Quality of care for patients with type 2 diabetes in general practice according to patients' ethnic background: a cross-sectional study from Oslo, Norway

<p>Abstract</p> <p>Background</p> <p>In recent decades immigration to Norway from Asia, Africa and Eastern Europe has increased rapidly. The aim of this study was to assess the quality of care for type 2 diabetes mellitus (T2DM) patients from these ethnic minority groups compared with the care received by Norwegians.</p> <p>Methods</p> <p>In 2006, electronic medical record data were screened at 11 practices (49 GPs; 58857 patients). 1653 T2DM patients cared for in general practice were identified. Ethnicity was defined as self-reported country of birth. Chi-squared tests, one-way ANOVAs, multiple regression, linear mixed effect models and generalized linear mixed models were used.</p> <p>Results</p> <p>Diabetes was diagnosed at a younger age in patients from the ethnic minority groups (South Asians (SA): mean age 44.9 years, Middle East/North Africa (MENA): 47.2 years, East Asians (EA): 52.0 years, others: 49.0 years) compared with Norwegians (59.7 years, p < 0.001). HbA1c, systolic blood pressure (SBP) and s-cholesterol were measured in >85% of patients in all groups with minor differences between minority groups and Norwegians. A greater proportion of the minority groups were prescribed hypoglycaemic medications compared with Norwegians (≥79% vs. 72%, p < 0.001). After adjusting for age, gender, diabetes duration, practice and physician unit, HbA1c (geometric mean) for Norwegians was 6.9% compared to 7.3-7.5% in the minority groups (p < 0.05). The proportion with poor glycaemic control (HbA1c > 9%) was higher in minority groups (SA: 19.6%, MENA: 18.9% vs. Norwegians: 5.6%, p < 0.001. No significant ethnic differences were found in the proportions reaching the combined target: HbA1c ≤ 7.5%, SBP ≤ 140 mmHg, diastolic blood pressure (DBP) ≤ 85 mmHg and total s-cholesterol ≤5.0 mmol/L (Norwegians: 25.5%, SA: 24.9%, MENA: 26.9%, EA: 26.1%, others:17.5%).</p> <p>Conclusions</p> <p>Mean age at the time of diagnosis of T2DM was 8-15 years younger in minority groups compared with Norwegians. Recording of important processes of care measures is high in all groups. Only one in four of most patient groups achieved all four treatment targets and prescribing habits may be sub-optimal. Patients from minority groups have worse glycaemic control than Norwegians which implies that it might be necessary to improve the guidelines to meet the needs of specific ethnic groups.</p

Samtalekunst - En kvalitativ studie om rådgiveres erfaring med å samtale med personer med en sjelden diagnose

Formål: Dette er en kvalitativ studie som undersøker hvordan erfarne rådgivere på nasjonale kompetansesentre for sjeldne diagnoser beskriver samtaler med personer med en sjelden diagnose og vedkommendes familie. Formålet med studien er å bidra med ytterligere innsikt i kompleksiteten i en slik samtale, og belyse hva rådgivere erfarer er viktig og vesentlig i denne. Teoretisk forankring: Studien er forankret i et fenomenologisk perspektiv, og spesielt filosofen M. Merleau-Ponty er sentral. Ved å la kroppen få forrang i møte med den andre i en samtale, har det åpnet for noen spesielle perspektiv. Metode: To kompetansesentre ble kontaktet og fem erfarne rådgivere ble inkludert i studien. De har ulik helse-, pedagogisk- og sosialfaglig bakgrunn, og over 20 års praksis innen sin fagprofesjon. Semistrukturerte forskningsintervju ble foretatt fra desember 2012- februar 2013. Intervjuene ble transkribert i lett modifisert verbatim form. Det ble benyttet Interpretativ Phenomenological Analysis (IPA). Funn: Noen tema har skilt seg ut og tas med videre i analysen. Disse er inndelt i følgende fire hovedkategorier: 1) Forberedelse til en rådgivingssamtale, 2) Å skape kontakt, 3) Samspillet mellom rådgiver og den som kommer til samtale, og 4) De vanskelige tingene som kan komme opp i en samtale. Videre arbeid med analysen førte til tre hovedfunn som bringes videre til diskusjonen. Disse er: a) Jeg forbereder meg, jeg forbereder meg ikke, b) For å lage det alminnelig, selv om det ikke er alminnelig og c) Hva skal jeg si til kjæresten min? Hovedfunnene gir innsikt i noen av de komplekse avveiningene rådgiverne står ovenfor og hvordan de håndterer dette i rådgivningssamtalen. Avsluttende ord: Studien viser at vanskelige samtaler ofte handler om det vanlige livet, og ikke nødvendigvis det som rådgiveren har forberedt skulle bli vanskelig. Å kunne håndtere disse uvanlige samtalene og gjøre dem mest mulig alminnelige kan best betegnes som samtalekunst

The ambiguity of preparing and being prepared for a patient consultation

This paper presents findings from a study on the ways in which counsellors working at national centres for rare disorders in Norway experience preparing, and being prepared for, a face-to-face patient consultation. The research involved semi-structured interviews with five experienced counsellors from different health professional backgrounds working at two separate centres. These interviews were then analysed with reference to the theoretical insights of phenomenologists. The excerpts chosen for this paper shed particular light on the process of preparing for a face-to-face patient consultation. Our findings underline the significance of preparing and being prepared while also drawing attention to the multifaceted, complex and ambiguous nature of the processes involved. Preparing for face-to-face consultations with patients is revealed to require approaches that are thoughtful, flexible and empathic. To be prepared for something one does not yet know is about being open to the unexpected and the unpredictable