Demonstrating the Clinical Impact of Continuous Glucose Monitoring Within an Integrated Healthcare Delivery System.

BACKGROUND: Approximately 30 million Americans currently suffer from diabetes, and nearly 55 million people will be impacted by 2030. Continuous glucose monitoring (CGM) systems help patients manage their care with real-time data. Although approximately 95% of those with diabetes suffer from type 2, few studies have measured CGM's clinical impact for this segment within an integrated healthcare system. METHODS: A parallel randomized, multisite prospective trial was conducted using a new CGM device (Dexcom G6) compared to a standard of care finger stick glucometer (FSG) (Contour Next One). All participants received usual care in primary care clinics for six consecutive months while using these devices. Data were collected via electronic medical records, device outputs, exit surveys, and insurance company (SelectHealth) claims in accordance with institutional review board approval. RESULTS: Ninety-nine patients were randomized for analysis (n = 50 CGM and n = 49 FSG). CGM patients significantly decreased hemoglobin A1c (p = .001), total visits (p = .009), emergency department encounters (p = .018), and labs ordered (p = .001). Among SelectHealth non-Medicare Advantage patients, per member per month savings were $417 for CGM compared to FSG, but $9 more for Medicare Advantage. Seventy percent of CGM users reported that the technology helped them better understand daily activity and diet compared to only 16% for FSG. DISCUSSION: Participants using CGM devices had meaningful improvements in clinical outcomes, costs, and self-reported measures compared to the FSG group. Although a larger study is necessary to confirm these results, CGM devices appear to improve patient outcomes while making treatment more affordable.

What's in a name? An evaluation of public perceptions around job role titles within the modern anaesthesia team.

The aim of this study was to examine the association made by members of the public between a healthcare professional's title and the function they actually perform within the anaesthesia team. It was also the intention of this research to establish whether the public felt that the title 'anaesthesia practitioner' or 'physicians' assistant (anaesthesia)' was more synonymous with a member of the non-medical team trained to administer anaesthesia. The study population evaluated was 55 members of the public who were randomly selected from the outpatient department at Good Hope Hospital, part of Heart of England NHS Foundation Trust. Results demonstrated that the titles the general public felt were most synonymous with healthcare professionals who administer anaesthesia were 'consultant anaesthetist' and 'anaesthesia practitioner'. Less than a third of those evaluated felt that an anaesthetic would be given by a 'physicians' assistant (anaesthesia)'.

Harm minimization in school drug education: final results of the School Health and Alcohol Harm Reduction Project (SHAHRP).

AIMS: The School Health and Alcohol Harm Reduction Project (SHAHRP study) aimed to reduce alcohol-related harm in secondary school students. DESIGN: The study used a quasi-experimental research design in which randomly selected and allocated intervention and comparison groups were assessed at eight, 20 and 32 months after baseline. SETTING: Metropolitan, government secondary schools in Perth, Western Australia. PARTICIPANTS: The sample involved over 2300 students. The retention rate was 75.9% over 32 months. INTERVENTION: The evidence-based intervention, a curriculum programme with an explicit harm minimization goal, was conducted in two phases over a 2-year period. MEASURES: Knowledge, attitude, total alcohol consumption, risky consumption, context of use, harm associated with own use and harm associated with other people's use of alcohol. FINDINGS: There were significant knowledge, attitude and behavioural effects early in the study, some of which were maintained for the duration of the study. The intervention group had significantly greater knowledge during the programme phases, and significantly safer alcohol-related attitudes to final follow-up, but both scores were converging by 32 months. Intervention students were significantly more likely to be non-drinkers or supervised drinkers than were comparison students. During the first and second programme phases, intervention students consumed 31.4% and 31.7% less alcohol. Differences were converging 17 months after programme delivery. Intervention students were 25.7%, 33.8% and 4.2% less likely to drink to risky levels from first follow-up onwards. The intervention reduced the harm that young people reported associated with their own use of alcohol, with intervention students experiencing 32.7%, 16.7% and 22.9% less harm from first follow-up onwards. There was no impact on the harm that students reported from other people's use of alcohol. CONCLUSIONS: The results of this study support the use of harm reduction goals and classroom approaches in school drug education.

Review of the psychometric properties of the Diabetes Self-Efficacy Scale: Australian longitudinal study.

The current paper presents the findings from the reliability and validity testing of an 18-item Diabetes Self-efficacy Scale derived from the 28-item Insulin Management Diabetes Self-efficacy Scale. Testing in the Australian context occurred at three points over 9 months. Diabetes self-efficacy is defined as the individual's judgement of confidence to carry out tasks specific to diabetes management. Data were obtained from an Australian metropolitan sample of adult, English speaking men and women with diabetes (N = 226). Participants were insulin-using and non-insulin-using. Factor analysis indicated five subscales. The data support the construct validity and reliability of the 18-item scale in terms of stability, internal consistency and item-total correlation matrices. This study provides consistent evidence that the Diabetes Self-efficacy Scale is a valid and reliable measure over time when the individual's efficacy beliefs are changing. Hence this instrument should be a useful outcome measure for educational diabetes related interventions.

Early unsupervised drinking--reducing the risks. The School Health and Alcohol Harm Reduction Project.

