scholarly journals Designing an integrated, nurse-driven and home-based digital intervention to improve insulin management in under-resourced settings

2021 ◽  
Vol 12 ◽  
pp. 204201882110546
Author(s):  
Patrick Ngassa Piotie ◽  
Paola Wood ◽  
Elizabeth M. Webb ◽  
Johannes F.M. Hugo ◽  
Paul Rheeder
Keyword(s):  
South Africa ◽  
Type 2 Diabetes ◽  
Primary Care ◽  
Healthcare Workers ◽  
Digital Health ◽  
Complex Interventions ◽  
Community Healthcare ◽  
Community Healthcare Workers ◽  
Project Intervention

Background: In South Africa, initiating insulin for people with type 2 diabetes and subsequent titration is a major challenge for the resource-constrained healthcare system. Inadequate support systems in primary care, including not being able to access blood glucose monitors and test strips for self-monitoring of blood glucose, results in patients with type 2 diabetes being referred to higher levels of care. In primary care, initiation of insulin may be delayed due to a shortage of healthcare workers. The delayed initiation of insulin is also exacerbated by the reported resistance of both healthcare providers and people with type 2 diabetes to start insulin. In South Africa, telehealth provides an opportunity to overcome these challenges and manage insulin therapy in primary care. Methods: We describe the development of a digital health intervention including the framework used, the theoretical approach and subsequent implementation strategies. Results: This intervention is an innovative, nurse-driven and app-enabled intervention called ‘the Tshwane Insulin Project intervention’. The Tshwane Insulin Project intervention was designed and evaluated using the framework recommended by the Medical Research Council for complex interventions. The Tshwane Insulin Project intervention was developed in four sequential phases: planning, design, implementation and evaluation. The Tshwane Insulin Project intervention followed the Integrated Chronic Disease Management framework to facilitate implementation and acceptability. The Tshwane Insulin Project comprises a facility-level intervention, where nurses evaluate patients and initiate insulin, an individual-level intervention where community healthcare workers visit patients at their homes to follow-up and provide educational information, while using telehealth to enable physician-directed insulin titration if needed, and a community-level intervention aimed at empowering community healthcare workers to support people living with diabetes and raise awareness of diabetes. Conclusion: The technological advancements in digital health and telemedicine present an opportunity to improve diabetes care in resource-limited countries. This work can inform those intending to develop and implement complex interventions in primary healthcare in developing countries.

scholarly journals What are the Experiences and Needs of Primary Care Nurses in Caring for Patients With Type 2 Diabetes in a Rural Village in South Africa? An Exploratory Study

2019 ◽  
Vol 11 (7) ◽  
pp. 90
Author(s):  
Ednah V Sechabe ◽  
Tebogo M Mothiba ◽  
Hilde Bastiaens
Keyword(s):  
South Africa ◽  
Type 2 Diabetes ◽  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Training Programme ◽  
Primary Health ◽  
Primary Care Nurses ◽  
Professional Nurses

Since 1994, the emphasis in the provision of health services in South Africa has shifted from hospital-based care to a community-based comprehensive primary health care system, especially important in the management of chronic diseases. However, primary health care professional nurses are not well trained to manage chronic conditions like type 2 diabetes. Therefore, this study aimed to explore the experiences and needs of primary care nurses as a basis for the development of a training programme for professional nurses who care for T2D patients. A qualitative descriptive approach was employed, using individual interviews with primary health care nurses caring for T2D patients in the Ga-Dikgale village clinics. Ethical considerations were observed throughout the study and quality supportive measures were employed. Three main themes emerged from the study findings which address the current practices and knowledge of professional nurses related to care provided to diabetes patients, the challenges experienced by professional nurses during the provision of care to diabetes patients on treatment and their training experiences, gaps and needs. A need for continuing education for professional nurses related to the care of patients with diabetes was identified. The results of this study will be used to develop a training programme to improve the knowledge and skills of professional nurses and to improve the quality of care of patients with type 2 diabetes.

