Effect of Core Values of General Practice on Adherence of Patients with Diabetes
Treatment adherence is closely related to disease control for patients with diabetes. Primary care is general, and continuous, which may satisfy the general and continuous healthcare needs of diabetic patients. But the association of core values of general practices with adherence of diabetic patients is not yet clear.
To explore the effect of core values of general practice (first contact/first line care, continuity, accessibility, comprehensiveness, coordination and patient-oriented) on the adherence (medication adherence, diet adherence, exercise adherence, self-monitoring adherence and regular hospital visits adherence) of type 2 diabetic patients, providing a reference for improving the adherence of such patients by precisely enhancing the core values of general practices.
A survey was conducted between August and September 2019 with a convenience sample of type 2 diabetics receiving contacted family doctor services from Shayuan Community Health Center of Guangzhou using a questionnaire consisting of three parts〔demographic information, the Chinese version of Primary Care Assessment Survey (ASPC) , and Adherence to Out-of-hospital Treatment of Type 2 Diabetics (AOTTD) 〕. Treatment adherence was compared by various personal factors. Multiple linear regression was used to analyze the association of the core values of general practice with treatment adherence.
Altogether, 224 cases who handed in responsive questionnaires were included for final analysis. The average scores of AOTTD, and ASPC of the respondents were (80.57±11.27) and (72.95±11.40) , respectively. The scores of AOTTD differed significantly by sex and understanding level of type 2 diabetes (P<0.05) . The total score of ASPC and the score of its each domain were associated with the total score of AOTTD, or the domain score of regular hospital visits (P<0.10) . The scores of two domains (accessibility and coordination) of the ASPC were associated with the medication adherence score (P<0.10) . The domain score of coordination was associated with the diet adherence score (P<0.10) . The score of each domain of the ASPC (except for coordination) was associated with the self-monitoring adherence score (P<0.10) .
For type 2 diabetics, strengthening each of the core values of general practice could contribute to the increase of their treatment adherence, and regular hospital visits adherence. Improving the accessibility of general practice could enhance their medication adherence. Improving the coordination of general practice could enhance their medication adherence and diet adherence. Improving first contact/first line care, continuity, accessibility, comprehensiveness, coordination and patient-oriented values of general practice could contribute to the increase of their medication adherence. But no association was found between the core values of general practice and patients'exercise adherence, which suggests that providing more exercise resources and environmental support for these patients may be a solution.
Prevalence and Associated Factors of Behaviors of Monitoring to Prevent Chronic Diabetic Complications among Type 2 Diabetes Patients Involved in Community-based Management
Chronic diabetic complications are highly prevalent, which may be an underlying cause of diabetes-related disability and death. Regularly and continuously self-monitoring may contribute to early detection, diagnosis and treatment of various diabetic complications, which is essential to reducing the adverse consequences of diabetes, and is a key program in community-based management that should be highly valued.
To investigate the prevalence and associated factors (such as diabetes prevalence and monitoring and other factors) of behaviors of monitoring (self-observation and screening tests) to prevent chronic diabetic complications among type 2 diabetes patients receiving community-based management.
The convenience sampling was used to select 785 type 2 diabetes patients from Chengdu's central urban areas who received community-based type 2 diabetic management from May to November 2019. They were invited to attend a survey for understanding their socio-demographic information and monitoring behaviors to prevent chronic diabetic complications using a questionnaire developed by us.
Only 103 (13.1%) of the patients did not suffer from any chronic complications, and 435 (55.4%) suffered from both metabolic syndrome and chronic diabetic complications. The average total score for self-observation of chronic diabetic complications in the participants was (2.58±0.86) , but the average total score of regularly self-observation of pulsations of the dorsalis pedis artery was only (1.47±0.84) . The average total score of performing screening tests for chronic diabetic complications was (2.77±0.57) . The average score of diabetic retinopathy screening, peripheral neuropathy screening, and lower extremity vascular disease screening was (1.88±0.99) , (1.46±0.84) , and (1.47±0.84) , respectively. About 78.2% (614/785) of patients underwent screening tests following the doctors' advices. But only 9.9% (78/785) took the initiative to conduct regular tests. About 17.7% (139/785) and 49.0% (385/785) of the patients could not correctly manage the abnormal results of self-observation and the screening test results. Multiple linear regression analysis indicated that the duration of diabetes since diagnosis, prevalence of chronic diabetic complications, and management of self-observed abnormalities were associated with the score of self-observation of chronic diabetic complications (P<0.05) . The duration of diabetes since diagnosis, the most recently measured HbA1c value, prevalence of chronic diabetic complications, causes and results management of screening tests for chronic diabetic complications were associated with average total score of performing screening tests for chronic diabetic complications (P<0.05) .
The prevalence of behaviors of monitoring to prevent chronic diabetic complications in community-dwelling type 2 diabetes patients was unsatisfactory, which was affected by the duration of diabetes since diagnosis, prevalence of chronic diabetic complications, the most recently measured HbA1c value, causes and results management of screening tests for chronic diabetic complications. In view of this, in the delivery of community-based management services, attentions should be paid to improving patients' initiative to actively and regularly observe their conditions and undergo relevant screening tests, thereby improving early diagnosis and treatment rates of chronic type 2 diabetic complications.
Effect of Health Literacy and Exercise Intervention on Medical Mistrust of Type 2 Diabetes Patients in the Community
Medical distrust in patients has been related with poor compliance to medications and suboptimal clinical outcomes. Effective interventions may improve medical distrust in patients which is warranted specific studies.
To evaluate the effect of health literacy and exercise interventions on medical mistrust in patients with type 2 diabetes (T2DM) .
This study was based on a cluster randomized-controlled trial conducted during February 2015 to March 2016. A total of 800 T2DM patients were recruited from four community health service centers in Minhang and Changning Districts of Shanghai by using a multi-stage sampling method. All patients were randomly divided into the control group and 3 intervention groups in the community. Routine care was provided to all the patients, and on this basis, health literacy intervention, exercise intervention and health literacy + exercise intervention (comprehensive intervention) were performed to the three intervention groups based on partnership to improve diabetes education (PRIDE) toolkit, respectively. Information was collected using the Chinese versions of Health Literacy Management Scale (c-HeLMS) , the 5-item Diabetes Numeracy Test Scale (c-DNT-5) , and Medical Mistrust Index (c-MMI) at baseline, 3-, 6-, 12- (end of intervention) and 24-months follow-up (post-intervention) . The generalized estimating equation was used to evaluate the effect of the interventions at each time point.
A total of 780 patients were recruited in this study. The c-MMI was a reliable and valid scale to measure medical mistrust in our subjects, with Cronbach's α of 0.826. The median score and interquartile range of c-MMI was 31 (7) at baseline while the rate of medical mistrust (scores≥30) was 65.9% (514/780) , both of which decreased at almost each follow-up survey in four groups. Compared with the control group, a lower risk of medical mistrust was observed at the 3-months〔OR (95%CI) =0.42 (0.23, 0.78) 〕 and 6-months of follow-up〔OR (95%CI) =0.46 (0.24, 0.88) 〕 for the health literacy group, at the 6-months〔OR (95%CI) =0.50 (0.25, 0.99) 〕, 12-months〔OR (95%CI) =0.43 (0.22, 0.86) 〕 and 24-months of follow-up〔OR (95%CI) =0.37 (0.19, 0.72) 〕 for the exercise group, and at the 6-months〔OR (95%CI) =0.30 (0.16, 0.56) 〕 for the comprehensive group.
Both health literacy and exercise intervention may effectively decrease the scores of c-MMI and reduce the risk of medical mistrust in diabetes patients.
