Impact of a self-care education programme on patients with type 2 diabetes in primary care in the Basque Country.

BACKGROUND: Type 2 diabetes mellitus (DM2) is a disease with high prevalence and significant impact in terms of mortality and morbidity. The increased prevalence of the disease requires the implementation of new strategies to promote patient self-management. The Spanish Diabetes Self-Management Program (SDSMP) has proven to be effective in other settings. The objective of this study is to assess its effectiveness in terms of care for DM2 patients in primary care settings within the Basque Health Service - Osakidetza (Spain). METHOD/DESIGN: This is a randomised clinical trial in which patients diagnosed with DM2, 18-79 years of age, from four health regions within the Basque Health Service will be randomised into two groups: an intervention group, who will follow the SDSMP, and a control group, who will receive usual care in accordance with the clinical guidelines for DM2 and existing regulations in our region. The intervention consists of 2,5 hour-group sessions once a week for six weeks. The sessions cover target setting and problem solving techniques, promotion of physical exercise, basic knowledge of nutrition, proper use of medication, effective communication with relatives and health professionals, and basic knowledge about DM2 and its complications. This content is complemented by educational material: books, leaflets and CDs. The primary outcome measure will be the change in glycated haemoglobin (HbA1c), and secondary outcome measures will include changes in levels of physical activity and intake of fruit and vegetables, cardiovascular risk, quality of life, self-efficacy, number of consultations and drug prescriptions. The results will be analysed 6, 12 and 24 months after the intervention. DISCUSSION: If the intervention were to be effective, the programme should be spread to the entire diabetic population in the Basque Country and it could also be applied for other diseases. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT01642394.

Efficacy of a self-management education programme on patients with type 2 diabetes in primary care: A randomised controlled trial.

AIM: The purpose of this study was to assess the efficacy of the Spanish Diabetes Self-Management Program (SDSMP) versus usual care in adults with type 2 diabetes mellitus (T2DM) residing in a Spanish region. METHODS: A two-year follow-up randomised controlled trial. The intervention consisted of 6 weekly structured peer-to-peer workshops. The primary outcome was change in HbA1c levels. Secondary outcomes included other clinical measures, quality of life, self-efficacy, life-style changes, medication and use of healthcare services. Mixed effect models were fitted. RESULTS: n=297 patients were recruited in each study arm. Baseline HbA1c levels were comparable in both groups with an overall mean 7.1 (SD=1.2). The intervention did not significantly modify HbA1c, or other cardiovascular variables. Significant improvements were seen in self-efficacy, and in particularly its disease control component. Certain differences were also observed in the use of healthcare resources and medication consumption. High workshop participation and satisfaction rates were achieved. CONCLUSION: HbA1c reductions are difficult to obtain in adequately controlled patients. On the other hand, raising awareness on one's disease can increase disease control self-efficacy. This finding, accompanied by reduced medication consumption and healthcare use rates, highlights that usual care would be benefited by incorporating certain SDSMP aspects. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT01642394.

A Pilot Study to Assess the Feasibility of the Spanish Diabetes Self-Management Program in the Basque Country.

Purpose. The purpose of this study was to assess the feasibility of the Spanish Diabetes Self-Management Program (SDSMP) in the primary care setting of the Basque Health Service and offer initial estimations of the randomized controlled trial (RCT) effects. Methods. Ten health centers (HCs) participated in a single-arm pilot study with a 6-month follow-up period between February 2011 and June 2012. Recruitment was performed via invitation letters, health professionals, and the local media. Each intervention group consisted of 8-15 people. The ability of each HC in forming up to 2 groups, participants' compliance with the course, and coordination and data collection issues were evaluated. Glycated haemoglobin (HbA1c) was the main outcome variable. Secondary outcomes were cardiovascular risk factors, drugs consumption, medical visits, quality of life, self-efficacy, physical exercise, and diet. Results. Two HCs did not organize a course. A total of 173 patients initiated the program, 2 dropped out without baseline data, and 90% completed it. No pre-post HbA1c differences existed. Certain improvements were observed in blood pressure control, self-efficacy, physical activity, and some dietary habits. Conclusion. The SDSMP is feasible in our setting. Our experience can be of interest when planning and conducting this program in similar health settings. The trial is registered with ClinicalTrials.gov identifier NCT01642394.

