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diabetes program - Coggle Diagram
diabetes program
disparities in uptake
contrast this poor uptake against the cost benefit
Cauch-Dudek et al. BMC Public Health 2013
Only one in five
newly-diagnosed diabetes patients attended a diabetes self-management education
program
In the subgroup of 31,580 patients who were diagnosed with
diabetes between January and April 2006, 20.6% had a program
visit within 6 months, growing only to 22.0% when
follow-up was lengthened to 8 months.
despite publically funded programs // no direct charge - demographic disparities remain
particularly those who are older,
poorer, sicker, or recent immigrants.
Nonetheless, the presence of these disparities in diabetes
self-management education program utilization is noteworthy
in a publicly-funded health care system where
patients are meant to have equitable access to these
services.
once again the people that need it most are not accessing it
Graziani C, Rosenthal MP, Diamond JJ: Diabetes education program use and patient-perceived barriers to attendance
US context, not free so would be thought that public funding would mitigate some of these
nearly one-half of attendees at centres based in Community Health Centres did not have diagnosed diabetes.
Utilization of Diabetes Education Centres in Ontario by People without Diabetes Hwee et al.
WHY SIGNIFICANT:
In a randomized trial, attending a self-management education program at diagnosis led to improved understanding of the illness, and these changes in illness beliefs were correlated with metabolic changes
Davies MJ, Heller S, Skinner TC, Campbell MJ, Carey ME, Cradock S, et al:
Effectiveness of the diabetes education and self management for
ongoing and newly diagnosed (DESMOND) programme for people with
newly diagnosed type 2 diabetes: cluster randomised controlled trial.
BMJ 2008, 336:491–495.
However, only one in
five people with newly diagnosed diabetes in the
publicly-funded health care system of Ontario attended a
diabetes self-management education program.
and utilisation was lowest in pops that need self-education the most .. old poor immigrants
need it the most because they are the most likely to not have previous diabetes education
Patient education has been recognized for its contributions to reducing the morbidity and mortality of diabetes
There is very little reported information concerning the participation of older adults in diabetes education and care programs, factors related to their attendance, and the influence of attendance on program outcomes.
purpose / effectiveness at achieving goals
what are goals (quanificated)
Reviews of randomized trials have suggested that
self-management education can lead to improvements in
knowledge, dietary habits, frequency and accuracy of glucose
self-monitoring, weight and glycemic control [8-16].
Cauch-Dudek et al. BMC Public Health 2013 references for evidence in bibliography
how is success measured?
tools to measure this:
Ontario Diabetes Database
HbA1c, FBG, Cholesterol, Weight, measures of depression, QOL, social support, self efficacy, waist circumference, physical activity level, clinical composite score
It has also been found to be cost-effective, or even cost saving [17-19].
Cauch-Dudek et al. BMC Public Health 2013 references for evidence in bibliography
most effective methods
web based interventions
comparison of types of interventions - MORE ABOUT MONITORING AND RECORDING BP, GLUCOSE LEVELS ETC THAN WHAT MAKES AN EFFECTIVE VIRTUAL DIABETES EDUCATION PROGRAM
self-monitoring
effective
Goal-setting, personalised coaching, interactive feedback and online peer support groups were some of the successful approaches which were applied in e-interventions
The success of these e-interventions are determined by many factors such as frequent contact between the intervention participants and the physician; weekly therapeutic changes; training on the website usage; interactive and individualised approach; online group discussion and integration of medical data
Sending automated e-mails whenever the website is updated and warning e-mails or SMS whenever the participant did not log in for a stipulated time is encouraged for more frequent engagement to the website throughout the intervention. In summary, the use of other technologies was found to be an excellent method of reinforcing web-based interventions.
physical activity
RAMADAS et al
WHAT MAKES AN EFFECTIVE VIRTUAL DEP
Computerised learning technologies for diabetes: a systematic review S. A. Boren et al
The authors concluded that patient self-management behaviours are important in chronic disease management, and initial evidence suggests that computerised learning technology interventions can play a significant role in the future.
The main conclusions are that many of the interventions were effective at increasing patients’ knowledge, helping patients adopt healthy behaviours and improving clinical outcomes.
summarises the impact of a variety of computerised interventions designed to empower patients in the self-management of diabetes and support diabetes education over a distance
The major improvements in web-based technologies in the past 3–4 years can be expected to make these approaches even better, more appropriate for wider audiences and at lower cost.
why disparities in pops
seniors 65+
living alone reduces attendance ?? to a point but not most significant
Watkins AJ, Kligman EW. Attendance patterns of older adults in a health promotion program. Public Health Rep. 1993;108(1):86-90.
the most significant impediments to active
participation were inability to walk half a mile or
climb two flights of stairs, and general health
limitations. Those who had to travel to attend
services = THIS STOPS PEOPLE
b. = THESE ARE GENERAL CHARACTERISTICS BUT NOT NECESSARILY CAUSATION
mid-east neighbourhood demographic: highest proportion of seniors living alone (43.2%) among the 5 sub-regions. All neighbourhoods but two have higher percentage of seniors living alone compared to Mid-East Toronto sub-region (43.2%).
Percentage of total population of seniors living alone is highest in Church-Yonge corridor and Moss Park - surrounding Sherbourne (52% to 25% ave)
determination of elderly attendance at programs
Health motivation: a determinant of older adults' attendance at health promotion programs, Loeb