scholarly journals A 24-Year-Old Female Transplant Recipient with Type 2 Membranoproliferative Glomerulonephritis and Disseminated Shingles: A Cautionary Tale of Deferring to Primary Care

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Benjamin T. Burdorf
Keyword(s):  
Primary Care ◽  
Membranoproliferative Glomerulonephritis ◽  
Emergency Services ◽  
Care Providers ◽  
Lethal Complications ◽  
Inadequate Care ◽  
Triple Regimen ◽  
Caucasian Female ◽  
Living Donor Kidney Transplant

In this report, the case of a 24-year-old Caucasian female with type 2 membranoproliferative glomerulonephritis status post-living donor kidney transplant managed on triple regimen immunosuppressive therapy who developed shingles is discussed. With its onset, she promptly reached out to her nephrologist who deferred her to primary care. Prior to seeing her primary provider, she developed disseminated herpes zoster. She consulted emergency services where she was given inadequate care and again deferred to primary care. One day later, the dissemination included her entire torso, face, oral cavity, and all extremities. Fortunately, the patient had the insight to again reach out to her nephrologist who arranged for her to be admitted for appropriate care 6 days after her initial inquiry that carried 6 days of zoster progression. This case demonstrates how it is pertinent that specialists recognize potentially lethal complications associated with the conditions they follow. Although convenient to defer to primary care, if specialists were to take on the responsibility of providing a broader scope of care for their unique subsets of patients, it would likely result in a reduction in the 80% of serious medical errors that occur as a result of miscommunication, or lack thereof, between care providers.

Who Participates in Internet-Based Self-Management Programs? A Study Among Novice Computer Users in a Primary Care Setting

2000 ◽  
Vol 26 (5) ◽  
pp. 806-811 ◽  
Author(s):  
Edward G. Fell ◽  
Russell E. Glasgow ◽  
Shawn Boles ◽  
H. Garth McKay
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
Self Management ◽  
Management Support ◽  
Care Providers ◽  
Computer Ownership ◽  
Primary Care Patients ◽  
Status Information ◽  
Insulin Use

PURPOSE the purpose of this study was to evaluate the participation rates and factors associated with nonparticipation among primary care patients who were invited to join an Internet-based self-management research program. METHODS Primary care providers invited their patients with type 2 diabetes to participate in an Internet-based diabetes self-management support program. Research staff contacted these patients by phone to assess their eligibility and interest in participating. Reasons for declining were assessed and demographic/medical status information was collected. RESULTS Of the eligible patients, 60% participated in the program. No significant differences were found between participants and decliners in gender, insulin use, computer familiarity, or computer ownership. There were significant differences in age and years since diagnosis. Participants were slightly younger and had diabetes for a fewer number of years than nonparticipants. Nonparticipation was not related to computer or Internet issues. CONCLUSIONS Most older diabetes patients without previous Internet experience will-takepart in Internet-based self-managment support programs if barriers to participation are addressed.

scholarly journals Effectiveness of the EMPOWER-PAR Intervention on Primary Care Providers’ Adherence to Clinical Practice Guideline on the Management of Type 2 Diabetes Mellitus: A Pragmatic Cluster Randomised Controlled Trial

2020 ◽  
Vol 8 (B) ◽  
pp. 470-479
Author(s):  
Maryam Hannah Daud ◽  
Anis Safura Ramli ◽  
Suraya Abdul-Razak ◽  
Jamaiyah Haniff ◽  
Tg Mohd Ikhwan Tg Abu Bakar Sidik ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Setting ◽  
Primary Care Setting ◽  
Controlled Trial ◽  
Primary Care Providers ◽  
Control Group ◽  
Care Providers ◽  
Control Groups

