scholarly journals Experiences with tailoring of primary diabetes care in well-organised general practices: a mixed-methods study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sytske van Bruggen ◽  
Marise J. Kasteleyn ◽  
Simone P. Rauh ◽  
Julia S. Meijer ◽  
Karin J. G. Busch ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Health Status ◽  
Diabetes Care ◽  
Implementation Fidelity ◽  
Self Management ◽  
Successful Implementation ◽  
List Type ◽  
Study Participation ◽  
Management Interventions ◽  
General Practices

Abstract Background Dutch standard diabetes care is generally protocol-driven. However, considering that general practices wish to tailor diabetes care to individual patients and encourage self-management, particularly in light of current COVID-19 related constraints, protocols and other barriers may hinder implementation. The impact of dispensing with protocol and implementation of self-management interventions on patient monitoring and experiences are not known. This study aims to evaluate tailoring of care by understanding experiences of well-organised practices 1) when dispensing with protocol; 2) determining the key conditions for successful implementation of self-management interventions; and furthermore exploring patients’ experiences regarding dispensing with protocol and self-management interventions. Methods in this mixed-methods prospective study, practices (n = 49) were invited to participate if they met protocol-related quality targets, and their adult patients with well-controlled type 2 diabetes were invited if they had received protocol-based diabetes care for a minimum of 1 year. For practices, study participation consisted of the opportunity to deliver protocol-free diabetes care, with selection and implementation of self-management interventions. For patients, study participation provided exposure to protocol-free diabetes care and self-management interventions. Qualitative outcomes (practices: 5 focus groups, 2 individual interviews) included experiences of dispensing with protocol and the implementation process of self-management interventions, operationalised as implementation fidelity. Quantitative outcomes (patients: routine registry data, surveys) consisted of diabetes monitoring completeness, satisfaction, wellbeing and health status at baseline and follow-up (24 months). Results Qualitative: In participating practices (n = 4), dispensing with protocol encouraged reflection on tailored care and selection of various self-management interventions A focus on patient preferences, team collaboration and intervention feasibility was associated with high implementation fidelity Quantitative: In patients (n = 126), likelihood of complete monitoring decreased significantly after two years (OR 0.2 (95% CI 0.1–0.5), p < 0.001) Satisfaction decreased slightly (− 1.6 (95% CI -2.6;-0.6), p = 0.001) Non-significant declines were found in wellbeing (− 1.3 (95% CI -5.4; 2.9), p = 0.55) and health status (− 3.0 (95% CI -7.1; 1.2), p = 0.16). Conclusions To tailor diabetes care to individual patients within well-organised practices, we recommend dispensing with protocol while maintaining one structural annual monitoring consultation, combined with the well-supported implementation of feasible self-management interventions. Interventions should be selected and delivered with the involvement of patients and should involve population preferences and solid team collaborations.

scholarly journals The perspectives of patients and their caregivers on self-management interventions for chronic conditions: a protocol for a mixed-methods overview

F1000Research ◽  
2021 ◽  
Vol 9 ◽  
pp. 120
Author(s):  
Ena Niño de Guzmán ◽  
Laura Martínez García ◽  
Ana I. González ◽  
Monique Heijmans ◽  
Jorge Huaringa ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Data Extraction ◽  
Complex Interventions ◽  
Cost Effective ◽  
Self Management ◽  
Synthesis Process ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Quantitative Evidence ◽  
Management Interventions

Introduction: Self-management (SM) interventions are complex interventions and one of the main components of high-quality chronic disease care for which the incorporation of the perspectives of patients and their informal caregivers is crucial. We aim to identify, appraise and synthesise the evidence exploring patients’ and caregivers’ perspectives on SM interventions. More precisely, we aim to 1) describe how they value the importance of outcomes of SM interventions, and 2) identify the factors that might impact on acceptability and feasibility of SM interventions based on their preferences and experiences. Methods and analysis: We will conduct four mixed-methods overviews as part of COMPAR-EU, a European Union (EU) funded project aimed to identify the most effective and cost-effective SM interventions for chronic obstructive pulmonary disease (COPD), heart failure (HF), obesity, and type 2 diabetes mellitus (T2DM). We will search in MEDLINE, CINAHL, and PsycINFO for systematic reviews of studies addressing patients’ preferences on outcomes, or their experiences with SM alongside their disease trajectory or with SM interventions, published in English. Selection of studies and data extraction will be conducted in pairs. We will assess the overlap of studies and methodological quality. We will follow a three-step synthesis process: 1) narrative synthesis for quantitative evidence, 2) thematic synthesis for qualitative evidence, and 3) integration of findings in the interpretation phase. Additionally, we will consult on the relevance of findings with patients and their caregivers. Systematic review registration: PROSPERO CRD42019117867

scholarly journals Testing Scalability of a Diabetes Self-Management Intervention in Northern Mexico: An Ecological Approach

