Impacts and outcomes of diabetes care in a high risk remote Indigenous community over time: implications for practice

2013 ◽  
Vol 19 (2) ◽  
pp. 107 ◽  
Author(s):  
Malcolm P. Forbes ◽  
James Ling ◽  
Sam Jones ◽  
Robyn McDermott
Keyword(s):  
High Risk ◽  
Diabetes Care ◽  
Care Service ◽  
National Sample ◽  
Diabetic Control ◽  
Care Processes ◽  
Care Systems ◽  
Diagnosed Diabetes ◽  
Clinical Measures ◽  
Diabetic Care

The aim of this study was to determine diabetes care processes and intermediate clinical outcomes in a remote primary care service in 2009 compared with 2004. A retrospective review of diabetes care from January 2009 to January 2010 was conducted using a chronic disease register (Project Ferret). Completeness of ascertainment was verified by a manual audit of charts. The results from this audit were compared with a similar study conducted in this community in 2004. The main outcome measure was diabetic management: in terms of (a) regular monitoring of diabetic care processes, and (b) compliance with national optimal management guidelines and comparison with diabetic outcomes data from a 2004 audit and the National data from 2009. People with diabetes on the register increased from 60 in 2004 to 77 in 2009. They were younger and heavier with a shorter duration of diagnosed diabetes. Recording of diabetic care processes in 2009 decreased between 5 and 32% compared with 2004 data. Intermediate clinical measures (e.g. glycosylated haemoglobin, blood pressure, triglycerides, albumin creatinine ratio) indicate stable or poorer diabetic control across all measures except total cholesterol. When compared with non-Indigenous diabetics, diabetes is diagnosed earlier and rates of smoking, hypertension, dyslipidaemia and diabetic nephropathy are higher in this population. Insulin use appears to be lower in the study population than reported in the national sample. Improved diabetic care processes and outcomes reported from 1999 to 2003 have not been sustained, and intermediate clinical measures have become more adverse over a 5 year period in this high risk remote community. Chronic care systems, including quality improvement, require renewed investment.

Race and Sex Differences and Fear of Dying: A Test of Two Hypotheses — High Risk or Social Loss?

1987 ◽  
Vol 17 (3) ◽  
pp. 229-236 ◽  
Author(s):  
Alan Marks
Keyword(s):  
Sex Differences ◽  
High Risk ◽  
Mortality Rates ◽  
National Sample ◽  
Zero Order ◽  
Fear Of Death ◽  
Level Of Education ◽  
Social Loss ◽  
Education And Health ◽  
The Social

A national sample of noninstitutionalized adult Americans is used to test two hypotheses and their relation to fear of death, The first hypothesis, referred to as the high risk hypothesis (i.e., groups with higher mortality rates will express more fear of death than groups with lower rates of mortality), is rejected. The second hypothesis, referred to as the social loss hypothesis, is developed and tested across six status categories—race, sex, age, religion, level of education, and health status. Zero order differences did appear for sex and race, however, these differences were eliminated with the introduction of controls. Both hypotheses are rejected.

scholarly journals Variability in preventive care practices among US adults with diabetes mellitus

2021 ◽  
Vol 9 (1) ◽  
pp. e001861
Author(s):  
Lorena Baccaglini ◽  
Adams Kusi Appiah ◽  
Mahua Ray ◽  
Fang Yu
Keyword(s):  
Blood Glucose ◽  
Diabetes Care ◽  
Target Population ◽  
Care Practice ◽  
Behavioral Risk ◽  
Cross Sectional ◽  
Complex Sampling ◽  
Patients With Diabetes ◽  
Care Practices ◽  
Diabetic Care

