Improve Patient Self-management Research Articles

A Study of Diabetes Correlated Emotional Distress among Patients with Type 2 Diabetes Mellitus: A cross Sectional Study

Background: Diabetes distress (DD) is a significant concern for individuals with type 2 diabetes, marked by emotional strain related to disease management and support, distinct from general psychological distress. Specific Background: Addressing DD can improve self-care practices and glycemic control, yet limited research exists on the relationship between emotional distress and sociodemographic factors in this population. Knowledge Gap: This study aims to fill this gap by exploring how sociodemographic traits influence emotional distress among type 2 diabetes patients. Aims: The primary objectives are to identify the correlation between emotional distress and diabetes and to determine the impact of sociodemographic characteristics on this distress. Results: A descriptive cross-sectional study conducted at the Endocrinology and Diabetes Center in Al-Basrah City included 150 patients aged 50–65 years, with a significant proportion of men (63.3%). The findings revealed a mean emotional distress score of 3.81, indicating high distress levels, with physician-associated distress at 3.32 and regimen-related distress at 3.48. Novelty: This research highlights the strong correlation between emotional and diabetes-related distress, particularly across different age and gender demographics, thus emphasizing the need for tailored interventions. Implications: The study emphasizes the importance of incorporating psychological assessments into diabetes management and policymakers' consideration of emotional dimensions in health program designs to improve patient self-management and quality of life. Highlights: Diabetes distress impacts self-care and glycemic control. Socio-demographics influence emotional distress levels in patients. Psychological assessments are crucial in diabetes management strategies. Keywords: diabetes distress, emotional distress, type 2 diabetes, sociodemographic factors, healthcare interventions

Peak flow monitoring using digital technology to improve patient self-management and asthma control in primary care: a pilot

Peak flow monitoring using digital technology to improve patient self-management and asthma control in primary care: a pilot

Development and validation of a novel treatment adherence, satisfaction and knowledge questionnaire (TASK-Q) for adult patients with hypothalamic-pituitary disorders

PurposeSuccessful treatment outcomes of adults with hypothalamic-pituitary disorders necessitate the adoption of intricate self-management behaviors, yet current scales for evaluating treatment adherence and satisfaction are inadequate for this patient group. This research introduces a novel treatment adherence, satisfaction and knowledge questionnaire (TASK-Q) developed specifically to identify patients’ unmet needs in better assessing and managing these disorders.MethodsThe study was conducted in three phases: (1) generating items and testing content validity, (2) refining these items through a pilot study, and (3) a main study evaluating the psychometric properties of the TASK-Q scale among 262 adults in a Pituitary Nurse-led Clinic, with 152 (58%) patients completing the questionnaire.ResultsExploratory factor analysis was used to test the factor structure and construct validity of the TASK-Q, revealing a 22-item scale divided into Satisfaction and Knowledge (17 items) and Adherence (5 items) subscales, and exhibiting high internal consistency (Cronbach’s α = 0.90). Significant correlations were identified between satisfaction and knowledge (r = 0.67, p < 0.001), satisfaction and adherence (r = 0.23, p = 0.005), and knowledge and adherence (r = 0.43, p < 0.001). Complex treatment regimens, like daily growth hormone injections and adjusting glucocorticoids during illness, negatively affected adherence (p < 0.001).ConclusionThe TASK-Q is a novel validated scale that can effectively evaluate patients’ perspectives on adherence, knowledge and satisfaction. Our findings highlight the significant impact of Advanced Nurse Practitioners in improving patient self-management behaviors, which likely leads to better treatment outcomes for people with hypothalamic-pituitary disorders.