scholarly journals Community healthcare workers’ satisfaction with ward-based outreach team services in Tshwane district, South Africa

2019 ◽  
Vol 61 (5) ◽  
pp. 172-176
Author(s):  
JV Ndimande ◽  
GA Ogunbanjo ◽  
SN Nyalunga ◽  
A Masango-Makgobela ◽  
T Bongongo
Keyword(s):  
South Africa ◽  
Healthcare Workers ◽  
Community Healthcare ◽  
Outreach Team ◽  
Community Healthcare Workers

scholarly journals Point-of-care HbA1c testing in an urban primary care diabetes clinic in South Africa: a mixed methods feasibility study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e045511
Author(s):  
Jennifer A Hirst ◽  
Kirsten Bobrow ◽  
Andrew Farmer ◽  
Jennie Morgan ◽  
Naomi Levitt
Keyword(s):  
South Africa ◽  
Type 2 Diabetes ◽  
Primary Care ◽  
Decision Making ◽  
Blood Glucose ◽  
Clinical Decision Making ◽  
Point Of Care ◽  
Clinical Decision ◽  
Glucose Testing

IntroductionMonitoring and treatment of type 2 diabetes in South Africa usually takes place in primary care using random blood glucose testing to guide treatment decisions. This study explored the feasibility of using point-of-care haemoglobin A1c (HbA1c) testing in addition to glucose testing in a busy primary care clinic in Cape Town, South Africa.Subjects185 adults aged 19–88 years with type 2 diabetes.Materials and methodsParticipants recruited to this mixed methods cohort study received a point-of-care HbA1c test. Doctors were asked to use the point-of-care HbA1c result for clinical decision-making. Qualitative interviews were held with clinical staff.ResultsPoint-of-care HbA1c test results were obtained for 165 participants of whom 109 (65%) had poor glycaemic control (>8% HbA1c, 64 mmol/mol). Medical officers reported using a combination of HbA1c and blood glucose 77% of the time for clinical decision-making. Nurses found the analyser easy to use and doctors valued having the HbA1c result to help with decision-making.DiscussionOur results suggest that 30% of patients may have received inappropriate medication or not received necessary additional medication if random blood glucose alone had been used in routine appointments. Clinicians valued having access to the HbA1c test result to help them make treatment decisions.

Abstract # P-1: Use of Type 2 Diabetes Screening Guidelines in Primary Care: Concordance Between Physician Survey and Medical Records

2016 ◽  
Vol 22 ◽  
pp. 14
Author(s):  
Michelle Mocarski ◽  
Sandhya Mehta ◽  
Karin Gillespie ◽  
Tami Wisniewski ◽  
K.M. Venkat Narayan ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Medical Records ◽  
Physician Survey ◽  
Diabetes Screening ◽  
Screening Guidelines

scholarly journals Effectiveness of two procedures for deploying a facilitated collaborative modeling implementation strategy—the PVS-PREDIAPS strategy—to optimize type 2 diabetes prevention in primary care: the PREDIAPS cluster randomized hybrid type II implementation trial

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Alvaro Sanchez ◽  
◽  
Susana Pablo ◽  
Arturo Garcia-Alvarez ◽  
Silvia Dominguez ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Diabetes Prevention ◽  
Implementation Strategy ◽  
Type Ii ◽  
Collaborative Process ◽  
Type 2 Diabetes Prevention ◽  
Cluster Randomized ◽  
Implementation Trial

