Perceived difficulty of diabetes treatment in primary care: does it differ by patient ethnicity?

PURPOSE: The purpose of this cross-sectional study was to determine the attitudes of internal medicine physicians toward treating diabetes in different patient ethnic groups and compared with treating common chronic medical conditions in primary care. METHODS: The survey instrument was administered to 55 internal medicine physicians. An e-mail message was sent to each physician with a hyperlink to a site where the survey could be completed. The instrument was a modified, quantitative 10-point scale designed to measure attitudes regarding the difficulty of treating diabetes. RESULTS: Diabetes was perceived to be more difficult to treat than hyperlipidemia and angina. African Americans with diabetes were perceived to be more difficult to treat than Caucasian patients. Difficulty in treating diabetes was comparable to that for hypertension, arthritis, and congestive heart failure. Physicians were confident about treatment efficacy for diabetes and changing diabetes outcomes, but not about the adequacy of time and resources for diabetes treatment. CONCLUSIONS: Diabetes was perceived as a difficult disease to treat, African American patients were more difficult to treat, and time and resources were inadequate for diabetes treatment. To improve diabetes care, there is a need to address these attitudes and concerns of internal medicine physicians.     

Does good clinical practice at the primary care improve the outcome care for diabetic patients? Gender differences

BackgroundThe Middle East region is predicted to have one of the highest prevalence of diabetes mellitus (DM) in the world. This is the first study in the region to assess treatment outcome of DM according to gender.ObjectiveTo assess the quality and effectiveness of diabetes care provided to patients attending primary care settings according to gender in the State of Qatar.DesignIt is an observational cohort study.SettingThe survey was carried out in primary health care (PHC) centers in the State of Qatar.Subjects and methodsThe study was conducted from January 2010 to August 2010 among diabetic patients attending (PHC) centers. Of the 2334 registered with diagnosed diabetes, 1705 agreed and gave their consent to take part in this study, thus giving a response rate of 73.1%. Face to face interviews were conducted using a structured questionnaire including socio-demographic, clinical and satisfaction score of the patients.ResultsMajority of subjects were diagnosed with type 2 DM (84.9%). A significantly larger proportion of females with DM were divorced or widowed (9.1%) in comparison to males with DM (3.4%; p < 0.001). A significantly larger proportion of females were overweight (46.5%; p = 0.009) and obese (29.5%; p = 0.003) in comparison to males. Males reported significantly greater improvements in mean values of blood glucose (mmol/l) (?2.11 vs. ?0.66; p = 0.007), HbA1c (%) (?1.44 vs. ?0.25; p = 0.006), cholesterol (mmol/l) (?0.16 vs. 0.12; p = 0.053) and systolic blood pressure (mmHg) (?9.04 vs. ?6.62; p < 0.001) in comparison to females. While there was a remarkable increase in male patients with normal range of fasting blood glucose (FBG; 51.6%) as compared to the FBG measurement 1 year before (28.5%: p < 0.001) there was only a slight increase in females normal range FBG during this period from 28.0% to 30.4% (p = 0.357).ConclusionThe present study revealed that the current form of PHC centers afforded to diabetic patients provided significantly improved outcomes for males, but only minor improved outcomes for females. This study reinforces calls for a gender-specific approach to diabetes care.     

Does racial bias exist in the medical management of heart failure?

BACKGROUND: It is suspected that effective therapies are often underutilized in black compared with white patients with coronary artery disease (CAD). HYPOTHESIS: We hypothesized that an unfavorable bias may exist against black patients in the medical management of heart failure. METHODS: In 566 consecutive adult subjects who were discharged alive from the hospital with a principal discharge diagnosis of heart failure, we assessed the effect of patient race on utilization of classes of medications (angiotensin-converting enzyme inhibitors [ACEI], digitalis, diuretic agents) and combinations of medications (effective vasodilators, i.e., ACEI or combined hydralazine and nitrate; effective combination therapy, i.e., effective vasodilator with digitalis and diuretic) known to be beneficial in symptomatic heart failure. RESULTS: Compared with black patients (n = 182), white patients were older, had a higher incidence of coronary artery disease, lower incidence of hypertension, and lower serum creatinine and left ventricular end-diastolic diameter. In crude analyses, the utilization of all medications was similar between white and black patients. After adjustment for clinical differences, black patients were more likely to receive ACEI (adjusted odds ratio [OR] = 1.84; 95% confidence interval [CI] 1.13-3.01), effective vasodilators (OR = 1.97; CI 1.20-3.23), and effective combination therapy (OR = 1.66; CI 1.02-2.69) than white patients at the time of discharge from the hospital. No multivariate association was seen between patient race and use of digoxin or diuretics. In an analysis of subsets of patients with ejection fraction < 45% (n = 260), no association was seen between patient race and utilization of effective medical therapy. CONCLUSION: Our results show no unfavorable bias against black patients with decompensated heart failure.     

