
Individualising Chronic Care Management by Analysing Patients’ Needs – A Mixed Method Approach
References
- Schofield, D, et al. The economic impact of diabetes through lost labour force participation on individuals and government: evidence from a microsimulation model. BMC Public Health, 2014; 14(1): 1–8. DOI: 10.1186/1471-2458-14-220
- European Coalition for Diabetes. Diabetes in Europe: Policy Puzzle. The State We Are In. 4th edition; 2014.
- International Diabetes Federation. IDF Diabetes Atlas – 7th Edition. Cho, N (ed.), International Diabetes Federation; 2015.
www.diabetesatlas.org . - Muller, G, Weser, G and Schwarz, PE. The European perspective of diabetes prevention: The need for individualization of diabetes prevention. J Endocrinol Invest, 2013; 36(5): 352–357. DOI: 10.1007/BF03347104
- Handelsman, Y, et al. American association of clinical endocrinologists and american college of endocrinology – clinical practice guidelines for developing a diabetes mellitus comprehensive care plan – 2015 — executive summary. Endocrine Practice, 2015; 21(4): 413–437. DOI: 10.4158/EP15672.GL
- Inzucchi, SE, et al. Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach: Position Statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). 2012; 35(6): 1364–1379.
- American Diabetes Association. 1. Strategies for Improving Care. Diabetes Care, 2016; 39(Supplement 1): S6–S12. DOI: 10.2337/dc16-S004
- Lindstrom, J, et al. Take action to prevent diabetes—the IMAGE toolkit for the prevention of type 2 diabetes in Europe. Horm Metab Res, 2010; 42(Suppl 1): S37–55. DOI: 10.1055/s-0029-1240975
- Funnell, MM, et al. National standards for diabetes self-management education. Diabetes Care, 2012; 35(Suppl 1): S101–S108. DOI: 10.2337/dc12-s101
- Mackey, LM, et al. Self-Management Skills in Chronic Disease Management: What Role Does Health Literacy Have? Medical Decision Making, 2016; 36(6): 741–759. DOI: 10.1177/0272989X16638330
- Kim, SH and Lee, A. Health-Literacy-Sensitive Diabetes Self-Management Interventions: A Systematic Review and Meta-Analysis. Worldviews on Evidence-Based Nursing, 2016; 324–333. DOI: 10.1111/wvn.12157
- Cramm, JM and Nieboer, AP. Self-management abilities, physical health and depressive symptoms among patients with cardiovascular diseases, chronic obstructive pulmonary disease, and diabetes. Patient Education and Counseling, 2012; 87(3): 411–415. DOI: 10.1016/j.pec.2011.12.006
- Camp, CJ, et al. Creating Effective Self-Management for Older Adults with Type 2 Diabetes and Cognitive Impairment. Advances in Aging Research, 2015; 4(2): 33–41. DOI: 10.4236/aar.2015.42005
- Feil, DG, Zhu, CW and Sultzer, DL. The relationship between cognitive impairment and diabetes self-management in a population-based community sample of older adults with Type 2 diabetes. Journal of Behavioral Medicine, 2012; 35(2): 190–199. DOI: 10.1007/s10865-011-9344-6
- Tomlin, A and Sinclair, A. The influence of cognition on self-management of type 2 diabetes in older people. Psychology Research and Behavior Management, 2016; 9: 7–20.
- Houle, J, et al. Socioeconomic status and glycemic control in adult patients with type 2 diabetes: a mediation analysis. BMJ Open Diabetes Res Care, 2016; 4(1): 1–8. DOI: 10.1136/bmjdrc-2015-000184
- Tao, X, et al. Association between socioeconomic status and metabolic control and diabetes complications: a cross-sectional nationwide study in Chinese adults with type 2 diabetes mellitus. Cardiovascular Diabetology, 2016; 15(1): 1–10. DOI: 10.1186/s12933-016-0376-7
- Shigaki, C, et al. Motivation and diabetes self-management. Chronic Illn, 2010; 6(3): 202–214. DOI: 10.1177/1742395310375630
- Siminerio, LM, Piatt, G and Zgibor, JC. Implementing the chronic care model for improvements in diabetes care and education in a rural primary care practice. Diabetes Educ, 2005; 31(2): 225–234. DOI: 10.1177/0145721705275325
- Grover, A and Joshi, A. An overview of chronic disease models: a systematic literature review. Glob J Health Sci, 2015; 7(2): 210–227.
- Davy, C, et al. Effectiveness of chronic care models: opportunities for improving healthcare practice and health outcomes: a systematic review. BMC Health Serv Res, 2015; 15: 194. DOI: 10.1186/s12913-015-0854-8
- Timpel, P and Schwarz, PEH. Diabetesprävention im hausärztlichen Bereich: Machbar, aber ausgebremst. Dtsch Arztebl, 2016; 113(17): 30–33.
