Primary Care and Health Outcomes among Older Patients with Diabetes

PurposeThis is an ongoing prospective cohort aiming to examine the biopsychosocial health profiles and predictors of health outcomes of older patients with multimorbidity in primary care in Hong Kong.ParticipantsFrom April 2016 to October 2017, 1077 patients aged 60+ years with at least two chronic diseases were recruited in four public primary care clinics in the New Territories East Region of Hong Kong.Findings to dateAfter weighting, the patients had 4.1 (1.8) chronic conditions and 2.5 (1.9) medications on average; 37% forgot taking medication sometimes; 71% rated their health as fair or poor; 17% were frail; 73% reported one (21%) or two or more (52%) body pain areas; 62% were overweight/obese; 23% reported chewing difficulty, 18% reported incontinence; 36% had current stage 1/2 hypertension; 38% had handgrip strength below the cut-off; 10% screened positive in sarcopenia; 17% had mild or severer cognitive impairment; 17% had mild to severe depression; 16% had mild to severe anxiety; 50% had subthreshold to severe insomnia; 28% indicated being lonely; 12% needed help in at least one out of the five daily functions and the EuroQoL-5-Dimensions-5-Level index score was 0.81 (0.20) and its Visual Analogue Scale (VAS) score was 67.6 (14.6). In the past 12 months, 17% were hospitalised, 92% attended general outpatient clinics, 70% attended specialist outpatient clinics and 10% used elderly daycare centre services, the median out-of-pocket health cost was HK$1000 (US$150). Female and male patients showed significant differences in many biopsychosocial health aspects.Future plansWith assessments and clinical data, the cohort can be used for understanding longitudinal trajectories of biopsychosocial health profiles of Chinese older patients with multimorbidity in primary care. We are also initially planning cohort studies on factors associated with various health outcomes, as well as quality of life and healthcare use.Cohort registration numberChiCTR-OIC-16008477

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Occupational Therapy in Primary Care -- Barriers, Pivots, and Outcomes: A pilot study

Internet Journal of Allied Health Sciences and Practice ◽

10.46743/1540-580x/2021.1982 ◽

2021 ◽

Author(s):

Sue Dahl-Popolizio ◽

Gretchen Anne Roman ◽

Felicia Trembath ◽

Bradley Doebbeling ◽

Alyssa Concha-Chavez

Keyword(s):

Primary Care ◽

Chronic Disease ◽

Health Behaviors ◽

Health Outcomes ◽

Lifestyle Modification ◽

Care Team ◽

Primary Care Team ◽

Interprofessional Team ◽

Patients With Diabetes ◽

Lifestyle Modification Program

Purpose: Habits, roles, and routines are important behaviors that affect lifestyle and can lead to the development of chronic disease such as diabetes mellitus. Primary care physicians (PCPs) have limited time, suggesting an interprofessional team approach would be beneficial in helping patients modify behaviors for the prevention and treatment of chronic disease. Occupational therapists (OTs) specialize in addressing health behaviors, and literature supports including OTs on the primary care team to improve the self-management techniques of patients with chronic disease. This study was guided by Lifestyle Redesign®, an evidence-based program that addresses the health behaviors of patients with diabetes in primary care. We aimed to improve health outcomes by combining an OT-led lifestyle modification program with patient-centered treatment recommendations from an external interprofessional team. We hypothesized that the health outcomes of patients with diabetes in primary care would improve after participating in an OT-led interprofessional lifestyle modification program, and that reimbursement for services would be obtainable. Method: Two PCPs in community practice initially agreed to involve an OT on their primary care team. Due to reimbursement concerns, the PCPs later preferred to refer patients to receive the OT-led intervention at an offsite clinic, rather than onsite at the primary care practice. Health outcomes were measured pre- and post-intervention using industry standard assessments and biometrics. Descriptive and non-parametric statistics were used to evaluate change. Results: Thirty-one patients with diabetes were referred, and three (9.7%) participated in the offsite lifestyle modification program. While statistical significance was not achieved (p≥0.10), trends toward individual improvement were noted for occupational performance and satisfaction and empowerment, and reimbursement was received from the third-party payers. Conclusions: Patient participation in this study was consistent with participation rates for offsite behavioral health referrals. An offsite OT-led interprofessional lifestyle modification program demonstrated potential for meaningful change and services were reimbursed. These findings support practice redesign efforts to include OTs as part of an integrated primary care model. Offering onsite services will increase patient accessibility to care and improve referral completion rates, thus providing OTs the opportunity to further demonstrate the efficacy of delivering chronic disease management in primary care.

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Division of Primary Care Services Between Physicians, Physician Assistants, and Nurse Practitioners for Older Patients With Diabetes

Medical Care Research and Review ◽

10.1177/1077558713495453 ◽

2013 ◽

Vol 70 (5) ◽

pp. 531-541 ◽

Cited By ~ 24

Author(s):

Christine M. Everett ◽

Carolyn T. Thorpe ◽

Mari Palta ◽

Pascale Carayon ◽

Valerie J. Gilchrist ◽

...

Keyword(s):

Primary Care ◽

Nurse Practitioners ◽

Older Patients ◽

Physician Assistants ◽

Care Services ◽

Primary Care Services ◽

Patients With Diabetes

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System Redesign: The Value of a Primary Care Liaison Model to Address Unmet Social Needs among Older Primary Care Patients

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182111135 ◽

2021 ◽

Vol 18 (21) ◽

pp. 11135

Author(s):

Jungyoon Kim ◽

Valerie Pacino ◽

Hongmei Wang ◽

April Recher ◽

Isha Jain ◽

...