IntroductionPatients with diabetes are advised to follow standard medical care including daily blood glucose and foot checks, eye examinations with pupil dilation, and cholesterol checks to prevent diabetes-related complications. It is unclear how these practices currently vary across different US population subgroups. The objective of this study was to assess variation in overall and individual diabetes care practices and identify specific factors associated with differences in these practices in a representative sample of US diabetic adults.Research design and methodsCross-sectional data were from the 2017 Behavioral Risk Factor Surveillance System. Survey logistic regression was used to account for the complex sampling design.ResultsAmong 30 780 eligible participants, 8957 (equivalent to 28% of the target population) followed all four diabetes care practices. Insulin-dependent participants had higher adjusted odds (adjusted OR=2.95; 95% CI 2.62 to 3.31) of following all four diabetic care practices compared with those who did not. Cost-related variables (having healthcare coverage and/or a personal doctor) were positively associated with diabetes care practices, with the strongest association observed for adherence to more costly practices (annual eye examination and cholesterol check) versus less costly ones (daily blood glucose check, daily foot check).ConclusionsOur findings suggest the need for diabetes care practice-specific and population subgroup-specific public health interventions to encourage early adherence to diabetic care practices and reduce complications.

scholarly journals Patient’s Utility for Various Attributes of Diabetes Care Services

2018 ◽  
Vol 8 (1) ◽  
pp. 1-9 ◽  
Author(s):  
Vinaytosh Mishra ◽  
Cherian Samuel ◽  
S. K. Sharma
Keyword(s):  
Health Care ◽  
Waiting Time ◽  
Diabetes Care ◽  
Care Service ◽  
Group Discussion ◽  
Health Care Service ◽  
Diabetic Patients ◽  
Relative Importance ◽  
Care Services

Diabetes is rising like an epidemic in India. The prevalence of diabetes in India has reached an alarming level of 72.95 millions. The purpose of this article is to assess the relative importance of various health care service attributes in diabetes care. Our study uses secondary research and focus group discussion to identify the attributes of a diabetes specialty clinic. The attributes included in the questionnaire were the quality of the care provide by the health care givers, spend per visit, hospitalization expense, waiting time and the distance to the hospital. Conjoint analysis was used to assess the relative importance of the attributes. It was found that the hospital’s quality was the most important attribute while the distance to the hospital was the attribute with the least importance. Although the quality of the hospital is the most important criterion in selecting a hospital in diabetes care, factors like waiting time, spend per visit, and hospitalization expense play an important role in the selection. We assess the relative importance of these factors for the diabetic patients in India. The study is first of its kind and could help policy makers in designing better health care services in diabetes care.

scholarly journals COVID-19: Rethinking the Lockdown Groupthink

2021 ◽  
Vol 9 ◽  
Author(s):  
Ari R. Joffe
Keyword(s):  
Public Health ◽  
High Risk ◽  
Cost Benefit Analysis ◽  
Health Care Systems ◽  
Herd Immunity ◽  
Cost Benefit ◽  
Risk Groups ◽  
School Closures ◽  
Trade Offs ◽  
Care Systems

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has caused the Coronavirus Disease 2019 (COVID-19) worldwide pandemic in 2020. In response, most countries in the world implemented lockdowns, restricting their population's movements, work, education, gatherings, and general activities in attempt to “flatten the curve” of COVID-19 cases. The public health goal of lockdowns was to save the population from COVID-19 cases and deaths, and to prevent overwhelming health care systems with COVID-19 patients. In this narrative review I explain why I changed my mind about supporting lockdowns. The initial modeling predictions induced fear and crowd-effects (i.e., groupthink). Over time, important information emerged relevant to the modeling, including the lower infection fatality rate (median 0.23%), clarification of high-risk groups (specifically, those 70 years of age and older), lower herd immunity thresholds (likely 20–40% population immunity), and the difficult exit strategies. In addition, information emerged on significant collateral damage due to the response to the pandemic, adversely affecting many millions of people with poverty, food insecurity, loneliness, unemployment, school closures, and interrupted healthcare. Raw numbers of COVID-19 cases and deaths were difficult to interpret, and may be tempered by information placing the number of COVID-19 deaths in proper context and perspective relative to background rates. Considering this information, a cost-benefit analysis of the response to COVID-19 finds that lockdowns are far more harmful to public health (at least 5–10 times so in terms of wellbeing years) than COVID-19 can be. Controversies and objections about the main points made are considered and addressed. Progress in the response to COVID-19 depends on considering the trade-offs discussed here that determine the wellbeing of populations. I close with some suggestions for moving forward, including focused protection of those truly at high risk, opening of schools, and building back better with a economy.

