Precision health care strategies for older adults with diabetes in Indonesia: a Delphi consensus study

Abstract

BACKGROUND Studies on precision health care for older adults with diabetes in Indonesia are still limited. This study was aimed to reach the experts consensus on the suitable precision health care strategies for older adults with diabetes.
 METHODS A total of 10 experts (4 physicians, 4 nurses, and 2 dietitians) agreed to participate in the 3-round interview using Delphi technique. The experts should have at least 5 years of experience in teaching or working as health professionals in a hospital.
 RESULTS Consensus was reached that precision health care consisted of eight elements: self-management, interdisciplinary collaborative practice, personalized genetic or lifestyle factors, glycemic target, patient preferences, glycemic control, patient priority-directed care, and biodata- or evidence-based practice. The strategies of precision health care for diabetes were divided into seven steps: conducting brief deducting teaching; assessing self-management level and risk of cardiovascular disease; organizing a brainstorming session among patients to exchange experiences on glycemic target and specific target behavior; making a list of patients’ needs and ranking the priorities; setting a goal and writing action; doing follow-up; and reporting the goal attempts.
 CONCLUSIONS The eight elements of precision health care provided the basis of precision health care strategies for diabetic older adults, which are the real and measurable strategies for precision health care implementation in clinical settings.

Recommendation of precision medicine application in Indonesia from multiple perspective: a review

“…Research [31] discussed several efforts devoted to accomplishing precision oncology using big data in Indonesia. Further, study [32] discussed strategies for implementing precision health care in older adults with diabetes in Indonesia. The study concluded that the precision health care strategies for diabetes patients can be broken down into seven phases: doing deductive teaching for a short period of time; assessing the level of self-management and cardiovascular disease risks; arranging a patient brainstorming session to share insights on glycemic targets and specific behavior; generating a list of patients' concerns and prioritizing them; establishing a goal and formulating a plan of action; carrying put follow-up; and keeping track of goal attempts.…”

“…The study concluded that the precision health care strategies for diabetes patients can be broken down into seven phases: doing deductive teaching for a short period of time; assessing the level of self-management and cardiovascular disease risks; arranging a patient brainstorming session to share insights on glycemic targets and specific behavior; generating a list of patients' concerns and prioritizing them; establishing a goal and formulating a plan of action; carrying put follow-up; and keeping track of goal attempts. Moreover, research [32] shows that there are eight components to precision health care in patients with diabetes: personalized genetic or lifestyle factors, selfmanagement, glycemic target and control, interdisciplinary collaborative practice, patient preferences, patient priority-directed care, and evidence-based practice. Even though there are several studies about precision medicine in Indonesia, the number of continuous research and study is still relatively limited and far from enough to develop precision medicine applications.…”

Precision health care for diabetes slowly will become reality in Indonesia: An opinion

“…So far, hospital-and community-based interventions in Indonesia to avoid diabetes complications have long been based on evidence-based practice and guidelines for diabetes care [4]. However, more precise intervention for patients with diabetes based on the availability of health data, treatment demands and targets can be executed and imposes challenges in the future [5,6].…”

“…Moreover, patient care and preference, patient-oriented, evidence-based care and self-management, referred to precision healthcare [7]. Over time, the approach has been implicated on patients with diabetes and becoming a new trend in clinical settings in developed countries but not really popular in Indonesia [6].…”

“…This concept should start to become a new approach in the care of diabetic patients, moreover most of the study from scholars in developed countries has proven the impact of precision medicine and precision health care for patients with diabetes. Few researchers in Indonesia have started to initiate a study using a precision health care approach in diabetic patients through patient care and preference, patient-oriented, evidence-based care and self-management and interdisciplinary research collaborations between doctors, nurses and nutritionists [6). An overview of how to implement precision health care programs and differences between traditional health education and precision health program for diabetes are also provided in Table 1.…”