scholarly journals Impact of a Pharmacist-Led Diabetes Management Intervention to Improve Health Equity

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 238-238
Author(s):  
Renae Smith-Ray ◽  
Tanya Singh ◽  
Evie Makris ◽  
Jaime Horan ◽  
Michael Taitel
Keyword(s):  
Medication Adherence ◽  
Health Equity ◽  
Diabetes Management ◽  
Multiple Chronic Conditions ◽  
Intervention Period ◽  
Management Intervention ◽  
Patients With Diabetes ◽  
Hispanic Patients ◽  
Block Level ◽  
Post Test

Abstract The COVID-19 pandemic and Black Lives Matter movement brought increased recognition to the need for health equity. Diabetes, the 7th leading cause of death, is one of many conditions where health inequities are evident. A higher percentage of Black (11.7%) and Hispanic (12.5%) U.S. adults are diagnosed with diabetes compared to non-Hispanic Whites (7.5%). To address this health inequity, a nationwide pharmacy chain implemented telephonic ‘Advanced Care’ (AC) outreach for patients with diabetes. During the AC call, pharmacists used motivational interviewing techniques to counsel patients on the importance of closing gaps in care and reducing barriers to medication adherence. Gaps included timely A1C testing, exams (eye, foot, kidney), immunizations (influenza, pneumonia, Hepatitis B), and recommendation of additional therapies for patients with multiple chronic conditions (ACE/ARB, statins). Medication fill gaps were compared between the Intervention period (8/1/20-1/31/-21) and a pre-intervention period (2/1/20-7/31/20). The AC pilot occurred in 8 Chicago Walgreens locations that primarily serve Black and Hispanic patients. Eight control stores were matched on census block-level household income and race/ethnicity, patient volume, and insurance mix. A pre/post-test vs. control difference-in-difference (DID) analysis was conducted to compare on-time refill rates. Of the 1,009 older patients (age≥50) called, 59.9% were reached. The DID analysis showed that patients in pilot stores had improved pre-post on-time refill rates compared to controls (p<0.0001). Diabetes self-management is key to reducing diabetes-related complications. Early findings from this pilot demonstrate that the Walgreens AC intervention improves medication adherence - an important step toward improving health equity.

Abstract MP62: The Role of Primary Care Physician Visits in Promoting Medication Adherence as Part of a Randomized Controlled Diabetes Management Intervention in American Samoa

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Smriti Shivpuri ◽  
Shira Dunsiger ◽  
Andrew D Seiden ◽  
Rochelle K Rosen ◽  
Judith D DePue ◽  
...  
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Medication Adherence ◽  
Health Behaviors ◽  
Diabetes Management ◽  
American Samoa ◽  
Care Physician ◽  
Management Intervention ◽  
Randomized Controlled ◽  
The Us

Background: The Native Hawaiian/Pacific Islander group is one of the fastest growing US ethnic groups, and Samoans make up the second largest Pacific Islander group in the US. Samoans are at a disproportionately high risk of type 2 diabetes mellitus (T2DM) and other cardiovascular disease risk factors, with prevalence rates of T2DM in adults in the US Territory of American Samoa around 20%, nearly double that of US Hispanics. A randomized, controlled trial of a community health worker (CHW)-facilitated diabetes management intervention in American Samoans with T2DM showed improved HbA1c levels in part through promoting health behaviors associated with diabetes management, including diet, physical activity, and most strongly, medication adherence. The current study sought to examine a potential intermediate variable through which the CHW intervention influenced health behaviors, in particular, whether the CHW intervention resulted in more frequent primary care physician (PCP) visits, which in turn, were associated with increased engagement in health behaviors. We also examined if relationships differed by baseline PCP utilization. Methods: Participants were 266 Samoan adults diagnosed with T2DM, randomized to the CHW intervention or wait-list control condition. Participants were additionally classified as meeting American Diabetes Association guidelines for PCP utilization at baseline (i.e., ≥4 PCP visits in the year prior to the intervention, “high utilizers”) or not (“low utilizers”). Regression models were used to examine the association between treatment assigned and frequency of PCP utilization, and whether PCP utilization was associated with the probability of engaging in diabetes management health behaviors (at least moderate intensity physical activity, healthy diet, medication adherence). Results: After adjustment for covariates including age, gender, and comorbidities, results indicate that CHW participants had greater rates of PCP visits over the intervention period, but only amongst low utilizers (RR = 1.94, 95% CI= 1.27, 2.97). A greater number of PCP visits, in turn, was associated with a higher odds of medication adherence (but not diet or physical activity), only amongst low utilizers (OR = 1.40, 95% CI= 1.12, 1.74). Conclusions: Results suggest that a CHW-facilitated diabetes intervention in the Samoan population may have promoted diabetes medication adherence (which has previously been associated with lower HbA1c in this cohort) by increasing the frequency with which participants encountered and interacted with their PCPs, specifically those participants in greatest need (i.e., those who had fewer PCP visits than recommended at baseline). Future research should further examine how increasing engagement with PCPs can serve as a mechanism through which to elicit behavior change in diabetic minority populations at high risk for cardiovascular disease.

