Diabetes Implementation of a Self-management Program in Resource Poor and Rural Community Clinics

Davis, Terry C.; Seligman, Hilary K.; DeWalt, Darren A.; Platt, Daci J.; Reynolds, Cristalyn; Timm, Donna F.; Arnold, Connie L.

doi:10.1177/2150131911435673

Cited by 7 publications

(5 citation statements)

References 16 publications

(27 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous studies of resource-poor community clinics or Appalachian dwelling people have demonstrated favorable effects related to patients' engagement in their own chronic care. However, this study did not support previous findings that educational strategies to enhance patients' self-care efforts (Davis et al, 2012), or self-management activities (Jessee et al, 2012) are effective in improving importanthealthcare outcomes.…”

Section: Discussioncontrasting

confidence: 99%

An Evaluation of a Comprehensive Cardiovascular Disease Risk Reduction Program in an Appalachian Free Clinic

Settle¹,

March²

2015

IJN

View full text Add to dashboard Cite

Effective cardiovascular disease (CVD) risk reduction challenges healthcare clinicians in spite of scientific advances. Managing CVD is more challenging in specific populations(Appalachian, high risk, impoverished, served by charitable clinic).Purpose: This study evaluated if a comprehensive CVD risk reduction program was effective in reducing risk factors in this population. Methods: A retrospective analysis of 125 records of participants of the CVD risk reduction program and a matched sample of 125 records from non-participants was conducted. Variables included hemoglobin A1C, body mass index, cholesterol, and blood pressure. Results: There was an overall reduction in CVD risk factors in both the education and non-education groups. However, he results could not be attributed solely to the risk reduction education program. Conclusions: Confounding variables (voluntary participation, incentives, patient/clinician relationship dynamics, self-motivation) may have contributed to outcomes. Future study may illuminate processes of self-care that encourage patient self-care efforts. Clinical relevance: Advanced nurse practitioners in busy primary care settings are expected to find ways to invite and engage impoverished, disadvantaged, patients in the effective self-management of CVD. This article provides insights into the challenges that clinicians face.

show abstract

Section: Discussioncontrasting

confidence: 99%

An Evaluation of a Comprehensive Cardiovascular Disease Risk Reduction Program in an Appalachian Free Clinic

Settle¹,

March²

2015

IJN

View full text Add to dashboard Cite

show abstract

“…During study week 7, participants created a short-term action plan focused on behavior change related to self-management of chronic disease and/or health maintenance using video and written materials outlining the well-established SMART goal framework. 25,62 Participants then reported their level of action plan initiation in the action plan initiation (API) survey, 72 from 1 (not at all) to 7 (completely) at weeks 8 and 9, a 2-week time window consistent with previously published studies. 26,72,73 Evidence of plan initiation was defined as API score ≥ 5.…”

Section: Primary Outcomementioning

confidence: 99%

“…[17][18][19][20] Selfmanagement, a core focus within both the PCMH health care reform movement and the Chronic Care Model, 18,[20][21][22][23] is commonly encouraged through a process of engaged goal setting using the SMART framework 24 and accessible to a diversity of patient populations. 25,26 Mindfulness meditation may enhance self-regulation [27][28][29] (e.g., attention, emotion regulation processes 30,31 ) by increasing cognitive resources 28 (e.g., reappraisal, exposure) and modifying self-related processing 32 (e.g., reduced rumination, enhanced body awareness). Mindfulness-based programs (MBPs) 33 , derived from mindfulness-based stress reduction (MBSR), 34,35 are evidence-based treatments that seem to harness self-regulatory mechanisms and could help people with self-regulation challenges catalyze behavior change related to managing chronic disease.…”

Section: Introductionmentioning

confidence: 99%

Mindfulness Training Enhances Self-Regulation and Facilitates Health Behavior Change for Primary Care Patients: a Randomized Controlled Trial

