Shared Care Combined with Telecare Improves Glycemic Control of Diabetic Patients in a Rural Underserved Community

Liou, Jhao-Kun; Soon, Maw–Soan; Chen, Ching‐Hui; Huang, Tzu-Fan; Chen, Yiping; Yeh, Yen-Po; Chang, Chun–Ju; Kuo, Shou‐Jen; Hsieh, Ming‐Chia

doi:10.1089/tmj.2013.0037

Cited by 31 publications

(28 citation statements)

References 12 publications

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“…A study conducted in a rural setting [ 53 ], showed an improvement in HbA1c levels among patients exposed to diabetes education with interactive online sessions, delivered by a multidisciplinary team (0.7 ± 1.3% vs 0.1 ± 1.0%; p < 0.03 after adjustment for baseline HbA1c, n = 95).…”

Section: Resultsmentioning

confidence: 99%

Quality improvement strategies at primary care level to reduce inequalities in diabetes care: an equity-oriented systematic review

Terens¹,

Vecchi²,

Bargagli³

et al. 2018

BMC Endocr Disord

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BackgroundThere is evidence that disparities exist in diabetes prevalence, access to diabetes care, diabetes-related complications, and the quality of diabetes care. A wide range of interventions has been implemented and evaluated to improve diabetes care. We aimed to review trials of quality improvement (QI) interventions aimed to reduce health inequities among people with diabetes in primary care and to explore the extent to which experimental studies addressed and reported equity issues.MethodsPubmed, EMBASE, CINAHL, and the Cochrane Library were searched to identify randomized controlled studies published between January 2005 and May 2016. We adopted the PROGRESS Plus framework, as a tool to explore differential effects of QI interventions across sociodemographic and economic factors.ResultsFrom 1903 references fifty-eight randomized trials met the inclusion criteria (with 17.786 participants), mostly carried out in USA. The methodological quality was good for all studies. Almost all studies reported the age, gender/sex and race distribution of study participants. The majority of trials additionally used at least one further PROGRESS-Plus factor at baseline, with education being the most commonly used, followed by income (55%). Large variation was observed between these studies for type of interventions, target populations, and outcomes evaluated. Few studies examined differential intervention effects by PROGRESS-plus factors. Existing evidence suggests that some QI intervention delivered in primary care can improve diabetes-related health outcomes in social disadvantaged population subgroups such as ethnic minorities. However, we found very few studies comparing health outcomes between population subgroups and reporting differential effect estimates of QI interventions.ConclusionsThis review provides evidence that QI interventions for people with diabetes is feasible to implement and highly acceptable. However, more research is needed to understand their effective components as well as the adoption of an equity-oriented approach in conducting primary studies. Moreover, a wider variety of socio-economic characteristics such as social capital, place of residence, occupation, education, and religion should be addressed.Electronic supplementary materialThe online version of this article (10.1186/s12902-018-0260-4) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Quality improvement strategies at primary care level to reduce inequalities in diabetes care: an equity-oriented systematic review

Terens¹,

Vecchi²,

Bargagli³

et al. 2018

BMC Endocr Disord

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“…Of the 32 interventions, 18 (56%) were PDA-, tablet-, computer-, or mobile phone–delivered or Web-based interventions [ 6 , 25 , 31 , 33 , 58 , 60 , 61 , 68 - 71 , 74 - 80 ], 7 interventions (22%) were telehealth interventions delivered via landline telephones [ 57 , 59 , 63 , 66 , 67 , 73 , 81 ], 6 (19%) used text messaging [ 20 , 56 , 62 , 64 , 65 , 72 ], and 1 employed videoconferencing [ 32 ].…”

Section: Resultsmentioning

confidence: 99%

Characterizing Active Ingredients of eHealth Interventions Targeting Persons With Poorly Controlled Type 2 Diabetes Mellitus Using the Behavior Change Techniques Taxonomy: Scoping Review

