic of 0.68 and 0.69, respectively. Important predictors for 1-year all-cause readmission included prescription of pantoprazole, chronic obstructive pulmonary disease, atherosclerosis, sex, rurality, and participation in disease management programs for type 2 diabetes mellitus and coronary heart disease. Relevant features for HF-specific readmission included a large number of canonical HF comorbidities. While many of the predictors we identified were known to be relevant comorbidities for HF, we also uncovered several novel associations. Disease management programs have widely been shown to be effective at managing chronic disease; however, our results indicate that in the short term they may be useful for targeting patients with HF with comorbidity at increased risk of readmission. Our results also show that living in a more rural location increases the risk of readmission. Overall, factors beyond comorbid disease were relevant for risk of HF readmission. This finding may impact how outpatient physicians identify and monitor patients at risk of HF readmission.

Peningkatan Kualitas Hidup Pasien Hipertensi dan Diabetes Mellitus Melalui Promosi Kesehatan di UPT Puskesmas Alianyang Kota Pontianak

The number of people with chronic diseases in Indonesia, especially hypertension and diabetes mellitus, continues to increase, including in the Pontianak City area, West Kalimantan. Alianyang Community Health Center, Pontianak City, is one of the basic health facilities that implements the Chronic Disease Management Program. The problem experienced by patients with chronic diseases such as hypertension and diabetes mellitus is a decrease in quality of life due to the disease they suffer. One of the causes of a decrease in a person's quality of life is a lack of knowledge and motivation in implementing a healthy lifestyle. Health promotion in the form of education on healthy lifestyles needs to be provided directly to patients and to prolanist cadres of the Alianyang Health Center. The targets of this activity are patients and prolanist cadres of the Alianyang Health Center. The activity aims to provide information to patients and prolanist cadres regarding efforts to improve the quality of life of hypertension and diabetes mellitus patients. The method used is health promotion through educational videos and leaflets. The results showed that there were changes before and after the delivery of health promotion, namely that the average participant experienced an increase in knowledge between the pre-test and post-test, namely 63.33 and 79.17 respectively. Evaluation of activities through questionnaires showed that participants felt the material presented was very interesting and participants gained new knowledge through the educational media provided.

Achieving consensus on the key elements of a nurse-led multidisciplinary chronic heart failure service in Thailand: An e-Delphi study.

To describe the outcomes of an e(electronic)-Delphi survey used to achieve consensus on the essential elements that should be included in a multidisciplinary, nurse-led service for patients with chronic heart failure (CHF). The study design was based on a three-round e-Delphi survey. A series of three survey rounds were used to gather expert opinions and achieve consensus on the key elements that should be included in a CHF disease management program from a sample of healthcare professionals and organizational leaders with expertise in existing CHF services. Consensus for each item was defined as at least 90% agreement. There were 20 participants (18 healthcare professionals and 2 organizational leaders) in round-1, 22 (20 healthcare professionals and 2 organizational leaders) in round-2, and 17 (15 healthcare professionals and 2 organizational leaders) in round-3. Fifteen participants attended a final online meeting (13 healthcare professionals and 2 organizational leaders). Consensus was obtained on five essential components: (i) consumer education, (ii) treatment optimization using a multidisciplinary approach, (iii) discharge planning, (iv) provision of supportive community care and (v) mechanisms to respond to early symptoms of decompensated CHF. Participants focused on mechanisms to improve treatment effectiveness, patient and family knowledge, communication between healthcare providers and supportive care in the community. The proposed model of care may be useful to other health service providers who are designing or adapting CHF models of care for the South-East Asian environment. This research provides a solid basis for using a Delphi method to resolve the challenges and issues of transferring global model-based recommendations in CHF knowledge. The Delphi method proved successful as an important step in developing a culturally acceptable model of chronic care that meets the goals of local healthcare providers.