- Asadi-Lari, M, Packham, C and Gray, D. Need for redefining needs. Health and Quality of Life Outcomes, 2003; 1(1): 1–5. DOI: 10.1186/1477-7525-1-1
- Lightfoot, J. Identifying needs and setting priorities: issues of theory, policy and practice. Health & Social Care in the Community, 1995; 3(2): 105–114. DOI: 10.1111/j.1365-2524.1995.tb00011.x
- Culyer, A. Need—is a consensus possible? Journal of Medical Ethics, 1998; 24(2): 77–80. DOI: 10.1136/jme.24.2.77
- Department of Health Social Services Inspectorate.
Care management and assessment: Practitioners’ guide . London: HMSO; 1991. - Mira, JJ, et al. Development and Validation of an Instrument for Assessing Patient Experience of Chronic Illness Care. International Journal of Integrated Care, 2016; 16(3): 13. DOI: 10.5334/ijic.2443
- Bongaerts, BWC, et al. Effectiveness of chronic care models for the management of type 2 diabetes mellitus in Europe: a systematic review and meta-analysis. BMJ Open, 2017; 7(3): 1–16. DOI: 10.1136/bmjopen-2016-013076
- Borg, C, Hallberg, IR and Blomqvist, K. Life satisfaction among older people (65+) with reduced self-care capacity: the relationship to social, health and financial aspects. Journal of Clinical Nursing, 2006; 15(5): 607–618. DOI: 10.1111/j.1365-2702.2006.01375.x
- Drennan, V, et al. Priorities in identifying unmet need in older people attending general practice: a nominal group technique study. Fam Pract, 2007; 24(5): 454–460. DOI: 10.1093/fampra/cmm034
- Crabtree, BF, et al. Delivery of clinical preventive services in family medicine offices. Ann Fam Med, 2005; 3(5): 430–435. DOI: 10.1370/afm.345
- Contel, JC, et al. Chronic and integrated care in Catalonia. International Journal of Integrated Care, 2015; 15: 1–13. DOI: 10.5334/ijic.2205
- Stopford, R, Winkley, K and Ismail, K. Social support and glycemic control in type 2 diabetes: A systematic review of observational studies. Patient Education and Counseling, 2013; 93(3): 549–558. DOI: 10.1016/j.pec.2013.08.016
- Sinclair, AJ, et al. Caring for older adults with diabetes mellitus: characteristics of carers and their prime roles and responsibilities. Diabet Med, 2010; 27(9): 1055–1059. DOI: 10.1111/j.1464-5491.2010.03066.x
- Greer, R and Boulware, LE. Reducing CKD risks among vulnerable populations in primary care. Adv Chronic Kidney Dis, 2015; 22(1): 74–80. DOI: 10.1053/j.ackd.2014.06.003
- Östenson, CG, et al. Research: Complications Self-reported non-severe hypoglycaemic events in Europe. Diabetic Medicine, 2014; 31(1): 92–101. DOI: 10.1111/dme.12261
- Rothman, RL, et al. The Spoken Knowledge in Low Literacy in Diabetes Scale: A Diabetes Knowledge Scale for Vulnerable Patients. The Diabetes Educator, 2005; 31(2): 215–224. DOI: 10.1177/0145721705275002
- Holtrop, JS, Luo, Z and Alexanders, L. Inadequate Reimbursement for Care Management to Primary Care Offices. The Journal of the American Board of Family Medicine, 2015; 28(2): 271–279. DOI: 10.3122/jabfm.2015.02.140207
- Ellis, JJ, et al. Suboptimal Statin Adherence and Discontinuation in Primary and Secondary Prevention Populations: Should We Target Patients with the Most to Gain? Journal of General Internal Medicine, 2004; 19(6): 638–645. DOI: 10.1111/j.1525-1497.2004.30516.x
- Tseng, C-W, et al. Race/Ethnicity and Economic Differences in Cost-Related Medication Underuse Among Insured Adults With Diabetes. The Translating Research Into Action for Diabetes Study, 2008; 31(2): 261–266.
- Kirkman, MS, et al. Determinants of Adherence to Diabetes Medications: Findings From a Large Pharmacy Claims Database. Diabetes Care, 2015; 38(4): 604–609. DOI: 10.2337/dc14-2098
- DeJean, D, et al. Patient Experiences of Depression and Anxiety with Chronic Disease: A Systematic Review and Qualitative Meta-Synthesis. Ontario Health Technology Assessment Series, 2013; 13(16): 1–33.
- Peyrot, M, Rubin, RR and Siminerio, LM. Physician and nurse use of psychosocial strategies in diabetes care: results of the cross-national Diabetes Attitudes, Wishes and Needs (DAWN) study. Diabetes Care, 2006; 29(6): 1256–62. DOI: 10.2337/dc05-2444
- Peyrot, M, et al. Diabetes Attitudes Wishes and Needs 2 (DAWN2): a multinational, multi-stakeholder study of psychosocial issues in diabetes and person-centred diabetes care. Diabetes Res Clin Pract, 2013; 99(2): 174–184. DOI: 10.1016/j.diabres.2012.11.016
- Collinsworth, A, et al. Community health workers in primary care practice: redesigning health care delivery systems to extend and improve diabetes care in underserved populations. Health Promot Pract, 2014; 15(2 Suppl): 51S–61S. DOI: 10.1177/1524839914539961
- Kovacs Burns, K, et al. Diabetes Attitudes, Wishes and Needs second study (DAWN2): cross-national benchmarking indicators for family members living with people with diabetes. Diabet Med, 2013; 30(7): 778–788. DOI: 10.1111/dme.12239
- Lee, JS. The unmet needs of the elderly with diabetes in home health care. Soc Work Health Care, 2007; 45(3): 1–17. DOI: 10.1300/J010v45n03_01
- Barnard, LS, et al. Material need support interventions for diabetes prevention and control: a systematic review. Curr Diab Rep, 2015; 15(2): 1–8. DOI: 10.1007/s11892-014-0574-1
- Maclaren, AS.
