Peer Support for Diabetes Management in Primary Care and Community Settings in Anhui Province, China

Background: Previous research has identified that people with type 2 diabetes (T2D) within the Hispanic community would benefit from an online peer support community (OPSC) and continuous glucose monitoring (CGM) data to facilitate diabetes self-management. Methods: A mixed-methods feasibility study enrolled Hispanic, Spanish-speaking adults with T2D, not on insulin. Participants were provided with CGM and access to an OPSC for 12 weeks. Feasibility was assessed by number of eligible participants who enrolled, attrition, quantity of CGM data, validated clinical measures of self-efficacy, quality of life and adverse events. Engagement in the OPSC was measured using objective metrics on the online platform. Qualitative interviews were conducted upon conclusion of the intervention to assess feasibility, acceptability, participant satisfaction, and key recommendations for improvement. Results: Of 46 participants screened, 39 were eligible and 26 completed the study. Participants significantly improved self-efficacy scores. Posts in the OPSC related to goal setting had the highest engagement followed by mid-week and end of week check-in posts respectively. Participant interviews described challenges accessing the OPSC platform as a barrier to engagement. Despite this, all participants were satisfied with the intervention. Key recommendations for improvement included providing greater variety of and individualized education and the use of a peer support platform that is easily accessible. Conclusions: The CGM + OPSC intervention tailored to the Hispanic community with T2D was feasible, acceptable and satisfactory and improved participant self-efficacy for diabetes management which may lead to improved clinical outcomes.

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140-LB: Improving Translation of Diabetes Management Practices in Community Primary Care

Diabetes ◽

10.2337/db21-140-lb ◽

2021 ◽

Vol 70 (Supplement 1) ◽

pp. 140-LB

Author(s):

CELESTE C. THOMAS ◽

MONICA E. PEEK ◽

CARLIE PAUL ◽

MARGARET ALLISON ◽

ANNA HEILBRUN ◽

...

Keyword(s):

Primary Care ◽

Management Practices ◽

Diabetes Management

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Exploring the interpersonal collaboration during the integration of diabetes teams into primary care.

10.32920/14641230.v1 ◽

2021 ◽

Author(s):

Enza Gucciardi ◽

Sherry Espin ◽

Antonia Morganti ◽

Linda Dorado

Keyword(s):

Primary Care ◽

Primary Care Physicians ◽

Diabetes Management ◽

Interprofessional Collaboration ◽

Diabetes Education ◽

Knowledge Exchange ◽

Management Training ◽

New Ways Of Working ◽

Positive Effects ◽

Diabetes Educators

Background Specialised diabetes teams, specifically certified nurse and dietitian diabetes educator teams, are being integrated part-time into primary care to provide better care and support for Canadians living with diabetes. This practice model is being implemented throughout Canada in an effort to increase patient access to diabetes education, self-management training, and support. Interprofessional collaboration can have positive effects on both health processes and patient health outcomes, but few studies have explored how health professionals are introduced to and transition into this kind of interprofessional work. Method Data from 18 interviews with diabetes educators, 16 primary care physicians, 23 educators’ reflective journals, and 10 quarterly debriefing sessions were coded and analysed using a directed content analysis approach, facilitated by NVIVO software. Results Four major themes emerged related to challenges faced, strategies adopted, and benefits observed during this transition into interprofessional collaboration between diabetes educators and primary care physicians: (a) negotiating space, place, and role; (b) fostering working relationships; (c) performing collectively; and (d) enhancing knowledge exchange. Conclusions Our findings provide insight into how healthcare professionals who have not traditionally worked together in primary care are collaborating to integrate health services essential for diabetes management. Based on the experiences and personal reflections of participants, establishing new ways of working requires negotiating space and place to practice, role clarification, and frequent and effective modes of formal and informal communication to nurture the development of trust and mutual respect, which are vital to success.

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Improving risk factor management for patients with poorly controlled type 2 diabetes: a systematic review of healthcare interventions in primary care and community settings

BMJ Open ◽

10.1136/bmjopen-2016-015135 ◽

2017 ◽

Vol 7 (8) ◽

pp. e015135 ◽

Cited By ~ 19

Author(s):

Mark E Murphy ◽

Molly Byrne ◽

Rose Galvin ◽

Fiona Boland ◽

Tom Fahey ◽

...

Keyword(s):

Primary Care ◽

Glycaemic Control ◽

Study Quality ◽

Regression Analyses ◽

Community Settings ◽

Baseline Hba1c ◽

Poor Glycaemic Control ◽

Healthcare Interventions ◽

Meta Analyses

ObjectivesPoorly controlled type 2 diabetes mellitus (T2DM) is a major international health problem. Our aim was to assess the effectiveness of healthcare interventions, specifically targeting patients with poorly controlled T2DM, which seek to improve glycaemic control and cardiovascular risk in primary care settings.DesignSystematic review.SettingPrimary care and community settings.Included studiesRandomised controlled trials (RCTs) targeting patients with poor glycaemic control were identified from Pubmed, Embase, Web of Science, Cochrane Library and SCOPUS. Poor glycaemic control was defined as HbA1c over 59 mmol/mol (7.5%).InterventionsInterventions were classified as organisational, patient-oriented, professional, financial or regulatory.OutcomesPrimary outcomes were HbA1c, blood pressure and lipid control. Two reviewers independently assessed studies for eligibility, extracted data and assessed study quality. Meta-analyses were undertaken where appropriate using random-effects models. Subgroup analysis explored the effects of intervention type, baseline HbA1c, study quality and study duration. Meta-regression analyses were undertaken to investigate identified heterogeneity.ResultsForty-two RCTs were identified, including 11 250 patients, with most undertaken in USA. In general, studies had low risk of bias. The main intervention types were patient-directed (48%) and organisational (48%). Overall, interventions reduced HbA1c by −0.34% (95% CI −0.46% to −0.22%), but meta-analyses had high statistical heterogeneity. Subgroup analyses suggested that organisational interventions and interventions on those with baseline HbA1c over 9.5% had better improvements in HbA1c. Meta-regression analyses suggested that only interventions on those with population HbA1c over 9.5% were more effective. Interventions had a modest improvement of blood pressure and lipids, although baseline levels of control were generally good.ConclusionsThis review suggests that interventions for T2DM, in primary care, are better targeted at individuals with very poor glycaemic control and that organisational interventions may be more effective.

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Useful information

Oxford Handbook of Primary Care and Community Nursing ◽

10.1093/med/9780198831822.003.0014 ◽

2020 ◽

pp. 831-844

Keyword(s):

Primary Care ◽

Herbal Medicine ◽

Educational Needs ◽

Alternative Therapies ◽

Assistive Technologies ◽

Faith Healing ◽

Community Settings ◽

Special Educational Needs ◽

Death Certification ◽

Complex Equipment

This chapter provides other useful topics for nurses working in primary care or community settings. It defines telecare and telehealth, assistive technologies (ranging from special educational needs equipment to moving and handling systems) and home adaptations (including complex equipment, methods of hiring or buying disability equipment, and wheelchair services), and complementary and alternative therapies (including acupuncture, aromatherapy, faith healing, herbal medicine, homeopathy, hypnotherapy, osteopathy, chiropractic treatments, and reflexology). It also outlines processes for the verification of the fact of death, certification of death, and the registration of births, marriages, civil partnerships, and deaths.

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