Outcomes of Project Dulce: A Culturally Specific Diabetes Management Program

2005 ◽  
Vol 39 (5) ◽  
pp. 817-822 ◽  
Author(s):  
Todd P Gilmer ◽  
Athena Philis-Tsimikas ◽  
Chris Walker
Keyword(s):  
Blood Pressure ◽  
Disease Management ◽  
Clinical Outcomes ◽  
Community Health Centers ◽  
Diabetes Management ◽  
Density Lipoprotein ◽  
Management Program ◽  
Stepped Care ◽  
High Risk Population ◽  
Case Management Program

BACKGROUND: Diabetes mellitus is a common and costly chronic disease that increasingly affects minority populations; however, there is little evidence regarding the clinical effectiveness and costs of culturally appropriate disease management programs. OBJECTIVE: To determine the clinical outcomes and costs of Project Dulce, a combined stepped-care diabetes nurse case management program and culturally oriented peer-led self-empowerment training program. METHODS: Pre—post clinical outcome and cost analysis of Project Dulce participants were compared with a cohort of historical controls over a one-year period. Subjects included 348 persons with diabetes with coverage under County Medical Services who were receiving services in community health centers in San Diego, CA. Generalized regression models were used to estimate changes in clinical outcomes (hemoglobin [Hb] A1c, blood pressure, cholesterol level) and costs associated with participation in Project Dulce. RESULTS: Project Dulce participants had significant reductions in HbA1c (0.8%; p < 0.001), systolic (5.4 mm Hg; p = 0.001) and diastolic (8.0 mm Hg; p < 0.001) blood pressure, total cholesterol (28.1 mg/dL; p < 0.001), and low-density-lipoprotein cholesterol (15.6 mg/dL; p < 0.001). Expenditures for pharmacy ($3157 Dulce vs $1618 control) and disease management ($507 Dulce) increased. Total costs were higher during the first year of disease management ($5711 Dulce vs $4365 control; p < 0.001). CONCLUSIONS: Project Dulce was effective in improving clinical outcomes for control of diabetes and related conditions in a medically indigent, culturally diverse population. Our finding of reduced hospital expenditures, although statistically insignificant, is clinically and economically important and suggests that intervention might provide an immediate benefit to a high-risk population.

Pharmacist Impact on Clinical Outcomes in a Diabetes Disease Management Program via Collaborative Practice

2005 ◽  
Vol 39 (11) ◽  
pp. 1828-1832 ◽  
Author(s):  
Patrick J Kiel ◽  
Amie D McCord
Keyword(s):  
Disease Management ◽  
Clinical Outcomes ◽  
Diabetes Management ◽  
Management Program ◽  
Collaborative Practice ◽  
Diabetes Disease Management Program ◽  
Daily Aspirin ◽  
The Mean ◽  
Diabetes Management Program

BACKGROUND Clinical outcomes resulting from pharmaceutical care have been incompletely addressed in the diabetes population. We conducted a retrospective study evaluating clinical outcomes in a diabetes disease management program in which clinical pharmacists possessed collaborative practice agreements. OBJECTIVE To evaluate changes in clinical outcomes for patients enrolled in a pharmacist-coordinated diabetes management program. METHODS Medical records of 157 patients enrolled in the diabetes management program between June 2003 and April 2004 were retrospectively reviewed. Data collection included baseline and follow-up values for hemoglobin A1C (A1C) and lipids as well as frequency of adherence to preventive care, including annual foot and eye examinations and daily aspirin therapy. RESULTS For patients with both baseline and follow-up data, the mean A1C reduction was 1.6% (n = 109; p < 0.001). For patients with an initial A1C of ≥8.5%, the mean reduction was 2.7% (n = 57; p < 0.001). The percentage of patients with A1C ≤7% increased from 19% at baseline to 50% at follow-up (p < 0.001). The mean low-density lipoprotein (LDL) reduction observed was 16 mg/dL (n = 73; NS) and the percentage of patients with LDL values ≤100 mg/dL increased from 30% at baseline to 56% at follow-up (p < 0.001). The frequency of microalbumin screening increased by 27% (p < 0.001), and the number of patients with annual eye and foot examinations increased by 27% (p < 0.05) and 15% (p < 0.05), respectively. The percentage of patients who had a positive microalbumin test and were taking a renal protective agent rose 19% from baseline to follow-up (NS). The percentage of patients taking daily aspirin increased from 42% at baseline to 80% at follow-up (p < 0.01). CONCLUSIONS The pharmacist-coordinated diabetes management program was effective in improving clinical markers for enrolled patients. Significant improvements were observed in A1C and LDL values as well as the frequency of adherence to preventive care.