Does the outcome of colonic flexure cancers differ from the other colonic sites?

Background  

Anecdotally, colonic flexure cancers (FC) appear to have a poorer prognosis compared to other colonic cancers (OCC). The aim of this study was to determine the outcome of colonic flexure cancers compared to the cancers of the rest of the colon.     

Chronic illness management: what is the role of primary care?

An estimated 99 million Americans live with a chronic illness. Meeting the needs of this population is one of the major challenges facing the U.S. health care system today and in the future. Dozens of studies, surveys, and audits have revealed that sizable proportions of chronically ill patients have not received effective therapy and do not have optimal disease control. The consistent findings of generally substandard care for many chronic conditions have spurred proposals that care be shifted to specialists or disease management programs. Published evidence to date does not indicate any clear superiority of these alternatives to primary care. The defining features of primary care (that is, continuity, coordination, and comprehensiveness) are well suited to care of chronic illness. A rapidly growing body of health services research points to the design of the care system, not the specialty of the physician, as the primary determinant of chronic care quality. The future of primary care in the United States may depend on its ability to successfully redesign care systems that can meet the needs of a growing population of chronically ill patients.     

Does day care also provide care for the caregiver?

People caring for relatives with dementia may need respite to be able to cope and maintain some quality of life. With the aim to investigate whether day care is an effective form of respite for caregivers of dementia sufferers, 115 new day care clients were invited and 90 caregivers agreed to participate. Of these, 51 fulfilled the inclusion criteria and were asked to assess feelings of worry, depression, overload and role captivity before using day care and again 4 months later. The study group comprised both co-residing (CR) and non-co-residing (NCR) caregivers and care recipients. Those NCR caregivers whose elderly relative dropped out of day care had significantly higher values for worry, overload and role captivity, and a higher level of depression than the caregivers in the NCR group whose care recipient continued day care. Although this study is of an explorative character, some conclusions may be drawn from it. Dementia sufferers seem to need an informal caregiver to help them when they are not at day care. Day care is probably a form of support most suitable for caregivers, who are looking after relatives in the early stages of the illness and are not yet too exhausted.     

Is there equity in the home health care market? Understanding racial patterns in the use of formal home health care

OBJECTIVE: This article explores whether the formal home health care (HHC) market is equitable or manifests unexplained racial disparities in use. METHODS: The database is the 1994 National Long Term Care Survey. We estimate logit regression models with a race dummy variable, race interaction terms, and stratification by race. We apply the Oaxaca decomposition technique to quantify whether the observed racial gap in formal HHC use is explained by racial differences in predisposing, enabling, need, and environmental characteristics. RESULT: We find numerous unique racial patterns in HHC use. Blacks with diabetes and low income have higher probabilities of HHC use than their White counterparts. Black older persons have a 25% higher chance of using HHC than Whites. Our Oaxaca analysis indicates that racial differences in predisposing, enabling, need, and environmental characteristics account for the racial gap in use of HHC. DISCUSSION: We find that the HHC market is equitable, enhancing availability, acceptability, and accessibility of care for older Black persons. Thus, the racial differences that we find are not racial disparities.     

Does the ICU computer improve patient care?

The introduction of sophisticated microprocessor-based instruments into the intensive care environment promises to relieve clinical staff of many routine duties and to provide more time for patient observation. A recent English survey investigates how much time can actually be saved thereby, and in what kinds of duties, and offers ideas on how to maintain clinical awareness when data logging has been automated.