Multidisciplinary coordinated care for Type 2 diabetes: A qualitative analysis of patient perspectives

Berkowitz, Seth A.; Eisenstat, Stephanie A.; Barnard, Lily S.; Wexler, Deborah J.

doi:10.1016/j.pcd.2018.01.005

Cited by 24 publications

(23 citation statements)

References 11 publications

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“…Second, as the existing social difficulties and concerns can limit social access and promote isolation of deprived populations, DSME programmes should consider the development of new social links as an objective for participants [ 38 ]. This objective, which goes beyond the medical aspect, might also help patients to attend the DSME programme and to strengthen disease self-management through peer support [ 34 , 39 ]. Longitudinal studies and more comprehensive evaluations of DSME programmes in primary care are now needed to better identify their impact on deprived patients.…”

Section: Discussionmentioning

confidence: 99%

Perspectives of deprived patients on diabetes self-management programmes delivered by the local primary care team: a qualitative study on facilitators and barriers for participation, in France

Allory

Lucas

Maury

et al. 2020

BMC Health Serv Res

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Background Diabetes self-management education (DSME) is an effective intervention for patients with type 2 diabetes mellitus (T2DM); nevertheless, patient participation in this type of programme is low. Implementation of DSME programmes in primary care practices by the local multi-professional team is a potential strategy to improve access to DSME for T2DM patients. The aim of this study was to identify perceived facilitators and barriers by patients to participation in local DSME delivered by primary care professionals in France. Method T2DM patients, informed and recruited during consulting with their usual care provider, who had attended a structured and validated DSME programme delivered by 13 primary care providers within a multi-professional primary care practice in a deprived area of 20,000 inhabitants, were invited to participate in this study. A qualitative study with semi-structured, in-depth interviews was conducted with study participants, between July 2017 and February 2018. A reflexive thematic analysis of the interviews was carried out. Coding schemes were developed to generate thematic trends in patient descriptions of facilitators and barriers to DSME participation. Results Nineteen interviews (mean length 31 min; [20–44 min]) were completed with T2DM patients. Four themes on facilitators for programme participation emerged from the data: geographical proximity of a DSME programme held in the local multi-professional primary care practice; effective promotion of the DSME programme by the local multi-professional team; pre-existing relationship between patients and their healthcare providers; and potential to establish new social interactions within the neighbourhood by participating in the programme. Three themes on barriers to attendance emerged: integrating the DSME programme into their own schedules; difficulties in expressing themselves in front of a group; and keeping the motivation for self-managing their T2DM. Conclusions From the patient perspective, the programme geographical proximity and the pre-existing patient-healthcare provider relationship were important factors that contributed to participation. Healthcare providers should consider these factors to improve access to DSME programmes and diabetes self-management in deprived populations. Longitudinal studies should be performed to measure the impact of these programmes.

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Section: Discussionmentioning

confidence: 99%

Perspectives of deprived patients on diabetes self-management programmes delivered by the local primary care team: a qualitative study on facilitators and barriers for participation, in France

Allory

Lucas

Maury

et al. 2020

BMC Health Serv Res

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“…Our goal was to conduct structured in-depth interviews with a sufficient number of trial participants to receive adequate feedback regarding their experience with an MTM intervention. We first developed an interview guide (Additional file 1: Table S2) using an iterative process that incorporated the perspectives of study team members and participants, and drew from past work in this patient population [18]. The interview guide was designed to assess participants' experience and satisfaction with the program and to identify areas of improvement.…”

Section: Qualitative Data Collection and Analysismentioning

confidence: 99%

“I was able to eat what I am supposed to eat”-- patient reflections on a medically-tailored meal intervention: a qualitative analysis

et al. 2020

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Background: Medically-tailored meal programs that provide home-delivered medically-appropriate food are an emerging intervention when type 2 diabetes co-occurs with food insecurity (limited or uncertain access to nutritious food owing to cost). We sought to understand the experiences of medically-tailored meal program participants. Methods: We conducted semi-structured interviews with participants in a randomized trial of medically-tailored meals (NCT02426138) until reaching content saturation. Participants were adults (age > 20 years) with type 2 diabetes in eastern Massachusetts, and the interviews were conducted from April to July 2017. Interviews were transcribed verbatim and coded by two independent reviewers. We determined emergent themes using content analysis. Results: Twenty individuals were interviewed. Their mean age was 58 (SD: 13) years, 60.0% were women, 20.0% were non-Hispanic black, and 15.0% were Hispanic. Key themes were 1) satisfaction and experience with medicallytailored meals 2) food preferences and cultural appropriateness, 3) diabetes management and awareness, and 4) suggestions for improvement and co-interventions. Within these themes, participants were generally satisfied with medically-tailored meals and emphasized the importance of receiving culturally appropriate food. Participants reported several positive effects of medically-tailored meals, including improved quality of life and ability to manage diabetes, and stress reduction. Participants suggested combining medically-tailored meals with diabetes self-management education or lifestyle interventions. Conclusions: Individuals with diabetes and food insecurity expressed satisfaction with the medically-tailored meal program, and reported that participation reduced stress and the burden of diabetes management. Suggestions to help ensure the success of medically-tailored meal programs included a strong emphasis on culturally acceptability and accommodating taste preferences for provided foods, and combining medically-tailored meals with diabetes education or lifestyle intervention. Trial registration: ClinicalTrials.gov NCT02426138.

