Home About us Contact
|
Home About us Contact | ||
|
|
||
Diabetes Self-care (diabetes + self-care)
Selected AbstractsAre clinical practical guidelines (CPGs) useful for health services and health workforce planning?DIABETIC MEDICINE, Issue 5 2010A critique of diabetes CPGs Diabet. Med. 27, 570,577 (2010) Abstract Aims, Chronic disease management is increasingly informed by clinical practice guidelines (CPGs). However, their implementation requires not only knowledge of guideline content by clinicians and practice processes that support implementation, but also a health workforce with the capacity to deliver care consistent with CPGs. This has a health services planning as well as a health workforce dimension. However, it is not known whether CPGs are described in a way that can inform health services and health workforce planning and potentially drive better quality care. This study aimed to ascertain whether CPGs are useful for health service and health workforce planning. Methods, This question was explored taking diabetes mellitus as a case study. A systematic search of Medline, EMBASE, CINAHL and Scopus was carried out to identify all CPGs relating to the management of diabetes mellitus in the primary healthcare setting. The search was limited to guidelines published in the English language between 2003 and 2009. The quality of guidelines was assessed against a subset of criteria set by the Appraisal of Guidelines for Research and Evaluation (AGREE) collaboration. Results, Seventy-five diabetes-related CPGs were identified, of which 27 met the inclusion criteria. In terms of quality, many guidelines adopted evidence-based recommendations for diabetes care (59%) and most were endorsed by national authorities (70%). With regards to coverage of 17 identified subpopulations, guidelines were generally selective in the populations they covered. Whilst many provided adequate coverage of common complications and comorbidities, approaches to management for those with reduced capacity for effective diabetes self-care were largely absent, except for indigenous populations. Conclusions, Clinical practice guidelines are potentially useful for health services and health workforce planning, but would be more valuable for this purpose if they contained more detail about care protocols and specific skills and competencies, especially for subpopulations who would be expected to have reduced capacity for effective self-care. If service planning ignores these subgroups that tend to require more resource-intensive management, underprovision of services is likely. [source] Information technology supporting diabetes sel-care: a pilot studyEUROPEAN DIABETES NURSING, Issue 1 2007A Halkoaho MSc Diabetes Nurse Specialist Abstract Although diabetes is a lifelong, incurable disease, people can live a full and normal life, provided that they receive appropriate and well-planned care. The care of people with diabetes should be organised as flexibly as possible to suit individual lifestyles. Information technology has become a useful tool to support functional patient,professional relationships and improve care balance. The Self-Care System software tool set by ProWellness is one such tool. Users can enter blood glucose data by using a computer, modem and mobile phone and diabetes nurses can monitor the situation from their own computer and, if necessary, give instructions by sending a SMS (text) message to the patient's mobile phone. This pilot study investigated whether the Self-Care System application supports people with diabetes and can be used as a diabetes education method. The study was carried out in the municipal consortium for healthcare of Siilinjärvi and Maaninka. Nine individuals with diabetes and three diabetes nurses were selected to participate in the study. Data were collected by questionnaire and interview. People with diabetes were sent a questionnaire and the nurses were interviewed. Content analysis was carried out on the interview data. The results suggest that the Self-Care System software supports and motivates diabetes self-care. The nurses felt that the application was useful when changes, such as starting insulin treatment, were introduced. The application was further described as effective and motivating in short-term intensive diabetes education and monitoring; however, both nurses and patients disliked the mechanical nature of the software. Copyright © 2007 FEND. [source] ,I'm the Boss': testing the feasibility of an evidence-based patient education programme using problem-based learningEUROPEAN DIABETES NURSING, Issue 1 2004K Wikblad FEND Professor in Diabetes Nursing Abstract Patient education programmes have shown only small to modest effects on diabetes self-care and metabolic control. Despite that, almost all diabetes teams agree that patient education is an extremely important part of the treatment of diabetes. It is, therefore, important to identify components of successful patient education as a basis for creating and testing an evidence-based education programme. In a review of controlled studies evaluating patient education such components were identified and these were then used in building up the new programme. This programme, called ,I'm the Boss', is based on the notion that the patient is an active care participant, setting his own self-care goals, and is the one responsible for his own life. The content of the programme did not, therefore, focus on diabetes as such, but on life with diabetes. Six themes were explored during six three-hour weekly sessions. The educational method used was problem-based learning. This method is founded in cognitive theory and views the learner as active in seeking knowledge and able to solve the self-care problems identified. The aim of this study was to explore the feasibility of the programme which was tested in four small groups (five to eight participants) of diabetic patients together with two facilitators. After completing the programme, the patients participated in focus group interviews to evaluate the programme. They identified both positive and negative factors. After each session the two facilitators reflected upon the group dynamics. In particular, problems with allowing patients to be the experts should be highlighted. This programme has been modified according to the evaluation and it is now being tested in a randomised, controlled, multicentre study. Copyright © 2004 FEND. [source] Investing time in health: do socioeconomically