Computerized Monitoring Protocols as a Pharmaceutical Care Practice Enhancement: A Conceptual Illustration Using Diabetes Mellitus

1993 ◽  
Vol 27 (7-8) ◽  
pp. 963-966
Author(s):  
Alan F. Boyd ◽  
Abraham G. Hartzema
Keyword(s):  
Diabetes Mellitus ◽  
Medical Care ◽  
Computer System ◽  
Patient Outcomes ◽  
Chronically Ill ◽  
Care Practice ◽  
Medline Search ◽  
Medical Interventions ◽  
Routine Medical Care ◽  
Monitoring Protocols

OBJECTIVE: To illustrate how a computer system used in an ambulatory care pharmacy setting might enhance care of patients with diabetes by prospectively monitoring and prompting them to seek routine medical care. DATA SOURCES: A MEDLINE search to identify existing works on informatics was conducted. An epidemiology and general medical literature review of diabetes mellitus was also performed via MEDLINE. Additionally, known textbooks on the disease were consulted. CONCLUSIONS: Programming a computer system to prompt pharmacists to remind their patients of necessary medical interventions could save medical resources by warning chronically ill patients not to ignore routine medical care. Also, this would allow the pharmacist to prospectively monitor patient outcomes. By knowing when medical interventions are due and obtaining feedback from patients on the results of the medical contact, pharmacists increase their knowledge about patient outcomes and the rationale behind changes in pharmacotherapy. It is expected that such a system would prevent the inconspicuous development of chronic complications.

scholarly journals Effectiveness of a nutrition education package on glycaemic control among children with type 1 diabetes mellitus aged 3-14 years in Uganda: study protocol for a cluster-randomized trial

2020 ◽  
Author(s):  
NICHOLAS BARI NDAHURA ◽  
JUDITH MUNGA ◽  
JUDITH KIMIYWE ◽  
EZEKIEL MUPERE
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Glycaemic Control ◽  
Medical Care ◽  
Type 1 Diabetes Mellitus ◽  
Nutrition Education ◽  
Control Group ◽  
Routine Medical Care ◽  
Level Of Knowledge

Introduction: Inadequate dietary management practices among children with type 1 diabetes mellitus (T1DM) often result in preventable complications, disability, and premature deaths, and yet strict glycaemic control can help reduce the long-term complications. Furthermore, parental caregiving has also been shown to have an impact on glycaemic control and yet often a gap exists between recommended care and provided care, resulting in failure of children with T1DM meeting their treatment targets. In Uganda, no published study has been conducted to find out if nutrition education has an effect on glycaemic control and caregivers level of knowledge on general and diabetes-specific nutrition for children with T1DM. Methods: The study will be a cluster randomised controlled trial with 10 health facilities randomised to control or intervention at a ratio of 1:1. A total of 100 caregiver-child pairs will be recruited. The participants in the control group will continue to receive routine medical care, while those in the intervention group will receive routine medical care and a nutrition education package. The primary outcome is glycated hemoglobin (HbA1c) values. Secondary outcomes will be caregivers level of knowledge on general and diabetes-specific nutrition knowledge, childrens dietary diversity score and childrens mean intake of energy, protein, and fat. Discussion: The findings of this study will be used in improving nutrition education in T1DM among children attending diabetes clinics in Uganda. Trial registration number: The trial is registered with The Pan African Clinical Trials Registry (PACTR201902548129842).

scholarly journals Perception of Life-Control Is Associated With Medical Care Satisfaction in Chronically Ill Rural Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 449-449
Author(s):  
Anne Halli-Tierney ◽  
Hyunjin Noh ◽  
Lewis Lee
Keyword(s):  
Older Adults ◽  
Medical Care ◽  
Chronic Conditions ◽  
Chronically Ill ◽  
Medical Intervention ◽  
Chronic Illnesses ◽  
Medical Interventions ◽  
Bivariate Correlation ◽  
Care Satisfaction ◽  
Life Circumstances