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“…Most of the research focused on identifying the factors that were present in practices which resulted in TBC for diabetes ( 24 ). Therefore, there is practically no empirical data on the effect of the organizational factors cited on TBC for diabetes ( 6 , 7 , 26 , 35 – 37 , 39 , 43 – 46 , 48 , 51 , 53 , 57 , 58 ). It is important to note that the three studies that did not see improved outcomes had a focus on Structure and Processes (the only unifying factor) and none focused on Governance ( 28 , 47 , 54 ).…”

Section: Resultsmentioning

confidence: 99%

“…Other studies have also demonstrated that people with diabetes can experience improved clinical outcomes when their care is provided locally through TBC ( 11 ), including decreases in patient's use of medications, morbidity mortality, utilization and cost, while increasing self-management and empowerment, healthy behaviors, satisfaction, and quality of life as well as increased job satisfaction ( 25 ). A recent study also found that socioeconomically diverse adults with type 2 diabetes believe that a coordinated team based care was a “good approach” suggesting its capacity to address socioeconomic challenges faced by low income patients ( 26 ). Additionally, a study of factors influencing type 2 diabetes self-management found that medically underserved patients who are able to manage their condition described a TBC approach of care and support ( 27 ).…”

Section: Introductionmentioning

confidence: 99%

Organizational Conditions That Impact the Implementation of Effective Team-Based Models for the Treatment of Diabetes for Low Income Patients—A Scoping Review

et al. 2020

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Background: Team-based care models (TBC) have demonstrated effectiveness to improve health outcomes for vulnerable diabetes patients but have proven difficult to implement in low income settings. Organizational conditions have been identified as influential on the implementation of TBC. This scoping review aims to answer the question: What is known from the scientific literature about how organizational conditions enable or inhibit TBC for diabetic patients in primary care settings, particularly settings that serve low-income patients? Methods: A scoping review study design was selected to identify key concepts and research gaps in the literature related to the impact of organizational conditions on TBC. Twenty-six articles were finally selected and included in this review. This scoping review was carried out following a directed content analysis approach. Results: While it is assumed that trained health professionals from diverse disciplines working in a common setting will sort it out and work as a team, co-location, and health professions education alone do not improve patient outcomes for diabetic patients. Health system, organization, and/or team level factors affect the way in which members of a care team, including patients and caregivers, collaborate to improve health outcomes. Organizational factors span across seven categories: governance and policies, structure and process, workplace culture, resources, team skills and knowledge, financial implications, and technology. These organizational factors are cited throughout the literature as important to TBC, however, research on the organizational conditions that enable and inhibit TBC for diabetic patients is extremely limited. Dispersed organizational factors are cited throughout the literature, but only one study specifically assesses the effect of organizational factors on TBC. Thematic analysis was used to categorize organizational factors in the literature about TBC and diabetes and a framework for analysis and definitions for key terms is presented. Conclusions: The review identified significant gaps in the literature relating to the study of organizational conditions that enable or inhibit TBC for low-income patients with diabetes. Efforts need to be carried out to establish unifying terminology and frameworks across the field to help explain the relationship between organizational conditions and TBC for diabetes. Gaps in the literature include research be based on organizational theories, research carried out in low-income settings and low and middle income countries, research explaining the difference between the organizational conditions that impact the implementation of TBC vs. maintaining or sustaining TBC and the interaction between organizational factors at the micro, meso and macro level and their impact on TBC. Few studies include information on patient outcomes, and fewer include information on low income settings. Further research is necessary on th...

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Multidisciplinary coordinated care for Type 2 diabetes: A qualitative analysis of patient perspectives

Abstract: Coordinated, multidisciplinary diabetes team care is understood by and acceptable to patients with type 2 diabetes.

Cited by 24 publications

References 11 publications

Perspectives of deprived patients on diabetes self-management programmes delivered by the local primary care team: a qualitative study on facilitators and barriers for participation, in France

Perspectives of deprived patients on diabetes self-management programmes delivered by the local primary care team: a qualitative study on facilitators and barriers for participation, in France

“I was able to eat what I am supposed to eat”-- patient reflections on a medically-tailored meal intervention: a qualitative analysis

Organizational Conditions That Impact the Implementation of Effective Team-Based Models for the Treatment of Diabetes for Low Income Patients—A Scoping Review

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