2021 ◽  
Vol 9 ◽  
Author(s):  
Benjamin Aceves ◽  
Catalina A. Denman ◽  
Maia Ingram ◽  
Jose Francisco Torres ◽  
Tomas Nuño ◽  
...  
Keyword(s):  
Chronic Disease ◽  
Health System ◽  
Scale Up ◽  
Implementation Fidelity ◽  
Health Centers ◽  
Self Management ◽  
Regional Health ◽  
Post Intervention ◽  
Management Intervention ◽  
Management Interventions

Background: Type 2 diabetes mellitus (T2DM) has become a major issue in Mexico, reporting almost 100,000 attributable deaths in 2016. Low-income Mexican citizens who face various issues associated with T2DM, including the lack of access to self-management services, are particularly affected by the condition. Health centers have been designated to serve T2DM patients by providing resources on chronic disease prevention. Meta Salud Diabetes (MSD) is a self-management intervention developed to address cardiovascular complications and other health issues within the T2DM population, which have been proven effective and useful for health centers. The intervention was designed for T2DM support groups—grupos de ayuda mutua (GAMs) located within health centers.Methods: From February to June 2019, a binational research team conducted a test scale-up study in Northwest Sonora under the Ministry of Health utilizing the Institute for Healthcare Improvement Framework for scaling up health interventions. Investigators worked in collaboration and trained 19 stakeholders from a regional health system identified from various ecological levels on MSD and implementation process.Results: All five GAMs within the regional health system received and completed the intervention. In total, 72 participants were enrolled with behavioral and biological [HbA1c, blood pressure, body mass index (BMI)] measures taken at baseline. Post-intervention measurements were taken from 72% of participants who completed the intervention. Statistical analysis demonstrated improved behavioral and biological measures when comparing baseline to post-intervention, specifically statistically significant improvements in HbA1c and sugar-sweetened beverage consumption. Implementation fidelity (IF) measures indicated extensive adherence to the intervention curriculum, and moderators specifically demonstrated influences on implementation. Stakeholders from various ecological levels provided support to those facilitating the MSD intervention by allotting time and resources to properly prepare for sessions. An implementation coordinator from the regional health office assisted MSD facilitators by resolving barriers to implementation and worked toward federal accreditation for GAMs to receive additional funding.Conclusion: Results provide evidence for using regional health systems as a scalable unit when implementing chronic disease self-management interventions state- and nationwide. This study will help inform future efforts to scale up the health intervention in various states throughout Mexico.Clinical Trial Registration:www.ClinicalTrials.gov; https://www.clinicaltrials.gov/ct2/show/NCT02804698?term=NCT02804698&amp;draw=2&amp;rank=1, identifier: NCT02804698.

scholarly journals The perspectives of patients and their caregivers on self-management interventions for chronic conditions: a protocol for a mixed-methods overview

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 120
Author(s):  
Ena Niño de Guzmán ◽  
Laura Martínez-García ◽  
Ana I. González ◽  
Monique Heijmans ◽  
Jorge Huaringa ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Data Extraction ◽  
Complex Interventions ◽  
Cost Effective ◽  
Self Management ◽  
Synthesis Process ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Quantitative Evidence ◽  
Management Interventions