disadvantaged patients spend more or less extra time on diabetes self-care?HEALTH ECONOMICS, Issue 6 2009Susan L. Ettner Abstract Background: Research on self-care for chronic disease has not examined time requirements. Translating Research into Action for Diabetes (TRIAD), a multi-site study of managed care patients with diabetes, is among the first to assess self-care time. Objective: To examine associations between socioeconomic position and extra time patients spend on foot care, shopping/cooking, and exercise due to diabetes. Data: Eleven thousand nine hundred and twenty-seven patient surveys from 2000 to 2001. Methods: Bayesian two-part models were used to estimate associations of self-reported extra time spent on self-care with race/ethnicity, education, and income, controlling for demographic and clinical characteristics. Results: Proportions of patients spending no extra time on foot care, shopping/cooking, and exercise were, respectively, 37, 52, and 31%. Extra time spent on foot care and shopping/cooking was greater among racial/ethnic minorities, less-educated and lower-income patients. For example, African-Americans were about 10 percentage points more likely to report spending extra time on foot care than whites and extra time spent was about 3,min more per day. Discussion: Extra time spent on self-care was greater for socioeconomically disadvantaged patients than for advantaged patients, perhaps because their perceived opportunity cost of time is lower or they cannot afford substitutes. Our findings suggest that poorly controlled diabetes risk factors among disadvantaged populations may not be attributable to self-care practices. Copyright © 2008 John Wiley & Sons, Ltd. [source] A systematic review of the efficacy of non-pharmacological treatments for depression on glycaemic control in type 2 diabeticsJOURNAL OF CLINICAL NURSING, Issue 19 2008Mei-Yeh Wang Aims and objectives., This paper reported a systematic review of three randomised controlled clinical trials evaluating the efficacy of non-pharmacological treatment of depression on glycaemic control in individuals with type 2 diabetes. Background., Depression is associated with poor adherence to self-care regimen in individuals with diabetes. A significant relationship between depression and poor glycaemic control has also been suggested. Hence, the management of depression becomes an important aspect of diabetes care. Design., Systematic review. Methods., Cochrane library, Pubmed, MEDLINE, EBM review, ProQuest Medical Bundle and SCOPUS databases were searched using the following medical subject headings or key words , depression, mood disorder, depressive symptoms, diabetes mellitus, glycaemic control, glycated haemoglobin, glucose, psychological therapy, psychotherapy, non-pharmacological therapy and cognitive behaviour therapy. The publication date was limited from 1996,2007. Studies were selected if they used a randomised controlled trial design, were written in English, used non-pharmacological treatments for treating depression, included individuals with type 2 diabetes mellitus as participants and included depressive symptoms and glycaemic control (determined by haemoglobin A1C) as outcomes. Results., Non-pharmacological treatments of depression reduce depressive symptoms in diabetic patients. However, cognitive behaviour therapy did not improve glycaemic control. The treatment effect sizes for glycaemic control in the two collaborative-care programmes were also small. Conclusions., The available evidence indicated that non-pharmacological treatment of depression had limited effect on glycaemic control in individuals with type 2 diabetes. Relevance to clinical practice., The depression-focused interventions might not achieve optimal diabetes-related outcomes. The beneficial effect of psychological treatment for glycaemic control may be strengthened by employing treatments tailored to each individual's diabetes self-care needs in addition to depression management. [source] Barriers to the self-care of type 2 diabetes from both patients' and providers' perspectives: literature reviewJOURNAL OF NURSING AND HEALTHCARE OF CHRONIC ILLNE SS: AN INTERNATIONAL INTERDISCIPLINARY JOURNAL, Issue 1 2009Sandra PY Pun MHA Aim., To review systematically the literature about barriers to diabetes self-care from both patients' and healthcare providers' perspectives. Background., Diabetes mellitus is a global health concern due to rapidly increasing prevalence. The healthcare costs for diabetes care and related complications are high. Tight glycaemic control achieved by intensive therapy has been shown to lower the risk of complications. Despite the provision of comprehensive management programmes, patients are often unable to achieve the desired outcomes. It is essential to understand the barriers to diabetes self-care in order to promote successfully self-care behaviours. Methods., A search of OVID Medline (R), CINAHL, Cochrane Library and British Nursing Index was carried out during 1986,2007 using keywords: Type 2 Diabetes Mellitus, self care, patient compliance, patient adherence and barriers to diabetes self care. Manual searching of relevant nursing journals and sourcing of secondary research extended the search. Results., A total of 16 original research papers using various methods including survey, descriptive correlational, sequential explanatory mixed-method and qualitative exploratory design were reviewed. In total, over 8900 patients and 4550 healthcare providers were recruited from over 28 countries in these studies. Major barriers identified included psychosocial, socioeconomic, physical, environmental and cultural factors. Conclusions., Healthcare providers can enhance patient empowerment and participation with family support to achieve feasible targets. Better health care delivery systems and reforms that improve affordability, accessibility, and efficiency of care are essential for helping both providers and patients to meet desirable standards of diabetes care. Relevance to clinical practice., Understanding barriers to diabetes self-care is the first step in facilitating providers to identify their role in enabling patients to overcome these barriers. Healthcare providers can develop strategies to clarify and individualise treatment guidelines, implement continuing education, improve communication skills, and help motivate patients to achieve desired behavioral changes. [source] | ||||||||||||||||||||||