scholarly journals Analysis of continuity of care and related factors in diabetic patients in Korea

2020 ◽  
Author(s):  
Ji Yeh Shin ◽  
Ha Jin Kim ◽  
BeLong Cho ◽  
Yun Jun Yang ◽  
Jae Moon Yun
Keyword(s):  
Primary Care ◽  
Continuity Of Care ◽  
Statistical Significance ◽  
Primary Care Clinic ◽  
Residential Area ◽  
Political Support ◽  
Diabetic Patients ◽  
Care Clinic ◽  
Medical Needs ◽  
Care Index

Abstract Background: Diabetes is one of the fastest growing diseases with approximately 463 million patients worldwide. It is established that to manage diabetes, continuity of care in primary care setting is crucial. We aim to statistically define and analyze factors of continuity that are associated with patient, clinic, and geographical relationship.Methods: We used 2014~2015 claim data from National Health Insurance Service (NHIS), with 39,096 eligible outpatient attendances across 29,912 office-based clinics. We applied multivariable logistic regression to analyze factors that may affect three kinds of continuity of care index for each patient: most frequent provider continuity index (MFPC), modified-modified continuity index (MMCI), and continuity of care index (COC). Results: Mean value of continuity of care indices were MFPC 0.90, MMCI 0.96, COC 0.85. Among patient factors, old age above 80 (MFPC 0.81 [0.74-0.89], MMCI 0.84 [0.76-0.92], COC 0.81 [0.74-0.89]) and disability were strongly associated with lower continuity of care. Another significant factor was residential area: further the patients lived from their primary care clinic, lower the continuity of diabetes care (MFPC 0.74 [0.70–0.78], MMCI 0.70 [0.66–0.73], COC 0.74 [0.70–0.78]). Patients who lived in metropolitan areas had higher continuity of care compared to those of other areas (metropolitan area, MFPC 1.19 [1.17-1.27], MMCI 1.17 [1.10-1.25], COC 1.19 [1.12-1.27]). There was no statistical significance among clinic factors, such as the number of physicians or nurses hired per clinic, between the lower and the higher continuity of care groups.Conclusion: Geographical proximity of patient’s residential area and clinic location showed the strongest correlation as factor of continuity. Political support is necessary to geographically align the imbalance of supply and demand of medical needs.

scholarly journals Analysis of Continuity of Care and Related Factors in Diabetes Patients in Korea

2020 ◽  
Author(s):  
Ji Yeh Shin ◽  
Ha Jin Kim ◽  
BeLong Cho ◽  
Yun Jun Yang ◽  
Jae Moon Yun
Keyword(s):  
Primary Care ◽  
Continuity Of Care ◽  
Metropolitan Area ◽  
Statistical Significance ◽  
Primary Care Clinic ◽  
Residential Area ◽  
Political Support ◽  
Care Clinic ◽  
Medical Needs ◽  
Care Index

Abstract Background: Diabetes is one of the fastest growing diseases with approximately 463 million patients worldwide. It is established that to manage diabetes, continuity of care in primary care setting is crucial. We aim to statistically define and analyze factors of continuity that are associated with patient, clinic and geographical relationship.Methods: We used 2014~2015 claim data from National Health Insurance Service (NHIS), with 39,096 eligible outpatient attendances across 29,912 office-based clinics. We applied multivariable logistic regression to analyze factors that may affect three kinds of continuity of care index for each patient: most frequent provider continuity index (MFPC), modified-modified continuity index (MMCI), and continuity of care index (COC). Results: Mean value of continuity of care indices were MFPC 0.90, MMCI 0.96, COC 0.85. Among patient factors, old age above 80 (MFPC 0.81 [0.74-0.89], MMCI 0.84 [0.76-0.92], COC 0.81 [0.74-0.89]) and disability were strongly associated with lower continuity of care. Another significant factor was residential area: further the patients lived from their primary care clinic, lower the continuity of diabetes care (MFPC 0.74 [0.70–0.78], MMCI 0.70 [0.66–0.73], COC 0.74 [0.70–0.78]). Patients who lived in metropolitan area had higher continuity of care compared to other areas (metropolitan area, MFPC 1.19 [1.17-1.27], MMCI 1.17 [1.10-1.25], COC 1.19 [1.12-1.27]). There was no statistical significance among clinic factors, such as number of hired physicians or nurses hired per clinic, between the lower and the higher continuity of care groups.Conclusion: Geographical proximity of patient’s residential area and clinic location showed highest correlation as factor of continuity. Political support is necessary to geographically align the imbalance of supply and demand of medical needs.