The School Health and Alcohol Harm Reduction Project (SHAHRP) aimed to reduce alcohol-related harm by enhancing students' abilities to identify and deal with high-risk drinking situations and issues. The SHAHRP study involved a quasi-experimental research design, incorporating intervention and control groups and measuring change over a 32-month period. The study occurred in metropolitan, government secondary schools (13 - 17-year-olds) in Perth, Western Australia. The 14 intervention and control schools involved in the SHAHRP study represent approximately 23% of government secondary schools in the Perth metropolitan area. The sample was selected using cluster sampling, with stratification by socio-economic area, and involved over 2,300 intervention and control students from junior secondary schools. The retention rate of the study was 75.9% over 32 months. The intervention incorporated evidence-based approaches to enhance potential for behaviour change in the target population. The intervention was a classroom-based programme, with an explicit harm minimization goal, and was conducted in two phases over a 2-year period. The results were analysed by baseline context of alcohol use to assess the impact of the programme on students with varying experience with alcohol. Knowledge and attitudes were modified simultaneously after the first phase of the intervention in all baseline context of use groups. The programme had little behavioural impact on baseline supervised drinkers; however, baseline non-drinkers and unsupervised drinkers were less likely to consume alcohol in a risky manner, compared to their corresponding control groups. In line with programme goals, early unsupervised drinkers from the intervention group were also significantly less likely to experience harm associated with their own use of alcohol compared to the corresponding control group. Unsupervised drinkers experienced 18.4% less alcohol-related harm after participating in both phases of the programme and this difference was maintained (19.4% difference) 17 months after the completion of the programme. This study indicates that a school drug education programme needs to be offered in several phases, that programme components may need to be included to cater for the differing baseline context of use groups, and that early unsupervised drinkers experience less alcohol-related harm after participating in a harm reduction programme.

The influence of extrinsic and intrinsic risk factors on the probability of sustaining an injury.

This study was designed to quantify the relative contributions of extrinsic and intrinsic risk factors to the probability of an injury event. A case-control design was used with data collected from injured patients at an emergency department (n=797) and a community sample matched on area of residence and time of injury (n=797). Principal components analysis was used to develop scales for the measurement of 'intrinsic' risk taking tendencies that were slightly modified versions of previously published measures. Two principal components were identified: 'health risk taking' (HRT) and 'adventurous risk taking' (ART). Logistic regression analysis identified variables that significantly predicted membership of the group of injured cases. The main hypothesis was supported by the results: that 'extrinsic' factors such as location, activity, drug and alcohol use and the type of people present at the time of the injury were related to a greater risk of injury than 'intrinsic' variables (health and adventurous risk taking tendencies). The results suggest that injury research and prevention efforts should continue to focus on the identification and modification of situational risk factors for injury rather developing programs that focus on high-risk individuals. High-risk alcohol use, use of prescribed drugs and aspects of work and recreational environments were identified as warranting particular attention.

Alcohol consumption, setting, gender and activity as predictors of injury: a population-based case-control study.

OBJECTIVE: A population-based case-control design was employed to quantify the risk of injury after consumption of alcohol as a function of setting, concurrent activity and usual drinking habits. METHOD: A total of 797 cases (66.6% men) and 797 controls (57.7% women) were interviewed. The response rate was 83% for eligible cases approached for an interview. Cases were injured patients from a hospital emergency department. Community controls used were each paired with a case on suburb of residence, and interviewed regarding their activities in the 6-hour period preceding their paired case's injury. RESULTS: Self-reported alcohol consumption was consistent with both medical records and breath-analyzer tests. Drinking any alcohol and using prescribed medication in the prior 6 hours were both associated with significantly increased risk of injury when controlling for demographic and setting variables. Use of illicit drugs (mainly cannabis) was associated with reduced risk of injury. Setting (e.g., recreational, work) and activity (e.g., sport, travel, work) variables were also independently associated with risk of injury. The risk of injury for women was significantly elevated for any consumption of alcohol; for men it was elevated only when consumption exceeded 90 grams. CONCLUSIONS: These data confirm earlier findings that risk of injury for women for a given level of consumption is greater than for men. They extend earlier findings by identifying significant setting, activity and drug use variables predictive of injury. In addition, when these latter variables are controlled, it is found that for women, but not for men, the risk of injury is significantly elevated even at low levels of alcohol intake.

Potential impacts on the incidence of fatal heroin-related overdose in Western Australia: a time-series analysis.

In response to the rising concerns about the rate of heroin-related fatalities, overdose prevention campaigns, run by both users' organizations and government agencies, have been implemented in a number of states across Australia. In Western Australia (WA) in mid-1997, various overdose prevention initiatives were implemented. These included the implementation of a protocol limiting police presence at overdose events; the commencement of naloxone administration by ambulance staff; and the establishment of the Opiate Overdose Prevention Strategy (OOPS) which provided follow-up for individuals treated for overdose in emergency departments. This paper reports the results of a multiple linear regression analysis of 60 months of time-series data, both prior to and following the implementation of these interventions, to determine their impact on the number of fatal heroin overdoses inWA. The model employed in the analysis controlled for changes over time in proxy indicators of use and community concerns about heroin, as well as market indicators. The results suggest that, although the interventions implemented have managed to reduce the expected number of fatalities, they have become less successful in doing so as time passes. This has implications for both existing and potential interventions to reduce fatal heroin-related overdose.