5 powerpoint slides (Group Review Synthesis Project)

Reference

Author/ Date – (APA Style)

Theoretical/ Conceptual Framework

Study Objectives, Research Question(s)/ Hypotheses

Study Population

Methodology (Type of Study)/ Intervention Design (if applicable)

Analysis, Results & Major Findings

Strengths/ Limitations

Conclusions Recommendations

Implications for Future Research

Implications for Practice

Hu, R., Shi, L., Liang, H., Haile, G. P., & Lee, D. C. (2016). Racial/Ethnic Disparities in Primary Care Quality Among Type 2 Diabetes Patients, Medical Expenditure Panel Survey, 2012. Preventing chronic disease, 13, E100-E100.

Prevalence of diabetes, diabetic medical -care accessibility, diabetic-associated impediment and mortality rates

The authors did not frame their questions in any theoretical or conceptual framework. They only attempted to explore racial/ethnic disparities in quality of primary care of type 2 diabetes.

The research examined race/ethnicity differences in relation to primary Medicare equality for people with type II diabetes.

2617 patients of type II diabetes.

Survey was used in collecting data. Multiple regression in addition to multivariate logistic regression investigated the relationship between racial/ethnic groups and primary care.

Stata/SE 14 was used in analyzing the data. Results showed equality in access to medical-care for ethic/racial minorities in USA.

MEPS data is often individually and privately reported thus face biasness. Secondary data used in the research did not include the causal inferences during the research. another limitation was primary data used was collected from patients rather and were not based on the patient’s medical outcome. Also, the longitudinal measures applied denied the inclusion of primary-care indicators.

There is equal care between the minorities and non-minorities in terms of medical access for type II diabetic patients in USA.

Research in the same area is necessary to support the findings of this research. The next research should focus on smaller ethnic/racial groups and find out the results on diabetes.

Policymakers need to expand primary medical-care for diabetic patients with emphasis to those with lower SES to ensure service delivery equality.

American Diabetes Association. (2016). Standards of medical care in diabetes—2016 abridged for primary care providers. Clinical diabetes: a publication of the American Diabetes Association, 34(1), 3.

Racial/ethnic groups, family, social factors and perception in reference to insulin were used as variables

Chronic Care Model (CCM)

The study examined Cultural-based obstacles faced by healthcare givers in the use of insulin for minority groups in USA. The second objective is to offer recommendations for the barriers.

Hispanics and Latino

Quantitative research, surveys

Provision of insulin in diabetic patients is affected by cultural factors in minority groups.

Limitations

The research did not consider the cost and accessibility of insulin for minority groups.

Mayberry, L. S., Bergner, E. M., Chakkalakal, R. J., Elasy, T. A., & Osborn, C. Y. (2016). Self-care disparities among adults with type 2 diabetes in the USA. Current diabetes reports, 16(11), 113.

Disparities in self-care for type II diabetes patients, self-care behavior, self-foot examination and smoking.

No Theoretical or conceptual framework was used

The hypothesis: non-Hispanic blacks contain more suboptimal glycemic than Hispanics in addition to non-Hispanic whites.

The sample size was 25 articles.

Descriptive research design was used in the research.

Questionnaires and probability sampling were used to form a hypothesis and collect data on Hispanics and non-Hispanics in the USA with and without Diabetes. results indicated non-white Hispanics together with Hispanics had proper medical observance.

Limitations

The research did not consider diet differences during the research.

There is a correlation between the existing disparities for minority and non-minorities with type II diabetes.

Recommendations

Use of reliable measures can provide more data on variations in diets and exercises for diabetes people.

There is need for research in self-foot examination, ways of solving it besides living with diabetes.

Education on importance of medical adherence and observation of diet for people with type II diabetes.

Lo-ciganic, W.H., Donohue, J.M., Jones, B.L, Perera, S., Thorpe, J.M., Thorpe, C.T., Marcum, Z.A., Gellad, W.F. (2016). Trajectories of diabetes medication adherence and hospitalization risk: A retrospective cohort study in a large state Medicaid program. Journal of General Internal Medicine. 31(9), 1052-1060. doi: 10.1007/s11606-061-3747-6

Use of group-based trajectory models to identify patient subgroups who at risk for medical non-compliance and understanding of geographical relations.

To evaluate adherence trajectories for oral hypoglycemics and subsequent hospitalizations in diabetics.

16,256 Medicaid enrolled starting oral hypoglycemics ages 18-64 with type 2 diabetes.

Retrospective cohort study using Pennsylvania administrative claims data, prescription codes, date or prescription bill, dispense, and days of supply.

Performing multivariate Cox proportional hazard models to assess association between medication trajectories and hospitalizations was performed.

There was low adherence to medication overall with 60% of new users discontinuing medication within first year. Patients filling only one prescription had 35-51% greater risk of diabetes related hospitalizations.

Strengths included data source coming from administrative data, and socioeconomic demographics were used as well. Limitations include, although prescription days covered represented days where an active script was filled it does not ensure medications were taken. Does not take into account discontinuation of medications due to adverse side effects.

It is important to understand if patients use medication regimes effectively, and the rate of subsequent hospitalizations for noncompliance. Understanding adherence trajectories can better inform health practitioners and health educators of the importance of compliance.

Further research in the field of cultural factors effect on insulin use in diabetic patients should be done to support the findings of the current study. in addition, the research should take into consideration the cost of insulin and its accessibility to the minority diabetic patients.

Insulin therapy should be given an upper hand to all diabetic patients and commenced from the point of patient diagnosis.