Factors Related to the Incidence of Diabetes Mellitus in the Kebon Baru Primary Health Center in South Jakarta in 2020

Introduction: Diabetes Mellitus is a health problem encountered in Indonesia as well as in the world, it can be seen from the number of sufferers that continues to increase every year. Data from the International Diabetes Federation (IDF) shows that the number of people with Diabetes Mellitus in 2015 has reached as many as 415 million people and increased in 2017 to 425 million people worldwide. The Basic Health Research (Riskesdas) showed an increase in the prevalence of Diabetes Mellitus in Indonesia from 6.9% in 2013 to 8.5% in 2018. At the Kebon Baru Health Center, Diabetes Mellitus was among the top 10 diseases in 2019 with 529 cases. Various counseling programs to prevent non-communicable diseases are carried out, the priority program is by organizing the Chronic Disease Management Program (Pronalis) and by counseling. Objective: The aim of this study is to determine the factors associated with the incidence of Diabetes Mellitus at the Kebon Baru Community Health Center, South Jakarta, in 2020. Method: This study used a quantitative approach with cross sectional design by analyzing the secondary data of the monthly report of Non-Communicable Diseases at Kebon Baru Primary Health Center in 2020. These data were collected in 2020 and analyzed in 2021. Result: The prevalence of Diabetes Mellitus at Kebon Baru Primary Health Care in 2020 was 16.5% with the average blood sugar level of 153 mg/dL. The variables that were proven to have a relationship with the incidence of Diabetes Mellitus were the variable age with a p value of 0.001 (OR 3.15; 95% CI 1.56-6.36) and the variable history Diabetes Mellitus with a p value of 0.00 (OR 5.3; 95% CI 2.74-10.37). Conclusion: Patients who go to Kebon Baru Primary Health Care at the age ranging from 45 years and over have a 3.15 times risk of suffering from Diabetes Mellitus than those in the age group under 45 years. In addition, patients who go to the Kebon Baru Primary Health Center and have family members suffering from Diabetes Mellitus have a risk of 5.33 times to suffer from DM than those who do not.

Gerontology in Public Health: A Scoping Review of Current Perspectives and Interventions.

The intersection of gerontology and public health is increasingly vital due to the global aging population and its implications for health systems. This scoping review aims to map existing literature on gerontology within public health, identify current perspectives, and evaluate interventions tailored to the needs of older adults. A systematic search was performed using predefined keywords across multiple databases, including PubMed, Google Scholar, Scopus, and Web of Science. The review included 42 studies that employed various designs, all focusing on public health interventions targeting the aging population. Key findings indicate a pressing need to integrate gerontological principles into public health practice, recognizing the heterogeneous nature of older adults and the significance of social determinants of health. Interventions ranged from preventive health measures and chronic disease management programs to health promotion activities and caregiver support, including the application of technology to improve health outcomes. However, there was a notable lack of research on diverse populations and mental health interventions. The review also uncovered critical gaps in the literature, such as economic barriers to care access and the necessity for comprehensive policies addressing the aging population's diverse needs. In conclusion, this review emphasizes the importance of a multidimensional approach to effectively addressing older adults' health needs. While several effective interventions exist, there is an urgent need to tackle identified gaps, particularly concerning diverse populations and mental health, to enhance overall health strategies for the aging demographic.

Korean National Burden of Disease: The Importance of Diabetes Management.

Diagnosing the current health status and disease burden in a population is crucial for public health interventions. The ability to compare the burden of different diseases through a single measure, such as disability-adjusted life years has become feasible and continues to be produced and updated through the Global Burden of Diseases (GBD) study. However, the disease burden values of the GBD study do not accurately reflect the unique situation in a specific country with various circumstances. In response, the Korean National Burden of Disease (KNBD) study was conducted to estimate the disease burden in Koreans by considering Korea's cultural context and utilizing the available data sources at the national level. Both studies identified non-communicable diseases, such as diabetes mellitus (DM), as the primary cause of disease burden among Koreans. However, the extent of public health interventions currently being conducted by the central and local governments does not align with the severity of the disease burden. This review suggests that despite the high burden of DM in South Korea, the current policies may not fully address its impact, underscoring the need for expanded chronic disease management programs and a shift towards prevention-focused healthcare paradigms.

