Šećerna bolest kao kronična bolest – potreba redefiniranja modela pružanja skrbi

Tradicionalnim modelom zdravstvene skrbi, prilagođenim liječenju akutnih bolesnih stanja, nije moguće optimalno zbrinuti osobe koje boluju od šećerne bolesti. Kako bi se poboljšala regulacije bolesti, te unaprijedila kvaliteta života bolesnika i osobna kontrola nad zdravljem, potrebno je redefinirati odnos liječnik-bolesnik. Tradicionalni, liječniku usmjeren pristup, obilježen izradom plana liječenja za bolesnike i poticanjem njihova pristajanja uz preporuke, nastoji se zamijeniti bolesniku usmjerenim pristupom koji se oslanja na autonomiju, aktivno sudjelovanje, osnaženost bolesnika za donošenje informiranih odluka, te suradnu skrb o šećernoj bolesti. Podaci istraživanja potvrđuju da implementacija modela osnaživanja bolesnika pozitivno doprinosi zdravstvenom samozbrinjavanju i zdravstvenim ishodima u bolesnika koji boluju od šećerne bolesti

Šećerna bolest kao kronična bolest – potreba redefiniranja modela pružanja skrbi

Tradicionalnim modelom zdravstvene skrbi, prilagođenim liječenju akutnih bolesnih stanja, nije moguće optimalno zbrinuti osobe koje boluju od šećerne bolesti. Kako bi se poboljšala regulacije bolesti, te unaprijedila kvaliteta života bolesnika i osobna kontrola nad zdravljem, potrebno je redefinirati odnos liječnik-bolesnik. Tradicionalni, liječniku usmjeren pristup, obilježen izradom plana liječenja za bolesnike i poticanjem njihova pristajanja uz preporuke, nastoji se zamijeniti bolesniku usmjerenim pristupom koji se oslanja na autonomiju, aktivno sudjelovanje, osnaženost bolesnika za donošenje informiranih odluka, te suradnu skrb o šećernoj bolesti. Podaci istraživanja potvrđuju da implementacija modela osnaživanja bolesnika pozitivno doprinosi zdravstvenom samozbrinjavanju i zdravstvenim ishodima u bolesnika koji boluju od šećerne bolesti

Procjena i praćenje psihosocijalnih potreba u liječenju osoba sa šećernom bolešću

Suvremena istraživanja i intervencije vezane uz psihološke i psihosocijalne činitelje u šećernoj bolesti usmjerila su se u dva područja [1]. Prvi smjer istraživanja i djelovanja tiče se povezanosti psihosocijalnih čimbenika sa zdravstvenim ishodima liječenja šećerne bolesti. S druge strane, psihosocijalnu dobrobit se promatra kao vrijedan ishod liječenja sam po sebi. Psihosocijalni čimbenici utječu na zdravstvene ishode bolesti, jer djeluju na uspješnost pojedinca u svim aspektima samozbrinjavanja šećerne bolesti. Pritom valja imati na umu da je veza između psihosocijalnih činitelja i zdravstvenih ishoda bolesti dinamička. S jedne strane, psihosocijalni resursi kojima raspolaže osoba oboljela od šećerne bolesti će pozitivno ili negativno djelovati na njezinu dobrobit. Oni će time posredno dovoditi i do boljeg ili slabijeg samozbrinjavanja, što će uvjetovati poželjne ili štetne zdravstvene ishode. S druge strane, poželjni zdravstveni ishodi će povećavati psihosocijalnu dobrobit, čime će doprinositi održavanju poželjnih obrazaca ponašanja samozbrinjavanja i očuvanju dobrog zdravstvenog stanja. Nepoželjni zdravstveni ishodi će otežavati daljnje pokušaje samozbrinjavanja i negativno djelovati na dobrobit pojedinca, čime će postizanje boljih zdravstvenih ishoda biti teže. Ovo je perspektiva koja je često od primarne važnosti medicinskom osoblju koje se bavi liječenjem osoba sa šećernom bolešću. Psihosocijalna dobrobit kao važan samostalni ishod skrbi za oboljele veže se uz činjenicu da šećerna bolest pogoduje razvoju različith psiholoških i psihosocijalnih smetnji i tegoba. Prevalencija depresije među osobama sa šećernom bolešću iznosi oko 20%, što je oko tri puta učestalije nego u općoj populaciji [2], a procjenjuje se da oko 40% osoba sa šećernom bolešću doživljava smetnje raspoloženja različitog intenziteta. Pritom oko dvije trećine depresivnih poremećaja kod dijabetičara ostaje neprepoznato i neliječeno. S druge strane, život sa šećernom bolešću u sličnoj mjeri povećava i vjerojatnost razvoja anksioznih poremećaja i klinički značajno povišene anksioznosti [3]. Konačno, osobe sa šećernom bolešću, a osobito mlađe ženske osobe, sklonije su razvoju poremećaja prehrane, kao i poremećenim obrascima hranjenja koji ne zadovoljavaju pune dijagnostičke kriterije [4]

