84 research outputs found
Measurement of Quality Improvement in Family Practice over Two-year Period Using Electronic Database Quality Indicators: Retrospective Cohort Study from Israel
Aim To investigate the associations between family physiciansâ
characteristics and the change in quality of health
care indicators (QI) over a two-year period.
Methods The retrospective cohort study included 161
(60.5%) of 266 family physicians who worked for the Clalit
health fund in Israel in the period from January 2003 until
December 2005. Family physiciansâ background characteristics
included seniority, location of the clinic (urban or rural),
workload, sex, managerial responsibilities, and board
certification. The performance in 11 QIs, including indicators
of diabetes follow-up (n = 4) and control (n = 2), hospitalization
for chronic obstructive pulmonary disease and
congestive heart failure (n = 2), and preventive medicine
measures (influenza immunization for high risk patients
and mammography) was evaluated at the end of 2003 and
2005.
Results There was an improvement in all the QIs except
mammography. The improvement was significant for 8/10
QIs, the greatest being in achieving low-density lipoprotein
cholesterol (+18.2%) and HbA1c (+5.9%) targets in diabetic
patients. Multivariate regression model showed that
the most significant factor associated with better QIs in December
2003 was board certification, while 2 years later it
was female sex and having a managerial position. Being
a board-certified physician remained positively associated
with high QIs for diabetes control.
Conclusion There was an improvement in most QIs in the
period of 2 years. Initially, board certification was significantly
associated with high QIs, but clinic managers and female
physicians showed the ability to improve their scores.
Research should continue to find ways to make all physicians
responsive to their QIs
Usefulness of electronic databases for the detection of unrecognized diabetic patients
BACKGROUND: Even mild hyperglycemia is associated with future acute and chronic complications. Nevertheless, many cases of diabetes in the community go unrecognized. The aim of the study was to determine if national electronic patient records could be used to identify patients with diabetes in a health management organization. METHODS: The central district databases of Israel's largest health management organization were reviewed for all patients over 20 years old with a documented diagnosis of diabetes mellitus (DM) in the chronic disease register or patient file (identified diabetic patients) or a fasting serum glucose level of >126 mg/100 ml according to the central laboratory records (suspected diabetic patients). The family physicians of the patients with suspected diabetes were asked for a report on their current diabetic status. RESULTS: The searches yielded 1,694 suspected diabetic patients; replies from the family physicians were received for 1,486. Of these, 575 (38.7%) were confirmed to have diabetes mellitus. Their addition to the identified patient group raised the relative rate of diabetic patients in the district by 3.2%. CONCLUSION: Cross-referencing existing databases is an efficient, low-cost method for identifying hyperglycemic patients with unrecognized diabetes who require preventive treatment and follow-up. This model can be used to advantage in other clinical sites in Israel and elsewhere with fully computerized databases
A qualitative analysis exploring preferred methods of peer support to encourage adherence to a Mediterranean diet in a Northern European population at high risk of cardiovascular disease.