Effects of wearable technology on patients with diabetes: A systematic review and meta-analysis (Preprint)

2020 ◽  
Author(s):  
Dongjun Wu ◽  
Nicholas Buys ◽  
Guandong Xu ◽  
Jing Sun
Keyword(s):  
Systematic Review ◽  
Blood Pressure ◽  
Relapse Prevention ◽  
Diabetes Management ◽  
Meta Analysis ◽  
Intervention Group ◽  
Wearable Technologies ◽  
Patients With Diabetes ◽  
Hba1c Levels

UNSTRUCTURED Aims: This systematic review and meta-analysis aimed to evaluate the effects of wearable technologies on HbA1c, blood pressure, body mass index (BMI), and fastening blood glucose (FBG) in patients with diabetes. Methods: We searched PubMed, Scopus, Embase, the Cochrane database, and the Chinese CNKI database from last 15 years until August 2021. The quality of the 16 included studies was assessed using the PEDro scale, and random effect models were used to estimate outcomes, with I2 used for heterogeneity testing. Results: A significant reduction in HbA1c (-0.475% [95% CI -0.692 to -0.257, P<0.001]) was found following telemonitoring. However, the results of the meta-analysis did not show significant changes in blood pressure, BMI, and glucose, in the intervention group (P>0.05), although the effect size for systolic blood pressure (0.389) and diastolic blood pressure may indicate a significant effect. Subgroup analysis revealed statistically significant effects of wearable technologies on HbA1c when supported by dietetic interventions (P<0.001), medication monitoring (P<0.001), and relapse prevention (P<0.001). Online messages and telephone interventions significantly affected HbA1c levels (P<0.001). Trials with additional online face-to-face interventions showed greater reductions in HbA1c levels. Remote interventions including dietetic advice (P<0.001), medication (P<0.001), and relapse prevention (P<0.001) during telemonitoring showed a significant effect on HbA1c, particularly in patients attending ten or more intervention sessions (P<0.001). Conclusion: Wearable technologies can improve diabetes management by simplifying self-monitoring, allowing patients to upload their live measurement results frequently and thereby improving the quality of telemedicine. Wearable technologies also facilitate remote medication management, dietetic interventions, and relapse prevention.

scholarly journals Diabetes and Frail Older Patients: Glycemic Control and Prescription Profile in Real Life

Pharmacy ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 115
Author(s):  
Anne-Sophie Mangé ◽  
Arnaud Pagès ◽  
Sandrine Sourdet ◽  
Philippe Cestac ◽  
Cécile McCambridge
Keyword(s):  
Glycemic Control ◽  
Older Patients ◽  
Diabetes Management ◽  
Real Life ◽  
Cross Sectional ◽  
Glucose Lowering ◽  
Frailty Status ◽  
Frail Patients ◽  
Patients With Diabetes ◽  
Hba1c Target

(1) Background: The latest recommendations for diabetes management adapt the objectives of glycemic control to the frailty profile in older patients. The purpose of this study was to evaluate the proportion of older patients with diabetes whose treatment deviates from the recommendations. (2) Methods: This cross-sectional observational study was conducted in older adults with known diabetes who underwent an outpatient frailty assessment in 2016. Glycated hemoglobin (HbA1c) target is between 6% and 7% for nonfrail patients and between 7% and 8% for frail patients. Frailty was evaluated using the Fried criteria. Prescriptions of glucose-lowering drugs were analyzed based on explicit and implicit criteria. (3) Results: Of 110 people with diabetes with an average age of 81.7 years, 67.3% were frail. They had a mean HbA1c of 7.11%. Of these patients, 60.9% had at least one drug therapy problem in their diabetes management and 40.9% were potentially overtreated. The HbA1c distribution in relation to the targets varied depending on frailty status (p < 0.002), with overly strict control in frail patients (p < 0.001). (4) Conclusions: Glycemic control does not seem to be routinely adjusted to the health of frail patients. Several factors can lead to overtreatment of these patients.

scholarly journals 83 A Medication Self-Management Intervention to Improve Medication Adherence For Older People with Multimorbidity: A Pilot Study