Does treatment of subsyndromal depression improve depression and diabetes related outcomes: protocol for a randomised controlled comparison of psycho-education, physical exercise and treatment as usual

<p>Abstract</p> <p>Background</p> <p>The prevalence of mood difficulties in persons with diabetes is approximately twice that in the general population, affecting the health outcomes and patients' quality of life in an undesirable way. Although subsyndromal depression is an important predictor of a more serious clinical depression, it is often overlooked. This study aims to compare the effects of two non-pharmacological interventions for subsyndromal depression, psychoeducation and physical exercise, with diabetes treatment as usual on mood- and diabetes-related outcomes.</p> <p>Methods and Design</p> <p>Type 2 diabetic patients aged 18-65 yrs. who report mood difficulties and the related need for help in a mail survey will be potential participants. After giving informed consent, they will be randomly assigned to one of the three groups (psychoeducation, physical activity, treatment as usual). Depressive symptoms, diabetes distress, health-related quality of life and diabetes self-care activities will be assessed at baseline, at 6 weeks, 6 months and 12 months. A structured clinical interview for DSM-IV Axis I Disorders (SCID-I) will be performed at baseline and at one-year follow-up in order to determine the clinical significance of the patients' depressive symptoms. Disease-related data will be collected from patients' files and from additional physical examinations and laboratory tests.</p> <p>The two interventions will be comparable in terms of format (small group work), duration (six sessions) and approach (interactive learning; supporting the participants' active roles). The group treated as usual will be informed about their screening results and about the importance of treating depression. They will be provided with brief re-education on diabetes and written self-help instructions to cope with mood difficulties.</p> <p>Primary outcomes will be depressive symptoms. Secondary outcomes will be glycaemic control, diabetes-related distress, self-management of diabetes and health-related quality of life. Tertiary outcomes will be biochemical markers reflecting common pathophysiological processes of insulin resistance, inflammation and oxidative damage that are assumed to be intertwined in both diabetes and depression. The mixed-effect linear model will be used to compare the outcome variables.</p> <p>Power analysis has indicated that the two intervention groups and the control group should comprise 59 patients to enable detection of clinically meaningful differences in depressive symptoms with a power of 80% and alpha = 0.05. Outcomes will be analysed on an intention-to-treat basis.</p> <p>Trial Registration</p> <p>ISRCTN: <a href="http://www.controlled-trials.com/ISRCTN05673017">ISRCTN05673017</a></p

Lista prihvaćenih znanstvenih projekata - 1. ciklus (2. dio)

Lista prihvaćenih znanstvenih projekata - 1. ciklus (2. dio

The reach of depression screening preceding treatment: are there patterns of patients&apos; self-selection

This study evaluated the reach of depression screening followed by treatment programs for subsyndromal depression and explored demographic and clinical characteristics of patients who were reached versus those who were not. A two-item Patient Health Questionnaire-Depression was sent to 4196 type 2 diabetic patients. Positively screened patients were interviewed to assess the severity of depression, and those with subclinical symptoms were invited to treatment groups. The reach of screening procedure was evaluated by the total response rate, proportion of positive depression screenings, and proportion of eligible patients entering treatment programs. Predictors of responsiveness to screening and of participation in treatment were determined using logistic regression. Of the 34% of patients who returned the questionnaire (n = 1442), 40% reported depressive symptoms and a need for professional help (n = 581). Age (OR = 1.06, 95% CI = 1.05-1.08), BMI (OR = 1.02, 95% CI = 1.00-1.04), HbA1C (OR = .92, 95% CI = .86-.99), and LDL-cholesterol (OR = .90, 95% CI = .81-1.00) correlated with response to screening. Willingness to accept treatment was predicted by professional status (OR = 3.24, 95% CI = 1.53-6.87), education (OR = 1.21, 95% CI = 1.05-1.38), and BMI (OR = .91, 95% CI = .85-.98). Older patients with better diabetes control were more likely to be reached by postal screening for depressive symptoms. Professionally inactive, better-educated persons and those with lower BMI were more likely to participate in the intervention for subsyndromal depression

