Diabetes Self-Management Education and Association With Diabetes Self-Care and Clinical Preventive Care Practices

Purpose: The purpose of the study is to assess self-reported receipt of diabetes education among people with diabetes and its association with following recommended self-care and clinical preventive care practices. Methods: We analyzed data from the 2017 and 2018 Behavioral Risk Factor Surveillance System for 61 424 adults (≥18 years) with self-reported diabetes in 43 states and Washington, DC. Diabetes education was defined as ever taking a diabetes self-management class. The association of diabetes education with self-care practices (daily glucose testing, daily foot checks, smoking abstention, and engaging in leisure-time physical activity) and clinical practices (pneumococcal vaccination, biannual A1C test, and an annual dilated eye exam, influenza vaccination, health care visit for diabetes, and foot exam by a medical professional) was assessed. Multivariable logistic regression with predicted margins was used to predict the probability of following these practices, by diabetes education, controlling for sociodemographic factors. Results: Of adults with diabetes, only half reported receiving diabetes education. Results indicate that receipt of diabetes education is associated with following self-care and clinical preventive care practices. Those who did receive diabetes education had a higher predicted probability for following all 4 self-care practices (smoking abstention, daily glucose testing, daily foot check, and engaging in leisure-time physical activity) and all 6 clinical practices (pneumonia vaccination, biannual A1C test, and an annual eye exam, flu vaccination, health care visit, and medical foot exam). Conclusions: The prevalence of adults with diabetes receiving diabetes education remains low. Increasing receipt of diabetes education may improve diabetes-related preventive care.

COVID-19 and Its Impact on Older Adults’ Routine and Urgent Health Care Visits

Older adults have not only been disproportionately affected by the COVID-19 pandemic, but relatedly, are also more vulnerable to other health problems. Moreover, previous research on epidemics shows that health care services are often disrupted during health crises—leading to less access to and lower utilization of health services unrelated to the health crisis. The primary aim of this research is to examine the impact of the COVID-19 pandemic on both routine and urgent health care visits. Using data collected in December 2020 on adults ages 54 to 100 living in one of nine senior living communities (SLCs) in the state of Nebraska (n = 723), logistic regression models were used to investigate correlates of missed health care visits, adjusting for sociodemographic and health characteristics. The results show that 58% of older adults in SLCs skipped or postponed a routine health care visit due to the pandemic, whereas 8% of older adults missed an urgent health care visit. The results further reveal that older adults with better perceived health (p < 0.05), higher life satisfaction (p < 0.01), and higher resilience (p < 0.05) all had lower odds of missing a routine health care visit due to the pandemic. In contrast, those who missed an urgent health care visit were more likely to have higher perceived financial strain (p < 0.05). The findings from this study demonstrate the consequences of the COVID-19 pandemic on older adults’ health care utilization, which may have serious implications for their long-term health.

Reasons for Uncontrolled Blood Pressure Among US Adults: Data From the US National Health and Nutrition Examination Survey

Identifying subgroups of the population with different reasons for uncontrolled blood pressure (BP) can inform where to direct interventions to increase hypertension control. We determined characteristics associated with not being aware of having hypertension and being aware but not treated with antihypertensive medication among US adults with uncontrolled BP using the 2015 to 2018 National Health and Nutrition Examination Surveys (N=2282). Among US adults with uncontrolled BP, systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg, 38.0% were not aware they had hypertension, 15.6% were aware but not treated and 46.4% were aware and treated with antihypertensive medication. After multivariable adjustment, US adults who were 18-39 versus ≥70 years old were more likely (prevalence ratio, 1.49 [95% CI, 1.11–1.99]) and those who had a health care visit in the past year were less likely (prevalence ratio, 0.61 [95% CI, 0.48–0.77]) to be unaware they had hypertension. Among US adults with uncontrolled BP who were aware they had hypertension, those 18 to 39, 40 to 49, 50 to 59, and 60 to 69 versus ≥70 years old were more likely to not be treated versus being treated with antihypertensive medication. Not being treated with antihypertensive medication versus being treated and having uncontrolled BP was less common among those with versus without a usual source of health care (prevalence ratio, 0.69 [95% CI, 0.51–0.94]) and who reported having versus not having a health care visit in past year (prevalence ratio, 0.46 [95% CI, 0.35–0.61]). In conclusion, to increase BP control, interventions should be directed towards populations in which hypertension awareness is low and uncontrolled BP is common despite antihypertensive medication use.

Givosiran (Givlaari)

CADTH recommends that Givlaari should be reimbursed by public drug plans for the treatment of acute hepatic porphyria (AHP) in adults if certain conditions are met. Givlaari should only be covered to treat patients who have experienced 4 or more attacks requiring either hospitalization, an urgent health care visit, or intravenous hemin in the year prior to the prescribing date. Givlaari should only be reimbursed if prescribed by a clinician experienced in the management of AHP, if it is not used in combination with prophylactic hemin, and if the cost of Givlaari is reduced. Reimbursement of Givlaari should be renewed after 12 months if there is a reduction in the annualized attack rate.

