ABSTRACT
Objective: To determine whether an intervention based on patient-practitioner communication is more effective than usual care in improving diabetes self-management in patients with type 2 diabetes with low educational level. Methods: 12-month, pragmatic cluster randomised controlled trial. Nine physicians and 184 patients registered at two practices in a deprived area of Granada (Andalusia, Spain) participated in the study. Adult patients with type 2 diabetes, low educational level and glycated haemoglobin (HbA1c) > 7% (53.01 mmol/mol) were eligible. The physicians in the intervention group received training on communication skills and the use of a tool for monitoring glycaemic control and providing feedback to patients. The control group continued standard care. The primary outcome was difference in HbA1c after 12 months. Dyslipidaemia, blood pressure, body mass index and waist circumference were also assessed as secondary outcomes. Two-level (patient and provider) regression analyses controlling for sex, social support and comorbidity were conducted. Results: The HbA1c levels at 12 months decreased in both groups. Multilevel analysis showed a greater improvement in the intervention group (between-group HbA1c difference= 0.16; p=0.049). No statistically significant differences between groups were observed for dyslipidaemia, blood pressure, body mass index and waist circumference. Conclusions: In this pragmatic study, a simple and inexpensive intervention delivered in primary care showed a modest benefit in glycaemic control compared with usual care, although no effect was observed in the secondary outcomes. Further research is needed to design and assess interventions to promote diabetes self-management in socially vulnerable patients (AU)
Objetivo: Determinar si una intervención basada en la comunicación médico-paciente es más efectiva que la atención habitual en la mejora del autocontrol de la diabetes en pacientes con diabetes tipo 2 con bajo nivel educativo. Métodos: Ensayo controlado aleatorizado pragmático por agrupación de 12 meses. Participaron en el estudio nueve profesionales médicos y 184 pacientes registrados/as en dos centros de salud en una zona pobre de Granada (Andalucía, España). Criterios de inclusión: adultos/as con diagnóstico de diabetes tipo 2, con bajo nivel educativo y hemoglobina glucosilada (HbA1c) >7% (53,01mmol/mol). Los/las sanitarios/as del grupo de intervención recibieron entrenamiento en las habilidades de comunicación y en el uso de una herramienta para la monitorización del control glucémico y proporcionar información a los/las pacientes. El grupo control continuó la atención estándar. La medida de resultado fue la diferencia en la HbA1c después de 12 meses. Otras medidas de resultado fueron la dislipidemia, la hipertensión arterial, el índice de masa corporal y la circunferencia abdominal. Se realizó una regresión con dos niveles (paciente y proveedor) controlando por sexo, apoyo social y comorbilidad. Resultados: La HbA1c a los 12 meses disminuyó en ambos grupos. El análisis multinivel mostró una mayor mejoría en el grupo de intervención (diferencia entre grupos HbA1c=−0,16; p=0,049). No se observaron diferencias estadísticamente significativas entre los grupos para la dislipidemia, la hipertensión arterial, el índice de masa corporal y la circunferencia abdominal. Conclusiones: Este estudio pragmático mostró que una intervención sencilla y de bajo coste ofrecida en atención primaria alcanzó un modesto beneficio en el control glucémico en comparación con la atención habitual, aunque no se observó ningún efecto en los resultados secundarios. Se necesita más investigación para diseñar y evaluar intervenciones para promover el autocontrol de la diabetes en pacientes socialmente vulnerables (AU)
Subject(s)
Humans , Diabetes Mellitus, Type 2/drug therapy , Glycemic Index , Hyperglycemia/prevention & control , Medication Therapy Management/trends , Evaluation of the Efficacy-Effectiveness of Interventions , Patient Compliance , Primary Health Care , Case-Control Studies , Self CareABSTRACT
OBJECTIVE: To determine whether an intervention based on patient-practitioner communication is more effective than usual care in improving diabetes self-management in patients with type 2 diabetes with low educational level. METHODS: 12-month, pragmatic cluster randomised controlled trial. Nine physicians and 184 patients registered at two practices in a deprived area of Granada (Andalusia, Spain) participated in the study. Adult patients with type 2 diabetes, low educational level and glycated haemoglobin (HbA1c) > 7% (53.01 mmol/mol) were eligible. The physicians in the intervention group received training on communication skills and the use of a tool for monitoring glycaemic control and providing feedback to patients. The control group continued standard care. The primary outcome was difference in HbA1c after 12 months. Dyslipidaemia, blood pressure, body mass index and waist circumference were also assessed as secondary outcomes. Two-level (patient and provider) regression analyses controlling for sex, social support and comorbidity were conducted. RESULTS: The HbA1c levels at 12 months decreased in both groups. Multilevel analysis showed a greater improvement in the intervention group (between-group HbA1c difference= 0.16; p=0.049). No statistically significant differences between groups were observed for dyslipidaemia, blood pressure, body mass index and waist circumference. CONCLUSIONS: In this pragmatic study, a simple and inexpensive intervention delivered in primary care showed a modest benefit in glycaemic control compared with usual care, although no effect was observed in the secondary outcomes. Further research is needed to design and assess interventions to promote diabetes self-management in socially vulnerable patients.
