Information needs for general practitioners on type 2 diabetes in Western countries. A systematic review.

BACKGROUND: Most people with type 2 diabetes receive treatment in primary care by general practitioners who are not specialised in diabetes. Thus, it is important to uncover the most essential information needs regarding type 2 diabetes in general practice. AIM: To identify information needs related to type 2 diabetes for general practitioners. DESIGN AND SETTING: A systematic review focused on literature relating to Western countries. METHOD: We searched the databases MEDLINE, Embase, PsycInfo and CINAHL from inception to January 2024. Two researchers conducted the selection process, and citation searches were performed to identify any relevant articles missed by the database search. Quality appraisal was conducted with the Mixed Methods Appraisal Tool. Meaning units were coded individually, grouped into categories, and then studies were summarized within the context of these categories using narrative synthesis. An evidence map was created to highlight research gaps. RESULTS: Thirty-nine included studies revealed eight main categories and 37 subcategories of information needs. Categories were organised into a comprehensive hierarchical model of information needs, suggesting that 'Knowledge of guidelines' and 'Reasons for referral' encompass more specific information needs. The evidence map shows geographical distribution of categories and knowledge gaps in qualitative research on management and risk factors. CONCLUSION: This systematic review provides GPs, policy makers, and researchers with a hierarchical model of information and educational needs for GPs, and an evidence map showing gaps in the current literature. Information needs about clinical guidelines and reasons for referral to specialised care overlapped with needs for more specific information.

Reasons for Nonadherence to Statins - A Systematic Review of Reviews.

PURPOSE: Lipid-lowering medications are often prescribed to decrease the risk of micro- and macro-cardiovascular complications related to dyslipidaemia. Despite widespread prescription of lipid-lowering drugs, including statins, adherence to therapy is a challenge worldwide. This systematic review of reviews aimed to conduct a critical appraisal and synthesis of review findings and to provide an overview of the factors that were found to affect adherence to lipid-lowering drugs, focusing on statins, in the reviews. PATIENTS AND METHODS: A systematic review methodology was used. MEDLINE, Embase, and Epistemonikos databases were searched for relevant publications. AMSTAR 2 criteria were used to assess the quality of the selected publications. RESULTS: From a total of 763 screened publications, 9 met all inclusion criteria and were included in this synthesis. Several factors were identified as being associated with adherence to lipid-lowering agents. Among them, high socio-economic and educational position, and middle age had a positive effect on adherence to lipid-lowering agents. Contrary, female sex, older and younger age, non-white race, low socio-economic position, high co-payments, being a new statin user, comorbidities, side effects, regimen complexity, type and intensity of statin dose, smoking, alcohol consumption, imperceptible benefits, and medical distrust contributed to non-adherence. The overall quality of the included reviews was considered critically low to moderate. CONCLUSION: This review of reviews has evaluated the impact of factors on adherence statins. Further research related to modifiable predictors for non-adherence is warranted.

Implementing a research-based innovation to generate intra-familial involvement in type 2 diabetes self-management for use in diverse municipal settings: a qualitative study of barriers and facilitators.

BACKGROUND: Involving family members in disease management is vital to people with type 2 diabetes. New innovations that support family members' involvement can help both the person with type 2 diabetes and the relatives to create the supportive environment they need. The objective of the present study is to examine what facilitates and obstructs implementation of an innovation that supports intra-familial involvement in life with type 2 diabetes. METHODS: Of the 48 healthcare professionals trained in facilitating the innovation in municipal patient education courses, single, semi-structured interviews were conducted with 13 of them. The interviews were focused specifically on the implementation process. All interviews were transcribed verbatim and analyzed using radical hermeneutics. RESULTS: The analysis revealed three distinct themes affecting implementation of the innovation. 1) Focusing on creating family involvement in patient education for people with type 2 diabetes was relevant and important to the healthcare professionals. 2) The dynamics of group-based patient education sessions changed when family members were involved, which affects healthcare professionals' group facilitation methods. 3) Implementing new methods in patient education requires great commitment and support from the organization and management. CONCLUSION: Implementation of an innovation to involve families and close relatives in patient education in Danish municipalities is feasible, but highly dependent on the commitment of healthcare professionals and managers as well as their openness to new ways of facilitating group processes.

Targeting "hardly reached" people with chronic illness: a feasibility study of a person-centered self-management education approach.

BACKGROUND: Self-management education is critical to the development of successful health behavior changes related to chronic illness. However, people in high-risk groups attend less frequently or benefit less from patient education programs than do people with more socioeconomic advantages. AIM: The aim was to test the feasibility of a participatory person-centered education approach and tool-kit targeting self-management of chronic illness in hardly reached people. METHODS: After participating in a training program, educators (n=77) tested the approach in practice. Data collection included online questionnaires for educators (n=65), observations of education sessions (n=7), and interviews with educators (n=11) and participants (n=22). Descriptive statistics were calculated. Transcripts of interviews and observations were analyzed using systematic text condensation. Feasibility was examined in terms of practicality, integration, suitability, and efficacy. RESULTS: Educators had a positive response to the approach and found that the tools supported involving participants in education and support. Participant satisfaction varied, depending on the ability of educators to integrate the tools into programs in a meaningful way. The tools provided time for reflection in the education process that benefited participants and educators alike. Educators found it challenging to allow participants to help set the agenda and to exchange experiences without educator control. Barriers to use reported by educators included lack of time for both training and preparation. LIMITATIONS: The testing included varied groups of participants, some groups included members of hardly reached populations and others did not. Also, some tools were only tried in practice by a few educators. CONCLUSION: The approach was feasible in terms of practicality, integration, acceptability, and efficacy and perceived by educators as suitable for both hardly reached participants and those who are less disadvantaged. Implementation of the approach requires time for training and preparation.