Twelve-year follow-up of a population-based primary care diabetes program in Israel

Goldfracht, Margalit; Levin, Diane E.; Peled, Ofra; Poraz, Irit; Stern, Ervin; Brami, Jean-Luc; Matz, Eran; Fruman, Amir; Weiss, Dorit; Lieberman, Nicky; Dreiher, Jacob

doi:10.1093/intqhc/mzr051

Cited by 13 publications

(15 citation statements)

References 21 publications

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“…We found significant improvements in process of care recording. These are consistent with changes in recording reported by multifaceted international programmes with similar components: registration , practice guidelines , incentives , ongoing professional education , nurse case management , and structured multidisciplinary support . Our findings suggest these changes can be sustained over time in a real‐life setting; however, despite evidence of ongoing improvement, there may be limits to what structured programmes can achieve in the long term.…”

Section: Discussionsupporting

confidence: 85%

Sustaining quality in the community: trends in the performance of a structured diabetes care programme in primary care over 16 years

Riordan

McHugh

Harkins³

et al. 2018

Diabet. Med.

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Section: Discussionsupporting

confidence: 85%

Sustaining quality in the community: trends in the performance of a structured diabetes care programme in primary care over 16 years

Riordan

McHugh

Harkins³

et al. 2018

Diabet. Med.

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“…The study population included women with pre-existing diabetes who gave birth during 2008-2011 in Haifa and Western Galilee District of CHS in Israel. Women with diabetes were identified from the chronic disease registry in CHS computerized systems (16). Women who gave birth during 2008-2011 in Haifa and Western Galilee District of CHS were identified by their newborns, who are also registered in CHS.…”

Section: Methodsmentioning

confidence: 99%

The Quality of Periconception Medical Care in Women With Diabetes Needs Improvement

2014

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OBJECTIVEWe evaluated the quality of periconception medical care in pregnant women with diabetes and assessed the influence of sociodemographic characteristics. RESEARCH DESIGN AND METHODSThe study was based on retrospective data collection from electronic database on cohort of Israeli women at Clalit Health Services (CHS) with pre-existing diabetes who gave birth in 2008-2011. It included data on A1C and other laboratory test results, prescription fillings, diet and ophthalmology consultations, and sociodemographics extracted from CHS computerized systems. The performance of each of nine recommended measures in the periconception period and a composite quality score was evaluated; the score ranged from 0-8. Multivariate logistic regression was used to examine independent sociodemographic predictors of lowquality overall scores. RESULTSA total of 166 women gave birth to 180 infants; the performance of the different quality parameters ranged from 81% for A1C and kidney function tests to only 30% for dietary consultation and 41.1% for ophthalmology exam. Forty-nine percent of women had A1C <7.0% (53 mmol/mol). Only 45% took folic acid, whereas 13.9% continued the use of potentially teratogenic drugs in the first trimester. One-third of women were in the low-quality (0-3) overall score. In the multiple logistic regression analysis, the only significant variables to predict lower composite quality scores were multiparity odds ratio of 3.43 (95% CI 1.66-7.10; P = 0.001), Arabian ethnicity 3.76 (1.78-7.92; P = 0.001), and immigrant 3.73 (1.25-11.16; P = 0.018). CONCLUSIONSThe periconception medical care of diabetic women is suboptimal. More intensive and targeted care is needed in order to optimize periconception care of diabetic patients, especially in the high-risk subpopulations.

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“…Therefore, the present study may represent a unique population. For comparison, the prevalence of diabetes in the general Israeli population from the same HMO was reported to be 6.4% . Interestingly, a recent study on acute HF from Dubai, United Arab Emirates demonstrated a prevalence of 66% .…”

Section: Discussionmentioning

confidence: 98%

“…For comparison, the prevalence of diabetes in the general Israeli population from the same HMO was reported to be 6.4%. 20 Interestingly, a recent study on acute HF from Dubai, United Arab Emirates demonstrated a prevalence of 66%. 21 explanation for this increase compared with some earlier reports may be related to the definition of diabetes.…”

Section: Diabetes and Clinical Outcome In Heart Failurementioning

confidence: 99%

Impaired fasting glucose: a predictor of reduced survival in patients with heart failure

Gotsman

Shauer

Lotan

et al. 2014

European J of Heart Fail

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Aims Glucose abnormalities are associated with heart failure (HF), are increasingly prevalent, and may have an impact on outcome. Our aim was to evaluate the effect of fasting glucose levels on clinical outcome in patients with HF. Methods and results Patients with a diagnosis of HF as coded at a health maintenance organization in Jerusalem, Israel were evaluated retrospectively. Impaired fasting glucose (IFG) was defined as fasting plasma glucose levels between 100 and 125 mg/dL. All patients were followed for cardiac‐related hospitalizations and death. A total of 6067 HF patients were included. Mean follow‐up was 487 days; mean age 75 ± 13 years; 48% of the patients (n = 2,942) had diabetes; and 11.9% (n = 722) had IFG. Overall survival during the follow‐up was 82.5%. Cox regression analysis after adjustment for significant predictors including age, gender, ischaemic heart disease, hyperlipidaemia, hypertension, body mass index, glomerular filtration rate, serum urea, sodium, and haemoglobin levels demonstrated that patients with diabetes and IFG had a very similar outcome. Both were significant predictors of reduced survival compared with ‘normal’ glucose levels (fasting glucose levels between 92 and 99 mg/dL) [diabetes, hazard ratio (HR) 1.42, 95% confidence interval (CI) 1.08–1.86, P = 0.01; IFG, HR 1.55, 95% CI 1.13–2.15, P < 0.01]. Diabetes and IFG were also predictors of increased cardiac‐related hospitalizations (diabetes HR 1.31, 95% CI 1.16–1.48, P < 0.001; IFG, HR 1.17, 95% CI 1.00–1.35, P < 0.05). Conclusions Diabetes and IFG are common in patients with HF and have a similar effect on outcome including survival and cardiac hospitalizations. Glucose abnormalities including subclinical diabetes confer significant risk in patients with HF.

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Twelve-year follow-up of a population-based primary care diabetes program in Israel

Abstract: A community-oriented program for diabetes care led to improvements in performance of tests, as well as control of HbA1c and LDL among 72% of diabetes patients in Israel.

Cited by 13 publications

References 21 publications

Sustaining quality in the community: trends in the performance of a structured diabetes care programme in primary care over 16 years

Sustaining quality in the community: trends in the performance of a structured diabetes care programme in primary care over 16 years

The Quality of Periconception Medical Care in Women With Diabetes Needs Improvement

Impaired fasting glucose: a predictor of reduced survival in patients with heart failure

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