Impact of mobile application and outpatient follow-up on renal endpoints and physiological indices in patients with chronic kidney disease: a retrospective cohort study in Southwest China

BackgroundChronic kidney disease (CKD) is a significant public health concern, and patient self-management is an effective approach to manage the condition. Mobile applications have been used as tools to assist in improving patient self-management, but their effectiveness in long-term outpatient follow-up management of patients with CKD remains to be validated. This study aimed to investigate whether using a mobile application combined with traditional outpatient follow-up can improve health outcomes of patients with CKD .MethodsThis retrospective cohort study recruited CKD patients with stage 1–5 who were not receiving renal replacement therapy from a CKD management center. Two groups were established: the APP + outpatient follow-up group and the traditional outpatient follow-up group. Baseline data was collected from January 2015 to December 2019, followed by a three-year long-term follow-up until December 2022. Laboratory data, all-cause mortality, and renal replacement treatment were then collected and compared between the two groups.Results5326 patients were included in the study, including 2492 in the APP + outpatient group and 2834 in the traditional outpatient group. After IPTW virtualization matching, the final matched the APP + outpatient group consisted of 2489 cases (IQR, 33–55) and 2850 (IQR, 33–55) in the traditional outpatient group. By the end of the study, it was observed that the laboratory data of Phosphorus, Sodium, Triglyceride, Hemoglobin showed significant improvements, Furthermore the APP + outpatient group demonstrated superior results compared to the traditional outpatient group (P < .05). And it was observed that there were 34 deaths (1.4%) in the APP + outpatient group and 46 deaths (1.6%) in the traditional outpatient group(P = .49). After matching for renal replacement therapy outcomes, the two groups were found to be comparable (95% CI [0.72–1.08], P = .23), with no significant difference. However, it was noted that the traditional outpatient group had a lower incidence of using temporary catheters during initial hemodialysis (95% CI [8.4-29.8%], P < .001).ConclusionThe development and application of an app combined with outpatient follow-up management can improve patient health outcomes. However, to ensure optimal preparation for kidney replacement therapy, patients in CKD stages 4–5 may require more frequent traditional outpatient follow-ups, and further develop an information-based decision-making support tool for renal replacement therapy.

Awareness and associated factors of venous thromboembolism in breast cancer surgical patients: a cross-sectional study

BackgroundVenous thromboembolism (VTE) is a major complication of breast cancer surgical patients. Assessing VTE awareness enables medical staff to tailor educational programs that improve patient self-management and reduce VTE risk. Therefore, this study aimed to assess VTE awareness among breast cancer surgical patients and identify factors influencing their awareness level.MethodsA multicenter cross-sectional study was conducted on breast cancer patients scheduled for surgery from May 2023 to November 2023. Data were collected using a general information form and a validated self-assessment questionnaire on VTE awareness for breast cancer surgical patients. Univariate analysis and multiple linear regression analysis were used to analyze the data.ResultsOf 1969 patients included, the term awareness rates for deep vein thrombosis and pulmonary embolism were 42.5% and 26.1%, respectively. Information about VTE was primarily obtained from doctors (30.4%), nurses (24.0%), and social media (23.3%). The overall average VTE awareness score was 1.55 ± 0.53, with the dimension of VTE preventive measures scoring highest, and VTE clinical symptoms/signs scoring lowest. Multivariate analysis identified education level, personal VTE history, chemotherapy and surgical history, and the hospital’s regional location as significant factors associated with VTE awareness level (p < 0.05).ConclusionThis study highlights a critical need for improved VTE awareness among breast cancer surgical patients, particularly regarding clinical symptoms/signs. Health education programs are recommended especially tailored for patients with lower education levels, no history of VTE, or without prior surgery or chemotherapy, to improve their understanding of VTE.

The effectiveness of chronic disease management planning on self-management among patients with diabetes at general practice settings in Australia: a scoping review

