Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2019

Open Access 01-12-2019 | Care | Research article

Relevant patient characteristics for estimating healthcare needs according to healthcare providers and people with type 2 diabetes: a Delphi survey

Authors: Dorijn F. L. Hertroijs, Martijn C. G. J. Brouwers, Arianne M. J. Elissen, Nicolaas C. Schaper, Dirk Ruwaard

Published in: BMC Health Services Research | Issue 1/2019

Login to get access

Abstract

Background

Recently, there has been growing interest in providing more tailored, patient-centered care for the treatment of type 2 diabetes mellitus (T2DM). Yet it remains unclear which patient characteristics should be determined to guide such an approach. Therefore, the opinions of healthcare providers (HCP) and people with T2DM about relevant patient characteristics for estimating healthcare needs of people with T2DM were assessed and compared.

Methods

Two separate online Delphi studies were conducted according to the RAND-UCLA Appropriateness Method: one with HCPs (n = 22) from Dutch primary and secondary care and one with people with T2DM treated in Dutch primary care (n = 46). The relevance of patient characteristics for estimating healthcare needs, defined as the number of yearly consultations, was assessed on a 5-point Likert scale. Characteristics with a median of 4 or 5 and an interquartile range ≤ 1.5 were considered relevant with consensus. Participants were also asked to select the top 5 of most relevant patient characteristics. To determine the overall top 5, the mean relative importance score of each characteristic was calculated.

Results

In two Delphi rounds, 28 and 15 patient characteristics were rated by HCPs and people with T2DM, respectively. Both HCPs and people with T2DM found health-related characteristics relevant for estimating healthcare needs of people with T2DM. However, HCPs preferred to estimate healthcare needs using person- and context-related characteristics. They ranked self-efficacy as the most relevant estimator. In contrast, people with T2DM were more in favor of health-related characteristics and ranked HbA1c as the most relevant estimator.

