Influence of a Pay-for-Performance Program on Glycemic Control in Patients Living with Diabetes by Family Physicians in a Canadian Province.

OBJECTIVES: We evaluated the influence of the introduction of a pay-for-performance program implemented in 2010 for family physicians on the glycemic control of patients with diabetes. METHODS: Administrative data for all 583 eligible family physicians and 83,580 adult patients with diabetes in New Brunswick over 10 years were used. We compared the probability of receiving at least 2 tests for glycated hemoglobin (A1C) levels and achieving glycemic control before (2005-2009) and after (2010-2014) the implementation of the program and between patients divided based on whether a physician claimed the incentive or did not. RESULTS: Patients living with diabetes showed greater odds of receiving at least 2 A1C tests per year if the detection of their diabetes occurred after (vs. before) the implementation of the program (OR, 99% CI=1.23, 1.18 to 1.28), if a physician claimed the incentive (vs. not claiming it) for their care (1.92, 1.87 to 1.96) in the given year, and if they were followed by a physician who ever (vs. never) claimed the incentive (1.24, 1.15 to 1.34). In a cohort-based analysis, patients for whom an incentive was claimed (vs. not claimed) had greater odds of receiving at least 2 A1C tests per year before implementation of the incentive, and these odds increased by 56% (1.49 to 1.62) following its implementation. However, there was no difference in A1C values among the various comparison groups. CONCLUSIONS: Introduction of the incentive was associated with greater odds of having a minimum of 2 A1C tests per year, which may suggest that it led physicians to provide better follow-up care for patients with diabetes. However, the incentive program has not been associated with differences in glycemic control.

Factors that could explain the increasing prevalence of type 2 diabetes among adults in a Canadian province: a critical review and analysis.

BACKGROUND: The prevalence of diabetes has increased since the last decade in New Brunswick. Identifying factors contributing to the increase in diabetes prevalence will help inform an action plan to manage the condition. The objective was to describe factors that could explain the increasing prevalence of type 2 diabetes in New Brunswick since 2001. METHODS: A critical literature review was conducted to identify factors potentially responsible for an increase in prevalence of diabetes. Data from various sources were obtained to draw a repeated cross-sectional (2001-2014) description of these factors concurrently with changes in the prevalence of type 2 diabetes in New Brunswick. Linear regressions, Poisson regressions and Cochran Armitage analysis were used to describe relationships between these factors and time. RESULTS: Factors identified in the review were summarized in five categories: individual-level risk factors, environmental risk factors, evolution of the disease, detection effect and global changes. The prevalence of type 2 diabetes has increased by 120% between 2001 and 2014. The prevalence of obesity, hypertension, prediabetes, alcohol consumption, immigration and urbanization increased during the study period and the consumption of fruits and vegetables decreased which could represent potential factors of the increasing prevalence of type 2 diabetes. Physical activity, smoking, socioeconomic status and education did not present trends that could explain the increasing prevalence of type 2 diabetes. During the study period, the mortality rate and the conversion rate from prediabetes to diabetes decreased and the incidence rate increased. Suggestion of a detection effect was also present as the number of people tested increased while the HbA1c and the age at detection decreased. Period and birth cohort effect were also noted through a rise in the prevalence of type 2 diabetes across all age groups, but greater increases were observed among the younger cohorts. CONCLUSIONS: This study presents a comprehensive overview of factors potentially responsible for population level changes in prevalence of type 2 diabetes. Recent increases in type 2 diabetes in New Brunswick may be attributable to a combination of some individual-level and environmental risk factors, the detection effect, the evolution of the disease and global changes.

Diversity within African American, female therapists: variability in clients' expectations and assumptions about the therapist.

Despite the presence of some literature that has addressed the characteristics of the African American female therapist, most psychotherapy training proceeds with the assumption that therapists are members of dominant groups, and most of the psychological and psychotherapy literature has been written by therapists and psychologists who come from dominant cultural perspectives. Not as much has been written about psychological paradigms or the process of psychotherapy from the perspective of the therapist who is not a dominant group member. This article explores both the common and divergent experiences that we, the authors, share as African American female therapists and the different reactions we frequently elicit in clients. We also explore how individual differences in our physical appearances, personal backgrounds, and different characteristics of our respective practices elicit distinct responses from clients that we believe are based on differences between us, despite the fact that we are both African American women. We believe that many of the stereotypes that affect perceptions of African American female clients also exist for African American female therapists. We will address how the intersection of gender, race, and sexual orientation of the client highlights the complexity of culturally competent practice.

The use and abuse of religious beliefs in dividing and conquering between socially marginalized groups: the same-sex marriage debate.

This article discusses the use and abuse of religious beliefs and their role in divide-and-conquer strategies. Divide-and-conquer strategies are engaged to disrupt potential coalitions between and among marginalized group members, specifically sexual minority groups and people of color. Tensions between these groups have been exacerbated by the debate on same-sex marriage and comparisons between the discriminatory treatment of each group. A component of this discussion includes a brief exploration of one of the historical abuses of religious doctrine used to legitimize the marginalization of people of color and sexual minorities in the United States. For African Americans, one form of marginalization was reflected in criminalizing interracial marriage, and for members of sexual minority groups, a form of marginalization is denying group members the right to marry. The author also explores culturally competent and respectful disciplinary and clinical responses to religiously derived prejudice against sexual minority group members and people of color and discusses the implications for multicultural discourse.

African american lesbians and other culturally diverse people in psychodynamic psychotherapies.

ABSTRACT The treatment of African American lesbians and other culturally diverse people in psychodynamic psychotherapies has been challenged as inappropriate. The Eurocentric, sexist, and heterocentric origins of these therapies have been viewed as intrinsically insensitive to the unique needs of diverse group members. Moreover, they have been viewed as pathologizing of nondominant cultural values and behaviors, while legitimizing the social pathologies of dominant groups. This discussion, however, argues that there is great diversity in the theories and practice of psychodynamic therapies, that they have undergone signifi-Beverly cant revisions since their origins in classical theory, and that there are minority and majority opinions within the culture of psychodynamic and psychoanalytic theory and practice. I also propose that the prevalence of dominant cultural identities among psychodynamic theoreticians and therapists is a significant factor in the practice of therapy and the development of theoretical paradigms. The usefulness of innovative psycho-dynamic paradigms in addressing some of the unique challenges associated with socially disadvantaged group membership is also explored.

Not any one thing.

Abstract The complex legacy of social class on African American lesbians in relationships was examined using a case study approach. Six highly educated, middle class African American lesbians in their mid-thirties to mid-fifties were interviewed in this exploratory study. Differences in social class were perceived as the reason for the conflict in these relationships. Conversely, similarities in social class were described as making relationships operate more smoothly. Although similarities in race can generate shared cultural values, it is the meaning given to a couple's perceived similarities and differences that influences the quality of the communication between partners. These preliminary findings highlight a previously unexplored contribution to the dynamics in African American lesbian relationships.