Expectations and fear of diabetes-related long-term complications in people with type 2 diabetes at primary care level

Objectives. To analyse the short- and long-term costs and benefits of alternative models of primary care for the management of patients with type 2 diabetes in Australia. The models of care reflect differential uptake of primary care-based incentive programs, including reminder systems and involvement of practice nurses in management. This paper describes our study protocol and its progress. Methods. We are undertaking an observational study using a cluster sample design that links retrospective patient data from a range of sources to estimate costs and intermediate outcomes (such as the level of glycosylated haemoglobin (HbA1c)) over a 3-year time horizon. We use the short-term data as a basis to estimate lifetime costs and benefits of alternative models of care using a decision analytic model. Initial report. We recruited 15 practices from a metropolitan area (Adelaide) and allocated them to three models of care. Three hundred and ninety-nine patients agreed to participate. We use multilevel analysis to evaluate the association between different models of care and patient-level outcomes, while controlling for several covariates. Discussion/conclusions. Given the large amount of funding currently used to maintain primary care-based incentives in general practices in Australia, the results of this study generate the knowledge required to promote investment in the most cost-effective incentives. What is known about the topic? Collaborative models of care can improve the outcomes in patients with chronic diseases such as type 2 diabetes (T2D), and the large amount of funding is currently used to maintain primary care-based initiatives to provide incentives for general practices to take a more multidisciplinary approach in management of chronic diseases. What does this paper add? There are few model-based studies of the cost-effectiveness of alternative models of care defined on the basis of the uptake of financial incentives within Australian primary care settings for diabetes management. Using routinely collected data, this project evaluates the effectiveness of alternative models of care and estimates long-term costs and benefits of various models of care. What are the implications for practitioners? This study explores opportunities for the use of linked, routinely collected data to evaluate clinical practice, and identifies the optimal model of care in management of patients with T2D, with respect to differences in long-term costs and outcomes.

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Long-term effects of self-management education for patients with Type 2 diabetes taking maximal oral hypoglycaemic therapy: a randomized trial in primary care

Diabetic Medicine ◽

10.1111/j.1464-5491.2004.01153.x ◽

2004 ◽

Vol 21 (5) ◽

pp. 491-496 ◽

Cited By ~ 66

Author(s):

A. N. Goudswaard ◽

R. P. Stolk ◽

N. P. A. Zuithoff ◽

H. W. de Valk ◽

G. E. H. M. Rutten

Keyword(s):

Type 2 Diabetes ◽

Primary Care ◽

Randomized Trial ◽

Management Education ◽

Self Management ◽

Long Term Effects

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Multimorbidity and achievement of treatment goals among patients with type 2 diabetes: a primary care, real-world study

BMC Health Services Research ◽

10.1186/s12913-021-06989-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Eveliina Heikkala ◽

Ilona Mikkola ◽

Jari Jokelainen ◽

Markku Timonen ◽

Maria Hagnäs

Keyword(s):