BACKGROUND: Epidemiological and randomised controlled trial evidence demonstrates that adherence to a Mediterranean diet (MD) can reduce cardiovascular disease (CVD) risk. However, methods used to support dietary change have been intensive and expensive. Peer support has been suggested as a possible cost-effective method to encourage adherence to a MD in at risk populations, although development of such a programme has not been explored. The purpose of this study was to use mixed-methods to determine the preferred peer support approach to encourage adherence to a MD. METHODS: Qualitative (focus groups) and quantitative methods (questionnaire and preference scoring sheet) were used to determine preferred methods of peer support. Sixty-seven high CVD risk participants took part in 12 focus groups (60% female, mean age 64Â years) and completed a questionnaire and preference scoring sheet. Focus group data were transcribed and thematically analysed. RESULTS: The mean preference score (1 being most preferred and 5 being least preferred) for group support was 1.5, compared to 3.4 for peer mentorship, 4.0 for telephone peer support and 4.0 for internet peer support. Three key themes were identified from the transcripts: 1. Components of an effective peer support group: discussions around group peer support were predominantly positive. It was suggested that an effective group develops from people who consider themselves similar to each other meeting face-to-face, leading to the development of a group identity that embraces trust and honesty. 2. Catalysing Motivation: participants discussed that a group peer support model could facilitate interpersonal motivations including encouragement, competitiveness and accountability. 3. Stepping Stones of Change: participants conceptualised change as a process, and discussed that, throughout the process, different models of peer support might be more or less useful. CONCLUSION: A group-based approach was the preferred method of peer support to encourage a population at high risk of CVD to adhere to a MD. This finding should be recognised in the development of interventions to encourage adoption of a MD in a Northern European population
Impact of Diabetes on Postinfarction Heart Failure and Left Ventricular Remodeling
Diabetes mellitus, the metabolic syndrome, and the underlying insulin resistance are increasingly associated with diastolic dysfunction and reduced stress tolerance. The poor prognosis associated with heart failure in patients with diabetes after myocardial infarction is likely attributable to many factors, important among which is the metabolic impact from insulin resistance and hyperglycemia on the regulation of microvascular perfusion and energy generation in the cardiac myocyte. This review summarizes epidemiologic, pathophysiologic, diagnostic, and therapeutic data related to diabetes and heart failure in acute myocardial infarction and discusses novel perceptions and strategies that hold promise for the future and deserve further investigation
Association of dietary intake and BMI among newly diagnosed type 2 diabetes patients attending diabetic clinics in Kampala
A randomised controlled trial of a Mediterranean Dietary Intervention for Adults with Non Alcoholic Fatty Liver Disease (MEDINA): study protocol
Measurement of Quality Improvement in Family Practice over Two-year Period Using Electronic Database Quality Indicators: Retrospective Cohort Study from Israel
Aim To investigate the associations between family physiciansâ
characteristics and the change in quality of health
care indicators (QI) over a two-year period.
Methods The retrospective cohort study included 161
(60.5%) of 266 family physicians who worked for the Clalit
health fund in Israel in the period from January 2003 until
December 2005. Family physiciansâ background characteristics
included seniority, location of the clinic (urban or rural),
workload, sex, managerial responsibilities, and board
certification. The performance in 11 QIs, including indicators
of diabetes follow-up (n = 4) and control (n = 2), hospitalization
for chronic obstructive pulmonary disease and
congestive heart failure (n = 2), and preventive medicine
measures (influenza immunization for high risk patients
and mammography) was evaluated at the end of 2003 and
2005.
Results There was an improvement in all the QIs except
mammography. The improvement was significant for 8/10
QIs, the greatest being in achieving low-density lipoprotein
cholesterol (+18.2%) and HbA1c (+5.9%) targets in diabetic
patients. Multivariate regression model showed that
the most significant factor associated with better QIs in December
2003 was board certification, while 2 years later it
was female sex and having a managerial position. Being
a board-certified physician remained positively associated
with high QIs for diabetes control.
Conclusion There was an improvement in most QIs in the
period of 2 years. Initially, board certification was significantly
associated with high QIs, but clinic managers and female
physicians showed the ability to improve their scores.
Research should continue to find ways to make all physicians
responsive to their QIs
Cost Analysis of an Intervention to Prevent Methicillin-Resistant Staphylococcus Aureus (MRSA) Transmission.
Our objective was to assess the cost implications of a vertical MRSA prevention program that led to a reduction in MRSA bacteremia.We performed a matched historical cohort study and cost analysis in a single hospital in Israel for the years 2005-2011. The cost of MRSA bacteremia was calculated as total hospital cost for patients admitted with bacteremia and for patients with hospital-acquired bacteremia, the difference in cost compared to matched controls. The cost of prevention was calculated as the sum of the cost of microbiology tests, single-use equipment used for patients in isolation, and infection control personnel.An average of 20,000 patients were screened yearly. The cost of prevention was 14,500, and the net cost attributable to nosocomial bacteremia was 199,600.A vertical MRSA prevention program targeted at high-risk patients, which was highly effective in preventing bacteremia, is cost saving. These results suggest that allocating resources to targeted prevention efforts might be beneficial even in a single institution in a high incidence country
Comment on: Wheeler et al. Macronutrients, Food Groups, and Eating Patterns in the Management of Diabetes: A Systematic Review of the Literature, 2010. Diabetes Care 2012;35:434-445
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