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
C Yang ◽  
Z Hui ◽  
S Zhu ◽  
X Wang ◽  
G Tang ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Pilot Study ◽  
Older People ◽  
Intervention Group ◽  
Self Management ◽  
Control Group ◽  
Medication Knowledge ◽  
Management Intervention ◽  
Patient Reported

Abstract Introduction Medication self-management support has been recognised as an essential element in primary health care to promote medication adherence and health outcomes for older people with chronic conditions. A patient-centred intervention empowering patients and supporting medication self-management activities could benefit older people. This pilot study tested a newly developed medication self-management intervention for improving medication adherence among older people with multimorbidity. Method This was a two-arm randomised controlled trial. Older people with multimorbidity were recruited from a community healthcare centre in Changsha, China. Participants were randomly allocated to either a control group receiving usual care (n = 14), or to an intervention group receiving three face-to-face medication self-management sessions and two follow-up phone calls over six weeks, targeting behavioural determinants of adherence from the Information-Motivation-Behavioural skills model (n = 14). Feasibility was assessed through recruitment and retention rates, outcome measures collection, and intervention implementation. Follow-up data were measured at six weeks after baseline using patient-reported outcomes including medication adherence, medication self-management capabilities, treatment experiences, and quality of life. Preliminary effectiveness of the intervention was explored using generalised estimating equations. Results Of the 72 approached participants, 28 (38.89%) were eligible for study participation. In the intervention group, 13 participants (92.86%) completed follow-up and 10 (71.42%) completed all intervention sessions. Ten participants (71.42%) in the control group completed follow-up. The intervention was found to be acceptable by participants and the intervention nurse. Comparing with the control group, participants in the intervention group showed significant improvements in medication adherence (β = 0.26, 95%CI 0.12, 0.40, P &lt; 0.001), medication knowledge (β = 4.43, 95%CI 1.11, 7.75, P = 0.009), and perceived necessity of medications (β = −2.84, 95%CI -5.67, −0.01, P = 0.049) at follow-up. Conclusions The nurse-led medication self-management intervention is feasible and acceptable among older people with multimorbidity. Preliminary results showed that the intervention may improve patients’ medication knowledge and beliefs and thus lead to improved adherence.

scholarly journals THE ROLE OF HEALTH LITERACY ON PROCESS AND OUTCOMES OF A DIABETES SELF-HELP INTERVENTION WITH KOREAN AMERICANS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S406-S406
Author(s):  
Miyong T Kim
Keyword(s):  
Health Literacy ◽  
Glucose Control ◽  
Self Efficacy ◽  
Diabetes Management ◽  
Self Care ◽  
Korean Americans ◽  
Target Population ◽  
Management Intervention ◽  
Underlying Mechanisms

Abstract The purpose of this study was to explicate the underlying mechanisms of the role of health literacy (HL) in diabetes management process involving a group of Korean Americans with type 2 diabetes mellitus (DM). We used data from a randomized clinical trial of an HL-focused diabetes self-management intervention (n = 250). A series of path analyses identified the level of self-efficacy and self-care skills as a significant mediator between HL and glucose control (HbA1C) and quality of life for the target population. In addition, education and acculturation were revealed as the most significant correlates of HL for this new immigrant group. Despite inconsistent empirical findings regarding the statistically significant effect of HL on glucose control, this study confirmed the apriority hypothesis that HL indirectly influences health outcome through mediators such self-care skills as self-efficacy. This study highlighted the importance of HL in chronic disease management for people with limited HL.

A Smartphone-Based Self-Management Intervention for Individuals with Bipolar Disorder (LiveWell): User Experiences of the Intervention Change Process (Preprint)

2021 ◽  
Author(s):  
Geneva Kay Jonathan ◽  
Cynthia A Dopke ◽  
Tania Michaels ◽  
Clair R Martin ◽  
Chloe Ryan ◽  
...  
Keyword(s):  
Mental Health ◽  
Bipolar Disorder ◽  
Medication Adherence ◽  
Behavior Change ◽  
Intervention Development ◽  
Signs And Symptoms ◽  
Self Management ◽  
Health Technologies ◽  
Management Intervention ◽  
Change Framework