[Panorama of self-management initiatives in Spain]. / Panorama de las iniciativas de educación para el autocuidado en España.

OBJECTIVE: To describe the current situation of self-management initiatives in Spain. METHODS: We performed a descriptive study of self-management support initiatives in Spain from the perspective of the patient as expert. Three databases were searched in October 2010 (Pubmed, Scientific Electronic Library Online [SCIELO] and Indice Médico Español [IME]), using the following Keywords «paciente experto¼ (expert patient), «paciente activo¼ (active patient) and «apoyo al autocuidado¼ (self-management support). Web sites were also consulted, using the same key words. Of the initiatives found, we selected those with the most advanced development and continuity, using the perspective of the expert patient (in which patients have an active role) and with a systematic format and methodology. A questionnaire was designed and was sent to the heads of the selected initiatives in the last quarter of 2010. To update the information, the questionnaire was sent again between August and September, 2012. Subsequently, the web sites were visited to review their contents and presence in social networks. RESULTS: Seven initiatives were identified in the autonomous regions of Murcia, Andalusia, Galicia, Castile-La Mancha, Basque Country, and Catalonia. These initiatives used distinct methodologies, formats and assessment systems. CONCLUSIONS: In Spain, there is increasing interest in the development of self-management support programs, although their scope is limited and their impact is mostly unknown, except for patient satisfaction. There is a need for studies on results assessment to identify the impact of these initiatives in our setting, as well as for studies on their implementation to encourage the introduction of patient activation initiatives in routine clinical practice.

La multimorbilidad vista desde la perspectiva de los profesionales de atención primaria / Multiple comorbidities from the perspective of primary care health professionals

OBJETIVO: Explorar la percepción de profesionales clínicos de atención primaria del País Vasco sobre la multimorbilidad y su influencia en la práctica clínica y en la organización de la prestación sanitaria. DISEÑO: Estudio cualitativo basado en entrevistas, taller de storytelling y cocreación. Emplazamiento: Comunidad autónoma del País Vasco. Atención primaria de Osakidetza. Participantes: Participaron 14 profesionales clínicos: 6 especialistas de medicina de familia, 3 especialistas hospitalarios (medicina interna, neumología y geriatría), 4 profesionales de enfermería, y una profesional de farmacia comunitaria. MÉTODOS: Estudio de carácter cualitativo, exploratorio, basado en un taller de cocreación (12 participantes) y 10 entrevistas con profesionales sanitarios. La investigación se llevó a cabo entre los meses de febrero a junio de 2013. Todas las entrevistas y el taller grupal se grabaron en formato audio y algunas de ellas en formato vídeo. RESULTADOS: Los temas emergentes dominantes fueron: a) los retos que plantea la multimorbilidad para un sistema sanitario "centrado en la enfermedad"; b) la manifestación de esos retos en la práctica clínica cotidiana en aspectos como la relación professional-paciente, la toma de decisiones clínicas, el manejo de la polifarmacia y la coordinación entre ámbitos asistenciales; c) las barreras existentes para un manejo apropiado de estos pacientes: formación, herramientas de ayuda a la decisión, falta de tiempo, etc., y d) la cuestión de las competencias y perfiles profesionales más adecuados. CONCLUSIONES: El aumento de la multimorbilidad es una realidad que preocupa a los profesionales de atención primaria. Los profesionales manifiestan la necesidad de disponer formación adecuada y de sistemas de ayuda a la decisión y de soporte de la práctica diaria que contemplen las situaciones y combinaciones de multimorbilidad más frecuentes. Un abordaje más efectivo de esta problemática requiere un cambio en el modelo sanitario que privilegie una visión integral del paciente, la transición de un enfoque paternalista a uno más proactivo y el desarrollo de la integración asistencial