BackgroundMedicare provides significant funding to improve, encourage and coordinate better practices in primary care. Medicare-rebated Chronic Disease Management (CDM) plans are a structured approach to managing chronic diseases in Australia. These chronic disease care plans are intended to be a vehicle to deliver guideline-based / evidence-based care.. However, recommended care is not always provided, and health outcomes are often not achieved. This scoping review aimed to identify the specific components of CDM plans that are most effective in promoting self-management, as well as the factors that may hinder or facilitate the implementation of these plans in general practice settings in Australia.MethodA comprehensive search was conducted using multiple electronic databases, considering inclusion and exclusion criteria. Two reviewers independently screened the titles and abstracts of the identified studies via Covidence, and the full texts of eligible studies were reviewed for inclusion. A data extraction template was developed based on the Cochrane Effective Practice and Organization of Care Group (EPOC) to classify the intervention methods and study outcomes. A narrative synthesis approach was used to summarize the findings of the included studies. The quality of the included studies was assessed using the JBI Critical Appraisal Checklist.ResultsSeventeen articles were included in the review for analysis and highlighted the effectiveness of CDM plans on improving patient self-management. The findings demonstrated that the implementation of CDM plans can have a positive impact on patient self-management. However, the current approach is geared towards providing care to patients, but there are limited opportunities for patients to engage in their care actively. Furthermore, the focus is often on achieving the outcomes outlined in the CDM plans, which may not necessarily align with the patient’s needs and preferences. The findings highlighted the significance of mutual obligations and responsibilities of team care for patients and healthcare professionals, interprofessional collaborative practice in primary care settings, and regular CDM plan reviews.ConclusionSelf-management support remains more aligned with a patient-centred collaboration approach and shared decision-making and is yet to be common practice. Identifying influential factors at different levels of patients, healthcare professionals, and services affecting patients’ self-management via CDM plans can be crucial to developing the plans.

Experiences of patients with advanced COPD affiliated to a cross-sectorial outgoing lung team: A qualitative study.

To explore experiences of patients affiliated to a cross-sectorial outgoing lung team. The outgoing lung team consisted of respiratory nurses from the hospital and community nurses. The lung team offered 24/7 help to patients with advanced chronic obstructive pulmonary disease (COPD) through visits and/or treatment in the patients' home. Affiliation to the lung team reduced both hospitalizations and length of hospital stay due to acute exacerbation of COPD. However, based on questionnaires on health-related quality of life, no significant differences were found between patients affiliated to the lung team and patients receiving usual care. A qualitative interview study. In total, 16 patients, aged 61-88 years were interviewed between February 2019 and July 2021. They had been affiliated to the outgoing lung team for 1-3 years. Semi-structured interviews were conducted in the patients' home and audio-recorded after informed consent was obtained. The interviews were transcribed verbatim and analysed, inspired by systematic text condensation by Malterud. Four themes emerged from the analysis: (1) feeling safe, (2) improvements in living with COPD, (3) avoiding hospitalization and (4) satisfied with staying at home. Affiliation to the cross-sectorial outgoing lung team gave the patients peace of mind and improved their ability to live with advanced COPD. The patients preferred contacting the lung team because they could stay at home and receive treatment, and thus avoid hospitalization. The findings from this study support that municipalities should consider implementing an outgoing lung team, as it has the potential to bring several benefits, including improving patient self-management. The manuscript adhered to Consolidated criteria for reporting qualitative research (COREQ) guideline. Patients were interviewed. Additionally, no patient or public contributed to the design or conduction of the study, analysis, or interpretation of the data.

Applying Customer Discovery Method to a Chronic Disease Self-Management Mobile App: Qualitative Study.

A significant health challenge is evident in the United States, with 6 in 10 adults having a chronic disease and 4 in 10 adults having 2 or more. Chronic disease self-management aims to prevent or delay disease progression and disability and reduce mortality risk. The evidence to support the use of information technology tools, including mobile apps, web-based portals, and web-based educational interventions, that support disease self-management and improve clinical outcomes is growing. Customer discovery and value proposition design methodology is a form of stakeholder engagement and is based on marketing and lean start-up business methods. As applied in health care, customer discovery and value proposition methodology can be used to understand the clinical problem and articulate the product's hypothesized unique value proposition relative to alternative options that are available to end users. This study aims to describe the experience and findings of academic researchers applying the customer discovery and value proposition methodology to identify stakeholders, needs, adaptability, and sustainability of a chronic disease self-management mobile app (CDapp). The motivation of the work is to make mobile health app interventions accessible and acceptable for all segments of patients' chronic diseases. Data were obtained through key informant interviews and analyzed using rapid qualitative analysis techniques. The value proposition framework was used to build the interview guide. The aim was to identify the needs, challenges (pains), and potential benefits (gains) of the CDapp for our stakeholders. Our results showed that the primary consumers (end users) of a CDapp were the patients. The app adopters (decision makers) can be medical center leaders including population health department managers or insurance providers, while the consumer adoption influencers (influencers or saboteurs) are clinicians and patient caregivers. We developed an ecosystem map to visualize the clinical practice workflow and how an app for chronic disease management might integrate within an academic health care center or system. A value proposition for the identified customer segments was generated. Each stakeholder segment was working within a different framework to improve patient self-management. Patients needed help to adhere to self-care activities and they needed tailored health education. Health care leaders aim to improve the quality of care while reducing costs and workload. Clinicians wanted to improve patient education and care while reducing the time burden. Our results also showed that within academic medical centers, there were variations regarding patients' self-reported abilities to manage their diseases. Customer discovery is a useful form of stakeholder engagement when designing studies that seek to implement, adapt, and sustain an intervention. The customer discovery and value proposition methodology can be used as an alternative or complementary approach to formative research to generate valuable information in a brief period.

