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1.
Med Care ; 61(Suppl 1): S62-S69, 2023 04 01.
Article in English | MEDLINE | ID: mdl-36893420

ABSTRACT

BACKGROUND: Community health centers (CHCs) pivoted to using telehealth to deliver chronic care during the coronavirus COVID-19 pandemic. While care continuity can improve care quality and patients' experiences, it is unclear whether telehealth supported this relationship. OBJECTIVE: We examine the association of care continuity with diabetes and hypertension care quality in CHCs before and during COVID-19 and the mediating effect of telehealth. RESEARCH DESIGN: This was a cohort study. PARTICIPANTS: Electronic health record data from 166 CHCs with n=20,792 patients with diabetes and/or hypertension with ≥2 encounters/year during 2019 and 2020. METHODS: Multivariable logistic regression models estimated the association of care continuity (Modified Modified Continuity Index; MMCI) with telehealth use and care processes. Generalized linear regression models estimated the association of MMCI and intermediate outcomes. Formal mediation analyses assessed whether telehealth mediated the association of MMCI with A1c testing during 2020. RESULTS: MMCI [2019: odds ratio (OR)=1.98, marginal effect=0.69, z=165.50, P<0.001; 2020: OR=1.50, marginal effect=0.63, z=147.73, P<0.001] and telehealth use (2019: OR=1.50, marginal effect=0.85, z=122.87, P<0.001; 2020: OR=10.00, marginal effect=0.90, z=155.57, P<0.001) were associated with higher odds of A1c testing. MMCI was associated with lower systolic (ß=-2.90, P<0.001) and diastolic blood pressure (ß=-1.44, P<0.001) in 2020, and lower A1c values (2019: ß=-0.57, P=0.007; 2020: ß=-0.45, P=0.008) in both years. In 2020, telehealth use mediated 38.7% of the relationship between MMCI and A1c testing. CONCLUSIONS: Higher care continuity is associated with telehealth use and A1c testing, and lower A1c and blood pressure. Telehealth use mediates the association of care continuity and A1c testing. Care continuity may facilitate telehealth use and resilient performance on process measures.


Subject(s)
COVID-19 , Diabetes Mellitus , Hypertension , Telemedicine , Humans , Cohort Studies , Glycated Hemoglobin , Pandemics , COVID-19/epidemiology , Diabetes Mellitus/epidemiology , Diabetes Mellitus/therapy , Continuity of Patient Care , Hypertension/epidemiology , Hypertension/therapy , Community Health Centers
2.
S Afr Fam Pract (2004) ; 65(1): e1-e10, 2023 02 13.
Article in English | MEDLINE | ID: mdl-36861910

ABSTRACT

BACKGROUND: High-risk people living with diabetes (PLWD) have increased risk for morbidity and mortality. During the first coronavirus disease 2019 (COVID-19) wave in 2020 in Cape Town, South Africa, high-risk PLWD with COVID-19 were fast-tracked into a field hospital and managed aggressively. This study evaluated the effects of this intervention by assessing the impact of this intervention on clinical outcomes in this cohort. METHODS: A retrospective quasi-experimental study design compared patients admitted pre- and post-intervention. RESULTS: A total of 183 participants were enrolled, with the two groups having similar demographic and clinical pre-Covid-19 baselines. Glucose control on admission was better in the experimental group (8.1% vs 9.3% [p = 0.013]). The experimental group needed less oxygen (p  0.001), fewer antibiotics (p  0.001) and fewer steroids (p = 0.003), while the control group had a higher incidence of acute kidney injury during admission (p = 0.046). The median glucose control was better in the experimental group (8.3 vs 10.0; p = 0.006). The two groups had similar clinical outcomes for discharge home (94% vs 89%), escalation in care (2% vs 3%) and inpatient death (4% vs 8%). CONCLUSION: This study demonstrated that a risk-based approach to high-risk PLWD with COVID-19 may yield good clinical outcomes while making financial savings and preventing emotional distress.Contribution: We propose a risk-based approach to guide clinical management of high risk patients, which departs significantly from the current disease-based model. More research using randomised control trial methodology should explore this hypothesis.


