Early experiences with quality-assured HbA1c and professional glucose point-of-care testing in general practice: a cross-sectional observational study among patients, nurses and doctors.

BACKGROUND: Point-of-care testing (POCT) is increasingly used in primary care. The rapid availability of the test result during the patient encounter increases the potential for patients and care providers to make a direct and joint decision on disease management. Our aim was to get insight into the first experiences of patients and healthcare professionals after introducing quality-controlled HbA1c and professional glucose POCT in diabetes care in their own general practices. METHODS: A cross-sectional observational study using paper questionnaires for patients, nurses and general practitioners (GPs) in 13 general practices in the Netherlands. HbA1c and professional glucose POCT was introduced after training and under day-to-day quality control. Patients filled in the questionnaire immediately after the test; nurses and GPs after a minimum period of three months from the starting date. Descriptive data analyses were performed. RESULTS: A total of 1551 fingerstick blood POC tests were performed (1126 HbA1c; 425 Glucose). For HbA1c POCT, 84 patients, 29 nurses and 11 GPs filled in the questionnaires. For professional glucose POCT, 30 patients, 17 nurses and 8 GPs responded. Response rates varied between 24 and 56%. Patients, nurses and GPs were generally (very) satisfied with the novel POC tests. Patients were most positive about the location (in the GPs' office) and execution of the POC test (by their own nurse), and the speed of the test result. Almost all nurses indicated to have sufficient knowledge and skills to perform the test. Both nurses and GPs had confidence in the test results and indicated they experienced a higher patient satisfaction than with regular blood tests. Perceived disadvantages were the time required to regularly calibrate the devices and the extension of the consultation time because of the test. Patients, nurses and GPs generally expressed they wanted to continue performing these POC tests in routine diabetes care. CONCLUSIONS: Patients, nurses and GPs expressed (very) positive first experiences after introducing HbA1c and professional glucose testing on two high-quality POCT devices in their own general practices. Further research, with a random selection procedure of practices and patients and in other regions and countries, is recommended to confirm these findings.

Foot ulcers: perception of patients with Type 2 diabetes / Úlceras de pie: percepción de pacientes con diabetes mellitus tipo 2

Abstract Introduction: In the past decade, the incidence of diabetes mellitus has increased exorbitantly around the world and foot ulcer has become the most serious and costly complication, leading to possible amputation or even death. Objective: To know the perception of diabetic patients attached to CESFAM BelarminaParedes, Futrono, Chile, regarding the occurrence of diabetic foot ulcers in 2015. Materials and methods: Qualitative research through intrinsic case study. Non-probabilistic intentional samples of cases based on criteria and convenience (12 patients), who signed an informed consent. Information was obtained through focus groups and analysis was made using data reduction. Validity was endorsed by the Ethics Committee of the Universidad de La Frontera. Results: Two qualitative domains were obtained out of 495 units of analysis obtained in Level I and their consequent reduction in Level III: "Concepts and experiences lived as a result of illness and healthcare team role" and "Contributions to improve quality of care". Conclusion: Participants consider that foot ulcer is a wound. Unaware of the risks, they deem amputation as a sequel. However, patients have etiological knowledge, describe signs and symptoms, and reveal pharmacological treatment. Additionally, they state changes in daily life, work absence and degree of dependency.

Resumen Introducción. En la última década, la diabetes miellitus ha presentado un aumento exorbitante en el mundo y la úlcera del pie se constituye como la complicación más seria y costosa, con posible amputación e inclusive la muerte. Objetivo. Conocer la percepción de los pacientes diabéticos pertenecientes al CESFAM Belarmina Paredes en Futrono, Chile, en relación con la aparición de úlceras del pie diabético. Materiales y métodos. Investigación cualitativa realizada mediante estudio intrínseco de casos. Muestra no probabilística, intencionada de casos por criterios y conveniencia, conformada por 12 pacientes con previa firma del consentimiento informado. La información se obtuvo por medio de grupos focales y el análisis se realizó a través de reducción de datos. Resultados. De las 495 unidades de significado develadas en el nivel 1 y su consecuente reducción en el nivel 3, se obtuvieron dos dominios cualitativos: "Conceptos y experiencias vividas producto de la enfermedad y rol equipo de salud" y "Aportes para mejorar calidad de atención". Conclusiones. Los participantes consideran que la úlcera del pie es una herida.Sin consciencia de riesgo, identifican la amputación como secuela; sin embargo, tienen conocimiento etiológico, describen signos, síntomas y develan tratamiento farmacológico. Expresan cambios en la vida diaria, ausencia laboral y grado de dependencia.