Gawande

Pine

et al. 2018

J GEN INTERN MED

View full text Add to dashboard Cite

BACKGROUND: Self-management of health is important for improving health outcomes among primary care patients with chronic disease. Anxiety and depressive disorders are common and interfere with self-regulation, which is required for disease self-management. An insurancereimbursable mindfulness intervention integrated within primary care may be effective for enhancing chronic disease self-management behaviors among primary care patients with anxiety, depression, trauma, and stress-related and adjustment disorders compared with the increasingly standard practice of referring patients to outside mindfulness resources. OBJECTIVE: Mindfulness Training for Primary Care (MTPC) is an 8-week, referral-based, insurance-reimbursable program integrated into safety-net health system patient-centered medical homes. We hypothesized that MTPC would be more effective for catalyzing chronic disease self-management action plan initiation within 2 weeks, versus a low-dose comparator (LDC) consisting of a 60-min mindfulness introduction, referral to community and digital resources, and addition to a 6-month waitlist for MTPC. PARTICIPANTS: Primary care providers (PCPs) and mental health clinicians referred 465 patients over 12 months. All participants had a DSM-V diagnosis. DESIGN AND INTERVENTIONS: Participants (N = 136) were randomized in a 2:1 allocation to MTPC (n = 92) or LDC (n = 44) in a randomized controlled comparative effectiveness trial. MTPC incorporates mindfulness, self-compassion, and mindfulness-oriented behavior change skills and is delivered as insurance-reimbursable visits within primary care. Participants took part in a chronic disease self-management action planning protocol at week 7. MAIN MEASURES: Level of self-reported action plan initiation on the action plan initiation survey by week 9. KEY RESULTS: Participants randomized to MTPC, relative to LDC, had significantly higher adjusted odds of self-management action plan initiation in an intention-to-treat analysis (OR = 2.28; 95% CI = 1.02 to 5.06, p = 0.025). CONCLUSIONS: An 8-week dose of mindfulness training is more effective than a low-dose mindfulness comparator in facilitating chronic disease self-management behavior change among primary care patients.

show abstract

“…The full-text versions of the remaining articles were reviewed for eligibility resulting in the exclusion of 224 for the reasons noted. Ultimately, 62 studies were included from the search, reporting on 60 unique patient samples 23 25–86…”

Section: Resultsmentioning

confidence: 99%

Exercise-based rehabilitation for major non-communicable diseases in low-resource settings: a scoping review

et al. 2019

View full text Add to dashboard Cite

IntroductionWhile there is substantial evidence for the benefits of exercise-based rehabilitation in the prevention and management of non-communicable disease (NCD) in high-resource settings, it is not evident that these programmes can be effectively implemented in a low-resource setting (LRS). Correspondingly, it is unclear if similar benefits can be obtained. The objective of this scoping review was to summarise existing studies evaluating exercise-based rehabilitation, rehabilitation intervention characteristics and outcomes conducted in an LRS for patients with one (or more) of the major NCDs.MethodsThe following databases were searched from inception until October 2018: PubMed/Medline, Embase, CINAHL, Cochrane Library, PsycINFO and trial registries. Studies on exercise-based rehabilitation for patients with cardiovascular disease, diabetes, cancer or chronic respiratory disease conducted in an LRS were included. Data were extracted with respect to study design (eg, type, patient sample, context), rehabilitation characteristics (eg, delivery model, programme adaptations) and included outcome measures.ResultsThe search yielded 5930 unique citations of which 60 unique studies were included. Study populations included patients with cardiovascular disease (48.3%), diabetes (28.3%), respiratory disease (21.7%) and cancer (1.7%). Adaptations included transition to predominant patient-driven home-based rehabilitation, training of non-conventional health workers, integration of rehabilitation in community health centres, or triage based on contextual or patient factors. Uptake of adapted rehabilitation models was 54%, retention 78% and adherence 89%. The majority of the outcome measures included were related to body function (65.7%).ConclusionsThe scope of evidence suggests that adapted exercise-based rehabilitation programmes can be implemented in LRS. However, this scope of evidence originated largely from lower middle-income, urban settings and has mostly been conducted in an academic context which may hamper extrapolation of evidence to other LRS. Cost-benefits, impact on activity limitations and participation restrictions, and subsequent mortality and morbidity are grossly understudied.

show abstract

Diabetes Implementation of a Self-management Program in Resource Poor and Rural Community Clinics

Cited by 7 publications

References 16 publications

An Evaluation of a Comprehensive Cardiovascular Disease Risk Reduction Program in an Appalachian Free Clinic

An Evaluation of a Comprehensive Cardiovascular Disease Risk Reduction Program in an Appalachian Free Clinic

Mindfulness Training Enhances Self-Regulation and Facilitates Health Behavior Change for Primary Care Patients: a Randomized Controlled Trial

Exercise-based rehabilitation for major non-communicable diseases in low-resource settings: a scoping review

Contact Info

Product

Resources

About