Management of type 2 diabetes: a challenge for patient and physician

Arend, I. J. M. Van Den; Stolk, Ronald P.; Krans, H. M. J.; Grobbee, Diederick E.; Schrijvers, A. J. P.

doi:10.1016/s0738-3991(99)00067-1

Cited by 85 publications

(26 citation statements)

References 23 publications

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“…The cornerstones of health care to support active patient participation are to guarantee the continuity of care, to integrate education in health care and to encourage the patient's attendance [35]. An increased patient satisfaction may be contributing to improved clinical outcomes [36].…”

Section: Discussionmentioning

confidence: 99%

GPs' perspectives of type 2 diabetes patients' adherence to treatment: A qualitative analysis of barriers and solutions

et al. 2005

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BackgroundThe problem of poor compliance/adherence to prescribed treatments is very complex. Health professionals are rarely being asked how they handle the patient's (poor) therapy compliance/adherence. In this study, we examine explicitly the physicians' expectations of their diabetes patients' compliance/adherence. The objectives of our study were: (1) to elicit problems physicians encounter with type 2 diabetes patients' adherence to treatment recommendations; (2) to search for solutions and (3) to discover escape mechanisms in case of frustration.MethodsIn a descriptive qualitative study, we explored the thoughts and feelings of general practitioners (GPs) on patients' compliance/adherence. Forty interested GPs could be recruited for focus group participation. Five open ended questions were derived on the one hand from a similar qualitative study on compliance/adherence in patients living with type 2 diabetes and on the other hand from the results of a comprehensive review of recent literature on compliance/adherence. A well-trained diabetes nurse guided the GPs through the focus group sessions while an observer was attentive for non-verbal communication and interactions between participants. All focus groups were audio taped and transcribed for content analysis. Two researchers independently performed the initial coding. A first draft with results was sent to all participants for agreement on content and comprehensiveness.ResultsGeneral practitioners experience problems with the patient's deficient knowledge and the fact they minimize the consequences of having and living with diabetes. It appears that great confidence in modern medical science does not stimulate many changes in life style. Doctors tend to be frustrated because their patients do not achieve the common Evidence Based Medicine (EBM) objectives, i.e. on health behavior and metabolic control. Relevant solutions, derived from qualitative studies, for better compliance/adherence seem to be communication, tailored and shared care. GPs felt that a structured consultation and follow-up in a multidisciplinary team might help to increase compliance/adherence. It was recognized that the GP's efforts do not always meet the patients' health expectations. This initiates GPs' frustration and leads to a paternalistic attitude, which may induce anxiety in the patient. GPs often assume that the best methods to increase compliance/adherence are shocking the patients, putting pressure on them and threatening to refer them to hospital.ConclusionGPs identified a number of problems with compliance/adherence and suggested solutions to improve it. GPs need communication skills to cope with patients' expectations and evidence based goals in a tailored approach to diabetes care.

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Section: Discussionmentioning

confidence: 99%

GPs' perspectives of type 2 diabetes patients' adherence to treatment: A qualitative analysis of barriers and solutions

et al. 2005

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“…Because self-care is essential for good diabetes management, considerable research has focused on how best to educate patients about self-care tasks and motivate them to engage in long-term adherence (ADA, 1998; Deakin et al, 2005; Loveman et al, 2003; Muhlhauser et al, 1998; Newman et al, 2004; van den Arend et al, 2000). Surprisingly, few studies have measured the time required to carry out self-care tasks or the time patients actually spend.…”

Section: Introductionmentioning

confidence: 99%

Investing time in health: do socioeconomically disadvantaged patients spend more or less extra time on diabetes self‐care?

Cadwell¹,

Russell²,

Brown³

et al. 2009

Health Economics

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Summary Background Research on self-care for chronic disease has not examined time requirements. TRIAD, a multi-site study of managed care patients with diabetes, is among the first to assess self-care time. Objective To examine associations between socioeconomic position and extra time patients spend on foot care, shopping/cooking, and exercise due to diabetes. Data 11,927 patient surveys from 2000–01. Methods Bayesian two-part models were used to estimate associations of self-reported extra time spent on self-care with race/ethnicity, education, and income, controlling for demographic and clinical characteristics. Results Proportions of patients spending no extra time on foot care, shopping/cooking and exercise were respectively 37%, 52% and 31%. Extra time spent on foot care and shopping/cooking was greater among racial/ethnic minorities, less-educated and lower-income patients. For example, African-Americans were about 10 percentage points more likely to report spending extra time on foot care than whites and extra time spent was about three more minutes/day. Discussion Extra time spent on self-care was greater for socioeconomically disadvantaged patients than for advantaged patients, perhaps because their perceived opportunity cost of time is lower or they cannot afford substitutes. Our findings suggest that poorly controlled diabetes risk factors among disadvantaged populations may not be attributable to self-care practices.

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“…Efficient treatment needs to be available before complications develop, and in line with national guidelines [4]. This is generally not the case in Norway, or elsewhere [3], as international studies demonstrate a need for improved care for diabetes patients [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Service innovation from the edges: enhanced by telemedicine decision support

Osmundsen

Jaatun

Heggem

et al. 2015

Pers Ubiquit Comput

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Increased prevalence of diabetes creates a need for improved care. Diabetes, as a chronic disease in which the patient is a central asset for effective care, is relevant as an illustrative example for also other chronic diseases that are on the rise globally. Such diseases demand localised co-produced healthcare services that respond to the need for integrated health care. The aim of the current paper was to investigate how telemedicine may facilitate patient consultations that improve quality, efficiency and patient involvement. Patient consultations facilitated by telemedicine were evaluated by the means of qualitative questionnaires to specialist, general practitioner and patients. The questionnaires revealed that the patient consultations improved quality of health care and saved time and cost. Findings suggest that such tripartite consultations may lead to outcomes where patients are empowered to take a more active role, the general practitioner increases his knowledge and competence, and the specialist is able to have a more holistic approach grounded in an understanding of patient history and local context. The support of telemedicine strengthens the consultations in terms of synchronous communication with visual clues and reduces time spent on the consultation by the specialist and travel time and cost for the patient. The contribution of this paper is to demonstrate how telemedicine can provide improved patient consultations by altering the established system of healthcare delivery.

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Management of type 2 diabetes: a challenge for patient and physician

Cited by 85 publications

References 23 publications

GPs' perspectives of type 2 diabetes patients' adherence to treatment: A qualitative analysis of barriers and solutions

GPs' perspectives of type 2 diabetes patients' adherence to treatment: A qualitative analysis of barriers and solutions

Investing time in health: do socioeconomically disadvantaged patients spend more or less extra time on diabetes self‐care?

Service innovation from the edges: enhanced by telemedicine decision support

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