scholarly journals Prevalence and unmet need for diabetes care across the care continuum in a national sample of South African adults: Evidence from the SANHANES-1, 2011-2012

PLoS ONE ◽  
2017 ◽  
Vol 12 (10) ◽  
pp. e0184264 ◽  
Author(s):  
Andrew Stokes ◽  
Kaitlyn M. Berry ◽  
Zandile Mchiza ◽  
Whadi-ah Parker ◽  
Demetre Labadarios ◽  
...  
Keyword(s):  
South African ◽  
Diabetes Care ◽  
Unmet Need ◽  
National Sample ◽  
Care Continuum

PDAs as Mobile-Based Health Information Deployment Platforms for Ambulatory Care

2008 ◽  
pp. 1022-1039
Author(s):  
Jason Sargent ◽  
Carole Alcock ◽  
Lois Burgess ◽  
Joan Cooper ◽  
Damian Ryan
Keyword(s):  
Ambulatory Care ◽  
Health Information ◽  
Point Of Care ◽  
Care Service ◽  
Development Project ◽  
Personal Digital Assistants ◽  
End User ◽  
Care Systems ◽  
A Current

This chapter discusses the broad theme of clinician-centric end-user acceptance toward the adoption of personal digital assistants (PDAs) as mobile-based health information deployment platforms within ambulatory care service settings. Personal digital assistants, ambulatory care, and point of care are defined and the interrelatedness of each discussed. Issues, controversies, and problems such as mapping existing workflows, security, and change management are identified, and solutions are suggested for the process of transforming predominantly paper-based ambulatory care systems into electronic point-of-care (ePOC) systems. A current research and development project, the ePOC PDA project, is used as a case study to highlight discussion points. The purpose of this chapter is to illustrate end-user implications and considerations when introducing ePOC systems into ambulatory care service settings and highlight ways and means of improving future levels of acceptance and support of ePOC systems for clinician end users.

scholarly journals Association between Continuity of Care and the Onset of Thyroid Disorder among Diabetes Patients in Korea

2019 ◽  
Vol 16 (2) ◽  
pp. 233
Author(s):  
Sang Lee ◽  
Sung-Youn Chun ◽  
Woorim Kim ◽  
Yeong Ju ◽  
Dong-Woo Choi ◽  
...  
Keyword(s):  
Continuity Of Care ◽  
Thyroid Dysfunction ◽  
National Sample ◽  
Thyroid Disorder ◽  
Final Study ◽  
Increased Risk ◽  
Cox Proportional Hazard Regression ◽  
Diagnosed Diabetes ◽  
Newly Diagnosed Diabetes ◽  
Diabetes Patients

Objectives: As the relationship between diabetes mellitus and thyroid dysfunction is well known, it is important to investigate the factors influencing this association. Continuity of care is associated with better quality of care and outcomes, such as reduced complications, among diabetes patients. Therefore, the purpose of this study was to investigate the association between continuity of care and the onset of thyroid dysfunction among diabetes patients. Methods: We used Korean National Health Insurance Service National Sample Cohort data from 2002 to 2013. Our final study population included 16,806 newly diagnosed diabetes patients who were older than 45 years of age. Continuity of care was measured using the Continuity of Care index. The dependent variable was the onset of thyroid disorder. Cox proportional hazard regression models were used for statistical analyses. Results: Diabetes patients with low continuity of care were at increased risk of the onset of thyroid disorder compared with those with high continuity of care (hazard ratio (HR): 1.28, 95% confidence interval (CI): 1.07–1.54). Subgroup analyses showed that this association was significant within patients with type 2 diabetes (HR: 1.24, 95% CI: 1.01–1.52) or whose main attending site was a local clinic (HR: 1.32, 95% CI: 1.07–1.64). Conclusions: Our results show that diabetes patients with low continuity of care are more likely to experience the onset of thyroid disorder. Therefore, improving continuity of care could be a reasonable method of preventing complications or comorbidities, including thyroid disorder, among diabetes patients.

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