Does treatment of subsyndromal depression improve depression-related and diabetes-related outcomes? A randomised controlled comparison of psychoeducation, physical exercise and enhanced treatment as usual

Background: Elevated depressive symptoms that do not reach criteria for a clinical diagnosis of depression are highly prevalent in persons with diabetes. This study was aimed at determining the efficacy of psychoeducation and physical exercise compared with enhanced treatment as usual on 1-year changes in depressive symptoms, diabetes distress and self-management, and quality of life and metabolic control in type 2 diabetes patients with subsyndromal depression. Methods: Adult type 2 diabetes patients who screened positively for depression and expressed a need for professional help with mood-related issues were eligible. Exclusion criteria were clinical depression, current psychiatric treatment and advanced diabetes complications. Out of 365 eligible patients 209 consented to either 6 weekly sessions of psychoeducation (A) and physical exercise (B), or to enhanced treatment as usual (C). Computer-generated sequences for block randomisation stratified by gender were used. Depressive symptoms (primary outcome) and diabetes distress, diabetes self-care, metabolic control and health-related quality of life(secondary outcomes) were analysed at 6-month and 12-month follow-up using repeated-measures ANOVAs. Results: Out of the 74 patients randomised into group A, 66 into B and 69 into group C, 203 completed the interventions, and 179 patients with all 3 assessments were analysed. Depressive symptoms in participants from the psychoeducational, physical exercise and the enhanced treatment as usual groups improved equally from baseline to 12-month follow-up (time versus time x group effect; F = 12.51, p < 0.001, η2 = 0.07 and F = 0.609, p = 0.656, η2 = 0.007 respectively), as did diabetes distress and quality of life (all p < 0.001), diabetes self-care (p < 0.001 to < 0.05), triglycerides, and total cholesterol and LDL-cholesterol (p < 0.001). Conclusions: The employed interventions had comparable positive effects on 12-month psychological and diabetes related outcomes suggesting that even minimal intervention addressing patients’ diabetes-related problems and concerns had favourable clinical implications and might be sufficient to treat subsyndromal depression. Further investigation is warranted to clarify possible mechanisms of improvement

The reach of depression screening preceding treatment: are there patterns of patients' self-selection?

This study evaluated the reach of depression screening followed by treatment programs for subsyndromal depression and explored demographic and clinical characteristics of patients who were reached versus those who were not. A two-item Patient Health Questionnaire-Depression was sent to 4196 type 2 diabetic patients. Positively screened patients were interviewed to assess the severity of depression, and those with subclinical symptoms were invited to treatment groups. The reach of screening procedure was evaluated by the total response rate, proportion of positive depression screenings, and proportion of eligible patients entering treatment programs. Predictors of responsiveness to screening and of participation in treatment were determined using logistic regression. Of the 34% of patients who returned the questionnaire (n=1442), 40% reported depressive symptoms and a need for professional help (n=581). Age (OR = 1.06, 95% CI = 1.05–1.08), BMI (OR = 1.02, 95% CI = 1.00–1.04), HbA1C (OR = .92, 95% CI = .86–.99), and LDL-cholesterol (OR = .90, 95% CI = .81–1.00) correlated with response to screening. Willingness to accept treatment was predicted by professional status (OR = 3.24, 95% CI = 1.53–6.87), education (OR = 1.21, 95% CI = 1.05–1.38), and BMI (OR = .91, 95% CI = .85–.98). Older patients with better diabetes control were more likely to be reached by postal screening for depressive symptoms. Professionally inactive, better-educated persons and those with lower BMI were more likely to participate in the intervention for subsyndromal depression