ABSTRACT
INTRODUCTION: For several decades, the Minneapolis American Indian population has experienced limited health care access and threefold diabetes health disparity. As part of an urban health initiative, the marketplace clinics located in nearby CVS, Target, and Supervalu stores committed financial support, providers, certified educators, and pharmacy staff for a community-based diabetes support group. OBJECTIVES: To measure the extent to which collaborating marketplace clinics and the community-based support group expanded diabetes care and provided self-management education for this largely urban Indian neighborhood. METHODS: A controlled quasi-experimental study and 3-years retrospective analysis of secondary data were used to test whether the Minneapolis marketplace clinics and the community diabetes support group participants (n = 48) had improved diabetes health outcomes relative to the comparison group (n = 87). The marketplace complemented intervention group employed motivational interviewing and the patient activation measure (PAM®) in coaching diabetes self-care and behavioral modification. The federally funded comparison group received only basic self-management education. RESULTS: T tests and effect sizes were used to quantify the difference between the study intervention and comparison groups. Statistical significance was determined for the following outcome variables: A1C ( P < .01), body mass index ( P < .04), and PAM® ( P < .001). DISCUSSION: Includes strengths, limitations, and future study recommendations. CONCLUSIONS: Positive effects of marketplace clinics and community health complementation were found with regard to improved blood glucose control, weight loss, and healthful lifestyle adaptation. Primary care and community health improvements could be realized by incorporating patient activation with diabetes prevention programs for the urban Indian two-thirds majority of the United States 5 million American Indian population.
Subject(s)
Ambulatory Care Facilities , Diabetes Mellitus/therapy , Indians, North American , Motivational Interviewing/methods , Self Care , Self-Help Groups , Urban Population , Behavior Therapy , Blood Glucose/metabolism , Diabetes Mellitus/metabolism , Disease Management , Glycated Hemoglobin/metabolism , Healthy Lifestyle , Humans , Minnesota , Retrospective Studies , Weight LossABSTRACT
We examined the relationship between the patient activation measure (PAM) and future diabetes-related health outcomes through retrospective analysis of secondary data using multivariate logistic regression. PAM scores from a 2004 survey on 1180 randomly sampled adults with diabetes and health information from a 2006 diabetes registry were the data sources used. The PAM was predictive for hemoglobin A1c (HgA1c) testing (P < .008), low-density lipoprotein cholesterol (LDL-C) testing (P < .005), HgA1c control (P < .01), and all-cause discharges (P < .03), but not for lipid-lowering drug use, LDL-C control, or acute myocardial infarction discharges. These results suggest that PAM scores can be used to identify patients at risk for poorer health outcomes.
Subject(s)
Diabetes Mellitus/therapy , Patient Participation/psychology , Self Care/psychology , Diabetes Mellitus/psychology , Female , Humans , Male , Middle Aged , Patient Education as Topic , Retrospective Studies , Self EfficacyABSTRACT
Medical error continues to be a topic of discussion. Blaming the physician or nurse for error is too simplistic and may serve to blur larger system problems from being identified and addressed. This article considers recent history of assignment of errors from a quality assurance perspective, multiple paths which result in error, reviewing the 1999 Institute of Medicine report and looking beyond the numbers to issues that can only be assigned to systems.