Subject(s)
Diabetes Mellitus, Type 2/therapy , Self-Management , Female , Humans , Male , Middle Aged , Quality Improvement , Treatment OutcomeABSTRACT
OBJECTIVE: To find the psychosocial nature of chronic diseases in elderly dependent persons. DESIGN: Transversal, observational study. SETTING: Two urban health districts in Granada and Jaén, Spain. PARTICIPANTS: One hundred five patients included in the Family and Home Care programme for elderly dependent persons. MAIN MEASUREMENTS: The type of chronic illness was analysed through the modified Rolland classification. Types of incapacity, demographic variables and the presence of multi-pathologies were recorded. RESULTS: 47.6% of the 105 participants were between 70 and 79 years old. On their psychosocial nature, 94.2% had some kind of disability, 78% had a gradual start, 61% had a progressive course of disease, and 63.8% had a possibly fatal prognosis. Psychosocial type B -- incapacitating, gradual start, progressive and possibly fatal -- was the most common (44.7%). CONCLUSION: The study of psychosocial type in elderly dependent persons is an important instrument for the analysis of families with chronic illnesses within them. Questions relating to its progressive course and the fatal prognosis may have a more determining prognostic weight.
Subject(s)
Chronic Disease/psychology , Age Factors , Aged , Aged, 80 and over , Chronic Disease/classification , Chronic Disease/mortality , Cross-Over Studies , Disease Progression , Female , Home Care Services , Humans , Male , Middle Aged , Prognosis , Sex Factors , Spain , Urban PopulationABSTRACT
Objetivo. Conocer la tipología psicosocial de las enfermedades crónicas en las personas mayores dependientes. Diseño. Estudio observacional, transversal. Emplazamiento. Dos zonas básicas de salud urbanas en Granada y Jaén. Participantes. Participaron 105 pacientes incluidos en el Programa de Atención Domiciliaria y Atención Familiar en Personas Mayores Dependientes. Mediciones principales. Se analiza la tipología de la enfermedad crónica según la clasificación de Rolland modificada. Se registran los tipos de incapacidad, las variables demográficas y la presencia de varias enfermedades. Resultados. De los 105 participantes, el 47,6% tiene entre 70 y 79 años. En cuanto a los rasgos de la tipología psicosocial, el 94,2% tiene algún tipo de incapacidad, el 78% tiene un inicio gradual, el curso es progresivo en el 61% y el 63,8% tiene un pronóstico posiblemente fatal. La tipología psicosocial B incapacitante, inicio gradual, progresiva y posiblemente fatales la más frecuente (44,7%). Conclusión. El estudio de la tipología psicosocial en personas mayores dependientes es un instrumento importante para el análisis de las familias con enfermedades crónicas en su seno. Los aspectos relativos al curso progresivo y al pronóstico fatal pueden proporcionar un factor pronóstico más determinante
Objective. To find the psychosocial nature of chronic diseases in elderly dependent persons. Design. Transversal, observational study. Setting. Two urban health districts in Granada and Jaén, Spain. Participants. One hundred five patients included in the Family and Home Care programme for elderly dependent persons. Main measurements. The type of chronic illness was analysed through the modified Rolland classification. Types of incapacity, demographic variables and the presence of multi-pathologies were recorded. Results. 47.6% of the 105 participants were between 70 and 79 years old. On their psychosocial nature, 94.2% had some kind of disability, 78% had a gradual start, 61% had a progressive course of disease, and 63.8% had a possibly fatal prognosis. Psychosocial type B--incapacitating, gradual start, progressive and possibly fatal--was the most common (44.7%). Conclusion. The study of psychosocial type in elderly dependent persons is an important instrument for the analysis of families with chronic illnesses within them. Questions relating to its progressive course and the fatal prognosis may have a more determining prognostic weight