AIM: The objective of this study was to evaluate the effectiveness of the EMPOWER- participatory action research (PAR) intervention, a multifaceted strategy based on the chronic care model (CCM) on primary care providers (PCP)’ adherence to type 2 diabetes mellitus (T2DM) clinical practice guideline (CPG) in the Malaysian primary care setting. METHODS: This was a pragmatic cluster randomized controlled trial –PAR conducted in ten public primary care clinics in Malaysia. Five clinics were randomly selected to provide the EMPOWER-PAR intervention for 1 year and another five clinics continued with usual care. The outcome measure was the absolute change in the proportion of PCP’s adherence to T2DM CPG captured using the “Indicators of Care Pro forma,” based on the recommendation by the Malaysian CPG on the Management of T2DM. Data were collected from the patients’ medical records, at baseline and at 1-year follow-up; and were analyzed using mixed method model. RESULTS: A total of 888 patients were recruited at baseline; 471 were in the intervention and 417 were in the control group. There was no significant demographic difference between the two groups at baseline except for ethnicity. At 1-year, 455 (96.6%) and 406 (97.3%) patients in the intervention and control groups completed the study, respectively. There were significant improvements in the absolute change in the proportion of PCPs’ adherence to T2DM CPG in the intervention group compared to the control group at 1-year follow-up in several indicators of care. These included the recording of BMI (0.6% vs. −1.8%, p<0.001); performing foot examination (2.4% vs. 0.6%, p<0.001); performing funduscopy/fundus photography (1.5% vs. 0.3%, p<0.001); monitoring renal profile (0.9% vs. −0.6%, p=0.001); measuring urine protein (1.2% vs. 0.6%, p<0.001), and giving lifestyle modification and self-management advice (1.2% vs. −0.3%, p<0.001) in the intervention versus control groups, respectively. CONCLUSION: The EMPOWER-PAR intervention has been proven to be effective in improving the PCPs’ adherence to T2DM CPG in several indicators of care. Findings from this study provided objective evidence of the effectiveness of multifaceted intervention based on the CCM in the Malaysian public primary care setting. TRIAL REGISTRATION: Registered with: ClinicalTrials.gov: NCT01545401. Date of registration: 1st March 2012.

scholarly journals A Practical Review of Diabetes Mellitus Type 2 Treatment in Primary Care

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Justin T. Call ◽  
Pedro Cortés ◽  
Dana M. Harris
Keyword(s):  
Diabetes Mellitus ◽  
Primary Care ◽  
Diabetes Mellitus Type 2 ◽  
Medical Knowledge ◽  
Primary Care Providers ◽  
Diabetes Mellitus Type ◽  
Care Providers ◽  
Sodium Glucose Cotransporter ◽  
Glucagon Like Peptide 1

Abstract The treatment of diabetes mellitus type 2 (DM2) is becoming more complex as new medications are approved. Primary care providers must maintain their medical knowledge on emerging medications for best patient care. This review simplifies the non-insulin treatments of diabetes with an emphasis on the cardio-renal protectants, sodium-glucose cotransporter 2 (SGLT-2) inhibitors and glucagon-like peptide 1 receptor agonists (GLP-1).

scholarly journals Characteristics of men and women with diabetes

2021 ◽  
Author(s):  
Enza Gucciardi ◽  
Shirley Chi-Tyan Wang ◽  
Lisa Amaral ◽  
Donna E. Stewart
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Diabetes Education ◽  
Primary Care Providers ◽  
Self Management ◽  
Care Providers ◽  
Family History Of Diabetes ◽  
Men And Women ◽  
History Of

OBJECTIVE To determine whether men and women with type 2 diabetes have different psychosocial, behavioural, and clinical characteristics at the time of their first visit to a diabetes education centre. DESIGN A questionnaire on psychosocial and behavioural characteristics was administered at participants’ first appointments. Clinical and disease-related data were collected from their medical records. Bivariate analyses (χ2 test, t test, and Mann-Whitney test) were conducted to examine differences between men and women on the various characteristics. SETTING Two diabetes education centres in the greater Toronto area in Ontario. PARTICIPANTS A total of 275 men and women with type 2 diabetes. RESULTS Women were more likely to have a family history of diabetes, previous diabetes education, and higher expectations of the benefits of self-management. Women reported higher levels of social support from their diabetes health care team than men did, and had more depressive symptoms, higher body mass, and higher levels of high-density lipoprotein cholesterol than men did. CONCLUSION The results of this study provide evidence that diabetes prevention, care, and education need to be targeted to men and women differently. Primary care providers should encourage men to attend diabetes self-management education sessions and emphasize the benefits of self-care. Primary care providers should promote regular diabetes screening and primary prevention to women, particularly women with a family history of diabetes or a high body mass index; emphasize the importance of weight management for those with and without diabetes; and screen diabetic women for depressive symptoms.

scholarly journals Patient Satisfaction with Doctor-Patient Interaction using SKIP-11 and Its Associated Factors among Type 2 Diabetics in Primary Care.