Type 2 Diabetes ◽

Primary Care ◽

Health Care ◽

Primary Health Care ◽

Treatment Target ◽

Adequate Treatment ◽

Treatment Targets ◽

Primary Health

Abstract Background Type 2 diabetes (T2D), with its prevalence and disability-causing nature, is a challenge for primary health care. Most patients with T2D are multimorbid, i.e. have one or more long-term diseases in addition to T2D. Multimorbidity may play a role in the achievement of T2D treatment targets, but is still not fully understood. The aims of the present cross-sectional, register-based study were to evaluate the prevalence and the most common patterns of multimorbidity among patients with T2D; and to study the potential associations between multimorbidity and treatment goal achievement, including measurements of glycosylated haemoglobin A1c (HbA1c), low-density lipoprotein (LDL) and systolic blood pressure (sBP). Methods The study population consisted of 4545 primary care patients who received a T2D diagnosis between January 2011 and July 2019 in Rovaniemi Health Centre, Finland. Data on seven long-term concordant (T2D-related) diseases, eight long-term discordant (non-T2D-related) diseases, potential confounders (age, sex, body mass index, prescribed medication), and the outcomes studied were collected from patients’ records. Logistic regression models with odds ratios (ORs) and 95 % confidence intervals (CIs) were assessed to determine the associations between multimorbidity and the achievement of treatment targets. Results Altogether, 93 % of the patients had one or more diseases in addition to T2D, i.e. were considered multimorbid. Furthermore, 21 % had only concordant disease(s) (Concordant subgroup), 8 % had only discordant disease(s) (Discordant subgroup) and 64 % had both (Concordant and discordant subgroup). As either single diseases or in combination with others, hypertension, musculoskeletal (MS) disease and hyperlipidaemia were the most prevalent multimorbidity patterns. Being multimorbid in general (OR 1.32, CI 1.01–1.70) and belonging to the Concordant (OR 1.45, CI 1.08–1.95) and Concordant and discordant (OR 1.31, CI 1.00–1.72) subgroups was associated with achievement of the HbA1c treatment target. Belonging to the Concordant and discordant subgroup was related to meeting the LDL treatment target (OR 1.31, CI 1.00–1.72). Conclusions Multimorbidity, including cardiovascular risk and the musculoskeletal disease burden, was extremely prevalent among the T2D patients who consulted primary health care. Primary care clinicians should survey the possible co-existence of long-term diseases among T2D patients to help maintain adequate treatment of T2D.

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Evaluating the effectiveness of a support programme for people with type 2 diabetes mellitus in primary care: an observational prospective study in Ecuador

BJGP Open ◽

10.3399/bjgpopen20x101025 ◽

2020 ◽

Vol 4 (2) ◽

pp. bjgpopen20X101025

Author(s):

Francisco Barrera-Guarderas ◽

Katherine De la Torre-Cisneros ◽

Maria Barrionuevo-Tapia ◽

Carmen Cabezas-Escobar

Keyword(s):

Diabetes Mellitus ◽

Blood Pressure ◽

Type 2 Diabetes ◽

Primary Care ◽

Type 2 Diabetes Mellitus ◽

Ocular Fundus ◽

Network Support ◽

Support Programme

BackgroundThe success of primary health care relies on the integration of empowered practitioners with cooperative patients regardless of socioeconomic status. Using resources efficiently would help to improve healthcare promotion and reduce complications of chronic non-communicable diseases (NCDs). The importance of network support programmes relies on the fact that they allow to accurately deliver medical care by shaping a sense of community and purpose among the patients.AimTo evaluate the effectiveness of a network support programme for patients with type 2 diabetes mellitus (T2DM).Design & settingA centre-based observational prospective study took place in a primary care setting in Ecuador.MethodThe impact of the diabetes care programme was assessed by comparing initial and final metabolic characteristics and outcomes of 593 patients with T2DM, followed-up from April 2007 to December 2017, using paired sample t-test. Electrocardiograms (ECGs), ankle-brachial indexes (ABIs), ocular fundus, and monofilament neuropathy tests were assessed with the McNemar test to evaluate complications at the beginning and end of the study.ResultsGlycated haemoglobin (HbA1c), lipid profile, and systolic blood pressure (SBP) showed statistically significant decreases between the initial measurement (IMs) and final measurements (FMs). In the FM, significantly lower HbA1c, diastolic blood pressure (DBP), and atherogenic index were found. Despite the length of time since diagnosis, during the follow-up time, long-term micro- and macro-vascular complications, such as ocular fundus, serum creatinine, and ABI, remained unchanged throughout the period of active participation in this healthcare programme.ConclusionThis study demonstrates the feasibility of reducing plasma glucose, plasma lipids, and long-term complications in patients with T2DM by implementing a network support programme, which involves the medical team and patients themselves in an environment with limited resources.

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Effectiveness of the Use of Augmented Reality in Teaching the Management of Anaphylactic Shock at the Primary Care Level: Protocol for a Randomized Controlled Trial

JMIR Research Protocols ◽

10.2196/22460 ◽

2021 ◽

Vol 10 (1) ◽

pp. e22460

Author(s):

Zalika Klemenc-Ketis ◽

Antonija Poplas Susič ◽

Nina Ružić Gorenjec ◽

Špela Miroševič ◽

Uroš Zafošnik ◽

...