Conclusions

The findings show that there is discrepancy in opinions on relevant patient characteristics for estimating healthcare needs between HCPs and people with T2DM. To achieve more tailored, patient-centered care, it is important that both groups agree on the topics to be discussed during patient consultations.
Appendix
Available only for authorised users
Literature
1.
IDF Diabetes Atlas Seventh Edition. International Diabetes Federation; 2015.
2.
Tamayo T, Rosenbauer J, Wild SH, Spijkerman AM, Baan C, Forouhi NG, et al. Diabetes in Europe: an update. Diabetes Res Clin Pract. 2014;103(2):206–17.PubMedCrossRef
3.
Zhang P, Zhang X, Brown J, Vistisen D, Sicree R, Shaw J, et al. Global healthcare expenditure on diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010;87(3):293–301.PubMedCrossRef
4.
Morgen CL, Currie CJ, Peters JR. Relationship between diabetes and mortality: a population study using record linkage. Diabetes Care. 2008;23(8):1103–7.CrossRef
5.
Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000;321(7258):405–12.PubMedPubMedCentralCrossRef
6.
Koch T, Jenkin P, Kralik D. Chronic illness self-management: locating the 'self'. J Adv Nurs. 2004;48(5):484–92.PubMedCrossRef
7.
Nederlands huisartsen genootschap. NHG-standaard Diabetes mellitus type 2 (vierde (partitiële) herziening). 2018.
8.
Netherlands Diabetes Federation. NDF Care Standard. Transparancy and quality of diabetes care for people with diabetes type 2 [NDF Zorgstandaard. Transparantie en kwaliteit van diabeteszorg voor mensen met type 2 diabetes. . Amersfoort: Netherlands Diabetes Federation 2105.
9.
Boule NG, Haddad E, Kenny GP, Wells GA, Sigal RJ. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. Jama. 2001;286(10):1218–27.PubMedCrossRef
10.
Povey RC, Clark-Carter D. Diabetes and healthy eating: a systematic review of the literature. Diabetes Educ. 2007;33(6):931–59 discussion 60-1.PubMedCrossRef
11.
Pimouguet C, Le Goff M, Thiebaut R, Dartigues JF, Helmer C. Effectiveness of disease-management programs for improving diabetes care: a meta-analysis. CMAJ. 2011;183(2):E115–27.PubMedPubMedCentralCrossRef
12.
Rothe U, Muller G, Schwarz PE, Seifert M, Kunath H, Koch R, et al. Evaluation of a diabetes management system based on practice guidelines, integrated care, and continuous quality management in a Federal State of Germany: a population-based approach to health care research. Diabetes Care. 2008;31(5):863–8.PubMedCrossRef
13.
Rutten GEHM, Alzaid A. Person-centered type 2 diabetes care: time for a paradigm shift. Lancet Diabetes Endocrinol. 2017;S2213–8587(17):30193–6.
14.
Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, et al. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of diabetes. Diabetes Care. 2015;38(1):140–9.PubMedCrossRef
15.
Wermeling PR, Gorter KJ, Stellato RK, de Wit GA, Beulens JW, Rutten GE. Effectiveness and cost-effectiveness of 3-monthly versus 6-monthly monitoring of well-controlled type 2 diabetes patients: a pragmatic randomised controlled patient-preference equivalence trial in primary care (EFFIMODI study). Diabetes Obes Metab. 2014;16(9):841–9.PubMedCrossRef
16.
Klabbers G, Bosma H, Kempen GI, Benzeval M, Van den Akker M, van Eijk JT. Do psychosocial profiles predict self-rated health, morbidity and mortality in late middle-aged and older people? J Behav Med. 2014;37(3):357–68.PubMed
17.
Elissen AMJ, Hertroijs DFL, Schaper NC, Bosma H, Dagnelie PC, Henry RM, et al. Differences in biopsychosocial profiles of diabetes patients by level of glycaemic control and health-related quality of life: the Maastricht study. PLoS One. 2017;12(7):e0182053.PubMedPubMedCentralCrossRef
18.
Laiteerapong N, Karter AJ, Moffet HH, Cooper JM, Gibbons RD, Liu JY, et al. Ten-year hemoglobin A1c trajectories and outcomes in type 2 diabetes mellitus: the Diabetes & Aging Study. J Diabetes Complicat. 2017;31(1):94–100.CrossRef
19.
Walraven I, Mast MR, Hoekstra T, Jansen AP, van der Heijden AA, Rauh SP, et al. Distinct HbA1c trajectories in a type 2 diabetes cohort. Acta Diabetol. 2015;52(2):267–75.PubMedCrossRef
20.
Elissen AM, Hertroijs DF, Schaper NC, Vrijhoef HJ, Ruwaard D. Profiling Patients' healthcare needs to support integrated, person-centered models for long-term disease management (profile): research design. Int J Integr Care. 2016;16(2):1.PubMedPubMedCentralCrossRef
21.
Hertroijs DFL, Elissen AMJ, Brouwers M, Schaper NC, Ruwaard D. Relevant patient characteristics for guiding tailored integrated diabetes primary care: a systematic review. Prim Health Care Res Dev. 2018:1–24.
22.
Hertroijs DFL, Elissen AMJ, Brouwers M, Schaper NC, Kohler S, Popa MC, et al. A risk score including body mass index, glycated haemoglobin and triglycerides predicts future glycaemic control in people with type 2 diabetes. Diabetes Obes Metab. 2018;20(3):681–8.PubMedCrossRef
23.
van der Scheer L, Garcia E, van der Laan AL, van der Burg S, Boenink M. The benefits of patient involvement for translational research. Health Care Anal. 2017;25(3):225–41.PubMedCrossRef
24.
Fitch K, Bernstein S, Aguilar MD, Burnand B, LaCalle JR, Lazaro P, et al. The RAND/UCLA appropriateness method user's manual. Santa Monica, CA: RAND; 2001.