Abstract P298: The Impact of JNC VII Recommendations for Controlling Blood Pressure in a Heart Failure Disease Management Program

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
George R Marzouka ◽  
Elyse Julian ◽  
Andre Dias ◽  
Leonardo Tamariz ◽  
Pat Trahan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Disease Management ◽  
Pressure Control ◽  
Management Program ◽  
P Value ◽  
Baseline Visit ◽  
Heart Failure Disease Management ◽  
One Year ◽  
The Impact

Background: A significant correlation between hypertension (HTN) and long-term risk for heart failure (HF) exists. The aim of this study was (i) to assess what percent of patients enrolled in a heart failure disease management program (HFDMP) reach the JNC VII target goals for blood pressure control; (ii) to assess if there is a disparity in HTN control by race or ethnicity; (iii) and to assess the impact of reaching JNC VII targets for blood pressure control on survival. Methods: Patients with an ejection fraction ≤40% were enrolled into HFDMPs and screened for HTN, defined as blood pressure (BP) ≥ 130/80. Patients were titrated to beta blocker therapy and ace inhibitor therapy following the ACC/AHA HF guidelines. Final BP was measured after one year. Results: Mean baseline systolic BP (SBP) (N = 648) was 149.9 mmHg and mean baseline diastolic BP (DBP) was 90.5 mmHg. At one year, mean SBP decreased to 138.0 mmHg, DBP to 81.8 mmHg. There was no significant increase in survival for patients with BP ≤130 and ≤80 versus patients with HTN. There was a significant disparity in BP control in Blacks and Hispanics compared to whites (p<0.001) Conclusion: Disease management programs are an effective way to reduce BP in hypertensive patients, as well as keeping normotensive patients within JNC VII guidelines however health disparities persisted by race and ethnicity. Mean SBP and DBP of cohort at baseline Vs. 12 Month Follow up Blood pressure ≤ 130/80 mmHg Baseline Visit Last Visit P-Value SBP,m sd 110.9 (12.6%) 120.9 (22.2%) <0.001 DBP , m sd 67.1 (8.6%) 72.4 (13.7%) <0.001 Blood pressure > 130/80 mmHg Baseline Visit Last Visit P-Value SBP , m sd 149.9 (21.4%) 138.0 (24.6%) <0.001 DBP , m sd 90.5 (16.3%) 81.8 (16.8%) <0.001

scholarly journals Chronic Disease Management Programs Based On Caring Theory With Blood Pressure Reduction

2021 ◽  
Vol 5 (1) ◽  
pp. 70-76
Author(s):  
Apriyani Puji Hastuti ◽  
Ardhiles Wahyu Kurniawan ◽  
Hanim Mufarokhah
Keyword(s):  
Blood Pressure ◽  
Chronic Disease ◽  
Disease Management ◽  
Diastolic Blood Pressure ◽  
Chronic Disease Management ◽  
Blood Pressure Reduction ◽  
Management Program ◽  
Pressure Reduction ◽  
Cross Sectional ◽  
Disease Management Programs

Background: Hypertension cases to overcome the patient's hypertension condition would be well or prosperous condition and the patient could prevent complications and control blood pressure. Activities in Chronic Disease Management Program (Prolanis) include medical or educational consultations, home visits, reminders, club activities.Purpose: This study aimed to analyze the application of the prolanis program based on the caring theory by reducing blood pressure in hypertensive patients.Methods: The design of this research is pre-experimental with cross sectional study approach. The population in this study were all patients with hypertension who took part in management program activities in the public health center (PHC), a number of 40 people, with the sampling technique used was accidental sampling and the total sample was 28 people. The data collection method used a questionnaire. The data analysis of this research is to use the Paired t test.Results: The result of this study is that there is a relationship between the application of a chronis disease management programs based on caring theory with blood pressure reduction with an average systolic blood pressure before the intervention of 142?26.15 and after the intervention of 138?1.21 with p= 0.000 which means that the module intervention can decrease systolic and diastolic blood pressure. While for diastolic blood pressure, the results of the study showed that the mean blood pressure before the intervention was 85?10.36 and after the intervention was 85?7.61 with p= 0.000.Conclusion: It can be concluded that there is a possitive effect between giving prolanis module based on caring theory with systolic and diastolic blood pressure

HUBUNGAN KEIKUTSERTAAN SENAM PROLANIS DENGAN KETERKONTROLAN TEKANAN DARAH PADA PASIEN BPJS DI KLINIK BATAM SEHAT

2020 ◽  
Vol 9 (2) ◽  
pp. 17-25
Author(s):  
Andi Ipaljri Saputra ◽  
Isramilda ,
Keyword(s):  
Blood Pressure ◽  
Chronic Disease ◽  
Disease Management ◽  
Disease Management Program ◽  
Chronic Disease Management ◽  
Statistical Tests ◽  
Management Program ◽  
P Value ◽  
Cross Sectional ◽  
Uncontrolled Blood Pressure

