Perceptions of a service redesign by adults living with type 2 diabetes

McDowell, Joan; McPhail, Kathryn; Halyburton, Gillian; Brown, Malcolm; Lindsay, Grace

doi:10.1111/j.1365-2648.2009.05003.x

Cited by 18 publications

(40 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Forty-two papers were identified as eligible for inclusion in this review: Aroni et al, 189 Becker et al, 190 Cvetkovski et al, 191 Donald et al, 155 Douglass et al, [192][193][194] Goeman et al, 136,195 Griffiths et al, 196 Hyland et al, 197 Jones et al, 198 Tumiel-Berhalter and Zayas, 199 De Vito, 200 Elkington et al, 110 Hopley et al, 201 Shipman et al, 202 Wilson et al, 203 Balcou-Debussche and Debussche, 204 Brez et al, 205 Broom,206 de-Graft, 207 Heisler et al, 208 Johnson et al, 209 Lawton et al, 210 McDowell et al, 211 Perera et al, 212 Mead et al, 213 Paquet et al, 214 Schoenberg and Peters, 215 Cowie et al, 216 Forsyth et al, 217 Fried et al, 218 Gately et al,…”

Section: Resultsmentioning

confidence: 99%

“…In total, 14 studies were of patients with asthma, 136,155,[189][190][191][192][193][194][195][196][197][198][199]212 five were of patients with COPD, 110,[200][201][202][203][204] seven were of patients with diabetes, [205][206][207][208][209][210][211] three were of patients with CHD 213-215 and 11 were of patients with mixed/multiple LTCs. [216][217][218][219]221,222,[224][225][226][227][228] The majority of studies were from the USA (n = 11 190,199,200,208,213,215,217,218,222,224,…”

mentioning

confidence: 99%

See 1 more Smart Citation

CHOICE: Choosing Health Options In Chronic Care Emergencies

Guthrie

Afzal

Blakeley

et al. 2017

Programme Grants Appl Res

View full text Add to dashboard Cite

BackgroundOver 70% of the health-care budget in England is spent on the care of people with long-term conditions (LTCs), and a major cost component is unscheduled health care. Psychological morbidity is high in people with LTCs and is associated with a range of adverse outcomes, including increased mortality, poorer physical health outcomes, increased health costs and service utilisation.ObjectivesThe aim of this programme of research was to examine the relationship between psychological morbidity and use of unscheduled care in people with LTCs, and to develop a psychosocial intervention that would have the potential to reduce unscheduled care use. We focused largely on emergency hospital admissions (EHAs) and attendances at emergency departments (EDs).DesignA three-phase mixed-methods study. Research methods included systematic reviews; a longitudinal prospective cohort study in primary care to identify people with LTCs at risk of EHA or ED admission; a replication study in primary care using routinely collected data; an exploratory and feasibility cluster randomised controlled trial in primary care; and qualitative studies to identify personal reasons for the use of unscheduled care and factors in routine consultations in primary care that may influence health-care use. People with lived experience of LTCs worked closely with the research team.SettingPrimary care. Manchester and London.ParticipantsPeople aged ≥ 18 years with at least one of four common LTCs: asthma, coronary heart disease, chronic obstructive pulmonary disease (COPD) and diabetes. Participants also included health-care staff.ResultsEvidence synthesis suggested that depression, but not anxiety, is a predictor of use of unscheduled care in patients with LTCs, and low-intensity complex interventions reduce unscheduled care use in people with asthma and COPD. The results of the prospective study were that depression, not having a partner and life stressors, in addition to prior use of unscheduled care, severity of illness and multimorbidity, were independent predictors of EHA and ED admission. Approximately half of the cost of health care for people with LTCs was accounted for by use of unscheduled care. The results of the replication study, carried out in London, broadly supported our findings for risk of ED attendances, but not EHAs. This was most likely due to low rates of detection of depression in general practitioner (GP) data sets. Qualitative work showed that patients were reluctant to use unscheduled care, deciding to do so when they perceived a serious and urgent need for care, and following previous experience that unscheduled care had successfully and unquestioningly met similar needs in the past. In general, emergency and primary care doctors did not regard unscheduled care as problematic. We found there are missed opportunities to identify and discuss psychosocial issues during routine consultations in primary care due to the ‘overmechanisation’ of routine health-care reviews. The feasibility trial examined two levels of an intervention for people with COPD: we tried to improve the way in which practices manage patients with COPD and developed a targeted psychosocial treatment for patients at risk of using unscheduled care. The former had low acceptability, whereas the latter had high acceptability. Exploratory health economic analyses suggested that the practice-level intervention would be unlikely to be cost-effective, limiting the value of detailed health economic modelling.LimitationsThe findings of this programme may not apply to all people with LTCs. It was conducted in an area of high social deprivation, which may limit the generalisability to more affluent areas. The response rate to the prospective longitudinal study was low. The feasibility trial focused solely on people with COPD.ConclusionsPrior use of unscheduled care is the most powerful predictor of unscheduled care use in people with LTCs. However, psychosocial factors, particularly depression, are important additional predictors of use of unscheduled care in patients with LTCs, independent of severity and multimorbidity. Patients and health-care practitioners are unaware that psychosocial factors influence health-care use, and such factors are rarely acknowledged or addressed in consultations or discussions about use of unscheduled care. A targeted patient intervention for people with LTCs and comorbid depression has shown high levels of acceptability when delivered in a primary care context. An intervention at the level of the GP practice showed little evidence of acceptability or cost-effectiveness.Future workThe potential benefits of case-finding for depression in patients with LTCs in primary care need to be evaluated, in addition to further evaluation of the targeted patient intervention.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

