Evaluating the Impact of a Collaborative Care Model in Diabetes Management in a Primary Healthcare Setting in Qatar Using Real-World Data

Objectives: To evaluate the impact of Collaborative Care Model (CCM) on diabetes-related outcomes among patients with diabetes attending a primary care setting. Methods: A multiple-time series, retrospective, observational study with a control group among patients with diabetes followed-up at Qatar Petroleum Diabetes Clinic. The impact of CCM on glycemic control, blood pressure, lipid profile, and anthropometrics was evaluated at baseline and up to 17 months of follow-up. Quantitative data were analyzed descriptively and inferentially using SPSS. Results: CCM significantly improved (p<0.05) the mean values (baseline vs. 17 months) of glycated hemoglobin A1c (6.9% vs. 6.5%), random blood glucose (194.38 mg/dL vs. 141.23 mg/dL), low-density lipoprotein cholesterol (3.7 mmol/L vs. 2.8 mmol/L), total cholesterol (5.43 mmol/L vs. 4.34 mmol/L), weight (78.52 Kg vs. 77.85 Kg), and body mass index (30.41 Kg/m2 vs. 30.17 Kg/m2) over 17-months within the intervention group; whereas, no significant changes occurred within the control group. Similarly, the between group comparisons demonstrated the superiority of CCM over usual care in improving several clinical outcomes. Conclusion: Inefficiencies in delivering diabetes care can be circumvented by the integration of CCM. The implementation of CCM in a primary healthcare setting improved several diabetes-related outcomes over 17-months

The Perspectives of Healthcare Professionals and Patients on the Value of Collaborative Care Model for Diabetes in Primary Healthcare Settings in Qatar

Background: Diabetes mellitus (DM) is one of the top health priorities in Qatar due to its high prevalence of 15.5%, which is projected to increase to 29.7% by 2035. DM management is still challenging despite healthcare advancement, warranting the need for a comprehensive Collaborative Care Model (CCM). Therefore, we aim to evaluate the value of CCM in DM care at a primary healthcare (PHC) setting in Qatar. Methodology: This study was a qualitative exploration of healthcare professionals' (HCPs') and patients' perspectives on the value of CCM provided at the center. Twelve patients and twelve HCPs participated in semi-structured one-to-one interviews. Qualitative data were analyzed and interpreted using a deductive coding thematic analysis process. Results: The interviews resulted in 14 different themes under the predefined domains: components of CCM (five themes), the impact of CCM (three themes), facilitators of CCM provision (three themes), and barriers of CCM provision (three themes). The majority of the participants indicated easy access to and communication with HCPs at QPDC. Participants appreciated the extra time spent with HCPs, frequent follow-up visits, and health education, which empowered them to self-manage DM. Generally, participants identified barriers and facilitators related to patients, HCPs, and healthcare system. Conclusion: The providers and users of CCM had an overall positive perception and appreciation of this model in PHC settings. Barriers to CCM such as unpleasant attitude and undesirable attributes of HCPs and patients, unsupportive hospital system, and high workload must be addressed before implementing the model in other PHC setting

Collaborative care model for diabetes in primary care settings in Qatar: a qualitative exploration among healthcare professionals and patients who experienced the service

Background: Diabetes mellitus is highly prevalent and associated with huge economic burden globally. The conventional care and management of diabetes mellitus is highly fragmented and complex, warranting the need for a comprehensive Collaborative Care Model (CCM). Little is known about the perception of patients with diabetes and their healthcare providers about CCM, its barriers and facilitators. This study aimed to explore the value of CCM in diabetes care at a primary healthcare (PHC) setting from the perspective of patients with diabetes and healthcare professionals (HCPs), in an effort to expand our current knowledge on collaborative care in diabetes at primary care level for the purpose of quality improvement and service expansion. Methods: Using an exploratory case study approach, semi-structured interviews were conducted among patients and HCPs who encountered CCM in Qatar during 2019 and 2020. The semi-structured interviews were transcribed verbatim and the data were analysed and interpreted using a deductive-inductive thematic analysis approach. Results: Twelve patients and 12 HCPs at a diabetes clinic participated in one-to-one interviews. The interviews resulted in five different themes: the process and components of collaborative care model (four subthemes), current organizational support and resources (three subthemes), impact of collaborative care model on diabetes outcomes (three subthemes), enablers of collaborative care model (three subthemes), and barriers to collaborative care model (three subthemes). The participants indicated easy access to and communication with competent and pleasant HCPs. The patients appreciated the extra time spent with HCPs, frequent follow-up visits, and health education, which empowered them to self-manage diabetes. HCPs believed that successful CCM provision relied on their interest and commitment to care for patients with diabetes. Generally, participants identified barriers and facilitators that are related to patients, HCPs, and healthcare system. Conclusions: The providers and users of CCM had an overall positive perception and appreciation of this model in PHC settings. Barriers to CCM such as undesirable attributes of HCPs and patients, unsupportive hospital system, and high workload must be addressed before implementing the model in other PHC settings. 2021, The Author(s).This research was funded by Qatar University under the Student Grant (number QUST-2-CPH-2018-12). Qatar University played no role in the conduct of the study or the content of this manuscript.Scopu

