Search

OBJECTIVE: Self-management education, supported by multidisciplinary health care teams, is essential for optimal diabetes management. We sought to determine whether acute diabetes complications or quality of care differed for patients in routine clinical care when their self-management education was delivered through group diabetes education classes versus individual counselling. METHODS: With the use of population-level administrative and primary data, all diabetic patients in Ontario who attended a self-management education program in 2006 were identified and grouped according to whether they attended group classes (n=12,234), individual counselling (n=55,761) or a mixture of both (n=9,829). Acute complications and quality of care in the following year were compared among groups. RESULTS: Compared with those attending individual counselling, patients who attended group classes were less likely to have emergency department visits for hypo/hyperglycemia (odds ratio 0.54, 95% confidence interval [CI]: 0.42-0.68), hypo/hyperglycemia hospitalizations (OR 0.49, CI: 0.32-0.75) or foot ulcers/cellulitis (OR 0.64, CI: 0.50-0.81). They were more likely to have adequate HbA1c testing (OR 1.10, CI: 1.05-1.15) and lipid testing (OR 1.25, CI: 1.19-1.32), and were more likely to receive statins (OR 1.22, CI: 1.07-1.39). CONCLUSION: Group self-management education was associated with fewer acute complications and some improvements in processes of care. Group sessions can offer care to more patients with reduced human resource requirements. With increased pressure to find efficiencies in health care delivery, group diabetes education may provide an opportunity to deliver less resource-intensive care that simultaneously improves patient care. KEY WORDS: Diabetes mellitus; patient education; self care; health promotion; comparative effectiveness research La traduction du resume se trouve a la fin de l'article. OBJECTIF : Une education a l'auto-prise en charge, appuyee par une equipe de soins de sante multidisciplinaire, est essentielle a une prise en charge optimale du diabete. Nous avons cherche a determiner si les complications aigues du diabete ou la qualite des soins different chez les patients recevant les soins cliniques habituels lorsque leur education a l'auto-prise en charge leur est offerte en groupe dans des classes d'education au diabete, plutot que sous forme de counseling individuel. METHODE : A l'aide de donnees primaires et administratives populationnelles, nous avons identifie tous les patients diabetiques de l'Ontario ayant assiste a un programme d'education a l'auto-prise en charge en 2006 et nous les avons regroupes selon qu'ils ont assiste a des classes en groupe (n=12 234), recu du counseling individuel (n=55 761) ou un melange des deux (n=9 829). Nous avons compare les complications aigues et la qualite des soins au cours de l'annee suivante dans ces trois groupes. RESULTATS : Comparativement a ceux qui ont recu du counseling individuel, les patients ayant assiste a des classes en groupe etaient moins susceptibles de s'etre rendus a l'urgence pour cause d'hypo- ou d'hyperglycemie (rapport de cotes 0,54, intervalle de confiance de 95 % [IC] : 0,42-0,68), d'etre hospitalises pour hypo- ou hyperglycemie (RC 0,49, IC : 0,32-0,75) ou de souffrir de plaies du pied ou de cellulite (RC 0,64, IC : 0,50-0,81). Ils etaient aussi plus susceptibles d'avoir fait faire un test d'HbA1c (RC 1,10, IC : 1,05-1,15) et un bilan lipidique (RC 1,25, IC : 1,19-1,32), et plus susceptibles de recevoir des statines (RC 1,22, IC : 1,07-1,39). CONCLUSION : L'education a l'auto-prise en charge recue en groupe etait associee a un moindre nombre de complications aigues et a certaines ameliorations du processus de soins. Les seances en groupe permettent de servir davantage de patients et exigent moins de ressources humaines. Etant donne les pressions accrues pour realiser des economies dans la prestation des soins de sante, l'education au diabete en groupe peut etre l'occasion d'offrir des services avec moins de ressources tout en ameliorant les soins aux patients. MOTS CLES : diabete sucre; education du patient; autosoins; promotion de la sante; recherche en efficacite comparative, Diabetes mellitus is a common chronic disease whose prevalence is growing. (1,2) It leads to numerous complications, which lower health-related quality of life and increase mortality. (3,4) The goal of [...]

Abstract Background Patients newly-diagnosed with diabetes require self-management education to help them understand and manage the disease. The goals of the study were to determine the frequency of diabetes self-management education program utilization by newly-diagnosed patients, and to evaluate whether there were any demographic or clinical disparities in utilization. Methods Using population-level health care data, all 46,553 adults who were diagnosed with any type of non-gestational diabetes in Ontario, Canada between January and June 2006 were identified. They were linked with a diabetes self-management education program registry to identify those who attended within 6 months of diagnosis. The demographic and clinical characteristics of attendees and non-attendees were compared. Results A total of 9,568 (20.6%) patients attended a diabetes self-management education program within 6 months of diagnosis. Younger age, increasing socioeconomic status, and the absence of mental health conditions or other medical comorbidity were associated with attendance. Patients living in rural areas, where access to physicians may be limited, were markedly more likely to attend. Recent immigrants were 40% less likely to attend self-management education programs than longer-term immigrants or nonimmigrants. Conclusion Only one in five newly-diagnosed diabetes patients attended a diabetes self-management education program. Demographic and clinical disparities in utilization persisted despite a publicly-funded health care system where patients could access these services without direct charges. Primary care providers and education programs must ensure that more newly-diagnosed diabetes patients receive self-management education, particularly those who are older, poorer, sicker, or recent immigrants.