Keyword(s):

Primary Care ◽

Randomized Controlled Trial ◽

Emergency Care ◽

Anaphylactic Shock ◽

Controlled Trial ◽

Short Term ◽

Care Level ◽

Primary Care Level ◽

Randomized Controlled

Background Augmented reality (AR) has benefits and feasibility in emergency medicine, especially in the clinical care of patients, in operating rooms and inpatient facilities, and in the education and training of emergency care providers, but current research on this topic is sparse. Objective The primary objective is to evaluate the short-term and long-term effectiveness of the use of AR in the treatment of patients with anaphylactic shock. The secondary objectives are to evaluate the safety in the treatment of patients with anaphylactic shock, evaluate the short-term and long-term effectiveness of stress management in this process, and determine the experiences and attitudes towards the use of AR in education. Methods The study will be conducted in 3 phases. In the first phase, we will develop and test the scenario for simulation of anaphylactic shock and the evaluation scale for assessing the effect of the intervention. In the second phase, a single-blinded, randomized controlled trial will be conducted. In the third phase, the use of AR in teaching the management of anaphylactic shock using focus groups will be evaluated qualitatively. All participants will participate in a 1-day training program consisting of a lecture on emergency care and anaphylactic shock as well as exercises in manual dexterity (aspiration, airway management, alternative airway management, artificial respiration, chest compressions, safe defibrillation, oxygen application, use of medication during emergency care). The test group will also focus on education about anaphylactic shock in AR (the intervention). The main outcome will be the evaluation of the participants' performance in coping with a simulated scenario of anaphylactic shock using a high-fidelity simulator (simulator with high levels of realism) and a standardized patient in an educational and clinical environment. The study will be conducted with primary care physicians. Results A scenario for the simulation with a high-fidelity simulator and standardized patient has already been developed. For the time being, we are developing an evaluation scale and starting to recruit participants. We plan to complete the recruitment of participants by the end of December 2020, start the randomized controlled trial in January 2021, and finish 1 year later. The first results are expected to be submitted for publication in 2021. Conclusions This will be the first study to evaluate the effectiveness of the use of AR in medical teaching. Specifically, it will be based on a clinical case of anaphylactic shock at the primary care level. With our study, we also want to evaluate the translation of these educational results into clinical practice and assess their long-term impact. Trial Registration ISRCTN Registry ISRCTN58047410; http://www.isrctn.com/ISRCTN58047410 International Registered Report Identifier (IRRID) PRR1-10.2196/22460

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Palliative care integration indicators: an European regional analysis

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2021-003181 ◽

2021 ◽

pp. bmjspcare-2021-003181

Author(s):

Miguel Antonio Sánchez-Cárdenas ◽

Eduardo Garralda ◽

Natalia Sofia Arias-Casais ◽

Edgar Ricardo Benitez Sastoque ◽

Danny Van Steijn ◽

...

Keyword(s):

Primary Care ◽

Palliative Care ◽

Health Systems ◽

Long Term Care ◽

European Countries ◽

Term Care ◽

Care Level ◽

Primary Care Level ◽

Care Facilities

ObjectiveTo estimate the capacity of European countries to integrate palliative care (PC) into their health systems through PC service provision for patients of all ages, with different care needs and diseases, in various settings and by a range of providers.MethodsSecondary analysis of survey data from 51 countries with 22 indicators explored the integration of available PC resources for children, for patients of all ages, at the primary care level, for oncology and cardiac patients, and in long-term care facilities. We also measured volunteer participation. Results were quantified, converted into weighted subscores by area and combined into a single ‘Integration Capacity Score (ICS)’ for each country.ResultsThirty-eight countries reported 543 specialised paediatric PC services. One-third of all surveyed countries reported 20% or more of patients with PC needs at the primary care level. Twenty-four countries have a total of 155 designated centres that integrate oncology and PC. Eight countries were pioneering cardiology services that integrate PC. Eight reported a volunteer workforce of over 1000 and 12 had policies regulating PC provision and interventions in long-term care facilities. Across all indicators, 39 countries (76%) score from low to very low integration capacity, 8 (16%) score at an intermediate level, and 4 (8%; the Netherlands, UK, Germany and Switzerland) report a high-level integration of PC into their health systems.ConclusionVariable progress according to these indicators shows that most European countries are still in the process of integrating PC into their health systems.

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