Kang, H., Mason Lobo, J., Kim, S., Sohn, M.W. (2018). Cost-related medication non-adherence among U.S. adults with diabetes. Diabetes Research and Clinical Practice. 143, 24-33. doi: 10.1016/j.diabres.2018.06.016

Conceptual model includes financial factors, regimen complexity, demographics, socioeconomic status, lifestyle factors affect cost related non-adherence.

No theoretical or conceptual model was reported in the article

Study objectives was to determine the rate of medical non-adherence as a result cost of medication.

All persons with diabetes who used prescription medications in the U.S. in 2013-2014.

Cross Sectional study with data derived from Behavioral Risk Factor Surveillance system.

Multivariate logistic regression model used to determine the influence between financial factors, health insurance, regimen complexity, age, race/ethnicity, education level, employment, lifestyle, BMI, smoking and diabetics are factors.

Strengths include the full use of many sociodemographic factors in association with medication compliance and financial cost. Limitations include only conducted in the U.S. Based upon survey data: which can have response bias, recall bias, or social desirability bias. Lack of insight into number of overall prescriptions, out of pocket expenses on prescriptions medications. and if medications other than insulin are being taken.

Key findings were household income and health insurance were associated to cost related non-medical compliance. For individuals greater than 65 years old, depression, , and household income were most important determinants, for those younger than 65, health insurance and house hold income were most important.

Areas of future research include noncompliance with polypharmacy, and co-management with other chronic illnesses that may be costly.

Full evaluation from health care practitioners to understand financial strain and follow up for patients. If little improvement is seen after treatment is started, evaluating if compliance is occurring is important.

Rodriguez J. E. Campbell, J. M. & Kirksey, O.W. (2014). Improving diabetes care for minority, uninsured, and underserved patients. Journal for Immigrant and Minority Health. 16, 747-750.

The study describes an intervention that can help in diabetes management for uninsured patients. The authors wanted to test the hypothesis that DDM can be effective in improving glycemic control in underserved and uninsured minority patients. This hypothesis was based on the evidence that underserved minority have difficulty complying with the guidelines of diabetic management.

Type 2 diabetic patients by their primary care providers and referred for DDM visits.

Thirty-six patients were selected by their primary providers to attend DDM visits with Pharma D/CDE. Preintervention and post-intervention HbA1c, triglycerides, LDL, HDL and BMI were measured. Patient’s HbA1c, triglycerides and HDL levels were averaged for pre-intervention and post-intervention groups were compared. Statistical analysis was performed with SPSS.

There are 15 African American participants, 10 Caucasians, and only 1 Hispanic member. 10 participants did not declare race. There were 26 females and 10 males, and the average age was 51 years. HbA1c, triglycerides, and BMI were statistically significantly reduced while HDL levels did not increase significantly after one DDM visit. This was in regard to comparison between pre-intervention and post-intervention groups.

The findings of the study show that the participants who take part in the DDM can have improvements in HbA1c, triglycerides and BMI. The limitations of the study include small study population due to the newness of the program and the difficulty of following a transient patient population. This may affect the statistical power of the study and therefore the generalizability. Another limitation is the brief time period of the study (6 months).

It is concluded that DDM intervention would help reduce the burden of diabetes and obesity, improve treatment compliance in minority groups and generally improve the prognosis of diabetes. Recommendations include a longer study duration that would allow an assessment of the potential lasting change. The authors also recommended that all the participants should have more sessions of DDM since it is beneficial.

The authors suggested a 3- year case control study to determine the difference between usual care and Pharm D/CDE collaborative model. More detailed analysis of the patients who did not continue with diabetes management can be performed to ascertain the barriers and solutions for the segment of that population.

The study illustrates that DDM given by Pharm D/CDE can be effective in uninsured, underserved minority population with reduced compliance to diabetes management. It is also an effective tool in promoting and achieving clinically significant weight loss.

Feldman. B S., Cohen-Stavi, C. J., Leibowitz, M., Hosen, M. B., Singer, S. R., ........... Balicer, R. D. (2014). Defining the role of medication adherence in poor glycemic control among a general adult population with diabetes. PLoS One. 9(9). e 108145. doi: 10.1371/journal.pone.0108145

The conceptual framework of this study is hinged on the healthcare system in Israel, which is essentially universal, consisting of four providers among which Clait Health Services (CHS) was chosen for this study. CHS provided data in the form of integrated clinical electronic health records from database linking data from hospitals, community-based clinics, and CHS pharmacies.

This study assesses the attributable impact of adherence to oral glucose medication as a risk factor for poor glycemic control in population subgroups of a large general population using an objective medication adherence measure.

The study population included all CHS members who are 19 years and older and diagnosed with type 2 diabetes. All participants had received prescriptions for any of the five types of oral glycemic agents (OAM) used.

Univariate logistic regression and multi-variate logistic regression to assess the association of the independent variables with poor glucose control as measured by HbA1c.

Participants with poor glucose control were 16.7% and were younger while a larger proportion of members with low SES, ethnic minorities, insulin users and those with long history of diabetes were also in the poorly controlled group. Participants with poor glucose control were more likely to have poor medication adherence.

This study evaluates a broad range of ages, evaluating compliance rates in poorly controlled diabetics.

Limitation to this study is not having been performed in the United States. Limitation includes no differentiation between type 1 and type 2 diabetics.

There is a broader age group of patients that are not compliant compared to common understanding of older patients being non-compliant.

Future research could include evaluating whether or not youth with type 1 diabetes or type 2 diabetes are more compliant with medication regimens and associated socioeconomic determinants of health that may be associated.

Health care practitioners, and health educated can be more aware to ensure advising patients on proper adherence protocol to minimize worsening disease progression.