KNOWLEDGE ATTITUDE AAND PRACTICE OF MALE PARTNER REGARDING FAMILY PLANNING, EASTERN PROVINCE, SAUDI ARABIA

BACKGROUND: Family planning is the act of controlling birth numbers and intervals by using contraception or voluntary sterilization, the availability of a variety of female contraceptive methods led to an increase in family planning programs and researches that targets women. It is important to identify the perception of Saudi men, regarding the use of contraception methods and the effect of socio-demographic characteristics on this perception and to identify their requirements to encourage them to be involved in family planning. this study is aimed to address the knowledge, practice and attitude of Saudi men toward family planning. METHOD: A descriptive cross-sectional study in 2020 on 1610 respondents using a structured questionnaire distributed online. RESULT: Most of the respondents heard about the term of family planning (69.1%), and were able to recognize the most commonly used contraceptives however, the majority of our sample are not using contraception (56.3%). their attitude toward family planning was positive. Conclusion: Our sample population has a positive attitude toward family planning and they were willing to participate in family planning counseling and health care visit.

Right For Me: a pragmatic multi-arm cluster randomised controlled trial of two interventions for increasing shared decision-making about contraceptive methods

Objectives: There is a paucity of evidence on how to facilitate shared decision-making under real-world conditions and, in particular, whether interventions should target patients, health care providers, or both groups. Our objectives were to assess the comparative effectiveness, feasibility, and acceptability of patient- and provider-targeted interventions for improving shared decision-making about contraceptive methods in a pragmatic trial that prioritised applicability to real-world care. Design: The study design was a 2X2 factorial cluster randomized controlled trial with four arms: (1) video + prompt card ("video"), (2) decision aids + training ("decision aids"), (3) dual interventions ("dual"), and (4) usual care. Clusters were 16 primary and/or reproductive health care clinics that deliver contraceptive care in the Northeast United States. Participants: Participants were people who had completed a health care visit at a participating clinic, were assigned female sex at birth, were aged 15-49 years, were able to read and write English or Spanish, and had not previously participated in the study. Participants were enrolled for 13 weeks before interventions were implemented in clinics (pre-implementation cohort) and for 26 weeks after interventions were implemented in clinics (post-implementation cohort). 5,018 participants provided data on at least one study outcome. Interventions: Interventions were a video and prompt card that encourage patients to ask three specific questions in the health care visit and a suite of decision aids on contraceptive methods and training for providers in how to use them to facilitate shared decision-making with patients in the health care visit. Main outcome measures: The primary outcome was shared decision-making about contraceptive methods. Secondary outcomes spanned psychological, behavioural, and health outcomes. All outcomes were patient-reported via surveys administered immediately, four weeks, and six months after the health care visit. Results: We did not observe any between-arm difference in the differences in shared decision-making between the pre- and post-implementation cohorts for the sample as a whole (video vs. usual care: adjusted odds ratio (AOR)=1.23 (95% confidence interval (CI): 0.82 to 1.85), p=0.80; decision aids vs. usual care: AOR=1.47 (95% CI: 0.98 to 2.18), p=0.32; dual vs. video: AOR=0.95 (95% CI: 0.64 to 1.41), p=1.00; dual vs. decision aids: AOR=0.80 (95% CI: 0.54 to 1.17), p=0.72) or for participants with adequate health literacy. Among participants with limited health literacy, the difference in shared decision-making between the pre- and post-implementation cohorts was different in the video arm from the usual care arm (AOR=2.40 (95% CI: 1.01 to 5.71), p=.047) and was also different in the decision aids arm from the usual care arm (AOR=2.65 (95% CI: 1.16 to 6.07), p=.021), however these differences were not robust to adjustment for multiple comparisons. There were no intervention effects on the secondary outcomes among all participants nor among prespecified subgroups. With respect to intervention feasibility, rates of participant-reported exposure to the relevant intervention components were 9.4% for the video arm, 31.5% for the decision aids arm, and 5.0% for the dual arm. All interventions were acceptable to most patients. Conclusions: The interventions studied are unlikely to have a meaningful population-wide impact on shared decision-making or other outcomes in real-world contraceptive care without additional strategies to promote and support implementation. Selective use of the interventions among patients with limited health literacy may be more promising and, if effective, could reduce disparities in shared decision-making. Trial registration: ClinicalTrials.gov NCT02759939.

Visual Examination Frequency for People Taking Ethambutol for Tuberculosis

CADTH identified 1 non-Canadian guideline that includes recommendations on the frequency of visual examinations for people with active tuberculosis who take ethambutol as part of their treatment. The guideline recommends testing for visual acuity and colour vision before starting treatment and at every health care visit throughout the course of treatment with ethambutol (recommendations based on clinical experience).