Subject(s)
COVID-19 , Diabetes Mellitus , Humans , Blood Glucose , Retrospective Studies , COVID-19/epidemiology , COVID-19/therapy , South Africa/epidemiology , Diabetes Mellitus/epidemiology , Diabetes Mellitus/therapy
4.
BMJ Open ; 13(3): e064425, 2023 Mar 15.
Article in English | MEDLINE | ID: mdl-36921945

ABSTRACT

OBJECTIVE: This study examines the effect of general health checks on the detection and treatment of diabetes and hypertension with controlling for the self-selection problem of undergoing general health checks. DESIGN: Retrospective observational cohort study. SETTING: Sample Research Database offered by Korean National Health Insurance Service, between 2002 and 2013. PARTICIPANTS: Two datasets, focusing on diabetes and hypertensions one by one, are constructed. The number of participants for the datasets is 133 329 (diabetes) and 101 738 (hypertension), respectively. METHODS: A bivariate probit model with selection was adopted to investigate the impact of general health checks on the diagnosis of critical chronic diseases. The dependent variable was an indicator variable denoting whether a participant has been treated for diabetes (or hypertension) or not for the first time during the sample period. An indicator variable that indicates whether that participant is eligible for free general health checks or not in the focal year (year of the first treatment or last year in the sample) was used as instrument variables to control for the self-selection problem of undergoing general health checks. RESULTS: We found that there exists substantial self-selection between undergoing general health checks and diagnosis for chronic diseases. The correlations between the unobserved factors influencing the decisions to obtain general health checks and those determining the detection of chronic diseases are highly significant and positive (ie, 0.188 (p<0.001) in diabetes and 0.220 (p<0.001) in hypertension). We confirmed that these positive, significant correlations generate upward bias in the estimated effect of general health checks on the detection and treatment of diabetes (0.312 (p<0.001) when self-selection ignored but 0.099 (p<0.001) when self-selection considered) and hypertension (0.293 (p<0.001) when self-selection ignored but insignificant when self-selection considered). The effect of general health checks and people's self-selection behaviour may differ by socio-economic characteristics of individuals. The general health check is effective in detecting chronic diseases among low-income individuals rather than high-income individuals, implying that general health checks are contributing to helping medically underprivileged low-income people detect and treat their chronic diseases. High-income individuals showed stronger self-selection behaviour than low-income individuals and this may overstate the effect of general health checks if the self-selection is overlooked, particularly among high-income individuals. CONCLUSION: Self-selection due to unobserved factors between undergoing general health checks and diagnosis of chronic diseases are substantial. After accounting for this, the effect of general health checks on the detection and treatment of diabetes and hypertension is insignificant or marginal. The increases in the treatments of the two diseases following general health checks are 1% and insignificant in diabetes and hypertension, respectively.


Subject(s)
Diabetes Mellitus , Hypertension , Humans , Retrospective Studies , National Health Programs , Hypertension/diagnosis , Hypertension/epidemiology , Diabetes Mellitus/diagnosis , Diabetes Mellitus/epidemiology , Diabetes Mellitus/therapy , Chronic Disease , Health Status , Republic of Korea/epidemiology
7.
J Diabetes Sci Technol ; 17(2): 509-516, 2023 Mar.
Article in English | MEDLINE | ID: mdl-36880565

ABSTRACT

People with diabetes admitted to hospital are at risk of diabetes related complications including hypoglycaemia and diabetic ketoacidosis. Point-of-care (POC) tests undertaken at the patient bedside, for glucose, ketones, and other analytes, are a key component of monitoring people with diabetes, to ensure safety. POC tests implemented with a quality framework are critical to ensuring accuracy and veracity of results and preventing erroneous clinical decision making. POC results can be used for self-management of glucose levels in those well-enough and/or by healthcare professionals to identify unsafe levels. Connectivity of POC results to electronic health records further offers the possibility of utilising these results proactively to identify patients 'at risk' in real-time and for audit purposes. In this article, the key considerations when implementing POC tests for diabetes in-patient management are reviewed and potential to drive improvements using networked glucose and ketone measurements are discussed. In summary, new advances in POC technology should allow people with diabetes and the teams looking after them whilst in hospital to integrate to provide safe and effective care.