Intervention to improve patient self-management and satisfaction in breast and lung cancers using the 4R Oncology model: Results by cancer, race and deprivation index.

326 Background: Patient self-management (pSM) is important for optimal cancer care, health equity and mitigation of clinician shortage (Howell 2021, Alfano 2022). 4R Oncology is an intervention fostering pSM and team-based care with a novel Care Sequence plan. 4R (Right Info / Care / Patient / Time) has been shown to improve pSM in breast cancer (Trosman 2021) but has not been studied for impact in other cancers or whether impact is affected by race or neighborhood deprivation index (NDI). 4R effect on patient satisfaction with care – important in care quality and reimbursement – is also unknown. We examined 4R impact on pSM and satisfaction in lung and breast cancers and whether it was influenced by race and NDI. Study took place at 3 centers of a large health system Oct 2020 - Dec 2021. Methods: Surveys of patient: 4R cohort who received 4R plans (N=192) and historical control who received care pre-4R (N=103). Cohorts included breast cancer stages 0-3 and all lung cancer stages. Results: Survey response: 53% (control), 42% (4R). 4R significantly improved 4 of 5 pSM metrics from control to 4R cohort in each cancer (table). Satisfaction with care improved in 3 of 5 metrics in lung and 2 metrics in breast cancer. pSM significantly improved in all metrics from control to 4R cohort for non-White patients, and in 2 of 5 metrics for White non-Hispanics. Satisfaction significantly increased in 3 metrics in both race groups. NDI did not affect 4R impact: both higher and lower NDI groups benefited similarly in all metrics from control to 4R cohorts (data not shown). Conclusions: 4R is effective in improving patient self-management and satisfaction with care across different cancers. Non-White patients derived more self-management benefit than White non-Hispanic, indicating that 4R may help address racial disparities. Deprivation index results suggest that 4R benefits both lower and higher socioeconomic status patients. Further model refinement should address remaining gaps along relevant metrics.[Table: see text]

PROMOTING PATIENT HYPERTENSION SELF-MANAGEMENT BEHAVIORS WITH THE EVIDENCE-BASED PROGRAM, HEALTH COACHES FOR HYPERTENSION CONTROL

Objective: To improve patient self-management of hypertension with a peer-led, community-based educational program which activates participants to make lifestyle changes by delivering personally relevant and meaningful information addressing psychosocial determinants of self-management behaviors. Design and method: The eight-session educational curriculum, Health Coaches for Hypertension Control (HCHC), was developed using the US National Institute of Health Stage Model approach to behavioral intervention development. In Stage II and III it was tested for efficacy through implementation with 146 participants using a pre- and posttest evaluation design including process, impact, and outcome measures. In Stage IV, it was evaluated for changes in knowledge and psychosocial measures using a batch randomization to intervention or wait-control group with 185 participants. Results: Stage IV research revealed that compared with control group participants, a higher proportion of treatment group participants moved from the cognitive to behavioral stages of motivational readiness for being physically active (P &lt; .001), practicing healthy eating habits (P = .001), handling stress well (P = .001), and living an overall healthy lifestyle (P = .003). They also demonstrated a greater average increase in perceived competence for self-management, F(1.134) = 4.957, P = .028, and a greater increase in mean hypertension-related knowledge, F(1.160) = 16.571, P &lt; .0005. The US Department of Health and Human Services, Administration for Community Living designated HCHC as an Evidence-Based Program in 2018. Since that time, Stage V (“implementation and dissemination”) research has demonstrated that HCHC has been successfully disseminated both in-person and on-line in 15 US states. Conclusions: HCHC is recommended as an extension of clinical patient education to support increasing health system interest in promoting sustainable patient outcomes through effective self-management. An agency wishing to disseminate HCHC would need to secure a license agreement to use copyrighted materials and arrange for certification of Master Trainers by the HCHC program manager. Master Trainers may then offer HCHC themselves or train lay leaders to offer the program.