show abstract

Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

CHOICE: Choosing Health Options In Chronic Care Emergencies

Guthrie

Afzal

Blakeley

et al. 2017

Programme Grants Appl Res

View full text Add to dashboard Cite

show abstract

“…18 Existing structures could be used, for example, by integrating preconception care into structured diabetes education programmes. 15,22 Preconception care for women with diabetes comprises several elements that may need to be delivered by different services. GPs who provide routine health care to women with diabetes, especially type 2 diabetes, are in a unique position to educate women about preconception care.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

“…The recent rise in numbers of women with diabetes becoming pregnant coincides with the restructuring of diabetes care services in the UK, which has resulted in the care of patients with type 2 diabetes being moved predominantly into primary care. 15 National and international guidelines emphasise the need for health services to deliver diabetes preconception care to women of childbearing age. interviews were conducted with 22 women, of different ethnic backgrounds, with type 1 or type 2 diabetes, who had attended one London teaching hospital.…”

Section: Introductionmentioning

confidence: 99%

“…2,4,[6][7][8][9][10][11][12] Preconception care for women with diabetes is an effective means to reduce the incidence of adverse pregnancy outcomes. 10,[13][14][15] However, to date, the majority of women with diabetes enter pregnancy poorly prepared, 1,5,6,11,13 and the provision of diabetes preconception care continues to be patchy across the UK. 14 Historically, in the UK, diabetes care has been provided in the specialist hospital setting.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Integrating preconception care for women with diabetes into primary care: a qualitative study

Mortagy¹,

Kielmann

Baldeweg

et al. 2010

Br J Gen Pract

View full text Add to dashboard Cite

BackgroundNational guidelines emphasise the need to deliver preconception care to women of childbearing age. However, uptake of the services among women with diabetes in the UK is low. Questions arising include how best to deliver preconception care and what the respective roles of primary versus secondary caregivers might be. AimTo explore the perspective of GPs and secondary care health professionals on the role of GPs in delivering preconception care to women with diabetes. Design of studyQualitative, cross-sectional study. SettingA London teaching hospital and GP practices in the hospital catchment area. MethodSemi-structured interviews with GPs and members of the preconception care team in secondary care. Thematic analysis using the framework approach. ResultsGPs and secondary care professionals differ in their perception of the number of women with diabetes requiring preconception care and the extent to which preconception care should be integrated into GPs' roles. Health professionals agreed that GPs have a significant role to play and that delivery of preconception care is best shared between primary and secondary care. However, the lack of clear guidelines and shared protocols detailing the GP's role presents a challenge to implementing 'shared' preconception care. ConclusionGPs should be more effectively involved in providing preconception care to women with diabetes. Organisational and policy developments are required to support GPs in playing a role in preconception care. This study's findings stress the importance of providing an integrated approach to ensure continuity of care and optimal pregnancy preparation for women with diabetes.

show abstract

Professionals’ perceptions of type 2 diabetes in primary care during a service redesign

McDowell

Inverarity

Gilmour

et al. 2012

European Diabetes Nursing

View full text Add to dashboard Cite

The purpose of this study was to survey primary health care professionals' perceptions of type 2 diabetes, an evaluation during a service redesign. Management of people with type 2 diabetes has been led by hospital based secondary care. The objective of the service redesign was to transfer the management of the majority of people with type 2 diabetes from secondary care to general practitioner (GP) led, multidisciplinary primary care (comprising the GP, practice nurses, dietitians and podiatrists) delivered closer to the patients. Prior to implementation, all primary health care professionals undertook accredited educational preparation and there was infrastructure development by the creation of new posts and streamlining of IT systems to support the planned change. The study aim was to examine health care professionals' perspectives of diabetes, its management, the value of clinical guidelines and the impact of practice organisation. A cross‐sectional survey design was used. Primary health care professionals in one geographical area were sent the validated Perceptions of Diabetes Questionnaire (n=112). The response rate was 34% (n=38). Professionals attached great importance to ongoing education of people with type 2 diabetes in essential areas of care. Type 2 diabetes was perceived as more difficult to treat than other chronic conditions. There was a high level of satisfaction with the workload associated with the service redesign and a team approach is valued. There is an association between diabetes‐specific education and confidence in diabetes management. Professionals identified some barriers to using clinical guidelines. Overall, professionals were satisfied with the new model of multidisciplinary, GP led care management and their workload with the support of additional education in diabetes. Copyright © 2012 FEND. Published by John Wiley & Sons, Ltd.

show abstract

Perceptions of a service redesign by adults living with type 2 diabetes

Abstract: AimThis paper is a report of a study conducted to explore the perceptions of adults with type 2 diabetes towards the service redesign.

Cited by 18 publications

References 27 publications

CHOICE: Choosing Health Options In Chronic Care Emergencies

CHOICE: Choosing Health Options In Chronic Care Emergencies

Integrating preconception care for women with diabetes into primary care: a qualitative study

Professionals’ perceptions of type 2 diabetes in primary care during a service redesign

Contact Info

Product

Resources

About