scholarly journals Provision of services in primary care for type 2 diabetes: a qualitative study with patients, GPs, and nurses in the East of England

2020 ◽  
Vol 70 (698) ◽  
pp. e668-e675
Author(s):  
Hajira Dambha-Miller ◽  
Simon J Griffin ◽  
Ann Louise Kinmonth ◽  
Jenni Burt
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Care Provision ◽  
Structured Interviews ◽  
High Quality ◽  
Face To Face ◽  
Healthcare Experiences ◽  
Provision Of Services ◽  
The Impact

BackgroundThere is little evidence on the impact of national pressures on primary care provision for type 2 diabetes from the perspectives of patients, their GPs, and nurses.AimTo explore experiences of primary care provision for people with type 2 diabetes and their respective GPs and nurses.Design and settingA qualitative primary care interview study in the East of England.MethodSemi-structured interviews were conducted, between August 2017 and August 2018, with people who have type 2 diabetes along with their respective GPs and nurses. Purposive sampling was used to select for heterogeneity in glycaemic control and previous healthcare experiences. Interviews were audio-recorded and analysed thematically. The consolidated criteria for reporting qualitative research were followed.ResultsThe authors interviewed 24 patients and 15 GPs and nurses, identifying a changing landscape of diabetes provision owing to burgeoning pressures that were presented repeatedly. Patient responders wanted GP-delivered care with continuity. They saw GPs as experts best placed to support them in managing diabetes, but were increasingly receiving nurse-led care. Nurses reported providing most of the in-person care, while GPs remained accountable but increasingly distanced from face-to-face diabetes care provision. A reluctant acknowledgement surfaced among GPs, nurses, and their patients that only minimum care standards could be maintained, with aspirations for high-quality provision unlikely to be met.ConclusionType 2 diabetes is a tracer condition that reflects many aspects of primary care. Efforts to manage pressures have not been perceived favourably by patients and providers, despite some benefits. Reframing expectations of care, by communicating solutions to both patients and providers so that they are understood, managed, and realistic, may be one way forward.

Effect of COVID-19 pandemic on glycaemic monitoring and other processes of care in Type 2 Diabetes: Protocol for a retrospective cohort study (Preprint)

2021 ◽  
Author(s):  
Mekha Mathew ◽  
Jeremy van Vlymen ◽  
Bernardo Meza-Torres ◽  
William Hinton ◽  
Gayathri Delanerolle ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Cohort Study ◽  
Retrospective Cohort ◽  
Glycated Haemoglobin ◽  
First Year ◽  
Process Of Care ◽  
Face To Face ◽  
The Impact

BACKGROUND Social distancing and other non-pharmaceutical interventions to reduce spread of COVID-19 infection in the UK have led to substantial changes in delivering ongoing care for patients with chronic conditions, including type 2 diabetes mellitus (T2DM). Clinical guidelines for management and prevention of complications for people with T2DM delivered in primary care services advise ‘routine annual reviews’ and were developed when face-to-face consultations were the norm. The shift in consultations from face-to-face to remoted-consultations caused a reduction in direct clinical contact and may impact on the process of care for people with T2DM. OBJECTIVE The aim of this study is to explore the impact of the first year of COVID-19 pandemic on the monitoring of T2DM with ‘routine annual reviews’ from a national primary care perspective in England. METHODS A retrospective cohort study of adults with T2DM will be performed using routinely collected primary care data from the Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC). We will describe the change in the rate of monitoring of glycated haemoglobin (HbA1c) between the first year of the COVID pandemic (2020) and the preceding year (2019). We will also report any change in the eight checks that compose the components of these reviews. The change in glycated haemoglobin (HbA1c) monitoring rates will be determined using a multi-level logistic regression model adjusting for patient and practice characteristics and similarly the change in a composite measure of the completeness of all eight checks will be modelled using ordinal regression. The models will be adjusted for the following patient level variables: age, gender, socio economic status, ethnicity, COVID-19 shielding status, duration of diabetes, comorbidities; then at practice-level: urban versus rural, practice size, Quality and Outcomes Framework (QOF) achievement, NHS Region and proportion of face-to-face consultations. Ethical approval was provided by the University of Oxford Medical Sciences Interdivisional Research Ethics Committee (2nd September 2021, Reference: R77306/RE001). RESULTS To create the retrospective diabetic cohort, we will use a representative sample of the adult Orchid-RCGP RSC population of approximately 6.5 million from 721 practices, 128 (17.8%) in the rural setting and 593 (82.2%) urban. The number of adults aged between 18 and 115 years, with a T2DM diagnosis was 393,987 (6.1%). CONCLUSIONS The COVID-19 pandemic has impacted on the delivery of care but little is known on the process of care of people with T2DM. This study will report the impact of the COVID-19 pandemic on these process of care.

