Report of the Health Care Delivery Work Group

Glasgow, Russell E.; Hiss, Roland G.; Anderson, Robert M.; Friedman, Neal; Hayward, Rodney A.; Marrero, David G.; Taylor, C. Barr; Vinicor, Frank

doi:10.2337/diacare.24.1.124

Cited by 148 publications

(84 citation statements)

References 81 publications

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“…We based our framework on a comprehensive review of existing models for health care (12)(13)(14)(15). Our model postulates that as with diabetes care delivery, preventive care for women with histories of GDM is dependent upon health care system structure and processes, including provider interactions, particularly regarding advice in the perinatal period.…”

Section: Conceptual Framework and Scale Developmentmentioning

confidence: 99%

Preventive Counseling Among Women With Histories of Gestational Diabetes Mellitus

et al. 2007

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OBJECTIVE -The purpose of this study was to examine the association between recall of recommendations for diabetes prevention and both health behaviors and screening among women with histories of gestational diabetes mellitus (GDM).RESEARCH DESIGN AND METHODS -We surveyed 228 women with histories of GDM within the past 5 years who were enrolled in a university-affiliated managed care plan. In a cross-sectional analysis, we assessed the association between recall of health care provider advice and both postpartum lifestyle behaviors and reported performance of postpartum diabetes screening. Multivariate models were constructed that adjusted for correlates of counseling including postpartum diabetes, dyslipidemia, insulin use during pregnancy, and provider type.RESULTS -Participants were predominantly non-Hispanic white, college educated and affluent, and overweight or obese. The majority reported that they received counseling on lifestyle modification and postpartum diabetes screening. Postpartum physical activity levels, fruit and vegetable intake, and screening were suboptimal. No significant association existed between recall of advice and physical activity or between recall of advice and diet. Recall of advice along with distribution of laboratory slips for glucose testing was associated with performance of postpartum diabetes screening using self-report (adjusted odds ratio 2.07 [95% CI 1.51-2.84]) or claims data (1.64 [1.16 -2.32]).CONCLUSIONS -Women with histories of GDM who recalled advice regarding postpartum glucose testing and received laboratory slips were significantly more likely to report having had postpartum diabetes screening. Although women's recall of services may not reflect the actual services received, simple counseling may not be sufficient to optimize postpartum behaviors to reduce future risk of diabetes. Diabetes Care 30:2489-2495, 2007G estational diabetes mellitus (GDM) is defined as glucose intolerance first identified during pregnancy (1,2). Although glucose intolerance resolves with delivery ϳ90% of the time (3), women with GDM have an increased risk for future glucose intolerance (4,5). Unfortunately, studies to date suggest that women with GDM may not be informed about the implications of their diagnosis, including how to reduce their future risk of diabetes or about the advantages of lifestyle modification (6,7). Also, although guidelines recommend postpartum testing for glucose intolerance with an oral glucose tolerance test (OGTT) at 6 weeks and an OGTT or fasting glucose periodically thereafter (1,2), many women with GDM do not undergo this postpartum diabetes screening (8 -10).Several studies suggest that physician practices may contribute to these deficits. A 1998 survey of academic obstetriciangynecologists found that only 62% believed that women with GDM were at risk for future diabetes after delivery and only 60% stated they practiced postpartum diabetes screening (11). A 2004 survey of a similar population noted that 75% practiced postpartum screening. No reports have e...

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Section: Conceptual Framework and Scale Developmentmentioning

confidence: 99%

Preventive Counseling Among Women With Histories of Gestational Diabetes Mellitus

et al. 2007

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“…There is also an urgent need for more research into health care provider and health care delivery factors that enhance selftreatment behavior (Glasgow et al, 2001). Studies in diabetes and other chronic illnesses have suggested that numerous variables can increase patient satisfaction with provider treatment and the likelihood of successful behavior change.…”

Section: Social and Environmental Variablesmentioning

confidence: 99%

“…Unfortunately, changing health care delivery systems so that they are more conducive to the successful management of chronic illnesses faces many barriers to implementation in realworld clinical settings. Not the least of these barriers is the pressure exerted by managed care to reimburse for briefer patient contacts (Glasgow et al, 2001).…”

Section: Health Care Professionals and Health Care Systemsmentioning

confidence: 99%

“…The need for brief, pragmatic, and user-friendly strategies to improve outcome in diabetic populations presents challenges for psychologists, who have typically been trained to approach intervention from an individual or small-group perspective (Glasgow et al, 2001). In contrast, the public health approach aims to disseminate interventions that are cost-effective and involve minimal effort to large numbers of patients, often accomplishing this by using health care personnel who are not licensed mental health providers to implement programs.…”

Section: A Public Health Approach To Diabetes Interventionmentioning

confidence: 99%

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Diabetes and behavioral medicine: The second decade.