Randomised pilot study comparing a coach to SMARTPhone reminders to aid the management of heart failure (HF) patients: humans or machines

Ambulatory management of congestive heart failure (HF) continues to be a challenging clinical problem. Recent studies have focused on the role of HF clinics, nurse practitioners and disease management programmes...

Quantifying sustained health system benefits of primary care-based integrated disease management for COPD: a 6-year interrupted time series study

BackgroundSevere exacerbation of chronic obstructive pulmonary disease (COPD) is a trajectory-changing life event for patients and a major contributor to health system costs. This study evaluates the real-world impact of...

Characterization of Erwinia amylovora isolates from the northern region of Saudi Arabia, including CRISPR genotyping

AbstractFire blight, caused by the bacterium Erwinia amylovora, poses a global threat to the pome fruit industry, leading to reduced yields and significant economic losses. A comprehensive countrywide survey was carried out to determine the possible E. amylovora distribution in pome fruit‐growing regions. During the period 2020–2023, 85 isolates characteristic of E. amylovora were obtained from pear across 23 locations in three main pear‐producing regions (Al‐Jouf, Hail and Tabuk) in northern Saudi Arabia (SA). Isolates were identified using biochemical, molecular and pathogenicity assays. Molecular characterization of Saudi strains was achieved using partial 16S rRNA and rpoB gene sequencing, rep‐PCR (specifically, BOX‐PCR) and CRISPR array analysis. The CRISPR genotyping in particular, using an existing scheme of three CRISPR arrays, CR1, CR2 and CR3, provided consistent patterns of the Saudi isolates with high similarity to those of E. amylovora strains from the UK and France, hinting at a possible origin of the fire blight infections from these countries. Some variation was observed in patterns between local strains, highlighting the importance of continued surveillance and genetic studies for effective disease management strategies. Identification of fire blight in three regions over several years should serve as a warning to the Ministry of Environment, Water and Agriculture in Saudi Arabia, prompting the initiation of a more comprehensive survey and an active disease management programme. This programme should include early detection and advice to growers on prevention and control measures. This is the first scientific study on the occurrence and genetic variability of E. amylovora in Saudi Arabia.

Implementation of Guidelines in Heart Failure: Problems and Potential Solutions

Heart failure (HF) is a long-term condition associated with high mortality, recurrent hospitalisations and a poor quality of life. Several classes of medications (angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, β-blockers, If channel blockers, angiotensin receptor neprilysin inhibitors, mineralocorticoid receptor antagonists and sodium–glucose cotransporter inhibitors) have demonstrated substantial benefits regarding clinical outcomes and have therefore been included in international guidelines for the management of HF with a high level of recommendation. However, observational studies show that the implementation of these guidelines remains suboptimal. Rates of prescription of recommended medications are highly variable between centres and underdosage is common. Factors related to the patient, the physician, the cost, the organisation of healthcare systems and, finally, the guidelines themselves play a role in this. These affect clinical outcomes and low adherence to guidelines is associated with an increased risk of mortality or rehospitalisation for HF. Education programmes targeting both patients and physicians should be developed to improve practice and awareness. Disease management programmes that involve cardiologists, GPs, HF nurses and other health professionals are also needed to fill the gap in treatment after a hospitalisation for HF and ensure regular follow-up with rapid uptitration of HF medications if tolerated. Better collaboration is needed between patients, health professionals, policymakers and payers to reduce the burden of HF.