Impact of pharmacist-involved collaborative care on diabetes management in a primary healthcare setting using real-world data

Background Diabetes mellitus is a complex multi-system disorder, requiring multi-disciplinary care. The conventional care model, where physicians are the sole caregivers may not be optimal. Addition of other healthcare team members improves healthcare outcomes for patients with diabetes. Aim To evaluate the impact of pharmacist-involved collaborative care on diabetes-related outcomes among patients with diabetes attending a primary healthcare setting in Qatar using real-world data. Method A retrospective cohort study was conducted among patients with diabetes attending Qatar Petroleum Diabetes Clinic. Patients were categorized as either receiving pharmacist-involved collaborative care (intervention group) or usual care (control group). Data were analyzed using SPSS®. Glycemic control (glycated hemoglobin A1c, HbA1c), blood pressure, lipid profile, and body mass index were evaluated at baseline and up to 17 months of follow-up. Results After 17 months of follow-up, pharmacist-involved collaborative care compared to usual care resulted in a significant decrease in HbA1c (6.8 ± 1.2% vs. 7.1 ± 1.3%, p < 0.01). Moreover, compared to baseline, pharmacist-involved collaborative care significantly improved (p < 0.05) the levels of HbA1c (7.5% vs. 6.8%), low-density lipoprotein cholesterol (3.7 mmol/L vs. 2.8 mmol/L), total cholesterol (5.43 mmol/L vs. 4.34 mmol/L), and body mass index (30.42 kg/m2 vs. 30.17 kg/m2) after 17 months within the intervention group. However, no significant changes for these parameters occurred within the control group. Conclusion The implementation of pharmacist-involved collaborative care in a primary healthcare setting improved several diabetes-related outcomes over 17 months. Future studies should determine the long-term impact of this care model.The authors acknowledge Qatar University for funding the research through the Office of Research Support grant numbers QUST-2-CPH-2019-1 and QUST-2-CPH-2018-12.Scopu

Empagliflozin in Patients with Chronic Kidney Disease

Background The effects of empagliflozin in patients with chronic kidney disease who are at risk for disease progression are not well understood. The EMPA-KIDNEY trial was designed to assess the effects of treatment with empagliflozin in a broad range of such patients. Methods We enrolled patients with chronic kidney disease who had an estimated glomerular filtration rate (eGFR) of at least 20 but less than 45 ml per minute per 1.73 m(2) of body-surface area, or who had an eGFR of at least 45 but less than 90 ml per minute per 1.73 m(2) with a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of at least 200. Patients were randomly assigned to receive empagliflozin (10 mg once daily) or matching placebo. The primary outcome was a composite of progression of kidney disease (defined as end-stage kidney disease, a sustained decrease in eGFR to &lt; 10 ml per minute per 1.73 m(2), a sustained decrease in eGFR of &amp; GE;40% from baseline, or death from renal causes) or death from cardiovascular causes. Results A total of 6609 patients underwent randomization. During a median of 2.0 years of follow-up, progression of kidney disease or death from cardiovascular causes occurred in 432 of 3304 patients (13.1%) in the empagliflozin group and in 558 of 3305 patients (16.9%) in the placebo group (hazard ratio, 0.72; 95% confidence interval [CI], 0.64 to 0.82; P &lt; 0.001). Results were consistent among patients with or without diabetes and across subgroups defined according to eGFR ranges. The rate of hospitalization from any cause was lower in the empagliflozin group than in the placebo group (hazard ratio, 0.86; 95% CI, 0.78 to 0.95; P=0.003), but there were no significant between-group differences with respect to the composite outcome of hospitalization for heart failure or death from cardiovascular causes (which occurred in 4.0% in the empagliflozin group and 4.6% in the placebo group) or death from any cause (in 4.5% and 5.1%, respectively). The rates of serious adverse events were similar in the two groups. Conclusions Among a wide range of patients with chronic kidney disease who were at risk for disease progression, empagliflozin therapy led to a lower risk of progression of kidney disease or death from cardiovascular causes than placebo