Introduction: Self-management (SM) interventions are complex interventions and one of the main components of high-quality chronic disease care for which the incorporation of the perspectives of patients and their informal caregivers is crucial. We aim to identify, appraise and synthesise the evidence exploring patients’ and caregivers’ perspectives on SM interventions. More precisely, we aim to 1) describe how they value the importance of outcomes of SM interventions, and 2) identify the factors that might impact on acceptability and feasibility of SM interventions based on their preferences and experiences. Methods and analysis: We will conduct four mixed-methods overviews as part of COMPAR-EU, a European Union (EU) funded project aimed to identify the most effective and cost-effective SM interventions for chronic obstructive pulmonary disease (COPD), heart failure (HF), obesity, and type 2 diabetes mellitus (T2DM). We will search in MEDLINE, CINAHL, and PsycINFO for systematic reviews of studies addressing patients’ preferences on outcomes, or their experiences with SM alongside their disease trajectory or with SM interventions, published in English. Selection of studies and data extraction will be conducted in pairs. We will assess the overlap of studies and methodological quality. We will follow a three-step synthesis process: 1) narrative synthesis for quantitative evidence, 2) thematic synthesis for qualitative evidence, and 3) integration of findings in the interpretation phase. Additionally, we will consult on the relevance of findings with patients and their caregivers. Systematic review registration: PROSPERO CRD42019117867

scholarly journals Information needs and perceptions of chatbots for hypertension medication self-management: a mixed methods study

JAMIA Open ◽  
2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Ashley C Griffin ◽  
Zhaopeng Xing ◽  
Sean P Mikles ◽  
Stacy Bailey ◽  
Saif Khairat ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Technology Use ◽  
Information Needs ◽  
Lifestyle Changes ◽  
Self Management ◽  
Structured Interviews ◽  
Patient Portals ◽  
Future Design ◽  
Management Interventions ◽  
Patient Information Needs

Abstract Objective Chatbots have potential to deliver interactive self-management interventions but have rarely been studied in the context of hypertension or medication adherence. The objective of this study was to better understand patient information needs and perceptions of chatbots to support hypertension medication self-management. Materials and Methods Mixed methods were used to assess self-management needs and preferences for using chatbots. We purposively sampled adults with hypertension who were prescribed at least one medication. Participants completed questionnaires on sociodemographics, health literacy, self-efficacy, and technology use. Semi-structured interviews were conducted, audio-recorded, and transcribed verbatim. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using applied thematic analysis. Results Thematic saturation was met after interviewing 15 participants. Analysis revealed curiosity toward chatbots, and most perceived them as humanlike. The majority were interested in using a chatbot to help manage medications, refills, communicate with care teams, and for accountability toward self-care tasks. Despite general enthusiasm, there were concerns with chatbots providing too much information, making demands for lifestyle changes, invading privacy, and usability issues with deployment on smartphones. Those with overall positive perceptions toward chatbots were younger and taking fewer medications. Discussion Chatbot-related informational needs were consistent with existing self-management research, and many felt chatbots would be valuable if customizable and compatible with patient portals, pharmacies, or health apps. Conclusion Although most were not familiar with chatbots, patients were interested in interacting with them, but this varied. This research informs future design and functionalities of conversational interfaces to support hypertension self-management.

Identifying the Predictors of Self-Management Behaviors in Patients with Diabetes Based on Ecological Approach: A Systematic Review

2020 ◽  
Vol 16 ◽  
Author(s):  
Mahnaz Davari ◽  
Hamed Rezakhani Moghaddam ◽  
Aghil Habibi Soola
Keyword(s):  
Scientific Information ◽  
The Self ◽  
Self Management ◽  
Ecological Approach ◽  
Selection Strategy ◽  
Diabetic Patients ◽  
Personal Factors ◽  
Management Interventions ◽  
Number Of Patients ◽  
Management Behaviors

Background: Recognizing and promoting the factors that affect the self-management behaviors of diabetes leads to a reduction in the number of patients and an improvement in the quality of care. The ecological approach focuses on the nature of people's interactions with their physical and socio-cultural environments. Objective: The purpose of this study was to identify the predictors of self-management behaviors with a comprehensive approach in these patients. Methods: The Keywords were investigated in the relevant national and international databases, including PubMed, Google Scholar, Science Direct, Scopus, and Scientific Information Database, Magiran, and Iran Medex to obtain the articles published from 2009 to 2019. The search and article selection strategy was developed based on the Prisma checklist and was carried out in three steps. Results: Most studies have shown that personal factors had the highest prediction power for the self-management of diabetes. Then, the interpersonal factors, society and policy-making factors, and group and organization factors were most frequently reported predictors of self-management behaviors in diabetic patients. Conclusion: Self-management of diabetes is necessary for controlling it because 95% of care is done by the patient. When designing self-management interventions, factors based on the individual level that increasing self-management behaviors should be taken into account.

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