Shared Medical Appointments: An Academic-Community Partnership to Improve Care Among Adults With Type 2 Diabetes in California Central Valley Region.

PurposeThe purpose of the study was to evaluate the effectiveness of ALDEA (Latinos con Diabetes en Acción), a Shared Medical Appointment (SMA) intervention, compared to usual primary care (UPC) for the treatment of adults with type 2 diabetes over a 6-month period. It was hypothesized that participants in the SMA will have greater reductions in A1C at 6 months post-intervention compared to the control group.MethodsThis study was a quasi-experimental design with a non-randomized matched control group that followed participants prospectively for 6 months. All adults living with type-2 diabetes receiving primary care at a 2 FQHC clinics were eligible for inclusion. Participants in the control group were matched retrospectively on baseline A1C and age.ResultsThe reductions in A1C were greater in the ALDEA SMA intervention group relative to the UPC control group at 6 months in both of the FQHC centers and in the combined sample.ConclusionsThis study demonstrated that patients in the ALDEA program had a significantly greater reduction in A1C at 6 months compared to the control group. Despite its limitations, the ALDEA SMA program was successful in empowering patients and improving glycemic control

Identity Formation and Role Expansion for Nurse Practitioner Residency Preceptors: A Qualitative Thematic Analysis

Employer-based nurse practitioner residency programs have been implemented to address the significant shortage of primary care providers in the community clinic settings. However, there continues to be a shortage of clinicians who serve as preceptors to nurse practitioner residents and students. Preceptors, also referred to as clinician educators, are essential in the training of learners and their socialization into the profession. Just as there is a shortage of clinicians of diverse backgrounds to reflect the population served in the community, there is also a significant shortage of preceptors of color to train learners from diverse backgrounds. The purpose of this descriptive qualitative reflexive thematic analysis study is to examine the needs and lived experience of community-based clinicians who precept NP residents in four Federally Qualified Health Centers (FQHCs). The study explored the preceptors’ identity formation and role expansion process, as well as how communities of practice may have shaped their experience. Additionally, the intersectionality of race and gender in these processes were explored. Twelve participants each completed a one-hour semi-structured interview via Zoom. Key findings from the study revealed that the culture and leadership within each FQHC sets the stage for clinician educator identity formation and engagement. Clinician educators held multiple identities and the strength of the identities determined the support of their role expansion and engagement within the communities of practice. Four themes emerged from their role expansion experience: 1) benefits of role expansion, 2) expectations and preparation, 3) tension in balancing all their roles, and 4) compensation for the added role. Facilitating factors in expanding existing community of practice for clinicians to communities of practice for clinician educators were identified. The intersectionality of race and gender discussions were limited, and recommendations for practice and future research are presented. Results from this study set the stage for further exploration of how best to support clinicians in their expansion to clinician educators as well as benefit preceptors across all levels of learners. Confident and skillful clinician educators can prepare and retain the next generation of clinicians to care for the most vulnerable and underserved populations

Beliefs about medicines and non-adherence in patients with stroke, diabetes mellitus and rheumatoid arthritis: a cross-sectional study in China

OBJECTIVES: To investigate beliefs about medicines and their association with medicine adherence in patients with chronic diseases in China. DESIGN: A cross-sectional questionnaire-based study SETTING: Two large urban hospitals in Hefei and Tianjin, China PARTICIPANTS: Hospital inpatients (313 stroke patients) and outpatients (315 diabetic patients and 339 rheumatoid arthritis (RA) patients) were recruited between January 2014 and September 2014. OUTCOME MEASURES: The Beliefs about Medicines Questionnaire (BMQ), assessing patients' beliefs about the specific medicine (Specific-Necessity and Specific-Concerns) prescribed for their conditions (stroke/diabetes/RA) and more general background beliefs about pharmaceuticals as a class of treatment (BMQ-General Benefit, Harm and Overuse); the Perceived Sensitivity to Medicines scale (PSM) assessed patients' beliefs about how sensitive they were to the effects of medicines and the Medication Adherence Report Scale. The association between non-adherence and beliefs about medicines was assessed using a logistic regression model. RESULTS: Patients with diabetes mellitus had a stronger perceived need for treatment (mean (SD) Specific-Necessity score, 3.75 (0.40)) than patients with stroke (3.69 (0.53)) and RA (3.66 (0.44)) (p=0.049). Moderate correlations were observed between Specific-Concerns and General-Overuse, General-Harm and PSM (Pearson correlation coefficients, 0.39, 0.49 and 0.49, respectively, p<0.01). Three hundred and eleven patients were non-adherent to their medicine (159 (51.0%) in the stroke group, 60 (26.7%) in the diabetes mellitus group and 62 (19.8%) in the RA group, p<0.01). Across the whole sample, after adjusting for demographic characteristics, non-adherence was associated with patients who had higher concerns about their medicines (OR, 1.35, 95% CI 1.07 to 1.71) and patients who believed that they were personally sensitive to the effects of medications (OR 1.44, 95% CI 1.16 to 1.85). CONCLUSION: The BMQ is a useful tool to identify patients at risk of non-adherence. In the future, adherence intervention studies may use the BMQ to screen for patients who are at risk of non-adherence and to map interventional support

Detecting Female Students Transforming Entrepreneurial Competency, Mindset, and Intention into Sustainable Entrepreneurship

Entrepreneurship has been viewed as an opportunity for economic development and changing economic scenario in global markets. Women are viewed as a reservoir of entrepreneurial talents, so they can be growth engines in novel markets. Previous studies have considered entrepreneurship as the most effective way towards the economic empowerment of women. Female students engaged in entrepreneurial education have been addressed persistently, while what transforms them in an education process is still unclear. Considering the transforming global economy and its influence on higher education, this study aims to detect female students transforming entrepreneurial competency, mindset, and intention into sustainable entrepreneurship. Using a self-compiled survey, we targeted 752 female students to investigate their entrepreneurial competency, mindset, and intention. SPSS and AMOS were used to transform the data for interpretation. We assumed that the impact of female student’s entrepreneurial competency could be modified by an entrepreneurial mindset and result in entrepreneurial intention. To detect this causal relationship, this study employed reliability, factor, structural equation modeling (SEM), and bootstrapping analyses to verify the evidence. The result of the SEM confirms that the female students’ entrepreneurial competency will, through their entrepreneurial mindset, impact entrepreneurial intention. With bootstrapping, 5000 samples were collected, and it was demonstrated that the measure constructs were still reliable in the model. This study found that there is a mediation effect between entrepreneurial competency and entrepreneurial intention. The entrepreneurial mindset plays a crucial role in the transformation process. Without an entrepreneurial mindset, entrepreneurial competency cannot exert a significant effect on entrepreneurial intention. The findings can help reinvent related entrepreneurial education in higher education