Gönder-Frederick¹,

Cox²,

Ritterband³

2002

Journal of Consulting and Clinical Psychology

166

144

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Diabetes management depends almost entirely on behavioral self-regulation. Behavioral scientists have continued a collaboration with other health systems researchers to develop a holistic approach to this disease. The authors summarized the literature in 4 major areas: self-management of diabetes, psychosocial adjustment and quality of life, neuropsychological impact, and psychobehavioral intervention development. Progress made in each of these areas over the past decade is highlighted, as are important issues that have not yet received sufficient scientific attention. Emerging areas likely to become central in behavioral research, such as diabetes prevention, are introduced. The future of behavioral medicine in diabetes is also discussed, including topics such as the changing role of psychologists in diabetes care, the urgent need for more and better intervention research, the growing importance of incorporating a health system-public health perspective, and obstacles to the integration of psychobehavioral approaches into routine health care delivery.A profound event in diabetes management during the past decade was the release of the 1993 report of the National Institutes of Health (NIH) funded Diabetes Control and Complications Trial (DCCT; DCCT Research Group, 1993), which radically altered both the goals and the philosophy of treatment of this disease. The DCCT was a controlled, prospective trial following more than 1,400 adults and adolescents with Type 1 diabetes (T1DM) over an average of 6.5 years. The results provided strong evidence that the use of intensive treatment regimens to maintain tighter glucose control can delay or prevent the development of at least some of the devastating long-term complications of diabetes, including retinopathy and nephropathy. Subsequent studies replicated these findings and demonstrated the benefits of maintaining tighter metabolic control for patients with Type 2 diabetes (T2DM; Ohkubo et al., 1995;Reichard, Nilsson, & Rosenqvist, 1993;Turner, Cull, & Holman, 1996).It is almost impossible to overestimate the impact of the DCCT on diabetes treatment and research. Seemingly overnight, large numbers of patients were expected to follow a demanding, intensive treatment regimen that previously had been recommended only for those who were most highly motivated and diligent in their diabetes self-management. Health care practitioners were also expected to know how to help patients achieve these lofty treatment goals. In addition to problems in implementing intensive treatment, questions arose concerning the effects of these regimens on quality of life (QOL) for patients. Intensive regimens also posed new dilemmas for health care practitioners and patients, not the least of which was the dramatic increase in risk for episodes of severe hypoglycemia when patients attempted to lower blood glucose (BG) levels. It quickly became clear that the greatest challenge to contemporary diabetes treatment was overcoming the many psychobehavioral and social-environmental barriers to optimal ...

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“…A meta-analysis on the effect of selfmanagement education on glycemic control also suggests that increased contact time between patient and physician reduces the A1C level (31). Furthermore, the structured personal care doctors were encouraged to evaluate the treatment and treatment goal with the patients, and this specific consultation style may have promoted greater patient participation in treatment decisions (32)(33)(34) and more supportive care (34,35), all factors that may have been of importance to regimen adherence (32)(33)(34)(35) and glycemic control (34,35) for the structured personal care women.…”

Section: Study Strengths and Limitationsmentioning

confidence: 99%

Structured Personal Diabetes Care in Primary Health Care Affects Only Women’s HbA1c

et al. 2006

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OBJECTIVE -Diabetic men and women differ in lifestyle and attitudes toward diabetes and may benefit differently from interventions to improve glycemic control. We explored the relation between HbA 1c (A1C), sex, treatment allocation, and their interactions with behavioral and attitudinal characteristics in patients with type 2 diabetes.RESEARCH DESIGN AND METHODS -Six years after their diabetes diagnosis, a population-based sample of 874 primary care patients cluster-randomized to receive structured personal care or routine care reported lifestyle, medication, social support, diabetes-related consultations, and attitudes toward diabetes. Multivariate analyses were applied, split by sex.RESULTS -A marked intervention effect on A1C was confined to the structured personal care women. The median A1C was 8.4% in structured personal care women and 9.2% in routine care women (P Ͻ 0.0001) and 8.5% in structured personal care men and 8.9% in routine care men (P ϭ 0.052). Routine care women had a 1.10 times higher A1C than structured personal care women, (P Ͻ 0.0001, adjusted analysis). Structured personal care women had relatively more consultations than routine care women, but neither number of consultations nor other covariates helped to explain the sex difference in A1C. Irrespective of treatment allocation, women had more adaptive attitudes toward diabetes but lacked support compared with men.CONCLUSIONS -In this study, the observed effect of structured personal care on A1C was present only among women, possibly because they were more inclined to comply with regular follow-up and had a tendency to have a more adaptive attitude toward diabetes. Diabetes Care 29:963-969, 2006

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Report of the Health Care Delivery Work Group

Abstract: R e v i e w s / C o m m e n t a r i e s / P o s i t i o n S t a t e m e n t s

Cited by 148 publications

References 81 publications

Preventive Counseling Among Women With Histories of Gestational Diabetes Mellitus

Preventive Counseling Among Women With Histories of Gestational Diabetes Mellitus

Diabetes and behavioral medicine: The second decade.

Structured Personal Diabetes Care in Primary Health Care Affects Only Women’s HbA1c

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