NURSE AND PATIENT PERCEPTION IN SELF-MONITORING OF DAWN EFFECT TO ENHANCE SELF-MANAGEMENT IN DIABETES MELLITUS PATIENT’S: A QUALITATIVE CASE STUDY

Background: A phenomenon in diabetes mellitus patients is called dawn effect, the condition of hyperglycemia suddenly increasing insulin requirement in the morning caused by nonattendance of nighttime hypoglycemia. Self-monitoring can be minimizing the impacts of dawn effect. Self-management can be actualized to oversee the blood glucose levels fluctuation in diabetes mellitus patients. Objective: to gain self-monitoring influencing factors of dawn effect phenomenon, and increase self-management in diabetic patient and nurse knowledge in Temanggung, Central Java Methods: A qualitative study design was used in this research with semi-structured interviews and open-ended questions. Participants were selected using purposive sampling technique from primary healthcare and secondary healthcare of both nurse and patient. Twelve participants consisted of senior nurse (n=5), patients with type 2 diabetes mellitus (n=7). Information of psychometric diabetes self-management scale and blood glucose monitoring were day by day collected within the morning. Result: Nurses' perception of the dawn effect is still relatively low due to a lack of knowledge and competence in self-management of diabetes patients. They followed the doctor's advice. In addition, the patient's perspective of blood glucose monitoring was taken into account, despite the fact that they did not have a glucometer from a mobile device (lack of self-management and dawn effect). Furthermore, all participants (n=7) increase in blood glucose level in the morning. Invasive glucometer has a high accuracy, but inducing finger discomfort, uncomfortable, and increase risk of infection when it checked daily. Conclusion: Perceptions of nurse and patient about self-monitoring can improve patient self-management and prevent the occurrence of dawn effects.

PS-P11-7: DIABETES AND HYPERTENSION SELF-MANAGEMENT: CHALLENGES AND SOLUTIONS FROM SOUTH AFRICAN PATIENTS AND HEALTH CARE PROVIDERS: A QUALITATIVE STUDY

Objective: This study aimed to unravel experiences, identify barriers to self management of diabetes and hypertension and solicit solutions for enhancing chronic disease self management from patients and their healthcare providers. Design and Methods: This was a qualitative study which collected data from eight in-depth interviews conducted with healthcare providers and four focus group discussions among patients with type 2 diabetes and hypertension receiving chronic disease care from two health facilities in a large peri-urban Township in Cape Town, South Africa. The Self Management framework described by Lorig and Holman, based on work done by Corbin and Strauss was used to analyse the data Results: Patients experienced challenges across all three self management tasks of behavioural or medical management, role management and emotional management. Main challenges included poor patient self-control towards lifestyle modification, sub-optimal patient-provider and family partnerships and post-diagnosis grief-reactions by patients. Barriers experienced were stigma, socio-economic and cultural influences, provider-patient communication gaps, disconnect between facility-based services and patients lived experiences and inadequate community care services. Patients suggested empowering community-based solutions to strengthen their disease self-management including dedicated multidisciplinary chronic disease management services, counselling services, strengthened family support, patient buddy system, patient-led community projects and advocacy. Providers suggested contextualised communication using audio-visual technologies and patient-centred provider consultations. Conclusions: Patients experienced several barriers to self-management of their chronic disease. Community-based dedicated multidisciplinary chronic disease healthcare teams, chronic disease counselling services, patient-driven projects towards healthy lifestyle and diet, and advocacy are needed to improve patient self-management. This will contribute towards SDG 3

E-Kalpin self-management effectiveness as haemodynamic predictor of hypertension patients during the covid-19 pandemic