Subject(s)
Diabetes Mellitus , Diabetic Ketoacidosis , Humans , Point-of-Care Systems , Point-of-Care Testing , Glucose , Hospitals , Diabetes Mellitus/therapy
8.
J Med Internet Res ; 25: e42134, 2023 Mar 14.
Article in English | MEDLINE | ID: mdl-36917174

ABSTRACT

BACKGROUND: Hypertension and diabetes are becoming increasingly prevalent worldwide. Telemedicine is an accessible and cost-effective means of supporting hypertension and diabetes management, especially as the COVID-19 pandemic has accelerated the adoption of technological solutions for care. However, to date, no review has examined the contextual factors that influence the implementation of telemedicine interventions for hypertension or diabetes worldwide. OBJECTIVE: We adopted a comprehensive implementation research perspective to synthesize the barriers to and facilitators of implementing telemedicine interventions for the management of hypertension, diabetes, or both. METHODS: We performed a scoping review involving searches in Ovid MEDLINE, Embase, CINAHL, Cochrane Library, Web of Science, and Google Scholar to identify studies published in English from 2017 to 2022 describing barriers and facilitators related to the implementation of telemedicine interventions for hypertension and diabetes management. The coding and synthesis of barriers and facilitators were guided by the Consolidated Framework for Implementation Research. RESULTS: Of the 17,687 records identified, 35 (0.2%) studies were included in our scoping review. We found that facilitators of and barriers to implementation were dispersed across the constructs of the Consolidated Framework for Implementation Research. Barriers related to cost, patient needs and resources (eg, lack of consideration of language needs, culture, and rural residency), and personal attributes of patients (eg, demographics and priorities) were the most common. Facilitators related to the design and packaging of the intervention (eg, user-friendliness), patient needs and resources (eg, personalized information that leveraged existing strengths), implementation climate (eg, intervention embedded into existing infrastructure), knowledge of and beliefs about the intervention (eg, convenience of telemedicine), and other personal attributes (eg, technical literacy) were the most common. CONCLUSIONS: Our findings suggest that the successful implementation of telemedicine interventions for hypertension and diabetes requires comprehensive efforts at the planning, execution, engagement, and reflection and evaluation stages of intervention implementation to address challenges at the individual, interpersonal, organizational, and environmental levels.


Subject(s)
Diabetes Mellitus , Health Services Accessibility , Hypertension , Implementation Science , Telemedicine , Humans , Diabetes Mellitus/therapy , Hypertension/therapy , Telemedicine/methods , Telemedicine/standards , Health Services Accessibility/standards , Patient Care Management/methods , Patient Care Management/standards
9.
Front Immunol ; 14: 1136098, 2023.
Article in English | MEDLINE | ID: mdl-36926346

ABSTRACT

Diabetic foot is one of the most common complications of diabetes, requiring repeated surgical interventions and leading to amputation. In the absence of effective drugs, new treatments need to be explored. Previous studies have found that stem cell transplantation can promote the healing of chronic diabetic wounds. However, safety issues have limited the clinical application of this technique. Recently, the performance of mesenchymal stem cells after transplantation has been increasingly attributed to their production of exocrine functional derivatives such as extracellular vesicles (EVs), cytokines, and cell-conditioned media. EVs contain a variety of cellular molecules, including RNA, DNA and proteins, which facilitate the exchange of information between cells. EVs have several advantages over parental stem cells, including a high safety profile, no immune response, fewer ethical concerns, and a reduced likelihood of embolism formation and carcinogenesis. In this paper, we summarize the current knowledge of mesenchymal stem cell-derived EVs in accelerating diabetic wound healing, as well as their potential clinic applications.


Subject(s)
Diabetes Mellitus , Diabetic Foot , Extracellular Vesicles , Mesenchymal Stem Cells , Humans , Wound Healing , Extracellular Vesicles/metabolism , Mesenchymal Stem Cells/metabolism , Stem Cells , Diabetic Foot/therapy , Diabetic Foot/metabolism , Diabetes Mellitus/therapy , Diabetes Mellitus/metabolism
10.
Inquiry ; 60: 469580231160892, 2023.
Article in English | MEDLINE | ID: mdl-36927267

ABSTRACT

Insufficient information exists on the associations between hospitals' adoption of mobile-based personal health record (mPHR) systems and patients' characteristics. This study explored the associations between patients' characteristics and hospitals' adoption of mPHR systems in Korea. This cross-sectional study used 316 hospitals with 100 or more beds as the unit of analysis. Previously collected data on mPHR adoption from May 1 to June 30, 2020 were analyzed. National health insurance claims data for 2019 were also used to analyze patients' characteristics. The dependent variable was mPHR system adoption (0 vs 1) and the main independent variables were the number of patients, age distribution, and proportions of patients with cancer, diabetes, and hypertension among inpatients and outpatients. The number of inpatients was significantly associated with mPHR adoption (adjusted odds ratio [aOR]: 1.174; 1.117-1.233, P < .001), as was the number of outpatients (aOR: 1.041; 1.028-1.054, P < .001). The proportion of inpatients aged 31 to 60 years to those aged 31 years and older was also associated with hospital mPHR adoption (aOR: 1.053; 1.022-1.085, P = .001). mPHR system adoption was significantly associated with the proportion of inpatients (aOR: 1.089; 1.012-1.172, P = .024) and outpatients (aOR: 1.138; 1.026-1.263, P = .015) with cancer and outpatients (aOR: 1.271; 1.101-1.466, P = .001) with hypertension. Although mPHR systems are useful for the management of chronic diseases such as diabetes and hypertension, the number of patients, younger age distribution, and the proportion of cancer patients were closely associated with hospitals' introduction of mPHR systems.


