A collaborative care team to integrate behavioral health care and treatment of poorly-controlled type 2 diabetes in an urban safety net primary care clinic

ObjectiveTo identify factors associated with sight-threatening diabetic macular oedema (STDM) in Indigenous Australians attending an Indigenous primary care clinic in remote Australia.Methods and analysisA cross-sectional study design of retinopathy screening data and routinely-collected clinical data among 236 adult Indigenous participants with type 2 diabetes (35.6% men) set in one Indigenous primary care clinic in remote Australia. The primary outcome variable was STDM assessed from retinal images.ResultsAge (median (range)) was 48 (21–86) years, and known diabetes duration (median (range)) was 8.0 (0–24) years. Prevalence of STDM was high (14.8%) and similar in men and women. STDM was associated with longer diabetes duration (11.7 vs 7.9 years, respectively; p<0.001) and markers of renal impairment: abnormal estimated Glomerular Filtration Rate (eGFR) (62.9 vs 38.3%, respectively; p=0.007), severe macroalbuminuria (>300 mg/mmol) (20.6 vs 5.7%, respectively; p=0.014) and chronic kidney disease (25.7 vs 12.2%, respectively; p=0.035). Some clinical factors differed by sex: anaemia was more prevalent in women. A higher proportion of men were smokers, prescribed statins and had increased albuminuria. Men had higher blood pressure, but lower glycated Haemoglobin A1c (HbA1c) levels and body mass index, than women.ConclusionSTDM prevalence was high and similar in men and women. Markers of renal impairment and longer diabetes duration were associated with STDM in this Indigenous primary care population. Embedded teleretinal screening, known diabetes duration-based risk stratification and targeted interventions may lower the prevalence of STDM in remote Indigenous primary care services.Trial registration numberAustralia and New Zealand Clinical Trials Register: ACTRN 12616000370404.

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Type 2 Diabetes Mellitus in Ambulatory Adult Nigerians: Prevalence and Associated Family Biosocial Factors in a Primary Care Clinic in Eastern Nigeria: A Cross-sectional Study

British Journal of Medicine and Medical Research ◽

10.9734/bjmmr/2015/18783 ◽

2015 ◽

Vol 9 (3) ◽

pp. 1-12 ◽

Cited By ~ 3

Author(s):

Gabriel Iloh ◽

A. Amadi ◽

C. Ebirim

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Primary Care ◽

Primary Care Clinic ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Care Clinic ◽

Associated Family

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Cost-effectiveness study of oral hypoglycemic agents in the treatment of outpatients with type 2 diabetes attending a public primary care clinic in Mexico City

ClinicoEconomics and Outcomes Research ◽

10.2147/ceor.s27826 ◽

2012 ◽

pp. 57 ◽

Cited By ~ 1

Author(s):

Marina Altagracia-Martinez ◽

Christian Díaz de León-Castañeda ◽

Kravzov-Jinich ◽

Moreno-Bonett ◽

Martínez-Núñez ◽

...

Keyword(s):

Type 2 Diabetes ◽

Primary Care ◽

Mexico City ◽

Primary Care Clinic ◽

Hypoglycemic Agents ◽

Effectiveness Study ◽

Oral Hypoglycemic Agents ◽

Care Clinic ◽

Cost Effectiveness Study

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Introducing Primary Care Telephone Visits: An Urban Safety-Net Community Clinic Experience

Journal of Primary Care & Community Health ◽

10.1177/2150132718792154 ◽

2018 ◽

Vol 9 ◽

pp. 215013271879215 ◽

Cited By ~ 1

Author(s):

Kelly Kyanko ◽

Kathleen Hanley ◽

Sondra Zabar ◽

Jennifer Joseph ◽

William Bateman ◽

...

Keyword(s):

Primary Care ◽

New York ◽

Primary Care Clinic ◽

Safety Net ◽

Lessons Learned ◽

Care Practice ◽

Patient Acceptability ◽

Care Clinic ◽

Telephone Consultation ◽

Urban Safety

Background: Telephone consultation is widely used in primary care and can provide an effective and efficient alternative for the in-person visit. Gouverneur Health, a safety-net primary care practice in New York City serving a predominately immigrant population, evaluated the feasibility and physician and patient acceptability of a telephone visit initiative in 2015. Measures: Patient and physician surveys, and physician focus groups. Results: Though only 85 of 270 scheduled telephone visits (31%) were completed, 84% of patients reported being highly satisfied with their telephone visit. Half of physicians opted to participate in the pilot. Among participating physicians, all reported they were able to communicate adequately and safely care for patients over the telephone. Conclusions: Participating patients and physicians in a linguistically and culturally diverse urban safety-net primary care clinic were highly satisfied with the use of telephone visits, though completion of the visits was low. Lessons learned from this implementation can be used to expand access and provision of high-quality primary care to other vulnerable populations.

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Barriers to Engagement in Collaborative Care Treatment of Uncontrolled Diabetes in a Safety-Net Clinic

The Diabetes Educator ◽

10.1177/0145721717739813 ◽

2017 ◽

Vol 43 (6) ◽

pp. 621-630

Author(s):

Brittaney Belyeu ◽

Lydia Chwastiak ◽

Joan Russo ◽

Meghan Kiefer ◽

Kathy Mertens ◽

...

Keyword(s):

Primary Care ◽

Chronic Pain ◽

Collaborative Care ◽

Primary Care Clinic ◽

Safety Net ◽

Management Program ◽

Care Team ◽

Care Clinic ◽

Uncontrolled Diabetes ◽

Safety Net Clinic

Purpose The purpose of the study was to evaluate patient factors associated with nonengagement in a Diabetes Collaborative Care Team (DCCT) program in a safety-net clinic. Methods The first 18 months of a multidisciplinary care, team-based diabetes care management program in a safety-net primary care clinic were studied. Nonengagement was defined as fewer than 2 visits with a team member during the 18 months of the program. Patients who did not engage in the program were compared with those who did engage on demographics, comorbid medical and psychiatric diagnoses, and cardiovascular risk factors, using univariate and multivariable analyses. Results Of the 151 patients referred to the DCCT, 68 (45%) were nonengaged. In unadjusted analyses, patients who did not engage were more likely to be female and have higher baseline A1C values; they were less likely to have major depressive disorder, anxiety disorder, any depression diagnosis, and hyperlipidemia. Female gender and chronic pain were independently associated with nonengagement after multivariable adjustment. Conclusions The findings suggest that among patients with uncontrolled diabetes in an urban safety-net primary care clinic, there is a need to address barriers to engagement for female patients and to integrate chronic pain management strategies within multicondition collaborative care models.

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