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JMIR Diabetes ◽  
10.2196/32369 ◽  
2022 ◽  
Vol 7 (1) ◽  
pp. e32369
Author(s):  
Salim Saiyed ◽  
Renu Joshi ◽  
Safi Khattab ◽  
Shabnam Dhillon

Background COVID-19 disrupted health care, causing a decline in the health of patients with chronic diseases and a need to reimagine diabetes care. With the advances in telehealth programs, there is a need to effectively implement programs that meet the needs of patients quickly. Objective The aim of this paper was to create a virtual boot camp program for patients with diabetes, in 3 months, from project conception to the enrollment of our first patients. Our goal is to provide practical strategies for rapidly launching an effective virtual program to improve diabetes care. Methods A multidisciplinary team of physicians, dieticians, and educators, with support from the telehealth team, created a virtual program for patients with diabetes. The program combined online diabetes data tracking with weekly telehealth visits over a 12-week period. Results Over 100 patients have been enrolled in the virtual diabetes boot camp. Preliminary data show an improvement of diabetes in 75% (n=75) of the patients who completed the program. Four principles were identified and developed to reflect the quick design and launch. Conclusions The rapid launch of a virtual diabetes program is feasible. A coordinated, team-based, systematic approach will facilitate implementation and sustained adoption across a large multispecialty ambulatory health care organization.


2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Diana Dubrall ◽  
Sarah Leitzen ◽  
Irmgard Toni ◽  
Julia Stingl ◽  
M. Schulz ◽  
...  

Abstract Background Adverse drug reactions (ADRs) in the pediatric population may differ in types and frequencies compared to other populations. Respective studies analyzing ADR reports referring to children have already been performed for certain countries. However, differences in drug prescriptions, among others, complicate the transferability of the results from other countries to Germany or were rarely considered. Hence, the first aim of our study was to analyze the drugs and ADRs reported most frequently in ADR reports from Germany referring to children contained in the European ADR database (EudraVigilance). The second aim was to set the number of ADR reports in relation to the number of drug prescriptions. These were provided by the Research Institute for Ambulatory Health Care in Germany. Methods For patients aged 0–17 years 20,854 spontaneous ADR reports were received between 01/01/2000–28/2/2019. The drugs and ADRs reported most frequently were identified. Stratified analyses with regard to age, sex and drugs used “off-label” were performed. Reporting rates (number of ADR reports/number of drug prescriptions) were calculated. Results Methylphenidate (5.5%), ibuprofen (2.3%), and palivizumab (2.0%) were most frequently reported as suspected. If related to the number of drug prescriptions, the ranking changed (palivizumab, methylphenidate, ibuprofen). Irrespective of the applied drugs, vomiting (5.4%), urticaria (4.6%) and dyspnea (4.2%) were the ADRs reported most frequently. For children aged 0–1 year, drugs for the treatment of nervous system disorders and foetal exposure during pregnancy were most commonly reported. In contrast, methylphenidate ranked first in children older than 6 years and referred 3.5 times more often to males compared to females. If age- and sex-specific exposure was considered, more ADR reports for methylphenidate referred to children 4–6 years and females 13–17 years. Drugs for the treatment of nervous system disorders ranked first among “off-label” ADR reports. Conclusions Our analysis underlines the importance of putting the number of ADR reports of a drug in context with its prescriptions. Additionally, differences in age- and sex-stratified analysis were observed which may be associated with age- and sex-specific diseases and, thus, drug exposure. The drugs most frequently included in “off-label” ADR reports differed from those most often used according to literature.


2021 ◽  
Author(s):  
Salim Saiyed ◽  
Renu Joshi ◽  
Safi Khattab ◽  
Shabnam Dhillon

BACKGROUND COVID-19 disrupted health care, causing a decline in the health of patients with chronic diseases and a need to reimagine diabetes care. With the advances in telehealth programs, there is a need to effectively implement programs that meet the needs of patients quickly. OBJECTIVE The aim of this paper was to create a virtual boot camp program for patients with diabetes, in 3 months, from project conception to the enrollment of our first patients. Our goal is to provide practical strategies for rapidly launching an effective virtual program to improve diabetes care. METHODS A multidisciplinary team of physicians, dieticians, and educators, with support from the telehealth team, created a virtual program for patients with diabetes. The program combined online diabetes data tracking with weekly telehealth visits over a 12-week period. RESULTS Over 100 patients have been enrolled in the virtual diabetes boot camp. Preliminary data show an improvement of diabetes in 75% (n=75) of the patients who completed the program. Four principles were identified and developed to reflect the quick design and launch. CONCLUSIONS The rapid launch of a virtual diabetes program is feasible. A coordinated, team-based, systematic approach will facilitate implementation and sustained adoption across a large multispecialty ambulatory health care organization.