Abstract Background The most efficient procedures to engage and guide healthcare professionals in collaborative processes that seek to optimize practice are unknown. The PREDIAPS project aims to assess the effectiveness and feasibility of different procedures to perform a facilitated interprofessional collaborative process to optimize type 2 diabetes prevention in routine primary care. Methods A type II hybrid cluster randomized implementation trial was conducted in nine primary care centers of the Basque Health Service. All centers received training on effective healthy lifestyle promotion. Headed by a local leader and an external facilitator, centers conducted a collaborative structured process—the PVS-PREDIAPS implementation strategy—to adapt the intervention and its implementation to their specific context. The centers were randomly allocated to one of two groups: one group applied the implementation strategy globally, promoting the cooperation of all health professionals from the beginning, and the other performed it sequentially, centered first on nurses, who later sought the pragmatic cooperation of physicians. The following patients were eligible for inclusion: all those aged ≥ 30 years old with at least one known cardiovascular risk factor and an impaired fasting glucose level (≥ 110-125 mg/dl) but without diabetes who attended centers during the study period. The main outcome measures concerned changes in type 2 diabetes prevention practice indicators after 12 months. Results After 12 months, 3273 eligible patients at risk of type 2 diabetes had attended their family physician at least once, and of these, 490 (15%) have been addressed by assessing their healthy lifestyles in both comparison groups. The proportion of at-risk patients receiving a personalized prescription of lifestyle change was slightly higher (8.6%; range 13.5-5.9% vs 6.8%; range 7.2-5.8%) and 2.3 times more likely (95% CI for adjusted hazard ratio, 1.38-3.94) in the sequential than in the global centers, after 8 months of the intervention program implementation period. The probability of meeting the recommended levels of physical activity and fruit and vegetable intake were four- and threefold higher after the prescription of lifestyle change than only assessment and provision of advice. The procedure of engagement in and execution of the implementation strategy does not modify the effect of prescribing healthy habits (p interaction component of intervention by group, p > 0.05). Discussion Our results show that the PVS-PREDIAPS implementation strategy manages to integrate interventions with proven efficacy in the prevention of type 2 diabetes in clinical practice in primary care. Further, they suggest that implementation outcomes were somewhat better with a sequential facilitated collaborative process focused on enhancing the autonomy and responsibility of nurses who subsequently seek a pragmatic cooperation of GPs. Trial registration Clinicaltrials.gov identifier: NCT03254979. Registered 16 August 2017—retrospectively registered.

scholarly journals Optimal cut-off points for adherence measure among patients with type 2 diabetes in primary care clinics: a retrospective analysis

2021 ◽  
Vol 12 ◽  
pp. 204062232199026
Author(s):  
Ming Tsuey Lim ◽  
Norazida Ab Rahman ◽  
Xin Rou Teh ◽  
Chee Lee Chan ◽  
Shantini Thevendran ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Medication Adherence ◽  
Poor Adherence ◽  
Adherence Measure ◽  
Primary Care Clinics ◽  
Assessment Period ◽  
Hba1c Target ◽  
Optimal Adherence

Background: Medication adherence measures are often dichotomized to classify patients into those with good or poor adherence using a cut-off value ⩾80%, but this cut-off may not be universal across diseases or medication classes. This study aimed to examine the cut-off value that optimally distinguish good and poor adherence by using the medication possession ratio (MPR) and proportion of days covered (PDC) as adherence measures and glycated hemoglobin (HbA1c) as outcome measure among type 2 diabetes mellitus (T2DM) patients. Method: We used pharmacy dispensing data of 1461 eligible T2DM patients from public primary care clinics in Malaysia treated with oral antidiabetic drugs between January 2018 and May 2019. Adherence rates were calculated during the period preceding the HbA1c measurement. Adherence cut-off values for the following conditions were compared: adherence measure (MPR versus PDC), assessment period (90-day versus 180-day), and HbA1c target (⩽7.0% versus ⩽8.0%). Results: The optimal adherence cut-offs for MPR and PDC in predicting HbA1c ⩽7.0% ranged between 86.1% and 98.3% across the two assessment periods. In predicting HbA1c ⩽8.0%, the optimal adherence cut-offs ranged from 86.1% to 92.8%. The cut-off value was notably higher with PDC as the adherence measure, shorter assessment period, and a stricter HbA1c target (⩽7.0%) as outcome. Conclusion: We found that optimal adherence cut-off appeared to be slightly higher than the conventional value of 80%. The adherence thresholds may vary depending on the length of assessment period and outcome definition but a reasonably wise cut-off to distinguish good versus poor medication adherence to be clinically meaningful should be at 90%.

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