Women's experience with receiving advice on diet and Self-Monitoring of blood glucose for gestational diabetes mellitus: a qualitative study.

OBJECTIVE: We aimed to explore how women with gestational diabetes mellitus (GDM) experience advice about diet and self-monitoring of blood glucose received in primary health care (PHC) and secondary health care (SHC) with a focus on how women perceived the care coordination and collaboration between healthcare professionals. DESIGN, SETTING AND SUBJECTS: Individual interviews were conducted with 12 pregnant women diagnosed with GDM. Six women had immigrant backgrounds, and six were ethnic Norwegian. Women received GDM care in the area of Oslo, Norway. Interviews were analysed using thematic analysis. RESULTS: Women described feeling shocked when they were diagnosed with GDM and feeling an immediate need for information about the consequences and management of GDM. Most of the women felt that their general practitioner (GP) had too little knowledge about GDM. Women with an immigrant background felt that the PHC midwives provided them with sufficient dietary advice related to GDM. Ethnic Norwegian women appreciated receiving more individually tailored dietary advice in SHC. Self-monitoring of blood glucose influenced women's daily lives; however, they perceived the training in PHC and SHC as adequate. The women experienced poor collaboration between healthcare professionals in PHC and SHC, which implied that they sometimes had to initiate follow-up steps in their GDM care by themselves. CONCLUSIONS: Ideally, women diagnosed with GDM should meet healthcare professionals with sufficient knowledge about GDM as soon as possible after being diagnosed. The collaboration between healthcare professionals involved in the care of women with GDM should be improved to avoid having women feel that they need to coordinate their own care.KEY POINTSCurrent awareness•The management of gestational diabetes mellitus requires appropriate follow-up by healthcare professionalsMain statements•Pregnant women's need for information about the consequences and management of gestational diabetes mellitus was highest immediately after diagnosis•Women perceived that they received more individually tailored information about diet and self-monitoring of blood glucose in secondary health care compared to primary health care•Women felt that general practitioners had insufficient knowledge about gestational diabetes mellitus•Based on our results, care coordination and collaboration between healthcare professionals involved in the care of women with gestational diabetes mellitus should be improved.

Experiences of self-management support in patients with diabetes and multimorbidity: a qualitative study in Norwegian general practice.

AIM: The purpose of this study was to explore how patients with diabetes and multimorbidity experience self-management support by general practitioners (GPs), nurses and medical secretaries in Norwegian general practice. BACKGROUND: Self-management support is recognised as an important strategy to improve the autonomy and well-being of patients with long-term conditions. Collaborating healthcare professionals (cHCPs), such as nurses and medical secretaries, may have an important role in the provision of self-management support. No previous study has explored how patients with diabetes and multimorbidity experience self-management support provided by cHCPs in general practice in Norway. METHODS: Semi-structured interviews with 11 patients with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) with one or more additional long-term condition were performed during February-May 2017. FINDINGS: Patients experienced cHCPs as particularly attentive towards the psychological and emotional aspects of living with diabetes. Compared to GPs, whose appointments were experienced as stressful, patients found cHCPs more approachable and more likely to address patients' questions and worries. In this sense, cHCPs complemented GP-led diabetes care. However, neither cHCPs nor GPs were perceived to involve patients' in clinical decisions or goal setting during consultations.

The roles of healthcare professionals in diabetes care: a qualitative study in Norwegian general practice.

Objective: To explore the experiences of general practitioners (GPs), nurses and medical secretaries in providing multi-professional diabetes care and their perceptions of professional roles.Design, setting and subjects: Semi-structured interviews were conducted with six GPs, three nurses and two medical secretaries from five purposively sampled diabetes teams. Interviews were analysed thematically.Main outcome measures: Healthcare professionals' (HCPs') experiences of multi-professional diabetes care in general practice.Results: The involvement of nurses and medical secretaries (collaborating health care professionals) was mainly motivated by GPs' time pressure and their perception of diabetes care as easy to standardize. GPs reported that diabetes care had become more structured and continuous after the involvement of collaborating health care professionals (cHCPs). cHCPs defined their role differently from GPs, emphasizing that their approach included acknowledging patients' need for diabetes education, listening to their stories and meeting their need for emotional support. GPs appeared less involved in patients' emotional concerns and more focused on the biomedical aspects of illness. There was little emphasis on teamwork among GPs and cHCPs, and none of the practices used care plans to involve patients in decisions or unify treatment among professionals. Participants stated that institutional structures including a discriminatory remuneration system, lack of role descriptions and missing procedures for collaborative approaches were an obstacle to MPC.Conclusions: cHCPs worked independently under delegated leadership of the GPs. Although cHCPs had a complementary role, HCPs in general practice may not take full advantage of the potential of sharing patient responsibility and learning with, from and about each other. Contextual barriers for team-based care approaches should be addressed in future research.KEY POINTSIt has been suggested that multi-professional approaches improve quality of care in people with long-term conditions.In this study, nurses and medical secretaries perceived to have a complementary role to general practitioners (GPs) in diabetes care, focusing on patient education, building trusting relationships and providing patients with emotional support.As multi-professional collaboration was minimal, GPs, nurses and medical secretaries in the included practices may not take full advantage of the potential of sharing care responsibility and learning with, from and about each other.