Ageing resource communities: new frontiers of rural population change, community development, and voluntarism . Skinner, M and Hanlon, N (eds.), PB – Routledge, London and New York, 2016, 220 pp, ISBN978 1 138 84526 8 (hardback), £90.00. Geographical Research, 2016; 54(2): 224–226. DOI: 10.1111/1745-5871.12183 - Joseph, AE and Cloutier-Fisher, D. Ageing in rural communities: Vulnerable people in vulnerable places. Ageing and place: Perspectives, policy, practice, 2005; 133–146.
- European Commission. Commission staff working document. Country Report Poland 2015; 2015.
- Mackenbach, JP, et al. Socioeconomic Inequalities in Health in 22 European Countries. New England Journal of Medicine, 2008; 358(23): 2468–2481. DOI: 10.1056/NEJMsa0707519
- International Diabetes Federation Europe. Access to quality medicines and medical devices for diabetes care in europe. Nolan, T (ed.), 2014; 1–172.
- OECD/EU.
Health at a Glance: Europe 2016 . 2016; OECD Publishing. - McEwen, LN, et al. Competing Demands for Time and Self-Care Behaviors, Processes of Care, and Intermediate Outcomes Among People With Diabetes. Translating Research Into Action for Diabetes (TRIAD), 2011; 34(5): 1180–1182.
- Chernof, BA, et al. Health Habit Counseling Amidst Competing Demands: Effects of Patient Health Habits and Visit Characteristics. Medical Care, 1999; 37(8): 738–747. DOI: 10.1097/00005650-199908000-00004
- Jaen, CR, Stange, KC and Nutting, PA. Competing demands of primary care: A model for the delivery of clinical preventive services. Journal of Family Practice, 1994; 38(2): 166–171.
- Reeve, J, et al. From personal challenge to technical fix: the risks of depersonalised care. Health & Social Care in the Community, 2012; 20(2): 145–154. DOI: 10.1111/j.1365-2524.2011.01026.x
- Papaspurou, M, et al. Fears and Health Needs of Patients with Diabetes: A Qualitative Research in Rural Population. Med Arch, 2015; 69(3): 190–195. DOI: 10.5455/medarh.2015.69.190-195
- Doherty, AM, Gayle, C and Ismail, K. 3 Dimensions of Care for Diabetes: integrating diabetes care into an individual’s world. Practical Diabetes, 2015; 32(9): 345–349. DOI: 10.1002/pdi.1987
- Pimouguet, C, et al. Effectiveness of disease-management programs for improving diabetes care: a meta-analysis. CMAJ: Canadian Medical Association Journal, 2011; 183(2): E115–E127. DOI: 10.1503/cmaj.091786
- Morris, HL, Carlyle, KE and Elston Lafata, J. Adding the patient’s voice to our understanding of collaborative goal setting: How do patients with diabetes define collaborative goal setting? Chronic Illness; 2016. DOI: 10.1177/1742395316648748
- Greaves, CJ, et al. Systematic review of reviews of intervention components associated with increased effectiveness in dietary and physical activity interventions. BMC Public Health, 2011; 11: 1–12. DOI: 10.1186/1471-2458-11-119
- Thota, AB, et al. Collaborative care to improve the management of depressive disorders: a community guide systematic review and meta-analysis. Am J Prev Med, 2012; 42(5): 525–538. DOI: 10.1016/j.amepre.2012.01.019
- Bongaerts, BWC, et al. Effectiveness of Chronic Care Models for the Management of Type 2 Diabetes Mellitus in Europe: a Systematic Review. BMJ Open, 1–16.
- Schwarz, PE and Riemenschneider, H. Slowing Down the Progression of Type 2 Diabetes: We Need Fair, Innovative, and Disruptive Action on Environmental and Policy Levels! Diabetes Care, 2016; 39(Suppl 2): S121–S126. DOI: 10.2337/dcS15-3001
- Stange, KC, et al. Sustainability of a practice-individualized preventive service delivery intervention. American Journal of Preventive Medicine, 2003; 25(4): 296–300. DOI: 10.1016/S0749-3797(03)00219-8
DOI: https://doi.org/10.5334/ijic.3067 | Journal eISSN: 1568-4156
Language: English
Submitted on: Mar 10, 2017
Accepted on: Sep 27, 2017
Published on: Nov 13, 2017
Published by: Ubiquity Press
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
© 2017 P. Timpel, C. Lang, Johan Wens, J C. Contel, A. Gilis-Januszewska, K. Kemple, P E. Schwarz, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.