Study of frailty prevalence and status of elder diabetic patients in a primary care clinic

2016 ◽  
Vol 120 ◽  
pp. S78
Author(s):  
Yuan-Ching Liu ◽  
Neng-Chun Yu ◽  
Shu-Hua Feng ◽  
Lan-Fen Lin ◽  
Chia-Hui Cheng ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Clinic ◽  
Diabetic Patients ◽  
Care Clinic

scholarly journals A 15 Month Experience with a Primary Care-based Telemedicine Screening Program for Diabetic Retinopathy.

2020 ◽  
Author(s):  
James Benjamin ◽  
Justin Sun ◽  
Devon Cohen ◽  
Joseph Matz ◽  
Angela Barbera ◽  
...  
Keyword(s):  
Primary Care ◽  
Diabetic Retinopathy ◽  
Screening Program ◽  
Primary Care Clinic ◽  
University Hospital ◽  
Eye Disease ◽  
Diabetic Patients ◽  
Close Monitoring ◽  
Care Clinic ◽  
Retinal Screening

Abstract Background: Using telemedicine for diabetic retinal screening is becoming popular especially amongst at-risk urban communities with poor access to care. The goal of the diabetic telemedicine project at Temple University Hospital is to improve cost-effective access to appropriate retinal care to those in need of close monitoring and/or treatment.Methods: This will be a retrospective review of 15 months of data from March 2016 to May 2017. We will investigate how many patients were screened, how interpretable the photographs were, how often the photographs generated a diagnosis of diabetic retinopathy (DR) based on the screening photo, and how many patients followed-up for an exam in the office, if indicated.Results: Six-hundred eighty-nine (689) digital retinal screening exams on 1377 eyes of diabetic patients were conducted in Temple’s primary care clinic. The majority of the photographs were read to have no retinopathy (755, 54.8%). Among all of the screening exams, 357 (51.8%) triggered a request for a referral to ophthalmology. Four-hundred forty-nine (449, 32.6%) of the photos were felt to be uninterpretable by the clinician. Referrals were meant to be requested for DR found in one or both eyes, inability to assess presence of retinopathy in one or both eyes, or for suspicion of a different ophthalmic diagnosis. Sixty-seven patients (9.7%) were suspected to have another ophthalmic condition based on other findings in the retinal photographs. Among the 34 patients that were successfully completed a referral visit to Temple ophthalmology, there was good concordance between the level of DR detected by their screening fundus photographs and visit diagnosis.Conclusions: Although a little more than half of the patients did not have diabetic eye disease, about half needed a referral to ophthalmology. However, only 9.5% of the referral-warranted exams actually received an eye exam. Mere identification of referral-warranted diabetic retinopathy or other eye disease is not enough. A successful telemedicine screening program must close the communication gap between screening and diagnosis by reviewer to provide timely follow-up by eye care specialists.

scholarly journals Prevalence of Depression and Its Associated Factors among Diabetes Mellitus Patients in an Urban Primary Care Clinic

2021 ◽  
pp. 100-106
Author(s):  
M. Miskan ◽  
K. Ambigga
Keyword(s):  
Diabetes Mellitus ◽  
Primary Care ◽  
Formal Education ◽  
Primary Care Clinic ◽  
Depression Scale ◽  
Diabetic Patients ◽  
Cross Sectional ◽  
Care Clinic ◽  
Prevalence Of Depression ◽  
Probable Depression

Aims: To determine the prevalence of depression among patients with Diabetes Mellitus and to identify its associated risk factors. Study design:  This is a cross sectional study. Place of study: This study was conducted in an urban primary care clinic in a tertiary hospital in Malaysia. Methodology: This study utilized a self-administered questionnaire, Hospital Anxiety and Depression scale (HADS-D) for the data collection. A total of 358 respondents were eligible to be included in this study. Results:  A total of 382 respondents were recruited in this study using universal sampling method. A total number of 358 eligible respondents were included in the final data analysis. The response rate for this study was 94%. Respondents’ mean age was 60.8 years ± 10.3, 56% females, 38% Malays, 76% were married, 37.7% had Diabetes for more than 5 years and 76.3% had completed secondary school education. This study concluded that 63.7% of participants had poor diabetes control and 26% had probable depression. On multiple logistic regression, respondents who earned income less than RM 500 per month were 2.6 times more likely to have probable depression (aOR: 2.64, 95% CI:1.29 -5.43). Patients who received no formal education were 4.5 times more likely to have probable depression (aOR: 4.51 95% CI:1.74-11.63). Respondents with co-morbid illness were almost 3 times more likely to have probable depression (aOR: 2.92, 95% CI: 0.1-0.8). Conclusion: Prevalence of probable depression was high and there was a significant association between depression with income, education level and co-morbid illness. Thus, there is a need to identify and manage depression accordingly among diabetic patients.