Abstract Prior studies show patient populations have varied experiences with healthcare systems, and this may influence satisfaction with medical care. Patients feeling control over life circumstances may have resilience and ability to adapt to adverse situations. Given socioeconomic and medical differences in older adults we examined factors influencing satisfaction with medical care in the setting of chronic conditions and pain. 100 older adults in rural West Alabama with chronic illnesses and pain were recruited from community senior centers and interviewed with a structured questionnaire. Participants were queried about medical interventions for chronic conditions and satisfaction with medical care. Overall assessment of life-control was measured by the West Haven Yale Multidimensional Pain Index (WHYMPI). Bivariate correlation and multivariate analysis were conducted. Correlations between satisfaction with medical intervention and life-control scores were significantly positive (r=.21, p<.05). Satisfaction with medical intervention and other covariates explained approximately 14.1% variance in life-control scores, R2=.141. Multivariate regression results confirmed those highly satisfied with medical intervention were marginally significantly likely to have increased life-control scores, b=.20, SE=.12, p=.088. Married persons were more likely to have higher life-control scores than those with other marital statuses, b=.84, SE=.34, p<.05. Income was positively associated with life-control scores, b=.18, SE=.08, p<.05. Older adults may perceive greater satisfaction from medical care if they feel greater control over life circumstances. Socioeconomic factors (marital status, income) are associated with life control. These findings can help predict satisfaction with healthcare and find ways to make healthcare more accessible to all.

scholarly journals Endocrinology in the time of COVID-19: Management of pituitary tumours

2020 ◽  
Vol 183 (1) ◽  
pp. G17-G23 ◽  
Author(s):  
Maria Fleseriu ◽  
Olaf M Dekkers ◽  
Niki Karavitaki
Keyword(s):  
Diabetes Mellitus ◽  
Cardiovascular Disease ◽  
Patient Outcomes ◽  
Multidisciplinary Care ◽  
Pituitary Tumours ◽  
Delivery Of Care ◽  
Routine Medical Care ◽  
The Times ◽  
Management Challenge ◽  
Regular Review

Patients with pituitary tumours, ensuing hormonal abnormalities and mass effects are usually followed in multidisciplinary pituitary clinics and can represent a management challenge even during the times of non-pandemic. The COVID-19 pandemic has put on hold routine medical care for hundreds of millions of patients around the globe, while many pituitary patients’ evaluations cannot be delayed for too long. Furthermore, the majority of patients with pituitary tumours have co-morbidities potentially impacting the course and management of COVID-19 (e.g. hypopituitarism, diabetes mellitus, hypertension, obesity and cardiovascular disease). Here, we summarize some of the diagnostic and management dilemmas encountered, and provide guidance on safe and as effective as possible delivery of care in the COVID-19 era. We also attempt to address how pituitary services should be remodelled in the event of similar crises, while maintaining or even improving patient outcomes. Regular review of these recommendations and further adjustments are needed, depending on the evolution of the COVID-19 pandemic status. We consider that the utilization of successful models of pituitary multidisciplinary care implemented during the COVID-19 pandemic should continue after the crisis is over by using the valuable and exceptional experience gained during these challenging times.

Evaluation of medical care for Diabetic and Hypertensive patients in primary care in Mexico: Observational retrospective study (Preprint)

2020 ◽  
Author(s):  
Agustin Lara-Esqueda ◽  
Sergio A Zaizar-Fregoso ◽  
Violeta M Madrigal-Perez ◽  
Mario Ramirez-Flores ◽  
Daniel A Montes-Galindo ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Medical Care ◽  
Serum Lipids ◽  
Quality Care ◽  
Premature Death ◽  
Current Standard ◽  
Anonymized Data ◽  
Quality Of Medical Care

BACKGROUND Diabetes Mellitus is a worldwide health problem and the leading cause of premature death with increasing prevalence over time. Usually, along with it, Hypertension presents and acts as another risk factor that increases mortality risk. Both diseases impact the country's health while also producing an economic burden for society, causing billions of dollars to be invested in their management. OBJECTIVE The present study evaluated the quality of medical care for patients diagnosed with diabetes mellitus (DM), hypertension (HBP), and both pathologies (DM+HBP) within a public health system in Mexico, according to the official Mexican standard for each pathology. METHODS 45,498 patients were included from 2012 to 2015. All information was taken from the electronic medical records database, exported as anonymized data for research purposes. Each patient record was compared against the standard to test the quality of medical care. RESULTS Glycemia with hypertension goals reached 29.6% in DM+HBP, 48.6% in DM, and 53.2% in HBP. The goals of serum lipids were reached by 3% in DM+HBP, 5% in DM, and 0.2% in HBP. Glycemia, hypertension, and LDL cholesterol reached 0.04%. 15% of patients had an undiagnosed disease of diabetes or hypertension. Clinical follow-up examinations reached 20% for foot examination and clinical eye examination in the whole population. Specialty referral reached 1% in angiology or cardiology in the whole population. CONCLUSIONS Goals for glycemic and hypertension reached 50% in the overall population, while serum lipids, clinical follow-up examinations, and referral to a specialist were deficient. Patients who had both diseases had more consultations, better control for hypertension and lipids, but inferior glycemic control. Overall, quality care for DM and/or HBP has not been met according to the standards. While patients with DM and HBP do not have a current standard to evaluate their own needs.

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