A Bayesian Difference-in-Difference Framework for the Impact of Primary Care Redesign on Diabetes Outcomes

A popular method for estimating a causal treatment effect with observational data is the difference-in-differences model. In this work, we consider an extension of the classical difference-in-differences setting to the hierarchical context in which data cannot be matched at the most granular level. Our motivating example is an application to assess the impact of primary care redesign policy on diabetes outcomes in Minnesota, in which the policy is administered at the clinic level and individual outcomes are not matched from pre- to post-intervention. We propose a Bayesian hierarchical difference-in-differences model, which estimates the policy effect by regressing the treatment on a latent variable representing the mean change in group-level outcome. We present theoretical and empirical results showing a hierarchical difference-in-differences model that fails to adjust for a particular class of confounding variables, biases the policy effect estimate. Using a structured Bayesian spike-and-slab model that leverages the temporal structure of the difference-in-differences context, we propose and implement variable selection approaches that target sets of confounding variables leading to unbiased and efficient estimation of the policy effect. We evaluate the methods’ properties through simulation, and we use them to assess the impact of primary care redesign of clinics in Minnesota on the management of diabetes outcomes from 2008 to 2017.

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The Impact of Pharmacist Care on Diabetes Outcomes in Primary Care Settings: An Umbrella Review of Systematic Reviews

University of the Future: Re-Imagining Research and Higher Education ◽

10.29117/quarfe.2020.0174 ◽

2020 ◽

Author(s):

Sara Hamdi Abdulrhim ◽

Sownd Sankaralingam ◽

Mohamed Izham

Keyword(s):

Primary Care ◽

Usual Care ◽

Systematic Reviews ◽

Diabetes Care ◽

Economic Outcomes ◽

Diabetes Outcomes ◽

Primary Care Settings ◽

Pharmacist Interventions ◽

The Impact ◽

Pharmacist Care

Objective: To systematically review published systematic reviews (SRs) examining the impact of pharmacist interventions in multidisciplinary diabetes care teams on diabetes-related clinical, humanistic, and economic outcomes in primary care settings. Methods: PubMed, EMBASE, Scopus, Database of Abstracts of Reviews of Effects, Cochrane Library, Joanna Briggs Institute (JBI) Database, Google Scholar, and PROSPERO were searched from inception to 2018. Studies published in English evaluating the effect of pharmacist interventions on diabetes outcomes were included. Two independent reviewers were involved in the screening of titles and abstracts, selection of studies, and methodological quality assessment. Results: Seven SRs were included in the study. Three of them included only randomized controlled trials, while the rest involved other study designs. Educational interventions by clinical pharmacists within the healthcare team were the most common types of interventions reported across all SRs. Pharmacist’s interventions compared to usual care resulted in favorable significant improvements in hemoglobin A1c (HbA1c), fasting blood glucose, blood pressure, body mass index, total cholesterol, lowdensity lipoprotein, high-density lipoprotein and triglycerides in more than 50% of the SRs. Improvement in HbA1c was the mostly reported clinical outcome of pharmacist intervention in the literature (reported in six SRs). Pharmacist’s interventions led to significant cost-saving ($8–$85,000 per person per year), cost-utility, and cost-benefit (benefit-to-cost ratio range from 1:1 to 8.5:1) versus usual care. Pharmacist’s interventions improved patients’ quality of life (QoL) in three SRs; however, no conclusion can be drawn due to the use of diverse QoL assessment tools. Conclusion: Most SRs support the benefit of pharmacist care on diabetes-related clinical, humanistic, and economic outcomes in primary care settings. Improvements in diabetes outcomes can significantly reduce the burden of diabetes on the healthcare system. Hence, the incorporation of pharmacists into multidisciplinary diabetes care teams is beneficial and should be strongly considered by clinicians and health policymakers.

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Evaluating the impact of an enhanced primary care diabetes service on diabetes outcomes: A before–after study

Primary Care Diabetes ◽

10.1016/j.pcd.2016.09.005 ◽

2017 ◽

Vol 11 (2) ◽

pp. 171-177 ◽

Cited By ~ 6

Author(s):

S. Seidu ◽

D.H. Bodicoat ◽

M.J. Davies ◽

H. Daly ◽

B. Stribling ◽

...

Keyword(s):

Primary Care ◽

Diabetes Outcomes ◽

The Impact

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The impact of a physician-directed health information technology system on diabetes outcomes in primary care: a pre- and post-implementation study

Journal of Innovation in Health Informatics ◽

10.14236/jhi.v17i3.731 ◽

2009 ◽

Vol 17 (3) ◽

pp. 165-174 ◽

Cited By ~ 2

Author(s):

Jacquelyn Hunt ◽

Joseph Siemienczuk ◽

William Gillanders ◽

Benjamin LeBlanc ◽

Yelena Rozenfeld ◽

...

Keyword(s):

Primary Care ◽

Information Technology ◽

Health Information Technology ◽

Health Information ◽

Implementation Study ◽

Technology System ◽

Diabetes Outcomes ◽

The Impact ◽

Information Technology System

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The impact of pharmacist care on diabetes outcomes in primary care settings: An umbrella review of published systematic reviews

Primary Care Diabetes ◽

10.1016/j.pcd.2019.12.007 ◽

2020 ◽

Vol 14 (5) ◽

pp. 393-400 ◽

Cited By ~ 2

Author(s):

Sara Abdulrhim ◽

Sowndramalingam Sankaralingam ◽

Mohamed Izham Mohamed Ibrahim ◽

Ahmed Awaisu

Keyword(s):

Primary Care ◽

Systematic Reviews ◽

Umbrella Review ◽

Diabetes Outcomes ◽

Primary Care Settings ◽

The Impact ◽

Pharmacist Care

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The Perspective of Older Men With Depression on Suicide and Its Prevention in Primary Care

Crisis ◽

10.1027/0227-5910/a000511 ◽

2018 ◽

Vol 39 (5) ◽

pp. 397-405 ◽

Cited By ~ 3

Author(s):

Steven Vannoy ◽

Mijung Park ◽

Meredith R. Maroney ◽

Jürgen Unützer ◽

Ester Carolina Apesoa-Varano ◽

...

Keyword(s):

Primary Care ◽

Low Socioeconomic Status ◽

Thematic Analysis ◽

Older Men ◽

Primary Care Providers ◽

Depression Treatment ◽

Care Providers ◽

Low Socioeconomic ◽

Self Image ◽

The Impact

Abstract. Background: Suicide rates in older men are higher than in the general population, yet their utilization of mental health services is lower. Aims: This study aimed to describe: (a) what primary care providers (PCPs) can do to prevent late-life suicide, and (b) older men's attitudes toward discussing suicide with a PCP. Method: Thematic analysis of interviews focused on depression and suicide with 77 depressed, low-socioeconomic status, older men of Mexican origin, or US-born non-Hispanic whites recruited from primary care. Results: Several themes inhibiting suicide emerged: it is a problematic solution, due to religious prohibition, conflicts with self-image, the impact on others; and, lack of means/capacity. Three approaches to preventing suicide emerged: talking with them about depression, talking about the impact of their suicide on others, and encouraging them to be active. The vast majority, 98%, were open to such conversations. An unexpected theme spontaneously arose: "What prevents men from acting on suicidal thoughts?" Conclusion: Suicide is rarely discussed in primary care encounters in the context of depression treatment. Our study suggests that older men are likely to be open to discussing suicide with their PCP. We have identified several pragmatic approaches to assist clinicians in reducing older men's distress and preventing suicide.

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