Abstract&#x0D; Background: The intervention program for preventing and controlling hypertension is a challenge for health workers, one of which is by helping individuals do self-management (Self-Care) to overcome hypertension, this can increase their self-confidence (Self-Efficacy) to live with chronic diseases. Self-management is an individual's ability to carry out self-care activities to maintain life, improve, and maintain individual health and well-being. E-Kalpin is a visual-based education developed to improve patient self-management in comorbid patients. Patients can use E-Kalpin as a medium that helps them supervise and control blood pressure.&#x0D; This study aimed to see the effectiveness of E-Kalpin's self-management as a predictor of hemodynamics in patients with hypertension during the covid pandemic.&#x0D; Method: This study used a quasi-experimental research design with a pretest-posttest approach with a control group. The population in this study were all patients with hypertension in the Aur Duri Public Health Center working area with a sample group of 30 respondents. The researcher used the E-Kalpin media as a media instrument which was arranged in the form of a questionnaire to obtain information and data from respondents.&#x0D; Results: This study resulted in a relationship between the use of the E-Kalpin application as a medium to assist them in supervising and controlling their illness. The statistical test results obtained a p-value of 0.018, meaning that at 5% alpha there was a significant difference in the average of the kalpin group and the control group. This means that using E-Kalpin can assist people with hypertension in their self-management thus it can be used as a hemodynamic predictor in daily activities.&#x0D; Conclusion: Health workers can use E-Kalpin as an educational medium that helps people with hypertension to predict the hemodynamics of the body in controlling blood pressure. For further research, it is recommended to examine various supporting factors or other variables that affect the use of E-Kalpin application media to assist patients in controlling blood pressure.

Does the 4R oncology model improve clinicians’ effectiveness in patient-facing planning of complex cancer care?

344 Background: The 4R Oncology model was proposed within the NCI ASCO Teams Project as an approach to facilitate patient facing care planning, team based delivery and patient self-management. 4R (Right Info/Care/Patient/Time) enables care teams and patients to manage complex care with a novel 4R Care Sequence plan. We previously reported that 4R significantly improved patient self-management, namely patients’ ability to organize and manage their care (Trosman JCO OP 2021). Here we report the impact of 4R on effectiveness of clinicians to plan and deliver complex multidisciplinary care. Methods: We surveyed clinicians (physicians and nurses) from 8 cancer centers (4 academic, 4 community) participating in a 4R adoption program. The survey was conducted Mar 2019 to Sep 2019 prior to 4R launch (Baseline cohort), and Nov 2021 to Jan 2022 post-4R launch (4R cohort). Baseline cohort included clinicians conducting care planning with patients. 4R cohort included clinicians who used 4R in care planning with patients. The survey focused on clinicians’ self-reported effectiveness in planning and management of guideline care. Descriptive statistics and Fisher’s 2-sided test were used in analyses. Results: Baseline cohort response rate was 79% (66/83); 4R cohort response rate was 86% (62/72). 4R implementation was associated with significant improvement in all 6 metrics of effective care planning between the baseline and 4R cohorts (Table). Within the 4R cohort, 87% (54/62) clinicians found 4R Care Sequences useful or very useful for care planning and management. The majority, 79% (49/62), spent ≤ 10 minutes on average developing and administering 4R Care Sequence to a new patient, and 58% (36/62) reported decreased overall volume of post-visit inquiries about care plan from patients who received 4R. When asked about 4R delivery format, 65% (40/62) preferred paper, 23% (14/62) electronic delivery and 12% (8/62) had no preference. Conclusions: The 4R Oncology model is a promising approach to improving clinicians’ effectiveness in patient facing care planning and reducing the workload associated with patient inquiries. An ongoing 4R research and implementation program continues efforts to identify optimal implementation methods and integrate 4R into clinical practice across the U.S.[Table: see text]

Effect of primary care-level chronic disease management policy on self-management of patients with hypertension and diabetes in Korea