OBJECTIVE: To explore the perception of primary care health professionals in the Basque Country (Spain) of multiple comorbidities and their influence on clinical practice and the organization of health services. DESIGN: Qualitative study based on interviews, a storytelling workshop and cocreation. Setting: The autonomous community of the Basque Country. Primary care in the Basque health system. Participants: Fourteen health professionals: 6 specialists in family medicine, 3 hospital specialists(internal medicine, pneumology, and geriatrics), 4 nurses, and 1 community pharmacist. METHODS: A qualitative, exploratory study was carried out, based on a cocreation workshop (12 participants) and 10 interviews with health professionals. The research was performed between February and June 2013. All interviews and the group workshop were audio recorded and some were video recorded. RESULTS: The emerging dominant themes were as follows: a) the challenges posed by multiple comorbidities for a "disease-centered" health system; b) the manifestation of these challenges in daily clinical practice in aspects such as the patient-health professional relationship, clinical decision-making, polypharmacy management, and coordination between healthcare settings; c) the barriers to the appropriate care of these patients: training, decision-making tools, lack of time, etc.; and d) the question of the most appropriate professional competencies and profiles. CONCLUSIONS: The increase in multiple comorbidities is a reality that worries primary care professionals, who express the need for adequate training, decision-making tools and support in daily clinical practice dealing with the most frequent situations and combinations of multiple comorbidities. The most effective approach to these problems requires a shift in the healthcare model toward an integrated view of the patient, a transition from a paternalist approach to a more proactive approach, and the development of healthcare integration

Panorama de las iniciativas de educación para el autocuidado en España / Panorama of self-management initiatives in Spain

Objetivo: Describir la situación actual de las iniciativas de apoyo al autocuidado en España. Métodos: Estudio descriptivo de iniciativas desarrolladas en España de apoyo al autocuidado desde la perspectiva del paciente como experto. En octubre de 2010 se consultaron las bases de datos PubMed, SCIELO e IME empleando las palabras clave "paciente experto", "paciente activo" y "apoyo al autocuidado", y páginas web mediante motores de búsqueda en Internet con las mismas palabras clave. De las iniciativas encontradas se seleccionaron aquellas con mayor desarrollo y continuidad, enfoque de paciente experto (con un rol activo), y formato y metodología sistematizados. Se diseñó un cuestionario que fue enviado a los responsables de las iniciativas seleccionadas en el último trimestre de 2010 y actualizado entre agosto y septiembre de 2012. Posteriormente se visitaron las páginas web para revisar el contenido y la presencia en las redes sociales. Resultados: Se identificaron siete iniciativas en las comunidades autónomas de Murcia, Andalucía, Galicia, Castilla-La Mancha, Euskadi y Cataluña, con diferentes metodologías, formatos y sistemas de evaluación. Conclusiones: En España se observa un creciente interés por el desarrollo de programas de educación para el autocuidado, pero su alcance es limitado y su impacto poco conocido, salvo en términos de satisfacción de los pacientes. Son necesarios estudios de evaluación de resultados para conocer su impacto en nuestro medio, así como estudios de implementación que favorezcan la introducción en la práctica asistencial de estas iniciativas de activación del paciente (AU)

Objective: To describe the current situation of self-management initiatives in Spain. Methods: We performed a descriptive study of self-management support initiatives in Spain from the perspective of the patient as expert. Three databases were searched in October 2010 (Pubmed, Scientific Electronic Library Online [SCIELO] and Indice Médico Español [IME]), using the following Keywords "paciente experto" (expert patient), "paciente activo" (active patient) and "apoyo al autocuidado" (self-management support). Web sites were also consulted, using the same key words. Of the initiatives found, we selected those with the most advanced development and continuity, using the perspective of the expert patient (in which patients have an active role) and with a systematic format and methodology. A questionnaire was designed and was sent to the heads of the selected initiatives in the last quarter of 2010. To update the information, the questionnaire was sent again between August and September, 2012. Subsequently, the web sites were visited to review their contents and presence in social networks. Results: Seven initiatives were identified in the autonomous regions of Murcia, Andalusia, Galicia, Castile-La Mancha, Basque Country, and Catalonia. These initiatives used distinct methodologies, formats and assessment systems. Conclusions: In Spain, there is increasing interest in the development of self-management support programs, although their scope is limited and their impact is mostly unknown, except for patient satisfaction. There is a need for studies on results assessment to identify the impact of these initiatives in our setting, as well as for studies on their implementation to encourage the introduction of patient activation initiatives in routine clinical practice (AU)