Subject(s)
Diabetes Mellitus , Health Records, Personal , Hypertension , Neoplasms , Humans , Cross-Sectional Studies , Big Data , Hospitals , Delivery of Health Care , Hypertension/epidemiology , Diabetes Mellitus/epidemiology , Diabetes Mellitus/therapy , Electronic Health Records
12.
J Diabetes Res ; 2023: 1359537, 2023.
Article in English | MEDLINE | ID: mdl-36818748

ABSTRACT

Impaired wound healing is common in patients with diabetes mellitus (DM). Different therapeutic modalities including wound debridement and dressing, transcutaneous electrical nerve stimulation (TENS), nanomedicine, shockwave therapy, hyperbaric (HBOT) and topical (TOT) oxygen therapy, and photobiomodulation (PBM) have been used in the management of chronic diabetic foot ulcers (DFUs). The selection of a suitable treatment method for DFUs depends on the hosts' physiological status including the intricacy and wound type. Effective wound care is considered a critical component of chronic diabetic wound management. This review discusses the causes of diabetic wounds and current therapeutic modalities for the management of DFUs, specifically wound debridement and dressing, TENS, nanomedicine, shockwave therapy, HBOT, TOT, and PBM.


Subject(s)
Diabetes Mellitus , Diabetic Foot , Hyperbaric Oxygenation , Humans , Wound Healing , Hyperbaric Oxygenation/methods , Chronic Disease , Diabetic Foot/therapy , Debridement , Diabetes Mellitus/therapy
17.
Rural Remote Health ; 23(1): 8179, 2023 Jan.
Article in English | MEDLINE | ID: mdl-36802734

ABSTRACT

INTRODUCTION: Ambulatory care sensitive indicators for chronic care patients, such as avoidable hospitalizations and preventable mortality, show worse results in Latvia in comparison with the EU average. Previous studies reveal the situation is not far behind in terms of the quantity of diagnostics and consultations, but it is possible to prevent at least 14% of hospitalizations in the chronic patient group. The aim of this study is to find out the opinions of GPs on the barriers and solutions for better care results for diabetic patients in the context of applying an integrated care approach. METHODS: A qualitative study was conducted in the form of semi-strucured in-depth interviews (5 themes, 18 questions), and analyzed using an inductive thematic analysis. The online interviews were conducted in May and April 2021. The respondents were GPs representing different rural regions (n=26). RESULTS: The results of the study reveal that the main barriers to integrated care are: the workload of GPs, especially in COVID conditions; the limited visit time; the lack of focused informational handouts; long queues for secondary care; and the lack of electronic patient health records (EHRs). GPs point to the need to set up patient EHRs, to develop diabetes training rooms in regional hospitals, and to expand GP practice with a third nurse. DISCUSSION: Special attention should be paid to developing integrated care tools at the healthcare system level and patient data digitization and care of socially isolated and sedentary patients by developing home care services, communication tools and integrating primary, secondary and social care at the regional level.


Subject(s)
COVID-19 , Delivery of Health Care, Integrated , Diabetes Mellitus , General Practitioners , Humans , Latvia , Qualitative Research , Diabetes Mellitus/therapy , Attitude of Health Personnel
18.
Molecules ; 28(3)2023 Jan 22.
Article in English | MEDLINE | ID: mdl-36770776

ABSTRACT

Diabetes mellitus is a complicated metabolic disease that has become one of the fastest-growing health crises in modern society. Diabetic patients may suffer from various complications, and diabetic foot is one of them. It can lead to increased rates of lower-extremity amputation and mortality, even seriously threatening the life and health of patients. Because its healing process is affected by various factors, its management and treatment are very challenging. To address these problems, smart biomaterials have been developed to expedite diabetic wound closure and improve treatment outcomes. This review begins with a discussion of the basic mechanisms of wound recovery and the limitations of current dressings used for diabetic wound healing. Then, the categories and characteristics of the smart biomaterial scaffolds, which can be utilized as a delivery system for drugs with anti-inflammatory activity, bioactive agency, and antibacterial nanoparticles for diabetic wound treatment were described. In addition, it can act as a responsive system to the stimulus of the pH, reactive oxygen species, and glucose concentration from the wound microenvironment. These results show that smart biomaterials have an enormous perspective for the treatment of diabetic wounds in all stages of healing. Finally, the advantages of the construction of smart biomaterials are summarized, and possible new strategies for the clinical management of diabetic wounds are proposed.