Since 2014 BPJS Health has implemented the Chronic Disease Management Program (PROLANIS) which has a program of medical/educational consultation activities, home visits, reminders, club activities such as gymnastics and health status monitoring with the target of all BPJS health participants with chronic diseases (Diabetes Mellitus) Type 2 and Hypertension). The Batam Sehat Clinic conducted a chronic disease management program in 2015 with 154 registered patients, while BPJS patients who took part in the PROLANIS exercise in July-September 2018 totaled 155 people. This type of research is an observational analytic survey with a cross-sectional approach conducted at Batam Sehat Clinic. Data obtained by taking medical records in the form of attendance PROLANIS gymnastics with a total sampling technique that the overall number of BPJS patients who take PROLANIS exercises from July-September is 155 BPJS patients. From 155 BPJS patients, the frequency distribution of BPJS patients participating in PROLANIS and blood pressure was controlled 71 (85.5%) and uncontrolled blood pressure was 12 (14.5%). While those who did not participate in PROLANIS exercise were controlled blood pressure 32 (44.4%) and 40 (55.6%) uncontrolled blood pressure. Based on the results of statistical tests it is known that there is a correlation between the participation of PROLANIS gymnastics and blood pressure control in BPJS patients in Batam Sehat Clinic with p-value = 0,000 where p <0.05. Based on this research, it can be concluded that there is a correlation between the participation of PROLANIS gymnastics and the control of blood pressure in BPJS patients.

scholarly journals Adherence to anti-hypertensive treatment within a chronic disease management 
program: A longitudinal, retrospective study

2014 ◽  
Vol 48 (5) ◽  
pp. 811-819 ◽  
Author(s):  
Ana Carolina Nascimento Raymundo ◽  
Angela Maria Geraldo Pierin
Keyword(s):  
Blood Pressure ◽  
Retrospective Study ◽  
Chronic Disease ◽  
Disease Management ◽  
Treatment Adherence ◽  
Disease Management Program ◽  
Chronic Disease Management ◽  
Angiotensin Receptor Blockers ◽  
Management Program ◽  
Converting Enzyme Inhibitors

Objective This study assessed pharmacological treatment adherence using the Morisky-Green Test and identified related variables. Method A longitudinal and retrospective study examined 283 patients with hypertension (62.5% women, 73.4 [10.9] years old) who were being monitored by a chronic disease management program for 17 months between 2011 and 2012. Nurses performed all the actions of the program, which consisted of advice via telephone and periodic home visits based on the risk stratification of the patients. Results A significant increase in treatment adherence (25.1% vs. 85.5%) and a decrease in blood pressure were observed (p<0.05). Patients with hypertension and chronic renal failure as well as those treated using angiotensin-converting enzyme inhibitors were the most adherent (p<0.05). Patients with hypertension who received angiotensin receptor blockers were less adherent (p<0.05). Conclusions Strategies such as nurse-performed chronic disease management can increase adherence to anti-hypertensive treatment and therefore contribute to the control of blood pressure, minimizing the morbidity profiles of patients with hypertension.

scholarly journals Evaluating the Impact of Outpatient Multi-Dose Medication Packaging Service (MDMPS) on Medication Adherence and Clinical Outcomes

2020 ◽  
Vol 11 ◽  
pp. 215013272096508
Author(s):  
Pratibha Nair ◽  
Kok Wai Kee ◽  
Choon Siong Mah ◽  
Eng Sing Lee
Keyword(s):  
Blood Pressure ◽  
Medication Adherence ◽  
Clinical Outcomes ◽  
Low Density Lipoprotein ◽  
Medication Possession Ratio ◽  
Density Lipoprotein ◽  
Control Group ◽  
Improve Medication Adherence ◽  
Standard Medication ◽  
The Impact

Background: There is limited understanding on the impact of the multidose medication packaging service (MDMPS). Objectives: The main objective of this study was to evaluate changes in medication adherence in patients using MDMPS compared to patients receiving standard medication packaging (control group). The other objectives were to determine the association between medication adherence and clinical outcomes, and to assess patients’/caregivers’ perceptions toward MDMPS. Methods: A retrospective cohort study was conducted among primary care patients in Singapore enrolled into MDMPS between 2012 and 2017. Eligible patients were taking at least five chronic medications, diagnosed with Hypertension, Hyperlipidemia and/or Type 2 Diabetes, with prescription records for at least six months before and after the index period. They were matched to control patients based on the type of comorbidities and medication adherence status. Medication Possession Ratio (MPR), glycated hemoglobin (HbA1c), blood pressure and low-density lipoprotein-cholesterol (LDL-C) of both groups were compared between baseline and at least six months post-index period. Interviewer-administered questionnaires were also conducted for MDMPS patients. Results: The MPR of MDMPS patients (n = 100) increased by 0.37% ( P < .001) compared to the control group (n = 100). MDMPS patients with diabetes had reduced HbA1c by 0.1% after six months ( P = .022) but was not significant after 12 months. No significant changes were seen in blood pressure and LDL-C between both groups. At least 50% of patients were highly satisfied with MDMPS. Conclusion: MDMPS can improve medication adherence. Further studies are needed to understand its clinical impact.

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