ABSTRACT
AIM: To characterise the impact of increasing severity and frequency of hypoglycaemia on utility, quality of life, primary care resource use and productivity (time away from normal activities) in people with both Type 1 and Type 2 diabetes. METHODS: A postal survey was sent to 3200 people with diabetes. Self-reported episodes of mild, moderate, severe and nocturnal hypoglycaemia were quantified from a list of signs and symptoms. A number of instruments were used to explore the effect of frequency and severity of hypoglycaemia on quality of life and productivity. RESULTS: There were 861 respondents for whom diabetes type was identifiable. Of these respondents, 629 (73%) experienced some form of hypoglycaemia, 516 (60%) non-exclusively experienced mild or moderate hypoglycaemia, 57 (7%) experienced severe hypoglycaemia and 191 (22%) experienced nocturnal hypoglycaemia. Quality of life and health-related utility decreased as the frequency and severity of hypoglycaemia increased. The use of primary care resources and lost productivity increased as the severity and frequency of hypoglycaemia increased. These associations were independent in multivariate analysis. CONCLUSIONS: These findings suggest hypoglycaemia impacts heavily on the well-being, productivity and quality of life of people with diabetes, and that every effort should be made to minimise hypoglycaemia while aiming for good glycaemic control.
Subject(s)
Diabetes Mellitus, Type 1/physiopathology , Diabetes Mellitus, Type 2/physiopathology , Hypoglycemia/epidemiology , Quality of Life/psychology , Sickness Impact Profile , Adolescent , Adult , Aged , Data Collection , Efficiency , Female , Humans , Hypoglycemia/physiopathology , Hypoglycemia/psychology , Incidence , Male , Middle Aged , Primary Health Care/statistics & numerical data , Severity of Illness Index , United Kingdom/epidemiologyABSTRACT
BACKGROUND: There have been significant conceptual developments regarding shared decision-making (SDM) and assessments of people's hypothetical preferences for involvement in treatment or care decisions. There are few data on the perceptions of patients and professionals about SDM in actual practice. OBJECTIVE: To explore, from paired doctor-patient interviews, participants' perceptions of SDM in the consultation and the level of consensus between the participants in the consultation process. DESIGN: Qualitative analysis of semi-structured interview data. SETTING AND PARTICIPANTS: Twenty general practitioners received training packages in 'risk communication' (RC) and 'SDM' to use as tools within the consultation. Forty patients with one of four conditions, for which a range of treatment options is available, were selected. Patient/doctor pairs were interviewed separately following consultations at four stages -'baseline' [general practitioner's (GP) usual consultation style], SDM training, RC alone, and both RC and SDM training. Interviews were transcribed and analysed using NVivo software. RESULTS: Risk communication interventions by doctors appeared to result in a greater perception of decisions being made in the consultation. High levels of satisfaction with consultations were evident before application of the interventions and did not change after the interventions. Doctors' and patients' perceptions of the consultations were highly congruent at all phases of the study. CONCLUSION: Shared decision-making and RC approaches were helpful in selected consultations and showed no detrimental effects to patients. However, the use of RC and SDM made only small differences to decision-making in consultations within the population studied. Increasing patient participation may be seen as more ethically justifiable than the traditional paternalistic approach but this needs to be set against the additional training costs incurred.
Subject(s)
Communication , Decision Making , Patient Participation , Physician-Patient Relations , Risk Assessment , Adult , Aged , Attitude of Health Personnel , Family Practice/methods , Female , Health Services Research , Humans , Interviews as Topic , Male , Middle Aged , Patient Satisfaction , Qualitative Research , United KingdomABSTRACT
Domestic violence is reaching epidemic proportions and is designated a national health crisis in the United States. Yet, the stories of abused women and their experiences are only just recently appearing in the literature. The use of coping strategies in dealing with abusive intimate partners is one such area that invites further research. Using the phenomenological method, 17 volunteers discuss their inner resources for surviving abusive experiences and developing ways to protect themselves in future relationships. Women's accounts of abuse experiences add depth to what is known about their strength and portray them as survivors rather than as victims. Future research is calledfor that adds to the understanding of the inner resources attributed to the women in the study findings.
Subject(s)
Adaptation, Psychological , Battered Women/psychology , Domestic Violence/psychology , Adult , Anecdotes as Topic , Female , Humans , Interviews as Topic , Middle Aged , Qualitative Research , United StatesABSTRACT
The World Health Organization identifies domestic violence as a major health crisis confronting women across the globe. The addition of women's voices about their abusive experiences increases understandings of domestic violence. In this phenomenological investigation of the coping strategies of abused women, 17 women provided meaningful insights into how, why, and when they left abusive relationships. Timing, selection of support systems, and intuition add new descriptions about abused women's leave-taking experiences. Implications for nursing practice include the use of helpful questioning and employment of the advocacy role. Based on thefindings of this study, more research is called for that allows abused women to demonstrate the variety of their experiences with the leave-taking process.