Effect of Professional CGM (pCGM) on Glucose Management in Type 2 Diabetes Patients in Primary Care

2021 ◽  
pp. 193229682199872
Author(s):  
Gregg D. Simonson ◽  
Richard M. Bergenstal ◽  
Mary L. Johnson ◽  
Janet L. Davidson ◽  
Thomas W. Martens
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Glucose Monitoring ◽  
Care Model ◽  
Time In Range ◽  
Glucose Management ◽  
The Impact ◽  
Primary Care Management

Background: Little data exists regarding the impact of continuous glucose monitoring (CGM) in the primary care management of type 2 diabetes (T2D). We initiated a quality improvement (QI) project in a large healthcare system to determine the effect of professional CGM (pCGM) on glucose management. We evaluated both an MD and RN/Certified Diabetes Care and Education Specialist (CDCES) Care Model. Methods: Participants with T2D for >1 yr., A1C ≥7.0% to <11.0%, managed with any T2D regimen and willing to use pCGM were included. Baseline A1C was collected and participants wore a pCGM (Libre Pro) for up to 2 weeks, followed by a visit with an MD or RN/CDCES to review CGM data including Ambulatory Glucose Profile (AGP) Report. Shared-decision making was used to modify lifestyle and medications. Clinic follow-up in 3 to 6 months included an A1C and, in a subset, a repeat pCGM. Results: Sixty-eight participants average age 61.6 years, average duration of T2D 15 years, mean A1C 8.8%, were identified. Pre to post pCGM lowered A1C from 8.8% ± 1.2% to 8.2% ± 1.3% (n=68, P=0.006). The time in range (TIR) and time in hyperglycemia improved along with more hypoglycemia in the subset of 37 participants who wore a second pCGM. Glycemic improvement was due to lifestyle counseling (68% of participants) and intensification of therapy (65% of participants), rather than addition of medications. Conclusions: Using pCGM in primary care, with an MD or RN/CDCES Care Model, is effective at lowering A1C, increasing TIR and reducing time in hyperglycemia without necessarily requiring additional medications.

Management of Patients with Type 2 Diabetes by Pharmacists in Primary Care Clinics

1998 ◽  
Vol 32 (6) ◽  
pp. 636-641 ◽  
Author(s):  
Elizabeth A Coast-Senior ◽  
Beverly A Kroner ◽  
Catherine L Kelley ◽  
Lauren E Trilli
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Blood Glucose ◽  
Glycemic Control ◽  
Glycosylated Hemoglobin ◽  
Fasting Blood Glucose ◽  
Face To Face ◽  
Primary Care Clinics ◽  
Blood Glucose Concentrations

OBJECTIVE: To determine the impact of clinical pharmacists involved in direct patient care on the glycemic control of patients with type 2 diabetes mellitus. DESIGN: Eligible patients included those with type 2 diabetes who received insulin or were initiated on insulin therapy by the pharmacists and were willing to perform self-monitoring of blood glucose. The pharmacists provided diabetes education, medication counseling, monitoring, and insulin initiation and/or adjustments. All initial patient interactions with the pharmacists were face-to-face. Thereafter, patient–pharmacist interactions were either face-to-face or telephone contacts. SETTING: Two primary care clinics in a university-affiliated Veterans Affairs Medical Center. PARTICIPANTS: Study subjects were patients with type 2 diabetes who were referred to the pharmacists by their primary care providers for better glycemic control. OUTCOME MEASURES: Primary outcome variables were changes from baseline in glycosylated hemoglobin, fasting blood glucose, and random blood glucose measurements. Secondary outcomes were the number and severity of symptomatic episodes of hypoglycemia, and the number of emergency room visits or hospitalizations related to diabetes. Twenty-three veterans aged 65 ± 9.4 years completed the study. Fifteen (65%) patients were initiated on insulin by the pharmacists; 8 (35%) were already using insulin. Patients were followed for a mean ± SD of 27 ± 10 weeks. Glycosylated hemoglobin, fasting blood glucose concentrations, and random blood glucose concentrations significantly decreased from baseline by 2.2% (p = 0.00004), 65 mg/dL (p < 0.01), and 82 mg/dL (p = 0.00001), respectively. Symptomatic hypoglycemic episodes occurred in 35% of patients. None of these episodes required physician intervention. CONCLUSIONS: This study demonstrates that pharmacists working as members of interdisciplinary primary care teams can positively impact glycemic control in patients with type 2 diabetes requiring insulin.

scholarly journals Patients’ views on interactions with practitioners for type 2 diabetes: a longitudinal qualitative study in primary care over 10 years

