Evaluation of a holistic treatment and teaching programme for patients with Type 1 diabetes who failed to achieve their therapeutic goals under intensified insulin therapy

Bott, U.; Bott, S.; Hemmann, D M; Berger, Michael

doi:10.1046/j.1464-5491.2000.00345.x

Cited by 38 publications

(44 citation statements)

References 20 publications

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“…229,236,251 The common approach was the promotion of structured routine reviews with an asthma trained nurse whose remit included self-management education and the provision of personalised asthma action plans (PAAPs).…”

Section: Primarily Organisational Changementioning

confidence: 99%

“…Five papers reporting three studies focused on T1DM, [251][252][253][254][255] eight focused on T2DM, [246][247][248][249][250]260,261,264 the remaining 15 included mixed populations. [237][238][239][240][241][242][243][244][245][256][257][258][259]262,263 Thirteen of the studies were conducted in the USA, [237][238][239][244][245][246][247][248][256][257][258][259]262 one in the UK, 240 three from Germany (in five papers), 251,[253][254][255]260 three from Austria, 250,…”

Section: Description Of the Studiesmentioning

confidence: 99%

“…[238][239][240][241][242][243][244][245][246][247][248][249][250][251][252][253][254][255] Education programmes encompassed interventions delivered by MCOs, 238,240,244,245 in primary 241 …”

Section: Primarily Professional Training With or Without Organisationmentioning

confidence: 99%

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A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

Taylor

Pinnock

Epiphaniou

et al. 2014

Health Services and Delivery Research

336

451

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BackgroundDespite robust evidence concerning self-management for some long-term conditions (LTCs), others lack research explicitly on self-management and, consequently, some patient groups may be overlooked.AimTo undertake a rapid, systematic overview of the evidence on self-management support for LTCs to inform health-care commissioners and providers about what works, for whom, and in what contexts.MethodsSelf-management is ‘the tasks . . . individuals must undertake to live with one or more chronic conditions . . . [including] . . . having the confidence to deal with medical management, role management and emotional management of their conditions’. We convened an expert workshop and identified characteristics of LTCs potentially of relevance to self-management and 14 diverse exemplar LTCs (stroke, asthma, type 2 diabetes mellitus, depression, chronic obstructive pulmonary disease, chronic kidney disease, dementia, epilepsy, hypertension, inflammatory arthropathies, irritable bowel syndrome, low back pain, progressive neurological disorders and type 1 diabetes mellitus). For each LTC we conducted systematic overviews of systematic reviews of randomised controlled trials (RCTs) of self-management support interventions (‘quantitative meta-reviews’); and systematic overviews of systematic reviews of qualitative studies of patients’ experiences relating to self-management (‘qualitative meta-reviews’). We also conducted an original systematic review of implementation studies of self-management support in the LTCs. We synthesised all our data considering the different characteristics of LTCs. In parallel, we developed a taxonomy of the potential components of self-management support.ResultsWe included 30 qualitative systematic reviews (including 515 unique studies), 102 quantitative systematic reviews (including 969 RCTs), and 61 studies in the implementation systematic review. Effective self-management support interventions are multifaceted, should be tailored to the individual, their culture and beliefs, a specific LTC and position on the disease trajectory, and underpinned by a collaborative/communicative relationship between the patient and health-care professional (HCP) within the context of a health-care organisation that actively promotes self-management. Self-management support is a complex intervention and although many components were described and trialled in the studies no single component stood out as more important than any other. Core components include (1) provision of education about the LTC, recognising the importance of understanding patients’ pre-existing knowledge and beliefs about their LTC; (2) psychological strategies to support adjustment to life with a LTC; (3) strategies specifically to support adherence to treatments; (4) practical support tailored to the specific LTC, including support around activities of daily living for disabling conditions, action plans in conditions subject to marked exacerbations, intensive disease-specific training to enable self-management of specific clinical tasks; and (5) social support as appropriate. Implementation requires a whole-systems approach which intervenes at the level of the patient, the HCP and the organisation. The health-care organisation is responsible for providing the means (both training and time/material resources) to enable HCPs to implement, and patients to benefit from, self-management support, regularly evaluating self-management processes and clinical outcomes. More widely there is a societal need to address public understanding of LTCs. The lack of public story for many conditions impacted on patient help-seeking behaviour and public perceptions of need.ConclusionsSupporting self-management is inseparable from the high-quality care for LTCs. Commissioners and health-care providers should promote a culture of actively supporting self-management as a normal, expected, monitored and rewarded aspect of care. Further research is needed to understand how health service managers and staff can achieve this culture change in their health-care organisations.Study registrationThis study is registered as PROSPERO CRD42012002898.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Primarily Organisational Changementioning

confidence: 99%

Section: Description Of the Studiesmentioning

confidence: 99%

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A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

Taylor

Pinnock

Epiphaniou

et al. 2014

Health Services and Delivery Research

336

451

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“…Usually, patient education is offered as an adjunct to clinical care, within routine one-to-one visits or as self-contained structured courses for individuals or groups [4,5,13,14]. This requires allocation of additional time and resources that are scarce in most clinics.…”

Section: Introductionmentioning

confidence: 99%

A 3-year prospective randomized controlled clinical trial of group care in type 1 diabetes

Trento

Passera

Borgo

et al. 2005

Nutrition, Metabolism and Cardiovascular Diseases

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Summary Background and aims: We showed that continuing education can be embedded into routine diabetes care by seeing patients in small groups rather than individually. Group care was cost-effective in improving quality of life, knowledge of diabetes, health behaviours and clinical outcomes in people with type 2 diabetes. The aim of this study was to verify if group care can also be applied to type 1 diabetes. Methods and results: Randomized, controlled clinical trial comparing 31 patients managed by group care with 31 managed by traditional one-to-one care. A syllabus was built and later remodulated with the patients in a series of focus-group meetings. The primary end-point was changes in quality of life. Secondary endpoints were: knowledge of diabetes, health behaviours, HbA1c and circulating lipids. Differential costs to the Italian National Health System and to the patients were also calculated.After 3 years, quality of life improved among patients on group care, along with knowledge and health behaviours (p ! 0.001, all). Knowledge added its effects to those of group care by independently influencing behaviours (p Z 0.004) while quality of life changed independently of either (p ! 0.001). Among controls, quality of life worsened (p ! 0.001) whereas knowledge and behaviours remained unchanged. HDL cholesterol increased among patients on group care (p Z 0.027) and total cholesterol decreased in the controls (p ! 0.05). HbA1c

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“…Positive effects on self-esteem, anxiety, diabetes knowledge, and selfefficacy were maintained at the 12-month follow-up. 49 Bott et al 50 included psychosocial modules in a 5-day inpatient training and teaching program for patients with type 1 diabetes who were not in adequate glycemic control (n = 83; 41% female; mean age 35 ± 10 years; mean A1C 8.1 ± 1.5%). Beyond the education component, patients attended two sessions of group discussions on individual goal setting and motivational and emotional aspects such as acceptance and coping strategies.…”

Section: Groups Dealing With the Daily Demands Of Diabetesmentioning

confidence: 99%

Psychosocial Group Interventions in Diabetes Care

Ven¹

2003

Diabetes Spectrum

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Evaluation of a holistic treatment and teaching programme for patients with Type 1 diabetes who failed to achieve their therapeutic goals under intensified insulin therapy

Cited by 38 publications

References 20 publications

A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

A 3-year prospective randomized controlled clinical trial of group care in type 1 diabetes

Psychosocial Group Interventions in Diabetes Care

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