Challenges of optimizing glycaemic control in children with Type 1 diabetes: a qualitative study of parents' experiences and views

Lawton, Julia; Waugh, Norman; Barnard, Katharine; Noyes, Kathryn; Harden, Jeni; Stephen, John; McDowell, Joan; Rankin, David

doi:10.1111/dme.12660

Cited by 41 publications

(54 citation statements)

References 29 publications

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“…16–19 In recent years, there is a keen awareness of pain as a component of health status, and pain has been termed the “5 th vital sign.” 20 Inadequately controlled postoperative pain delays important recovery milestones, such as ambulation or attending to activities of daily living, and results in longer hospital stays and chronic post-surgical pain. 21–25 Poorly managed pain is also a common reason for readmission, and is correlated with poor patient satisfaction and experience. 26,27 However, although some patients benefit from chronic opioid therapy, most do not, and morbidity and abuse outweigh any benefits derived.…”

Section: Discussionmentioning

confidence: 99%

Effect of Preoperative Opioid Exposure on Healthcare Utilization and Expenditures Following Elective Abdominal Surgery

et al. 2017

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Importance Morbidity and mortality associated with prescription opioid use is escalating in the United States. The extent to which chronic opioid use influences postoperative outcomes following elective surgery is not well understood. Objective To examine the extent to which preoperative opioid use is correlated with healthcare utilization and costs following elective surgical procedures. Design Truven Health Marketscan® Databases were used to identify patients. Setting Outpatient services claims from patients who underwent elective procedure requiring an inpatient stay. Participants Patients ages 18 and older who underwent elective hysterectomy, bariatric surgery, reflux procedures, and ventral hernia repair between 2009 and 2013 (n=184,053). Exposure Receipt of prescription opioid analgesic within 30 days of and 30 to 90 days prior to procedure. Preoperative opioid use was drawn from insurance claims and converted into oral morphine equivalents (OMEs). Main Outcomes and Measures Outcomes included postoperative healthcare utilization (length of stay, 30-day readmission rate, discharge destination) and cost (hospital stay, 90-, 180-, and 365-day). We used generalized linear regression to determine the effect of preoperative opioid use on healthcare utilization and cost outcomes after adjusting for number of comorbidities, psychological conditions, and demographic characteristics. Results In this cohort, 10.0% of patients used opioids preoperatively. Compared with non-users, patients using opioids preoperatively were more likely to have a longer and more expensive hospital stay (2.8 days vs. 2.5 days, p<0.001; $21,919.00 vs. $21,241.80, p = 0.02, respectively) and were more likely to be discharged to a rehabilitation facility (3.5% vs. 2.4%, p<0.001), adjusting for covariates. Preoperative opioid use was also correlated with a greater rate of 30-day readmission (3.7% vs. 3.1%, p<0.001) and overall greater expenditures at 90- ($5,405.40 vs. $3,681.70, p<0.001), 180- ($10,148.20 vs. $6,469.80, p<0.001), and 365-($19,695.60 vs. $11,419.40, p<0.001) days following surgery, adjusted for covariates. Conclusions and Relevance Preoperative opioid use is an independent risk factor for longer length of stay, higher 30-day readmission rates and probability of being discharged to a rehabilitation facility, and greater costs in the postoperative period. Preoperative interventions focused on opioid cessation and alternative analgesics may improve the safety and efficiency of elective surgery among chronic opioid users.

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Section: Discussionmentioning

confidence: 99%

Effect of Preoperative Opioid Exposure on Healthcare Utilization and Expenditures Following Elective Abdominal Surgery

et al. 2017

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“…Alongside studies involving parents [11,12], and in recognition that children are socially competent actors in their own right [13,14], a growing body of qualitative research has explored children's experiences of, and involvement in, managing their diabetes. This includes studies that have explored: challenges children encounter living with diabetes, parent-child partnerships, management of diabetes at school, and children's views about attending clinics [15][16][17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

Children's experiences of managing Type 1 diabetes in everyday life: a thematic synthesis of qualitative studies

et al. 2017

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Although the synthesis has identified how children's everyday life experiences inform ways in which they undertake diabetes self-management, it was not possible to determine new ways to provide support. To help children optimise their glycaemic control, further work should be undertaken to identify their need for support and which takes into account the potential ways in which parents, friends and peers can offer assistance.

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“…Previous studies have sought the views of parents [12, 15] or youth living with diabetes [13]. However, to our knowledge, this is the first qualitative study with diverse diabetes care providers on the barriers they perceive in families of children with T1D and their suggested strategies for addressing them.…”

Section: Discussionmentioning

confidence: 99%

Diabetes care provider perceptions on family challenges of pediatric type 1 diabetes

Redondo

Callender

Gonynor

et al. 2017

Diabetes Research and Clinical Practice

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Challenges of optimizing glycaemic control in children with Type 1 diabetes: a qualitative study of parents' experiences and views

Cited by 41 publications

References 29 publications

Effect of Preoperative Opioid Exposure on Healthcare Utilization and Expenditures Following Elective Abdominal Surgery

Effect of Preoperative Opioid Exposure on Healthcare Utilization and Expenditures Following Elective Abdominal Surgery

Children's experiences of managing Type 1 diabetes in everyday life: a thematic synthesis of qualitative studies

Diabetes care provider perceptions on family challenges of pediatric type 1 diabetes

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