2021 ◽  
Vol 20 (4) ◽  
Author(s):  
Siti Suhaila Mohd Yusoff ◽  
George Wong Pah Kiam ◽  
Lili Husniati Yaacob ◽  
Nani Draman
Keyword(s):  
Primary Care ◽  
Patient Satisfaction ◽  
Associated Factors ◽  
Primary Care Providers ◽  
University Hospital ◽  
Care Providers ◽  
Related Factors ◽  
Patient Interactions ◽  
Patient Interaction

ABSTRACT Introduction: The quality of diabetes care is widely suboptimal, and most of the interventions depend on the active involvement and participation of patients. Understanding and determining patient related factors can help primary care providers pay more attention and give greater care to those patients. This will improve patient satisfaction, which further enhances compliance with or adherence to diabetic treatment. Therefore, this study aims to determine patient satisfaction with doctor-patient interaction and its associated factors among patients with type 2 diabetes mellitus. Materials and Methods: This cross-sectional study was performed among adults who had had diabetes for at least six months. Participants were selected by systemic random sampling in the outpatient clinic of the University Hospital. Patient satisfaction with doctor-patient interaction was measured using 11- items with a three-domain version of the “Skala Kepuasan Interaksi Perubatan-11” questionnaire. The total scores ranged from 11 to 55, and those who scored 44 and above (> 80%) were considered satisfied. Results: A total of 417 patients were recruited in the study. 60% were satisfied with their doctor-patient interactions. Among the subtypes in the satisfied group, the domain of rapport had the highest percentage of satisfaction at 77.7%. HbA1c was found to be significant associated with patient satisfaction with doctor-patient interaction (95% CI: 0.81, 0.97; p = 0.008) Conclusion: 60% of the participants clearly illustrated positive feedback and were more satisfied with their doctor-patient interactions. HbA1c was found to be significantly associated with patient satisfaction concerning doctor-patient interaction  

scholarly journals Implementation of an Electronic Alert for Improving Adherence to Diabetic Foot Exam Screenings in Type 2 Diabetic Patients in Primary Care Clinics

2020 ◽  
Author(s):  
◽  
Ruby Denson
Keyword(s):  
Primary Care ◽  
Diabetic Foot ◽  
Primary Care Providers ◽  
Completion Rate ◽  
Diabetic Patients ◽  
Intervention Implementation ◽  
Care Providers ◽  
Increased Risk ◽  
Provider Adherence

Practice Problem: Patients with type 2 diabetes mellitus (T2DM) are at an increased risk of complications including foot ulcerations (Harris-Hayes et al., 2020). Preventive care is essential for the early detection of foot ulcers but despite the advantages of preventive screening, a limited number of primary care providers perform annual foot exams (Williams et al., 2018). PICOT: The clinical question that guided this project was, “In adult patients with T2DM receiving care in a primary care setting, will the implementation of an electronic clinical reminder alert (ECR) increase provider adherence to performing an annual diabetic foot exam and risk assessment, compared to adherence rate pre alert implementation, in 30 days?” Evidence: Evidence indicates that ECR alerts to remind providers to perform foot exams improve provider adherence to perform annual foot exams. Intervention: An ECR alert was implemented to remind providers to perform an annual diabetic foot exam to increase provide adherence. Outcome: Twenty-three patients had a completion rate of 46% for their annual diabetic foot exam pre intervention implementation and 45 patients had a completion rate of 56.25% post intervention implementation. There was no statistical significance noted but an increase in provider adherence in performing foot exams, which suggests clinically significant outcomes. Conclusion: Annual foot exams and an ECR alert to remind providers to perform foot exams on people with diabetes can help improve health outcomes in diabetic patients.

scholarly journals How Do Type 2 Diabetes Patients Value Urban Integrated Primary Care in China? Results of a Discrete Choice Experiment

2019 ◽  
Vol 17 (1) ◽  
pp. 117
Author(s):  
Xin Wang ◽  
Kuimeng Song ◽  
Paiyi Zhu ◽  
Pim Valentijn ◽  
Yixiang Huang ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Integrated Primary Care ◽  
World Health ◽  
Care Providers ◽  
Diabetes Patients

Objectives: Fragmented healthcare in China cannot meet the needs of the growing number of type 2 diabetes patients. The World Health Organization proposed an integrated primary care approach to address the needs of patients with chronic conditions. This study aims to measure type 2 diabetes patients’ preferences for urban integrated primary care in China. Methods: A discrete choice experiment was designed to measure type 2 diabetes patient preferences for seven priority attributes of integrated care. A two-stage sampling survey of 307 type 2 diabetes mellitus (T2DM) patients in 16 community health stations was carried out. Interviews were conducted to explore the reasons underpinning the preferences. A logit regression model was used to estimate patients’ willingness to pay and to analyze the expected impact of potential policy changes. Results: Travel time to care providers and experience of care providers are the most valued attributes for respondents rather than out-of-pocket cost. Attention to personal situation, the attentiveness of care providers, and the friendliness and helpfulness of staff were all related to interpersonal communication between patients and health care providers. Accurate health information and multidisciplinary care were less important attributes. Conclusions: The study provides an insight into type 2 diabetes patients’ needs and preferences of integrated primary care. People-centered interventions, such as increasing coverage by family doctor and cultivating mutual continuous relationships appear to be key priorities of policy and practice in China.

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