BACKGROUND Bipolar disorder is a severe mental illness characterized by recurrent episodes of depressed, elevated and mixed mood states. Pharmacological management combined with adjunctive psychotherapy can decrease symptoms, lower relapse rates and improve quality of life; however, access to psychotherapy is limited. Mental health technologies such as smartphone applications are being studied as a means to increase access to and enhance the effectiveness of adjunctive psychotherapies for bipolar disorder. These studies have demonstrated that individuals with bipolar disorder find this intervention format acceptable, but our understanding of how people utilize and integrate these tools into their behavior change and maintenance processes remains limited. OBJECTIVE The objective of this study was to explore how individuals with bipolar disorder perceive and utilize a smartphone intervention for health behavior change and maintenance. METHODS Individuals with bipolar disorder participated in a pilot study of LiveWell, a smartphone-based self-management intervention. At the end of the study, all participants completed in-depth qualitative exit interviews. The behavior change framework developed to organize the intervention design was used to deductively code behavioral targets and determinants involved in target engagement and inductive coding was used to identify themes not captured by this framework. RESULTS In terms of behavioral targets, participants emphasized the importance of managing mood episode related signs and symptoms. They also discussed the importance of maintaining regular routines, sleep duration, and medication adherence. In addition, participants emphasized that receiving support from a coach as well as seeking and receiving assistance from family, friends and providers was important for managing behavioral targets and staying well. In terms of determinants, participants stressed the important role of monitoring for their behavior change and maintenance efforts. Participants indicated that monitoring facilitated self-awareness and reflection which they felt was valuable for staying well. Some participants also felt that the intervention facilitated learning information necessary for managing bipolar disorder but others felt that the information provided was too basic. CONCLUSIONS In addition to addressing acceptability, satisfaction, and engagement, person-based design of mental health technologies can be used to understand how people experience the impact of these technologies on their behavior change and maintenance efforts. This understanding may then be used to guide ongoing intervention development. In this study, participants discussed their perceptions that managing signs and symptoms and maintaining regular routines, sleep duration, and medication adherence were important for staying well and that monitoring played an important role in these efforts. These perceptions aligned with the intervention's primary behavioral targets and use of a monitoring tool as a core intervention feature. However, participants also highlighted how the intervention encouraged involving family and friends in their change efforts. While content addressing building and engaging supports was included in the intervention, this was not a primary intervention target. Participant feedback thus indicates that developing additional content and tools to address building and engaging social support may be an important avenue for improving LiveWell. Our findings suggest that using a comprehensive behavior change framework to understand participant perceptions of their behavior change and maintenance efforts may help facilitate ongoing intervention development. CLINICALTRIAL NCT02405117

scholarly journals Do pre-existing diabetes social support or depressive symptoms influence the effectiveness of a diabetes management intervention?

2015 ◽  
Vol 98 (11) ◽  
pp. 1402-1409 ◽  
Author(s):  
Ann-Marie Rosland ◽  
Edith Kieffer ◽  
Michael Spencer ◽  
Brandy Sinco ◽  
Gloria Palmisano ◽  
...  
Keyword(s):  
Social Support ◽  
Depressive Symptoms ◽  
Diabetes Management ◽  
Management Intervention

scholarly journals Online Balint Group Work Versus Pharmacotherapy in Treatment of Coronavirus Anxiety in Healthcare Workers in Iran: A Pilot Randomized Controlled Trial

2021 ◽  
Author(s):  
najmeh shahini ◽  
shakiba gholamzad ◽  
zanireh salimi ◽  
Mansoureh Kiani Dehkordi ◽  
Saeedeh Hajebi Khaniki ◽  
...  
Keyword(s):  
Group Work ◽  
Healthcare Workers ◽  
Controlled Trial ◽  
Intervention Period ◽  
Randomized Controlled ◽  
Resilience Scale ◽  
Significant Difference ◽  
Post Test ◽  
Balint Group ◽  
Pilot Randomized Controlled Trial

Abstract Background: An increase in symptoms of anxiety is already being reported in relation to the COVID-19 pandemic.Objectives: We aimed to compare the effectiveness of Balint group work with pharmacotherapy in coronavirus related anxiety among healthcare workers (HCWs) in Iran.Methods: In This pilot clinical trial, after passing a phone screening procedure by a psychiatrist, subjects were quasi-randomly assigned to Balint (8 sixty-minute online sessions) or pharmacotherapy (Sertraline) groups. Both groups were asked to fill two questionnaires, including the Corona Disease Anxiety Scale (CDAS) and Connor-Davidson resilience scale (CD-RISC), at the beginning and the end of the 4-week intervention period.Results: A total of 45 HCWs enrolled in this study. The results showed a significant difference between the post-test and pre-test scores of both groups in the total scores of anxiety and its subcomponents (p≤0.001). There was no significant difference between the effectiveness of the two interventions on anxiety (p=0.52). Both interventions had a significant effect on the subjects' resilience and its subscales (p≤0.05) except for positive acceptance change. The spiritual influences domain had a significantly higher increase in the pharmacotherapy group (P=0.031).Conclusions: We showed Balint group work maybe can better to pharmacotherapy with Sertraline in management of COVID-19 related anxiety and boosting resilience in healthcare workers.

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