ANALYSIS OF MEDICATION COMPLIANCE WITH TYPE 2 DIABETES MELLITUS PATIENTS OGAN ILIR DISTRICT 2024

Diabetes mellitus is a disease that can cause complications if proper treatment is not given. There are still high cases of diabetes mellitus, where there is an increase in diabetes mellitus cases from year to year. This study aims to determine factors related to medication adherence in diabetes mellitus patients at the Pegayut Community Health Center, Ogan Ilir Regency in 2024. The design of this research is quantitative with a cross-sectional approach.4 . The population in this study was 710 diabetes mellitus patients who visited the Community Health Center in 2023, with a total sample of 88 people in this study. The sampling method uses purposive sampling. This research was carried out on 10-29 February 2024. Data collection techniques are interviews using questionnaires. Bivariate data analysis used the Chi-Square test and multivariate logistic regression. The results of the research show that there is a relationship between motivation (p value 0.01) and the role of officers (p value 0.03) on compliance with taking medication for diabetes mellitus patients at the Pegayut Community Health Center, Ogan Ilir Regency in 2024. There is no relationship between age (p value 0.82 ), gender (p value 0.88), knowledge (p value 0.68) and family support (p value 0.15) on medication adherence for diabetes mellitus patients at the Pegayut Community Health Center, Ogan Ilir Regency in 2024. The most dominant factors with compliance with taking medication for diabetes mellitus patients at the Pegayut Community Health Center, Ogan Ilir Regency in 2024, namely motivation (p value 0.01) (odds ratio 3.07), meaning that if motivation is sufficient, they are 3.07 times less likely to comply with medication compared to those with good motivation. The conclusion is that there is a relationship between motivation and the role of officers. There is no relationship between age, type, knowledge and family support on compliance with taking medication for diabetes mellitus patients at the Pegayut Community Health Center, Ogan Ilir Regency in 2024. It is hoped that the Community Health Center will continue to provide motivation and support to diabetes mellitus sufferers to comply with taking diabetes mellitus medication and increase their participation. patients through a chronic disease management program (prolanis).

Is pay for performance promoting inverse inequality in Irish general practice?

In 2020, the Chronic Disease Management (CDM) programme was introduced in Ireland. This programme resources GPs to review public (GMS) patients, diagnosed with eight named chronic diseases, twice yearly according to a structured protocol. This pay for performance initiative has been widely adopted by GPs. However, it is hypothesised that private patients (PPs) receive a poorer standard of care, as they may be reluctant to attend due to the cost involved. To assess whether the management of eight chronic diseases named in the CDM programme is to the same standard among both PPs and GMS patients. A retrospective audit of GP practices in the Midwest of Ireland. Data relating to 25 GMS patients and 25 PPs, matched by age, gender, and clinical condition, is collected from each practice. Patients have at least 1 of the eight named chronic diseases. Parameters include vaccination status (influenza, pneumococcal, COVID); body mass index; blood pressure; smoking status; renal function; HbA1c; lipid profile; brain natriuretic peptide (BNP) in patients with heart failure; and lung function tests in patients with COPD or asthma. COVID vaccination status acts as a control because it is freely available for both PPs and GMS patients. Preliminary results from 2 GP practices show large consistent disparities in management between PPs and GMS patients in most parameters. Limiting Pay for Performance to the care of GMS patients only, based on age or income, promotes inverse inequality. We argue that CDM care should be offered to all patients.

Evaluating A Multicomponent Chronic Disease Management Pilot Intervention among Korean Patients with Hypertension and Diabetes.

A local clinic-based chronic disease management intervention including care planning, education about disease management, monitoring, and evaluation of the achievement of objects was introduced in Korea in 2019. We evaluated the effect of the intervention on medication adherence in patients with hypertension and diabetes. In 2019, a one-year retrospective case-control group study design was performed using data from the National Health Insurance Service in Korea. Propensity score matching was used to control for selection bias. Medication adherence, calculated by medication possession rate, was the dependent variable. We conducted multivariate logistic regression analyses to examine the association between participation in the intervention and medication adherence, adjusting for covariates. A control group was set as a reference for participation in the full/partial component intervention. The proportions of participants in the full component intervention in the experimental group were 43.2% and 42.6% for patients with hypertension or diabetes, respectively. Both these groups tended to be more medication adherent than their counterparts (hypertension OR: 1.23, 95% CI 1.03-1.45, diabetes OR: 1.64, 95% CI: 1.24-2.17). Institutionalizing a comprehensive chronic disease management program using multidisciplinary teams in the primary care context is crucial. Also, it is necessary to refine reimbursement payment systems.