25.
Andersen R, Newman JF. Societal and individual determinants of medical utilization in the United States. Milbank Mem Fun Q Health Soc. 1973;51:95–124.CrossRef
26.
Von der Gracht HA. Consensus measurement in Delphi studies. Review and implications for future quality assurance. Technol Forecast Soc Chang. 2012;79(8):1525–36.CrossRef
27.
Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, 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). Diabetes Care. 2012;35(6):1364–79.PubMedPubMedCentralCrossRef
28.
Marrero DG, Ard J, Delamater AM, Peragallo-Dittko V, Mayer-Davis EJ, Nwankwo R, et al. Twenty-first century behavioral medicine: a context for empowering clinicians and patients with diabetes: a consensus report. Diabetes Care. 2013;36(2):463–70.PubMedPubMedCentralCrossRef
29.
Strychar I, Elisha B, Schmitz N. Type 2 diabetes self-management: role of diet self-efficacy. Can J Diabetes. 2012;36(6):337–44.CrossRef
30.
Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191–215.PubMedCrossRef
31.
Brundisini F, Vanstone M, Hulan D, DeJean D, Giacomini M. Type 2 diabetes patients' and providers' differing perspectives on medication nonadherence: a qualitative meta-synthesis. BMC Health Serv Res. 2015;15:516.PubMedPubMedCentralCrossRef
32.
Cavanaugh K, Wallston KA, Gebretsadik T, Shintani A, Huizinga MM, Davis D, et al. Addressing literacy and numeracy to improve diabetes care: two randomized controlled trials. Diabetes Care. 2009;32(12):2149–55.PubMedPubMedCentralCrossRef
33.
King DK, Glasgow RE, Toobert DJ, Strycker LA, Estabrooks PA, Osuna D, et al. Self-efficacy, problem solving, and social-environmental support are associated with diabetes self-management behaviors. Diabetes Care. 2010;33(4):751–3.PubMedPubMedCentralCrossRef
34.
Moore Beckerle C, Lavin MA. Association of self-efficacy and self-care with glycemic control in diabetes. Diabetes Spectrum. 2013;26(3):172–8.CrossRef
35.
Alghafri TS, Alharthi SM, Al-Balushi S, Al-Farsi Y, Al-Busaidi Z, Bannerman E, et al. Health professionals' perceptions about physical activity promotion in diabetes care within primary health care settings in Oman. Heliyon. 2017;3(12):e00495.PubMedCrossRef
36.
Kristensen MAT, Holge-Hazelton B, Waldorff FB, Guassora AD. How general practitioners perceive and assess self-care in patients with multiple chronic conditions: a qualitative study. BMC Fam Pract. 2017;18(1):109.PubMedPubMedCentralCrossRef
37.
Stiggelbout AM, Van der Weijden T, De Wit MP, Frosch D, Legare F, Montori VM, et al. Shared decision making: really putting patients at the Centre of healthcare. BMJ. 2012;344:e256.PubMedCrossRef
38.
Boyle E, Saunders R, Drury V. A qualitative study of patient experiences of type 2 diabetes care delivered comparatively by general practice nurses and medical practitioners. J Clin Nurs. 2015;25:1977–86.CrossRef
39.
40.
InEen. Transparent integrated care. Report 2015 Care Groups. Diabetes mellitus, VRM, COPD and asthma [Transparante ketenzorg. Rapportage 2015 zorggroepen. Diabetes mellitus, VRM, COPD and asthma. Op weg naar genuanceerde rapportage van zorg]. Utrecht: InEen 2016.
41.
Struijs JN, Baan CA. Integrating care through bundled payments--lessons from the Netherlands. N Engl J Med. 2011;364(11):990–1.PubMedCrossRef
42.
Bosma H. Social epidemiology: shuttling between upstream and downstream: a personal and narrative review. OA Epidemiol. 2014;2(1):5.
43.
Rutten G, van Vugt HA, de Weerdt I, de Koning E. Implementation of a structured diabetes consultation model to facilitate a person-centered approach: results from a Nationwide Dutch study. Diabetes Care. 2018;41(4):688–95.PubMedCrossRef
44.
Morrison G, Weston P. Self-efficacy: a tool for people with diabetes managed by continuous subcutaneous insulin infusion. J Diabetes Nurs. 2013;17:32–7.
45.
Metadata
Title
Relevant patient characteristics for estimating healthcare needs according to healthcare providers and people with type 2 diabetes: a Delphi survey
Authors
Dorijn F. L. Hertroijs
Martijn C. G. J. Brouwers
Arianne M. J. Elissen
Nicolaas C. Schaper
Dirk Ruwaard
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2019
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-019-4371-z

Other articles of this Issue 1/2019

BMC Health Services Research 1/2019 Go to the issue

Research article

Using concept mapping to inform the development of a transitional reintegration intervention program for formerly incarcerated people with HIV

Research article

Developing national strategies for reaching men with HIV testing services in Tanzania: results from the male catch-up plan

Research article

Feasibility and long-term efficacy of a proactive health program in the treatment of chronic back pain: a randomized controlled trial

Research article

Barriers and facilitators to recruitment and enrollment of HIV-infected individuals with opioid use disorder in a clinical trial

Research article

Challenges affecting prompt access to adequate uncomplicated malaria case management in children in rural primary health facilities in Chikhwawa Malawi

Research article

Point-of-care testing (POCT) for HIV/STI targeting MSM in regional Australia at community ‘beat’ locations