Differences in perspectives regarding diabetes management between health care providers and patients.

Chronic conditions such as type 2 diabetes are challenging to manage. This is often due to failure of both the practice of effective diabetes self-care management by the patient and inadequate intervention strategies and follow-up by the health care provider (HCP). The aims of the study are (i) to use a social marketing survey approach to understand the gaps in perceptions between patients with type 2 diabetes and HCPs on diabetes-related topics such as levels of awareness, use and satisfaction with community resources, and perceived barriers to self-management and (ii) to present the results of a public awareness campaign/diabetes management demonstration project (Cities for Life) on change in discordant views between HCPs and patients. The study was conducted as a separate sample pre-post quasiexperimental design study as part of a clinical-community program, Cities for Life in Birmingham, AL. The surveys were administered before (Wave 1 or W1 in 2012) and after (Wave 2 or W2 in 2013) implementation of the Cities for Life program. HCPs (n = 50 and 48) and patients with type 2 diabetes and prediabetes (n = 201 and 204) responded to surveys at W1 and W2, respectively. At both timepoints, HCPs and patients identified diabetes as a major health priority and stated education and information as the most valuable aspects of community-based programs (CBPs). Although 86% of HCPs reported recommending CBPs for lifestyle modification and that their patients frequently participated in CBPs (W1 = 70%; W2 = 82%), fewer patients reported participation (W1 = 31%; W2 = 22%). Patients frequently were not able to name any CBPs for diabetes prevention or treatment (W1 = 45%; W2 = 59%) despite a large proportion perceiving CBPs as valuable (W1 = 41%; W2 = 39%). A substantial percentage of patients reported receiving "a lot of support" from family/friends/or coworkers (W1 = 54%; W2 = 64%; p < .05), but HCPs believed that a much lower proportion of their patients received "a lot of support" (W1 = 0%, W2 = 10%, p < .05). Patients and HCPs independently reported patients' lack of motivation as one of the main barriers to better diabetes care. HCPs and patients reported discordant views regarding two important aspects of diabetes self-management: the use of community resources and the degree of social suppor t received by patients. HCPs overestimated the patients' use of community resources, and underestimated the patients' degree of social support. Trans-disciplinary interventions to address patients' lack of motivation and to engage social support networks may improve communication and mutual understanding about the role and benefits of community resources in diabetes and other chronic disease self-management.

Recruiting primary care practices for practice-based research: a case study of a group-randomized study (TRANSLATE CKD) recruitment process.

Background: We assessed the challenging process of recruiting primary care practices in a practice-based research study. Methods: In this descriptive case study of recruitment data collected for a large practice-based study (TRANSLATE CKD), 48 single or multiple-site health care organizations in the USA with a total of 114 practices were invited to participate. We collected quantitative and qualitative measures of recruitment process and outcomes for the first 25 practices recruited. Information about 13 additional practices is not provided due to staff transitions and limited data collection resources. Results: Initial outreach was made to 114 practices (from 48 organizations, 41% small); 52 (45%) practices responded with interest. Practices enrolled in the study (n = 25) represented 22% of the total outreach number, or 48% of those initially interested. Average time to enroll was 71 calendar days (range 11-107). There was no difference in the number of days practices remained under recruitment, based on enrolled versus not enrolled (44.8 ± 30.4 versus 46.8 ± 25.4 days, P = 0.86) or by the organization size, i.e. large versus small (defined by having ≤4 distinct practices; 52 ± 23.6 versus 43.6 ± 27.8 days; P = 0.46). The most common recruitment barriers were administrative, e.g. lack of perceived direct organizational benefit, and were more prominent among large organizations. Conclusions: Despite the general belief that the research topic, invitation method, and interest in research may facilitate practice recruitment, our results suggest that most of the recruitment challenges represent managerial challenges. Future research projects may need to consider relevant methodologies from businesses administration and marketing fields.

Missed opportunities for improving practice performance in adult immunizations: a meta-narrative review of the literature.

BACKGROUND: We sought to characterize how the term "missed opportunities" is reported in the literature in the context of immunization rates and to assess how missed opportunities can be operationalized. METHODS: Peer-reviewed literature searches were conducted in April - May, 2015, to answer: "What methods research studies used to operationalize missed opportunities to vaccinate?" A meta-narrative review methodology was used. RESULTS: Seven studies met inclusion criteria. The methodologies for quantifying missed opportunities fell into two general categories based on: 1. the number of healthcare encounters per patient without appropriate vaccination services, defined as a number of visits per patient with no vaccination related services (Missed opportunities per patient); 2. vaccination status as "non-vaccinated" among a group of patients who had a healthcare encounter where the vaccination should/could have had happened (Missed opportunities per population). CONCLUSIONS: Our study provided an initial overview of the methods reported in the literature, and concluded that the quantifiable missed opportunity holds promise as a measurable outcome (variable) for research and quality improvement projects aimed to increase adult immunization recommendation and uptake in primary care.