Type 2 Diabetes Patients' Needs and Preferences for Care Concerning Sexual Problems: A Cross-Sectional Survey and Qualitative Interviews.

Sexual dysfunction is highly prevalent among patients with type 2 diabetes; however, little is known regarding these patients' needs and preferences for care for sexual problems. A cross-sectional survey and 25 semistructured interviews were therefore conducted among 40- to 75-year-old type 2 diabetes patients to explore this. We learned from the survey and interviews that most participants were unaware of the association between type 2 diabetes and sexual problems. Although certain barriers for discussing sexual problems with a care provider were identified (e.g., feelings of embarrassment), patients still reported a need for discussing their problems, because sex was viewed as an important part of their relationship. Some patients had sought help, but were dissatisfied with the offered care. Patients experienced a lack of attention and information from diabetes care providers. Improving this, together with a care provider-initiated conversation, was suggested to lower the threshold for discussion. Moreover, patients preferred a care provider with whom they have a close relationship, whereas age, gender, and medical specialty were regarded to be less important. An important recommendation was to make care for sexual problems an integral part of routine diabetes care. Future research should look into these recommendations.

Effects of a cognitive behavioural treatment in patients with type 2 diabetes when added to managed care; a randomised controlled trial.

Effects of a cognitive behavioural treatment (CBT) in type 2 diabetes patients were studied in a randomised controlled trial. Patients were recruited from a diabetes care system (DCS). The intervention group (n = 76) received managed care from the DCS and CBT. The control group (n = 78) received managed care only. Effects on risk of developing coronary heart disease (CHD), clinical characteristics, lifestyle, determinants of behaviour change, quality of life, and depression were assessed after 6 and 12 months. The intervention did not result in a significant reduction of CHD risk (difference between intervention and control group was -0.32 % (95 % CI: -2.27; 1.63). The amount of heavy physical activity increased significantly in the intervention group at 6 months [intervention versus control group was 20.14 min/day (95 % CI: 4.6; 35.70)]. Quality of life and level of depression improved as well. All effects disappeared after 6 months. No effects were found on clinical characteristics.

Effect of medication review and cognitive behaviour treatment by community pharmacists of patients discharged from the hospital on drug related problems and compliance: design of a randomized controlled trial.

BACKGROUND: Drug related problems (DRPs) are common among elderly patients who are discharged from the hospital and are using several drugs for their chronic diseases. Examples of drug related problems are contra-indications, interactions, adverse drug reactions and inefficacy of treatment. Causes of these problems include prescription errors and non-compliance with treatment. The aim of this study is to examine the effect of medication review and cognitive behaviour therapy of discharged patients by community pharmacists to minimize the occurrence of drug related problems. METHODS/DESIGN: A randomized controlled trial will be performed. Community pharmacists will be randomized into a control group and an intervention group. 342 Patients, aged over 60 years, discharged from general and academic hospitals, using five or more prescription drugs for their chronic disease will be asked by their pharmacy to participate in the study. Patients randomized to the control group will receive usual care according to the Dutch Pharmacy Standard. The medication of patients randomised to the intervention group will be reviewed by the community pharmacist with use of the national guidelines for the treatment of diseases, when patients are discharged from the hospital. The Pharmaceutical Care network Europe Registration form will be used to record drug related problems. Trained pharmacy technicians will counsel patients at home at baseline and at 1,3,6,9 and 12 months, using Cognitive Behaviour Treatment according to the Theory of Planned Behaviour. The patient's attitude towards medication and patient's adherence will be subject of the cognitive behaviour treatment. The counselling methods that will be used are motivational interviewing and problem solving treatment. Patients adherence towards drug use will be determined with use of the Medication Adherence Report Scale Questionnaire. There will be a follow-up of 12 months.The two primary outcome measures are the difference in occurrence of DRPs between intervention and control group and adherence with drug use. Secondary endpoints are attitude towards drug use, incidence of Re-hospitalisations related to medicines, functional status of the patient, quality of life and the cost-effectiveness of this intervention. DISCUSSION: Combining both medication review and Cognitive Behaviour Treatment may decrease DRPs and may result in more compliance with drug use among patients discharged from the hospital and using 5 or more chronic drugs. TRIAL REGISTRATION: Dutch Trial Register NTR1194.