Diabetes Self-Management in a Community Health Center: Improving Health Behaviors and Clinical Outcomes for Underserved Patients

Anderson, Daren; Christison-Lagay, Joan

doi:10.2337/diaclin.26.1.22

Cited by 29 publications

(31 citation statements)

References 21 publications

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“…Achieving change is a challenge, even in well-motivated teams, 237 and the need to build relationships with existing services 263 and the need for regular oversight and frequent review to ensure intervention fidelity. 258 A team approach involving the community as was seen as essential to the success of projects in deprived, minority communities, 247 the involvement of health-care workers as peers rather than professionals enabled them to motivate patients. 262 Practical issues such as sufficient and ongoing funding to enable complex interventions to be instigated and sustained, were highlighted.…”

Section: Discussionmentioning

confidence: 99%

“…239,240,246,258 Frequent staff turnover can be a particular challenge which needs to be addressed, 219,260,262 to ensure that skills are not lost. l Professional training in supporting self-management, [230][231][232]259 collaborative multidisciplinary working, 230,232 with good communication and referral systems between professionals, 235 and the involving staff members in the design of interventions 228,275 are potentially important ingredients of implementing self-management support.…”

Section: Implementation Systematic Reviewmentioning

confidence: 99%

“…[237][238][239][240][241][242][243][244][245][256][257][258][259]262,263 Thirteen of the studies were conducted in the USA, [237][238][239][244][245][246][247][248][256][257][258][259]262 one in the UK, 240 three from Germany (in five papers), 251,[253][254][255]260 three from Austria, 250,252,261 four from Australia, [241][242][243]249 and one each from Canada 263 and Italy. 264 About half (n = 12) were conducted in primary care or community settings, [239][240][241]246,247,…”

Section: Description Of the Studiesmentioning

confidence: 99%

“…Impl SRs: diabetes, COPD, asthma Successful programmes have used PDSA cycles and similar collaborative approaches to harness and build on professional/organisational motivation in order to achieve the desired service redesign. 237,[256][257][258] Phase 3 end-of-project workshop Towards the end of our study we organised a national, multidisciplinary end-of project workshop. The three specific objectives of this workshop were to:…”

Section: Leadership and Implementing Long-term Condition Supportmentioning

confidence: 99%

“…Five papers reporting three studies focused on T1DM, [251][252][253][254][255] eight focused on T2DM, [246][247][248][249][250]260,261,264 the remaining 15 included mixed populations. [237][238][239][240][241][242][243][244][245][256][257][258][259]262,263 Thirteen of the studies were conducted in the USA, [237][238][239][244][245][246][247][248][256][257][258][259]262 one in the UK, 240 three from Germany (in five papers), 251,[253][254][255]260 three from Austria, 250,…”

Section: Description Of the Studiesmentioning

confidence: 99%

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A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

Taylor

Pinnock

Epiphaniou

et al. 2014

Health Services and Delivery Research

345

451

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BackgroundDespite robust evidence concerning self-management for some long-term conditions (LTCs), others lack research explicitly on self-management and, consequently, some patient groups may be overlooked.AimTo undertake a rapid, systematic overview of the evidence on self-management support for LTCs to inform health-care commissioners and providers about what works, for whom, and in what contexts.MethodsSelf-management is ‘the tasks . . . individuals must undertake to live with one or more chronic conditions . . . [including] . . . having the confidence to deal with medical management, role management and emotional management of their conditions’. We convened an expert workshop and identified characteristics of LTCs potentially of relevance to self-management and 14 diverse exemplar LTCs (stroke, asthma, type 2 diabetes mellitus, depression, chronic obstructive pulmonary disease, chronic kidney disease, dementia, epilepsy, hypertension, inflammatory arthropathies, irritable bowel syndrome, low back pain, progressive neurological disorders and type 1 diabetes mellitus). For each LTC we conducted systematic overviews of systematic reviews of randomised controlled trials (RCTs) of self-management support interventions (‘quantitative meta-reviews’); and systematic overviews of systematic reviews of qualitative studies of patients’ experiences relating to self-management (‘qualitative meta-reviews’). We also conducted an original systematic review of implementation studies of self-management support in the LTCs. We synthesised all our data considering the different characteristics of LTCs. In parallel, we developed a taxonomy of the potential components of self-management support.ResultsWe included 30 qualitative systematic reviews (including 515 unique studies), 102 quantitative systematic reviews (including 969 RCTs), and 61 studies in the implementation systematic review. Effective self-management support interventions are multifaceted, should be tailored to the individual, their culture and beliefs, a specific LTC and position on the disease trajectory, and underpinned by a collaborative/communicative relationship between the patient and health-care professional (HCP) within the context of a health-care organisation that actively promotes self-management. Self-management support is a complex intervention and although many components were described and trialled in the studies no single component stood out as more important than any other. Core components include (1) provision of education about the LTC, recognising the importance of understanding patients’ pre-existing knowledge and beliefs about their LTC; (2) psychological strategies to support adjustment to life with a LTC; (3) strategies specifically to support adherence to treatments; (4) practical support tailored to the specific LTC, including support around activities of daily living for disabling conditions, action plans in conditions subject to marked exacerbations, intensive disease-specific training to enable self-management of specific clinical tasks; and (5) social support as appropriate. Implementation requires a whole-systems approach which intervenes at the level of the patient, the HCP and the organisation. The health-care organisation is responsible for providing the means (both training and time/material resources) to enable HCPs to implement, and patients to benefit from, self-management support, regularly evaluating self-management processes and clinical outcomes. More widely there is a societal need to address public understanding of LTCs. The lack of public story for many conditions impacted on patient help-seeking behaviour and public perceptions of need.ConclusionsSupporting self-management is inseparable from the high-quality care for LTCs. Commissioners and health-care providers should promote a culture of actively supporting self-management as a normal, expected, monitored and rewarded aspect of care. Further research is needed to understand how health service managers and staff can achieve this culture change in their health-care organisations.Study registrationThis study is registered as PROSPERO CRD42012002898.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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