scholarly journals Characteristics of patients with diabetes who accept referrals for care management services

2016 ◽  
Vol 4 ◽  
pp. 205031211562643 ◽  
Author(s):  
Bree Holtz ◽  
Ann M Annis ◽  
Wendy Morrish ◽  
Jennifer Davis Burns ◽  
Sarah L Krein
Keyword(s):  
Primary Care ◽  
Chronic Conditions ◽  
Care Management ◽  
Primary Care Clinic ◽  
Self Care ◽  
Diabetic Patients ◽  
Care Clinic ◽  
Patients With Diabetes ◽  
Computer Based ◽  
Large Primary

Introduction: Patients with chronic conditions can improve their health through participation in self-care programs. However, awareness of and enrollment in these programs are generally low. Objective: We sought to identify factors influencing patients’ receptiveness to a referral for programs and services supporting chronic disease management. Methods: We analyzed data from 541 high-risk diabetic patients who completed an assessment between 2010 and 2013 from a computer-based, nurse-led Navigator referral program within a large primary care clinic. We compared patients who accepted a referral to those who declined. Results: A total of 318 patients (75%) accepted 583 referrals, of which 52% were for self-care programs. Patients who accepted a referral had more primary care visits in the previous year, were more likely to be enrolled in another program, expressed more interest in using the phone and family or friends for support, and were more likely to report recent pain than those who declined a referral. Discussion: Understanding what factors influence patients’ decisions to consider and participate in self-care programs has important implications for program design and development of strategies to connect patients to programs. This work informs outreach efforts to identify and engage patients who are likely to benefit from self-care activities.

scholarly journals A 15 month experience with a primary care-based telemedicine screening program for diabetic retinopathy

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
James E. Benjamin ◽  
Justin Sun ◽  
Devin Cohen ◽  
Joseph Matz ◽  
Angela Barbera ◽  
...  
Keyword(s):  
Primary Care ◽  
Diabetic Retinopathy ◽  
Screening Program ◽  
Primary Care Clinic ◽  
Cost Effective ◽  
University Hospital ◽  
Diabetic Patients ◽  
Close Monitoring ◽  
Care Clinic ◽  
Retinal Screening

Abstract Background Using telemedicine for diabetic retinal screening is becoming popular especially amongst at-risk urban communities with poor access to care. The goal of the diabetic telemedicine project at Temple University Hospital is to improve cost-effective access to appropriate retinal care to those in need of close monitoring and/or treatment. Methods This will be a retrospective review of 15 months of data from March 2016 to May 2017. We will investigate how many patients were screened, how interpretable the photographs were, how often the photographs generated a diagnosis of diabetic retinopathy (DR) based on the screening photo, and how many patients followed-up for an exam in the office, if indicated. Results Six-hundred eighty-nine (689) digital retinal screening exams on 1377 eyes of diabetic patients were conducted in Temple’s primary care clinic. The majority of the photographs were read to have no retinopathy (755, 54.8%). Among all of the screening exams, 357 (51.8%) triggered a request for a referral to ophthalmology. Four-hundred forty-nine (449, 32.6%) of the photos were felt to be uninterpretable by the clinician. Referrals were meant to be requested for DR found in one or both eyes, inability to assess presence of retinopathy in one or both eyes, or for suspicion of a different ophthalmic diagnosis. Sixty-seven patients (9.7%) were suspected to have another ophthalmic condition based on other findings in the retinal photographs. Among the 34 patients that were successfully completed a referral visit to Temple ophthalmology, there was good concordance between the level of DR detected by their screening fundus photographs and visit diagnosis. Conclusions Although a little more than half of the patients did not have diabetic eye disease, about half needed a referral to ophthalmology. However, only 9.5% of the referral-warranted exams actually received an eye exam. Mere identification of referral-warranted diabetic retinopathy and other ophthalmic conditions is not enough. A successful telemedicine screening program must close the communication gap between screening and diagnosis by reviewer to provide timely follow-up by eye care specialists.

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