2017 ◽  
Vol 68 (666) ◽  
pp. e36-e43 ◽  
Author(s):  
Hajira Dambha-Miller ◽  
Barbora Silarova ◽  
Greg Irving ◽  
Ann Louise Kinmonth ◽  
Simon J Griffin
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Descriptive Analysis ◽  
Free Text ◽  
Individual Level ◽  
Face To Face ◽  
Relational Continuity ◽  
Over Time

BackgroundIt has been suggested that interactions between patients and practitioners in primary care have the potential to delay progression of complications in type 2 diabetes. However, as primary care faces greater pressures, patient experiences of patient–practitioner interactions might be changing.AimTo explore the views of patients with type 2 diabetes on factors that are of significance to them in patient–practitioner interactions in primary care after diagnosis, and over the last 10 years of living with the disease.Design and settingA longitudinal qualitative analysis over 10 years in UK primary care.MethodThe study was part of a qualitative and quantitative examination of patient experience within the existing ADDITION-Cambridge and ADDITION-Plus trials from 2002 to 2016. The researchers conducted a qualitative descriptive analysis of free-text comments to an open-ended question within the CARE measure questionnaire at 1 and 10 years after diagnosis with diabetes. Data were analysed cross-sectionally at each time point, and at an individual level moving both backwards and forwards between time points to describe emergent topics.ResultsAt the 1-year follow-up, 311 out of 1106 (28%) participants had commented; 101 out of 380 (27%) participants commented at 10-year follow-up; and 46 participants commented at both times. Comments on preferences for face-to-face contact, more time with practitioners, and relational continuity of care were more common over time.ConclusionThis study highlights issues related to the wider context of interactions between patients and practitioners in the healthcare system over the last 10 years since diagnosis. Paradoxically, these same aspects of care that are valued over time from diagnosis are also increasingly unprotected in UK primary care.

scholarly journals What are the development priorities for management of type 2 diabetes by general practitioners in Ningbo, China: a qualitative study of patients’ and practitioners’ perspectives

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e037215
Author(s):  
Angharad Woolley ◽  
Li Li ◽  
Josie Solomon ◽  
Jialin Li ◽  
Kai Huang ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
General Practitioners ◽  
Diagnostic Screening ◽  
Face To Face ◽  
Care Facilities ◽  
Qualitative Descriptive ◽  
The City ◽  
Primary Care Management

ObjectivesTo explore patients’ and general practitioners’ (GPs’) perspectives on primary care management of patients with type 2 diabetes mellitus (T2DM) in Ningbo, China. We aimed to understand the current benefits and challenges and to identify development priorities.DesignExploratory qualitative descriptive study using face-to-face interviews and analysed by thematic, inductive analysis.Setting11 primary care facilities spread across the city of Ningbo, China.Participants23 patients with T2DM and 20 GPs involved in caring for patients with T2DM.ResultsGPs were considered the first point of contact and providers of information. However, the care varied, and many GPs lacked confidence and felt overworked. The medication was a particularly weak area. The diagnostic screening commenced late, leading to crisis presentations. Patients were variably informed about their condition, contributing to poor adherence.ConclusionsFuture developments of primary care for T2DM in Ningbo should centre around improving GP confidence and workload and patient education and adherence.

scholarly journals Decolonizing Diabetes

2019 ◽  
Vol 14 (2) ◽  
pp. 252-275
Author(s):  
Roger Stephen Pilon ◽  
Monique Benoit ◽  
Marion Maar ◽  
Sheila Cote ◽  
Fern Assinewe ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Lived Experience ◽  
Indigenous Peoples ◽  
Research Question ◽  
Structured Interviews ◽  
Northern Ontario ◽  
Main Research ◽  
The Impact ◽  
The Way

This article presents insights into the colonial experience of Indigenous Peoples living with type 2 diabetes within seven First Nation communities in Northern Ontario. A constructivist grounded theory methodology, guided by a decolonizing and participatory action approach to conducting research with Indigenous Peoples, was utilised in this study. Twenty-two individuals with type 2 diabetes were interviewed. The main research question explored the impact of colonization on the lived experience and perceptions about developing type 2 diabetes for Indigenous Peoples.  Using semi-structured interviews, the three main categories that emerged from the analysis of the interview transcripts were changing ways of eating, developing diabetes, and choosing your medicine.  A substantive theory was developed that suggests that Indigenous Peoples, with type 2 diabetes, often live with the perception that there is ‘no going back’ to the way things once were prior to European contact. As a result, they have adapted the way they live with diabetes which can, at times, be at odds with Indigenous world views. An adaptation that considers a complementary approach to the way individuals live and manage diabetes including both Traditional and Western ways may provide a framework for a decolonized model of type 2 diabetes care for Indigenous Peoples.

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