Background: In 2010, a safety signal was detected for narcolepsy following vaccination with Pandemrix, an AS03-adjuvanted monovalent pandemic H1N1 influenza (pH1N1) vaccine. To further assess a possible association and inform policy on future use of adjuvants, we conducted a multi-country study of narcolepsy and adjuvanted pH1N1 vaccines., Methods: We used electronic health databases to conduct a dynamic retrospective cohort study to assess narcolepsy incidence rates (IR) before and during pH1N1 virus circulation, and after pH1N1 vaccination campaigns in Canada, Denmark, Spain, Sweden, Taiwan, the Netherlands, and the United Kingdom. Using a case-control study design, we evaluated the risk of narcolepsy following AS03- and MF59-adjuvanted pH1N1 vaccines in Argentina, Canada, Spain, Switzerland, Taiwan, and the Netherlands. In the Netherlands, we also conducted a case-coverage study in children born between 2004 and 2009., Results: No changes in narcolepsy IRs were observed in any periods in single study sites except Sweden and Taiwan; in Taiwan incidence increased after wild-type pH1N1 virus circulation and in Sweden (a previously identified signaling country), incidence increased after the start of pH1N1 vaccination. No association was observed for Arepanrix-AS03 or Focetria-MF59 adjuvanted pH1N1 vaccines and narcolepsy in children or adults in the case-control study nor for children born between 2004 and 2009 in the Netherlands case-coverage study for Pandemrix-AS03., Conclusions: Other than elevated narcolepsy IRs in the period after vaccination campaigns in Sweden, we did not find an association between AS03- or MF59-adjuvanted pH1N1 vaccines and narcolepsy in children or adults in the sites studied, although power to evaluate the AS03-adjuvanted Pandemrix brand vaccine was limited in our study., (Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: To determine primary care physician screening, treatment, and control rates for hypertension and to examine whether type of physician payment model affected these rates., Design: A cross-sectional chart abstraction study., Setting: Community health centres (salary), primary care networks (capitation), or traditional fee-for-service practices in Ontario., Participants: A total of 135 primary care physicians, 45 from each of the 3 different models of care. Data were abstracted from 28 adult patient charts randomly selected from each physician., Main Outcome Measures: Screening rates were based on the presence of at least 1 blood pressure reading in the past 3 years, treatment rates on the number of patients with hypertension treated with antihypertensive medication, and control rates on the number of patients with hypertension whose most recent blood pressure readings were below 140/90 mm Hg, below 130/80 mm Hg for patients with diabetes, or below 120/75 mm Hg for patients with renal disease., Results: Overall, 92.5% of all patients were screened for hypertension, 86.4% of patients with hypertension were treated with antihypertensive medications, and 44.9% of patients with hypertension had their blood pressure controlled. Mean screening rates were 90.6%, 93.5%, and 93.3% (P = .22), and after adjusting for sociodemographic factors and comorbid conditions, mean treatment rates were 90.9%, 81.0%, and 87.4% (P < .05) and mean control rates were 54.5%, 38.6%, and 41.6% (P < .05) for capitation, salary, and fee-for-service physicians, respectively., Conclusion: Our results showed that although screening rates were similar between all 3 models, there were differences in treatment and control rates, with capitation physicians having the best treatment and control rates. Further investigation into whether this type of payment model results in improved chronic disease management for other chronic diseases and preventative care maneuvers will give support to health care policy makers who are moving toward capitation-type payment models for primary care delivery.

Background: Traditionally, the determination of the occurrence of hypertension in patients has relied on costly and time-consuming survey methods that do not allow patients to be followed over time., Objectives: To determine the accuracy of using administrative claims data to identify rates of hypertension in a large population living in a single-payer health care system., Methods: Various definitions for hypertension using administrative claims databases were compared with 2 other reference standards: (1) data obtained from a random sample of primary care physician offices throughout the province, and (2) self-reported survey data from a national census., Results: A case-definition algorithm employing 2 outpatient physician billing claims for hypertension over a 3-year period had a sensitivity of 73% (95% confidence interval [CI] 69%-77%), a specificity of 95% (CI 93%-96%), a positive predictive value of 87% (CI 84%-90%), and a negative predictive value of 88% (CI 86%-90%) for detecting hypertensive adults compared with physician-assigned diagnoses. Compared with self-reported survey data, the algorithm had a sensitivity of 64% (CI 63%-66%), a specificity of 94%(CI 93%-94%), a positive predictive value of 77% (76%-78%), and negative predictive value of 89% (CI 88%-89%). When this algorithm was applied to the entire province of Ontario, the age- and sex-standardized prevalence of hypertension in adults older than 35 years increased from 20% in 1994 to 29% in 2002., Conclusions: It is possible to use administrative data to accurately identify from a population sample those patients who have been diagnosed with hypertension. Given that administrative data are already routinely collected, their use is likely to be substantially less expensive compared with serial cross-sectional or cohort studies for surveillance of hypertension occurrence and outcomes over time in a large population.