Keyword(s):

Primary Care ◽

Health Outcomes ◽

Older Patients ◽

Unmet Needs ◽

Social Needs ◽

Care Staff ◽

Care Hospital ◽

Patient Counseling ◽

Caregiver Support ◽

Primary Care Staff

Assessing and addressing social determinants of health can improve health outcomes of older adults. The Nebraska Geriatrics Workforce Enhancement Program implemented a primary care liaison (PCL) model of care, including training primary care staff to assess and address unmet social needs, patient counseling to identify unmet needs, and mapping referral services through cross-sectoral partnerships. A PCL worked with three patient-centered medical homes (PCMHs) that are part of a large integrative health system. A mixed-methods approach using a post-training survey and a patient tracking tool, was used to understand the reach, adoption, and implementation of the PCL model. From June 2020 to May 2021, the PCL trained 61 primary care staff to assess and address unmet social needs of older patients. A total of 327 patients, aged 65 years and older and within 3–5 days of acute-care hospital discharges, were counseled by the PCL. For patients with unmet needs, support services were arranged through community agencies: transportation (37%), in-home care (33%), food (16%), caregiver support (2%), legal (16%), and other (16%). Our preliminary results suggest that the PCL model is feasible and implementable within PCMH settings to address unmet social needs of older patients to improve their health outcomes.

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Primary Care Provider Encounter Cadence and HbA1c Control in Older Patients With Diabetes

American Journal of Preventive Medicine ◽

10.1016/j.amepre.2019.04.018 ◽

2019 ◽

Vol 57 (4) ◽

pp. e95-e101

Author(s):

Jessica M. Dobbins ◽

Sarah Wixson Elliott ◽

Tristan Cordier ◽

Gil Haugh ◽

Andrew Renda ◽

...

Keyword(s):

Primary Care ◽

Care Provider ◽

Primary Care Provider ◽

Older Patients ◽

Patients With Diabetes ◽

Hba1c Control

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Effect of a general practitioner management plan on health outcomes and hospitalisations in older patients with diabetes

Internal Medicine Journal ◽

10.1111/imj.13286 ◽

2016 ◽

Vol 46 (12) ◽

pp. 1430-1436 ◽

Cited By ~ 6

Author(s):

G. E. Caughey ◽

A. I. Vitry ◽

E. N. Ramsay ◽

A. L. Gilbert ◽

S. Shakib ◽

...

Keyword(s):

General Practitioner ◽

Health Outcomes ◽

Older Patients ◽

Management Plan ◽

Patients With Diabetes

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Primary Care for Older Patients Will Get Scarcer

Internal Medicine News ◽

10.1016/s1097-8690(08)70999-5 ◽

2008 ◽

Vol 41 (17) ◽

pp. 45

Author(s):

JOYCE FRIEDEN

Keyword(s):

Primary Care ◽

Older Patients

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Frailty and Health Care Utilization among Community-Dwelling Older Patients with Diabetes Mellitus

Diabetes ◽

10.2337/db18-1468-p ◽

2018 ◽

Vol 67 (Supplement 1) ◽

pp. 1468-P

Author(s):

SHIVANI PRIYADARSHNI ◽

SRUTHI NELLURI ◽

ZUBAIR RAHAMAN ◽

MICHAEL J. MINTZER ◽

STUTI DANG ◽

...

Keyword(s):

Diabetes Mellitus ◽

Health Care ◽

Health Care Utilization ◽

Older Patients ◽

Community Dwelling ◽

Care Utilization ◽

Patients With Diabetes

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Preventative health screening community events, a mechanism to target minority ethnic populations in improving primary care utilisation to improve health outcomes

British Journal of General Practice ◽

10.3399/bjgp20x711005 ◽

2020 ◽

Vol 70 (suppl 1) ◽

pp. bjgp20X711005

Author(s):

Raza Naqvi ◽

Octavia Gale

Keyword(s):

Primary Care ◽

Health Care ◽

Health Outcomes ◽

Ethnic Minority ◽

Access To Health Care ◽

Health Screening ◽

Service Utilisation ◽

Community Based ◽

Access To Health ◽

Minority Ethnic

BackgroundPreventative medicine has become a central focus in primary care provision, with greater emphasis on education and access to health care screening. The Department of Health reports existing health inequalities and inequalities in access within ethnic minority groups. Studies assessing the value of community engagement in primary care have reported variable outcomes in term of subsequent service utilisation.AimTo consider the benefit of community-based health screening checks to improve access and health outcomes in minority ethnic groups.MethodAn open community health screening event (n = 43), to allow targeted screening within an ethnic minority population. Screening included BP, BMI, BM and cholesterol. Results were interpreted by a healthcare professional and counselling was provided regarding relevant risk factors. Post-event feedback was gathered to collate participant opinion and views.ResultsSeventy-nine per cent of participants were from ethnic minority backgrounds: 64% were overweight or obese and 53% of participants were referred to primary care for urgent review following abnormal findings. All those referred would not have accessed healthcare without the event referral. All (100%) participants believed it improved health education and access to health care.ConclusionThis study clearly demonstrates the value of targeted community-led screening and education events in public health promotion. There was a significant benefit in providing community-based screening. There is a need for a longitudinal analysis to determine the impact on health outcomes and long-term access to healthcare provision.

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