AimsThis study aimed to evaluate the effect of introducing a regional chronic disease management project on the self-management of patients with hypertension and diabetes. MethodsThis study included 174,546 patients. The relationship between introducing chronic disease management in a region and the self-awareness of disease status was analyzed using a generalized estimating equation model. Poisson regression analysis was used to evaluate the effect of policy adoption on medication adherence and risk-reduction behavior in patients with hypertension and diabetes. Finally, we used a difference-in-differences model to assess the net effectiveness of policies. ResultsOverall, regions with policies implemented showed more condition awareness and drug adherence than those without; however, this was only significant in regions where patients and physicians were incentivized. Risk-reduction behavior for patients with diabetes was higher in regions with policies implemented than in those without. The policy had a net effect of significantly and non-significantly increasing disease awareness and medication adherence, respectively. ConclusionChronic disease management policies at the primary care level that incentivized both patients and physicians improved patient self-management. However, the effects on patients with diabetes and hypertension differed. Future studies should account for additional patient outcomes, including long-term impact assessments and clinical outcomes.

Diabetes self-management: a qualitative study on challenges and solutions from the perspective of South African patients and health care providers

ABSTRACT Background Health education and self-management are among key strategies for managing diabetes and hypertension to reduce morbidity and mortality. Inappropriate self-management support can potentially worsen chronic diseases outcomes if relevant barriers are not identified and self-management solutions are not contextualised. Few studies deliberately solicit suggestions for enhancing self-management from patients and their providers. Objective This qualitative study aimed to unravel experiences, identify self-management barriers, and solicit solutions for enhancing self-management from patients and their healthcare providers. Methods Eight in-depth interviews were conducted with healthcare providers. These were followed by four focus group discussions among patients with type-2- diabetes and or hypertension receiving chronic disease care from two health facilities in a peri-urban township in Cape Town, South Africa. The Self-Management framework described by Lorig and Holman, based on work done by Corbin and Strauss was used to analyse the data. Results Patients experienced challenges across all three self-management tasks of behavioural/medical management, role management, and emotional management. Main challenges included poor patient self-control towards lifestyle modification, sub-optimal patient-provider and family partnerships, and post-diagnosis grief-reactions by patients. Barriers experienced were stigma, socio-economic and cultural influences, provider-patient communication gaps, disconnect between facility-based services and patients’ lived experiences, and inadequate community care services. Patients suggested empowering community-based solutions to strengthen their disease self-management, including dedicated multidisciplinary diabetes services, counselling services; strengthened family support; patient buddies; patient-led community projects, and advocacy. Providers suggested contextualised communication using audio-visual technologies and patient-centred provider consultations. Conclusions Community-based dedicated multidisciplinary chronic disease healthcare teams, chronic disease counselling services, patient-driven projects and advocacy are needed to improve patient self-management.

Does the 4R oncology model improve clinicians’ effectiveness in patient-facing planning of complex cancer care?

1542 Background: The 4R Oncology model was proposed within the NCI ASCO Teams Project as an approach to facilitate patient-facing care planning, team-based delivery and patient self-management. 4R (Right Info/Care/Patient/Time) enables care teams and patients to manage complex care with a novel 4R Care Sequence plan. We previously reported that 4R significantly improved patient self-management, namely patients’ ability to organize and manage their care (Trosman JCO OP 2021). Here we report the impact of 4R on effectiveness of clinicians to plan and deliver complex multidisciplinary care. Methods: We surveyed clinicians (physicians and nurses) from 8 cancer centers (4 academic, 4 community) participating in a 4R adoption program. The survey was conducted Mar 2019 to Sep 2019 prior to 4R launch (Baseline cohort), and Nov 2021 to Jan 2022 post-4R launch (4R cohort). Baseline cohort included clinicians conducting care planning with patients. 4R cohort included clinicians who used 4R in care planning with new patients. The survey focused on clinicians’ self-reported effectiveness in planning and management of guideline-based care. Descriptive statistics and Fisher’s 2-sided test were used in analyses. Results: Baseline cohort’s response rate was 79% (66/83); 4R cohort’s response rate was 86% (62/72). 4R implementation was associated with significant improvement in all 5 metrics of effective care planning between the baseline and 4R cohorts (Table). Within the 4R cohort, 87% (54/62) clinicians found 4R Care Sequences useful or very useful for care planning and management. The majority, 79% (49/62), spent 10 minutes or less on average developing and administering 4R Care Sequence to a new patient, and 58% (36/62) reported decreased overall volume of post-visit inquiries about care plan from patients who received 4R. When asked about 4R delivery format, 65% (40/62) preferred paper, 23% (14/62) electronic delivery and 12% (8/62) had no preference. Conclusions: The 4R Oncology model is a promising approach to improving clinicians’ effectiveness in patient-facing care planning and reducing the workload associated with patient inquiries. An ongoing 4R research and implementation program continues efforts to identify optimal implementation methods and integrate 4R into clinical practice across the U.S. [Table: see text]

Barriers to telemedicine for patients with heart failure: Who are the patients being left behind?