Kebede¹,

Liedtke²,

Möllers³

et al. 2017

J Med Internet Res

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BackgroundThe behavior change technique taxonomy v1 (BCTTv1; Michie and colleagues, 2013) is a comprehensive tool to characterize active ingredients of interventions and includes 93 labels that are hierarchically clustered into 16 hierarchical clusters.ObjectiveThe aim of this study was to identify the active ingredients in electronic health (eHealth) interventions targeting patients with poorly controlled type 2 diabetes mellitus (T2DM) and relevant outcomes.MethodsWe conducted a scoping review using the BCTTv1. Randomized controlled trials (RCTs), studies with or pre-post-test designs, and quasi-experimental studies examining efficacy and effectiveness of eHealth interventions for disease management or the promotion of relevant health behaviors were identified by searching PubMed, Web of Science, and PsycINFO. Reviewers independently screened titles and abstracts for eligibility using predetermined eligibility criteria. Data were extracted following a data extraction sheet. The BCTTv1 was used to characterize active ingredients of the interventions reported in the included studies.ResultsOf the 1404 unique records screened, 32 studies fulfilled the inclusion criteria and reported results on the efficacy and or or effectiveness of interventions. Of the included 32 studies, 18 (56%) were Web-based interventions delivered via personal digital assistant (PDA), tablet, computer, and/or mobile phones; 7 (22%) were telehealth interventions delivered via landline; 6 (19%) made use of text messaging (short service message, SMS); and 1 employed videoconferencing (3%). Of the 16 hierarchical clusters of the BCTTv1, 11 were identified in interventions included in this review. Of the 93 individual behavior change techniques (BCTs), 31 were identified as active ingredients of the interventions. The most common BCTs identified were instruction on how to perform behavior, adding objects to the environment, information about health consequences, self-monitoring of the outcomes and/or and prefers to be explicit to avoid ambiguity. Response: Checked and avoided of a certain behavior Author: Please note that the journal discourages the use of parenthesis to denote either and/or and prefers to be explicit to avoid ambiguity. Response: Checked and avoided “and/or” and prefers to be explicit to avoid ambiguity. Response: Checked and avoided, and feedback on outcomes of behavior.ConclusionsOur results suggest that the majority of BCTs employed in interventions targeting persons with T2DM revolve around the promotion of self-regulatory behavior to manage the disease or to assist patients in performing health behaviors necessary to prevent further complications of the disease. Detailed reporting of the BCTs included in interventions targeting this population may facilitate the replication and further investigation of such interventions.

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“…Jedoch wurde durch die Internationalität des Scoping Reviews der Selektionsbias minimiert. Delegative Leistungen werden bisher oft in Modellvorhaben in unterversorgten Gebieten durchgeführt und zeigen teilweise ähnliche Resultate [36][37][38]. Ein flächendeckendes Versorgungsmodell könnte daher einen innovativen Lösungsbeitrag zur Behebung des Ärztemangels darstellen.…”

Section: Diskussion Und Schlussfolgerungenunclassified

“…Ein flächendeckendes Versorgungsmodell könnte daher einen innovativen Lösungsbeitrag zur Behebung des Ärztemangels darstellen. Ebenso bietet die vorliegende ökonomische Analyse eine Grundlage für die Diskussion um eine leistungsgerechte Vergütung delegativer Leistungen, wie sie von Hausärzten gefordert werden [35][36][37][38][39]. Eine Steigerung der innerbetrieblichen Effektivität und Effizienz durch eine verbesserte Praxisorganisation konnte in den vorliegenden Studien teilweise nachgewiesen werden [27][28][29][30][31][32], wurde jedoch häufig durch hohe Implementierungskosten verdeckt.…”

Section: Diskussion Und Schlussfolgerungenunclassified

Ökonomische Potentiale der Delegation mit und ohne Telemedizin bei Menschen mit Diabetes Mellitus – Ergebnisse einer Subgruppenanalyse eines Scoping Reviews

Geelvink

Mirhoseiny

Vollmar

et al. 2017

Gesundh ökon Qual manag

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Zusammenfassung Zielsetzung Seit einiger Zeit wird über die Delegation von ärztlichen Tätigkeiten in der Versorgung chronisch erkrankter Menschen diskutiert, wobei aufgrund der hohen Prävalenz und den damit verbundenen Kosten Menschen mit Diabetes mellitus besonders im Fokus der Diskussion stehen. Ziel dieser Arbeit ist es, mögliche Einsparungspotentiale der Delegation zu identifizieren. Methodik Eine systematische Literaturrecherche wurde mit definierten Schlagwörtern durchgeführt. Eine Subgruppenanalyse aus dem aufgestellten Scoping Review betrachtete zuvor festgelegte Items zu Design, Outcome und Kosten. Ergebnisse Es konnten 20 Studien mit 8567 Patienten in die Subgruppenanalyse eingeschlossen werden, wobei randomisiert kontrollierte Studien überwiegen. 81,25 % weisen eine Verbesserung des HbA1c auf. Die Mehrheit der Studien (60 %) untersucht eine Delegation mit Pflegefachkräften. In 65 % der Fälle zeigen sich Kosteneinsparungen. Schlussfolgerung Trotz Heterogenität der Studien zeigen die durchgeführten Kostenanalysen finanzielle Einsparungen, sodass die Delegation als ein kosteneffektives Versorgungsmodell erscheint.

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Shared Care Combined with Telecare Improves Glycemic Control of Diabetic Patients in a Rural Underserved Community

Abstract: Shared care combined with telecare could significantly reduce HbA1c levels in type 2 diabetic patients with poor glycemic control in underserved rural communities. Further studies should be conducted to clarify the target users and to develop cost-effective interventions.

Cited by 31 publications

References 12 publications

Quality improvement strategies at primary care level to reduce inequalities in diabetes care: an equity-oriented systematic review

Quality improvement strategies at primary care level to reduce inequalities in diabetes care: an equity-oriented systematic review

Characterizing Active Ingredients of eHealth Interventions Targeting Persons With Poorly Controlled Type 2 Diabetes Mellitus Using the Behavior Change Techniques Taxonomy: Scoping Review

Ökonomische Potentiale der Delegation mit und ohne Telemedizin bei Menschen mit Diabetes Mellitus – Ergebnisse einer Subgruppenanalyse eines Scoping Reviews

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