A Scoping Review of Facilitators of Multi-Professional Collaboration in Primary Care.

INTRODUCTION: Multi-professional collaboration (MPC) is essential for the delivery of effective and comprehensive care services. As in other European countries, primary care in Norway is challenged by altered patient values and the increased expectations of health administrations to participate in team-based care. This scoping review reports on the organisational, processual, relational and contextual facilitators of collaboration between general practitioners (GP) and other healthcare professionals (HCPs) in primary care. METHODS: A systematic search in specialist and Scandinavian databases retrieved 707 citations. Following the inclusion criteria, nineteen studies were considered eligible and examined according to Arksey and O'Malley's methodological framework for scoping reviews. The retrieved literature was analysed employing a content analysis approach. A group of stakeholders commented on study findings to enhance study validity. RESULTS: Primary care research into MPC is immature and emerging in Norway. Our analysis showed that introducing common procedures for documentation and handling of patient data, knowledge sharing, and establishing local specialised multi-professional teams, facilitates MPC. The results indicate that advancements in work practices benefit from an initial system-level foundation with focus on local management and MPC leadership. Further, our results show that it is preferable to enhance collaborative skills before introducing new professional teams, roles and responsibilities. Investing in professional relations could build trust, respect and continuity. In this respect, sufficient time must be allocated during the working day for professionals to share reflections and engage in mutual learning. CONCLUSION: There is a paucity of research concerning the application and management of MPC in Norwegian primary care. The work practices and relations between professionals, primary care institutions and stakeholders on a macro level is inadequate. Health care is a complex system in which HCPs need managerial support to harvest the untapped benefits of MPC in primary care. As international research demonstrates, local managers must be supported with infrastructure on a macro level to understand the embedding of practice and look at what professionals actually do and how they work.

Psychosocial barriers to healthcare use among individuals with diabetes mellitus: A systematic review.

PURPOSE: To conduct a systematic review regarding psychosocial barriers to healthcare use in individuals with diabetes mellitus, using a well-established model of health-service use as a theoretical framework. METHODS: We used database-specific controlled vocabularies and additional free text terms, and conducted searches via MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science, OVID Journals. Included studies were rated according to the UK National Institute for Health and Care Excellence (NICE) criteria. A narrative data synthesis was conducted, using the Andersen model and developing categories from the included studies. PRINCIPAL RESULTS: In total, 2923 studies were identified, and 15 finally included. We identified barriers according to the main categories "population characteristics", "norms and values", and "healthcare services" on a contextual and individual level, as well as "health status". Frequently reported barriers were "socioeconomic status", and "physician characteristics". Ethnic minorities were frequently analysed and may have specific barriers, e.g. "cultural beliefs" and "language". MAJOR CONCLUSIONS: We identified a broad range of barriers to healthcare use in individuals with diabetes mellitus. However, the number of studies is low. Further research is needed to analyse barriers in more detail considering special subgroups.

Health promotion interventions in type 2 diabetes.

AIM: To present the most common quality criteria in health promotion interventions in type 2 diabetes mellitus (T2DM). METHODS: A systematic literature search was conducted to identify review articles, health technology assessments and policy reports of evaluated health promotion interventions in T2DM. A descriptive analysis of study characteristics and evaluation criteria are presented. RESULTS: Seven studies met the inclusion criteria. The findings indicate that the most common health promotion interventions used in T2DM are initiatives targeting health care professionals. The main ambition of the programs was to increase the collaboration between health care professionals and patients, and between health care centres, program managers and community stakeholders. CONCLUSIONS: This investigation extends our knowledge of the most common health promotion interventions in T2DM and which structure, process and outcome measurements that are reported in such interventions. Future research could usefully explore how the effectiveness of multicomponent and complex interventions may be evaluated and extend the association of these factors into other settings and in relation to other lifestyle related chronic diseases.