Heart failure is associated with high rates of hospitalization, which are more prevalent in frail patients, impacting the quality of life and clinical outcomes. Telemedicine is considered cost-effective for improving patient self-management and hospitalization. However, socioeconomic deprivation and frailty could hinder access to virtual care. We investigated if frailty and socioeconomic factors were associated with telemedicine access among heart failure patients. For this cross-sectional analysis of Continuum study, 35 patients were allocated to the "able to use" group (had a smart device and were able to use it) or the "not able to use" group. Socioeconomic deprivation was determined according to the deprivation index. Frailty was assessed using the Fried criteria. The mean age was 69.9 ± 9 years, 74% were in New York Heart Association class II. A total of 14 patients (39%) were physically frail. Patients considered not able to use the app were more socioeconomically deprived (p = 0.011) and frail (p = 0.036). There was no correlation between frailty score and socioeconomic deprivation (r = 0.15, p = 0.411). Telemedicine use seems to be independently associated with frailty and socioeconomic deprivation in heart failure patients. More efforts should be made to foster the inclusion of vulnerable patients and improve global telemedicine access.

Self-reported Sleep Quality Before and After Atrial Fibrillation Ablation.

Poor sleep quality is highly prevalent in atrial fibrillation (AF) with reported links between worse sleep quality and higher AF severity. Little research has examined whether sleep quality changes after AF ablation despite it being a routinely performed procedure. The aim of this study was to evaluate self-reported sleep quality before and after AF ablation and to examine whether sleep quality differs by AF severity or sex. This longitudinal pilot study assessed sleep using the Pittsburgh Sleep Quality Index at preablation and at 1, 3, and 6 months after ablation. Atrial fibrillation disease severity was assessed by the Canadian Cardiology Society Severity of AF scale. Outcomes were analyzed using descriptive statistics, Spearman ρ correlations, and multilevel longitudinal models. The sample (N = 20) was 55% female with a mean age of 65 (±7) years. Poor sleep quality (mean Pittsburgh Sleep Quality Index scores > 5) was evident at all time points. Improvement was noted at 3 months (moderate effect size d = 0.49); and negligible further improvement, from 3 to 6 months post ablation. Improvement was seen primarily in male subjects (large effect size d = 0.89 at 3 months), with smaller improvements for female subjects. Although Severity of AF scale scores were not correlated with sleep quality, Severity of AF scale severity scores did significantly improve over time. Patients with AF have poor sleep quality that improves for the first 3 months after AF ablation, with men showing more improvement than women. A more accurate understanding of the sleep challenges after AF ablation could lead to development of more realistic patient education and improve patient self-management.

Implementing Home Health Monitoring for Chronic Disease Management in British Columbia

Home health monitoring (HHM) enables health care providers to monitor a patient’s health status remotely using digital technology. In 2013, the government of British Columbia (BC) partnered with a telecommunications provider and invested $52M in HHM programs for patients with complex care needs. Telehealth has evolved over the past two decades to improve access and delivery of care, with HHM emerging as a strategy for proactive chronic disease management. The goals of the provincial HHM initiative are to reduce acute care utilization, reduce health system costs and improve patient self-management of chronic conditions. Following a series of successful pilot projects, funding for expanded HHM initiatives was made available through a provincial Strategic Investment Fund and continued support from Canada Health Infoway. Evaluations of several HHM programs demonstrated high levels of patient satisfaction, reduced emergency department visits, health system cost savings, and improved patient self-care and quality of life. Optimizing referral rates and expanding HHM programs to include a wider range of chronic conditions are opportunities for future growth, with sustainability dependent on securing long-term funding sources.