Decentralizing diabetes care from tertiary to primary care: how many persons with diabetes can be down-referred to primary care settings?

Olickal, Jeby Jose; Suryanarayana, BS; Chinnakali, Palanivel; Saya, Ganesh Kumar; Ganapathy, Kalaiselvan; Vivekanandhan, T; Subramanian, Sadhana; Subrahmanyam, D. K. S.

doi:10.1093/pubmed/fdab156

Cited by 3 publications

(2 citation statements)

References 15 publications

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“…As multimorbidity management calls for a realignment of healthcare through a framework of patient-centred medicine 40,41 , primary care physicians or family physicians form the crux of such restructuring. Patients can be down-referred from tertiary and secondary to primary care wherever possible 42,43 . Hence, primary care physicians are better positioned to coordinate health care delivery in chronic illnesses and multimorbidity.…”

Section: Discussionmentioning

confidence: 99%

A longitudinal qualitative study on physician experience in managing multimorbidity across the COVID-19 pandemic in Odisha, India

Mahapatra,

Sahoo,

Pati

2024

Sci Rep

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While many studies have documented adverse impact of multiple chronic conditions or multimorbidity on COVID-19 outcomes in patients, there is scarcity of report on how physicians managed these patients. We investigated the experiences and challenges of clinicians in managing patients with multimorbidity throughout the COVID-19 pandemic in Odisha state, India. To understand the factors influencing illness management and the adaptive responses of physicians alongside the evolving pandemic, we followed a longitudinal qualitative study design. Twenty-three physicians comprising general practitioners, specialists, and intensivists, were telephonically interviewed in-depth. Saldana’s longitudinal qualitative data analysis method was employed for data analysis. COVID-19 pandemic initially diverted the attention of health systems, resulting in reduced care. With time, the physicians overcame fear, anxiety, and feelings of vulnerability to COVID-19 and started prioritising patients with multimorbidity for treatment and vaccination. All physicians recommended teleconsultation and digital health records to benefit chronic illness care during future public health crises. The findings underscore the transformative potential of physician resilience and adaptation during the COVID-19 pandemic, emphasizing the importance of prioritizing patients with multimorbidity, incorporating teleconsultation, and implementing digital health records in healthcare systems to enhance chronic illness care and preparedness for future public health crises.

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Section: Discussionmentioning

confidence: 99%

A longitudinal qualitative study on physician experience in managing multimorbidity across the COVID-19 pandemic in Odisha, India

Mahapatra,

Sahoo,

Pati

2024

Sci Rep

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“…This also may influence the PWDs to travel more for diabetes care. Primary care services that include all necessary tests and treatments may entice more patients to their nearest PHCs (Olickal et al 2021). In the present study, PWDs aged less than 30 years travelled significantly more distances than the older age group.…”

Section: Discussionmentioning

confidence: 99%

How far persons with diabetes travel for care? Spatial analysis from a tertiary care facility in Southern India

et al. 2021

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Accessibility determines health care utilization among individuals with noncommunicable diseases as they need to visit health facilities frequently. Hence, we aimed to assess the road distance and travel time to the diabetes clinic of Persons with Diabetes (PWDs) seeking care at a public tertiary care facility in South India. PWDs house locations were geocoded using ArcGIS World Geocoding Services, and ArcGIS Pro Business Analyst Geoprocessing extension was used to conduct network analysis. A simple median regression analysis was done to compare the association of sociodemographic variables with distance and time. Of the total 2261 PWDs included, the mean (SD) age was 53.7 (11.5) years, and 49.4% were males and about 66.0% of the PWDs resided in rural areas. The median (IQR) travel distance of PWDs from their home to the diabetes clinic was 30.5 (7.6-78.5) km and the median (IQR) time spent in travelling was 77.9 (16.4-194.7) minutes. About 76% travelled more than 5 km to the diabetes clinic. About 85% of PWDs travelled farther than the nearest available public health facility to avail care from the diabetes clinic. Younger age group, male gender, PWDs from rural areas and the state of Tamil Nadu travelled significantly longer distance compared to their counterparts. To conclude, about three-fourth of the PWDs travelled more than 5 km for care at the diabetes clinic. Also, about 9 out of 10 travelled farther than the nearest available public health facility where diabetes care was available.

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Managing multiple long-term conditions or multimorbidity across COVID-19 pandemic: a longitudinal qualitative study from India

Mahapatra,

Sahoo,

Pati

2023

Preprint

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Objectives While many studies have documented adverse impact of multiple chronic conditions or multimorbidity on COVID-19 outcomes in patients, there is scarcity of report on how physicians managed these patients. We investigated the experiences and challenges of clinicians in managing patients with multimorbidity throughout the COVID-19 pandemic in Odisha state, India. Methods To understand the factors influencing illness management and the adaptive responses of physicians alongside the evolving pandemic, we followed a longitudinal qualitative study design. Twenty-three physicians comprising general practitioners, specialists, and intensivists, were telephonically interviewed in-depth. Saldana’s longitudinal qualitative data analysis method was employed for data analysis. Results COVID-19 pandemic initially diverted the attention of health systems, resulting in reduced care. With time, the physicians overcame fear, anxiety, and feelings of vulnerability to COVID-19 and started prioritising patients with multimorbidity for treatment and vaccination. All physicians recommended teleconsultation and digital health records to benefit chronic illness care during future public health crises Conclusion As the COVID-19 pandemic progressed, the importance of multiple long-term conditions was given increasingly importance by physicians underscoring the need to address them perennially. They became gradually resilient with the pandemic and paced with the changing health system to ensure care continuity for patients with multimorbidity.

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Decentralizing diabetes care from tertiary to primary care: how many persons with diabetes can be down-referred to primary care settings?

Cited by 3 publications

References 15 publications

A longitudinal qualitative study on physician experience in managing multimorbidity across the COVID-19 pandemic in Odisha, India

A longitudinal qualitative study on physician experience in managing multimorbidity across the COVID-19 pandemic in Odisha, India

How far persons with diabetes travel for care? Spatial analysis from a tertiary care facility in Southern India

Managing multiple long-term conditions or multimorbidity across COVID-19 pandemic: a longitudinal qualitative study from India

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