Subject(s)
Diabetes Mellitus , Diabetic Foot , Humans , Biocompatible Materials/therapeutic use , Diabetic Foot/drug therapy , Wound Healing , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Bandages , Diabetes Mellitus/therapy
19.
Front Public Health ; 11: 1038062, 2023.
Article in English | MEDLINE | ID: mdl-36778542

ABSTRACT

Introduction: Nigeria's skilled health professional health workforce density is insufficient to achieve its national targets for non-communicable diseases (NCD) which include 25% reduction in the prevalence of diabetes and hypertension, particularly at the primary health care (PHC) level. This places a great demand on community health workers (CHWs) who constitute the majority of PHC workers. Traditionally, CHWs are mainly involved in infectious diseases programmes, and maternal and child health services. Their involvement with prevention and control of NCDs has been minimal. With government prioritization of PHC for combating the rising NCD burden, strengthening CHWs' skills and competencies for NCD care delivery is crucial. Methods: We conducted a mixed methods study to explore the roles and practices of CHWs in the delivery of hypertension and diabetes care at PHC facilities in four states (two each in northern and southern regions) in Nigeria. We reviewed the National Standing Orders that guide CHWs' practices at the PHC facilities and administered a survey to 76 CHWs and conducted 13 focus groups (90 participants), and in-depth individual interviews with 13 CHWs and 7 other local and state government stakeholders. Results: Overall, we found that despite capacity constraints, CHWs frequently delivered services beyond the scope of practice stipulated in the National Standing Orders. Such informal task-shifting practices were primarily motivated by a need to serve the community. Discussion: While these practices may partially support health system functions and address unmet need, they may also lead to variable care quality and safety. Several factors could mitigate these adverse impacts and strengthen CHW roles in the health system. These include a stronger enabling policy environment to support NCD task-sharing, investment in continuous capacity building for CHWs, improved guidelines that can be implemented at the point of care, and improved coordination processes between PHC and higher-level facilities.


Subject(s)
Diabetes Mellitus , Hypertension , Noncommunicable Diseases , Child , Humans , Community Health Workers , Diabetes Mellitus/therapy , Hypertension/therapy , Nigeria , Noncommunicable Diseases/prevention & control
20.
PLoS One ; 18(2): e0279230, 2023.
Article in English | MEDLINE | ID: mdl-36848352

ABSTRACT

BACKGROUND: Community-based health interventions are increasingly viewed as models of care that can bridge healthcare gaps experienced by underserved communities in the United States (US). With this study, we sought to assess the impact of such interventions, as implemented through the US HealthRise program, on hypertension and diabetes among underserved communities in Hennepin, Ramsey, and Rice Counties, Minnesota. METHODS AND FINDINGS: HealthRise patient data from June 2016 to October 2018 were assessed relative to comparison patients in a difference-in-difference analysis, quantifying program impact on reducing systolic blood pressure (SBP) and hemoglobin A1c, as well as meeting clinical targets (< 140 mmHg for hypertension, < 8% Al1c for diabetes), beyond routine care. For hypertension, HealthRise participation was associated with SBP reductions in Rice (6.9 mmHg [95% confidence interval: 0.9-12.9]) and higher clinical target achievement in Hennepin (27.3 percentage-points [9.8-44.9]) and Rice (17.1 percentage-points [0.9 to 33.3]). For diabetes, HealthRise was associated with A1c decreases in Ramsey (1.3 [0.4-2.2]). Qualitative data showed the value of home visits alongside clinic-based services; however, challenges remained, including community health worker retention and program sustainability. CONCLUSIONS: HealthRise participation had positive effects on improving hypertension and diabetes outcomes at some sites. While community-based health programs can help bridge healthcare gaps, they alone cannot fully address structural inequalities experienced by many underserved communities.


Subject(s)
Diabetes Mellitus , Hypertension , Hypotension , Humans , Community Health Workers , Diabetes Mellitus/therapy , Glycated Hemoglobin , Hypertension/therapy , Minnesota/epidemiology , Community Health Services
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