Quality indicators for diabetes prevention programs in health care targeted at people at high risk.

OBJECTIVE: Type 2 diabetes can be efficiently prevented by lifestyle intervention provided for people at high diabetes risk. The aim of this paper was to conduct a literature search on existing quality indicators for type 2 diabetes prevention and to collate and present a set of indicators that could be applied in European countries with different health care systems and cultures. METHODS: Scientific and grey literature was searched for relevant studies using electronic databases. We also hand searched previous systematic reviews and reference lists of relevant articles. RESULTS: The only publication identified was the report presenting the results from the IMAGE project. The IMAGE indicators were used as the basis for the proposed indicators. CONCLUSIONS: Publications on quality indicators of diabetes prevention programmes are scarce. The quality indicators presented here are a first step toward the definition of a core set of European indicators to monitor and improve the quality of diabetes prevention.

Education and health professionals training programs for people with type 2 diabetes: a review of quality criteria.

OBJECTIVE: To contribute to the development of a set of quality criteria for patient education and health professionals training that could be applied in European countries. METHODS: Literature review quality criteria, pre-selection based on a comparison of the criteria, peer group and expert based selection of the criteria. RESULTS: 14 quality criteria were selected: goals, rationale, target group, setting, scheduling of the education/training sessions, environmental requirements, qualification of the trainers/educators, core components of the educator/trainer's role, curriculum, education methods, education didactics, monitoring of the effectiveness and quality of the program, implementation level and source of funding. DISCUSSION: A set of preliminary quality criteria for patient education and health professionals training was developed, which could be applied in European countries.

National Diabetes Plans: can they support changes in health care systems to strengthen diabetes prevention and care?

Healthcare systems do not fit well with the "modern" patient, who has a right to autonomy and self-determination. The services that are designed and delivered in policy contexts are not prone to encourage innovation. National Diabetes Plans, defined as "any formal strategy for improving diabetes policy, services and outcomes that encompass structured and integrated or linked activities which are planned and co-ordinated nationally and conducted at the national, regional, and local level", may hold a great potential not only to improve prevention and care for type 2 diabetes, but also for transforming healthcare delivery. Today, changes to adapt healthcare delivery tend to be implemented within existing provider structures, with limited understanding of specific context, structures, processes and potential for change. National Diabetes Plan can be a diagnostic tool for barriers, can be a driver for planning the change, and can help develop capacities and competences that are needed to strengthen healthcare systems to better address health promotion and chronic diseases.

Idiopathic reactive hypoglycaemia - prevalence and effect of fibre on glucose excursions.

BACKGROUND: Idiopathic reactive hypoglycaemia (IRH) is a condition characterized by aggravated postprandial glucose excursions in otherwise healthy individuals. We investigated its prevalence and the impact of fibre diet supplementation. METHODS: First, IRH prevalence was assessed in 362 subjects without a diagnosis of abnormal glucose metabolism through an oral glucose tolerance test (OGTT). IRH was defined by 1 h- or 2 h-glucose ≤3.9 mmol/L or 1 h- or 2 h-glucose < fasting glucose. Second, in a cross-over trial we evaluated effects of 2 weeks with, and without, 20 g fibre (fructose- oligosaccharides) diet supplementation in subjects with IRH. At the end of each 2-week cycle we analysed fasting biomarker levels and conducted a 4 h-OGTT. RESULTS: IRH was found in 12.4% and a normal glucose tolerance in 56.4% of the participants. The IRH group was characterized by higher fasting (5.3 vs. 5.2 mmol/L, p < 0.05) but lower 2 h- (4.4 vs. 6.5 mmol/L, p < 0.01) glucose levels, whereas age (68 ± 10 vs. 70 ± 9 years) and BMI (24.7 ± 3.3 vs 25.0 ± 3.5 kg/m(2)) were similar. The 2-week fibre diet-supplementation (n = 12, age 56 ± 8 years, 6 females, BMI 25.0 ± 2.9 kg/m(2)) improved both the reactive glucose pattern during the 4 h-OGTT (significantly increased late-onset glucose nadirs and reduced the frequency of glucose ≤3.9 mmol/L [21 to 11, p = 0.04]) and reduced fasting plasma glucose (5.4 ± 0.6 to 5.1 ± 0.5 [p < 0.05]) and total cholesterol (5.3 ± 1.1 to 4.9 ± 1.1 mmol/L [p < 0.04]). CONCLUSIONS: A reactive glucose pattern following intake of a high glycaemic load is relatively prevalent and this phenomenon could be modulated by dietary fibre supplementation.