2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Laura Rehner ◽  
Kilson Moon ◽  
Wolfgang Hoffmann ◽  
Neeltje van den Berg

Abstract Background The goal of palliative care is to prevent and alleviate a suffering of incurable ill patients. A continuous intersectoral palliative care is important. The aim of this study is to analyse the continuity of palliative care, particularly the time gaps between hospital discharge and subsequent palliative care as well as the timing of the last palliative care before the patient’s death. Methods The analysis was based on claims data from a large statutory health insurance. Patients who received their first palliative care in 2015 were included. The course of palliative care was followed for 12 months. Time intervals between discharge from hospital and first subsequent palliative care as well as between last palliative care and death were analysed. The continuity in palliative care was defined as an interval of less than 14 days between palliative care. Data were analysed using descriptive statistics and Chi-Square. Results In 2015, 4177 patients with first palliative care were identified in the catchment area of the statutory health insurance. After general inpatient palliative care, 415 patients were transferred to subsequent palliative care, of these 67.7% (n = 281) received subsequent care within 14 days. After a stay in a palliative care ward, 124 patients received subsequent palliative care, of these 75.0% (n = 93) within 14 days. Altogether, 147 discharges did not receive subsequent palliative care. During the 12-months follow-up period, 2866 (68.7%) patients died, of these 78.7% (n = 2256) received palliative care within the last 2 weeks of life. Of these, 1223 patients received general ambulatory palliative care, 631 patients received specialised ambulatory palliative care, 313 patients received their last palliative care at a hospital and 89 patients received it in a hospice. Conclusions The majority of the palliative care patients received continuous palliative care. However, there are some patients who did not receive continuous palliative care. After inpatient palliative care, each patient should receive a discharge management for a continuation of palliative care. Readmissions of patients after discharge from inpatients palliative care can be an indication for a lack of support in the ambulatory health care setting and for an insufficient discharge management. Palliative care training and possibilities for palliative care consultations by specialists should strengthen the GPs in palliative care.


Healthcare ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 198
Author(s):  
Cristian Lieneck ◽  
Eric Weaver ◽  
Thomas Maryon

Ambulatory health care provider organizations participating in Accountable Care Organizations (ACOs) organizations assume costs beyond typical practice operations that are directly associated with value-based care initiatives. Identifying these variables that influence such costs are essential to an organization’s financial viability. To enable the U.S. healthcare system to respond to the COVID-19 pandemic CMS issued blanket waivers that permit enhanced flexibility, extension, and other emergency declaration changes to ACO reporting requirements through the unforeseen future. This relaxation and even pausing of reporting requirements encouraged the researchers to conduct a systematic review and identify variables that have influenced costs incurred by ambulatory care organizations participating in ACOs prior to the emergency declaration. The research findings identified ACO-ambulatory care variables (enhanced patient care management, health information technology improvements, and organizational ownership/reimbursement models) that helped to reduce costs to the ambulatory care organization. Additional variables (social determinants of health/environmental conditions, lack of integration/standardization, and misalignment of financial incentives) were also identified in the literature as having influenced costs for ambulatory care organizations while participating in an ACO initiative with CMS. Findings can assist ambulatory care organizations to focus on new and optimized strategies as they begin to prepare for the post-pandemic resumption of ACO quality reporting requirements once the emergency declaration is eventually lifted.


2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Macare ◽  
S Groos ◽  
J Kretschmann ◽  
A Weber ◽  
B Hagen

Abstract Introduction Among cardiovascular conditions, heart failure shows the highest rate of mortality. Despite increased awareness, striking differences in prognosis between men and women with HF still exist in ambulatory health care. In Germany, disease-management-programs (DMP) recognized this need and launched a structured treatment program especially for HF. Indicators assessing successful prevention and quality of care within DMP include among others, referral and prescription rates of prognosis-relevant medications (beta-blockers, AC-I, AT-1-antagonists). Aim To evaluate gender differences in heart failure therapy in the State of North-Rhine Westfalia, Germany. Methods Cross sectional analysis of the 2018 cohort (n=84.398, mean age 79±10.2 yrs., male 61.5%). Logistic regression analyses were run on referrals and prescription of beta-blockers, ACE-I and AT-1-antagonists (all, yes/no). Models tested for gender effects and included known covariates e.g. age and duration of participation (in yrs.) and comorbidities (diabetes, lipid disorder, hypertension, smoking, all yes/no). Results Logistic regression models indicated that gender significantly affected referral rates, OR 1.15, CI-95% 1.09–1.20 and OR 1.15, CI-95% 1.09–1.20, for referrals to hospitals and other physicians. Men received higher rates of referrals to other physicians and other institutions (26.5 vs. 14.2%) and (6.4 vs. 3.5%) than women. Prescription rates were also significantly associated with gender: OR 1.23, CI-95% 1.19–1.27, OR 1.36, CI-95% 1.29–1.43, and OR 0.79, CI-95% 0.72–0.87, for beta-blockers, ACE-I and AT-1-antagonists, respectively. Men received beta-blocker and ACE-I more often (33.8 vs. 4.4% and 28.6 and 8.1%); women had higher rates of AT-1- antagonist prescription (1.2 vs. 5.5%). Conclusion Although, as previously shown work indicated, differences decrease over time, marked gender differences in referral and prescription rates in heart failure still exist in ambulatory health care settings. These results indicate that secondary prevention in women with HF needs to improve. Funding Acknowledgement Type of funding source: None


2020 ◽  
Vol 3 (9) ◽  
pp. e2018752
Author(s):  
Anushree Agarwal ◽  
Eric Vittinghoff ◽  
Janet J. Myers ◽  
R. Adams Dudley ◽  
Abigail Khan ◽  
...  

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