Differences in Secure Messaging, Self-management, and Glycemic Control Between Rural and Urban Patients: Secondary Data Analysis.
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ABSTRACT: Background
Rural patients with diabetes have difficulty accessing care and are at higher risk for poor diabetes management. Sustained use of patient portal features such as secure messaging (SM) can provide accessible support for diabetes self-management.Objective
This study explored whether rural patients' self-management and glycemic control was associated with the use of SM.Methods
This secondary, cross-sectional, mixed methods analysis of 448 veterans with diabetes used stratified random sampling to recruit a diverse sample from the United States (rural vs urban and good vs poor glycemic control). Administrative, clinical, survey, and interview data were used to determine patients' rurality, use of SM, diabetes self-management behaviors, and glycemic control. Moderated mediation analyses assessed these relationships.Results
The sample was 51% (n=229) rural and 49% (n=219) urban. Mean participant age was 66.4 years (SD 7.7 years). More frequent SM use was associated with better diabetes self-management (P=.007), which was associated with better glycemic control (P<.001). Among rural patients, SM use was indirectly associated with better glycemic control through improved diabetes self-management (95% CI 0.004-0.927). These effects were not observed among urban veterans with diabetes (95% CI -1.039 to 0.056). Rural patients were significantly more likely than urban patients to have diabetes-related content in their secure messages (P=.01).Conclusions
More frequent SM use is associated with engaging in diabetes self-management, which, in turn, is associated with better diabetes control. Among rural patients with diabetes, SM use is indirectly associated with better diabetes control. Frequent patient-team communication through SM about diabetes-related content may help rural patients with diabetes self-management, resulting in better glycemic control.
SUBMITTER: Robinson SA
PROVIDER: S-EPMC8663667 | biostudies-literature |
REPOSITORIES: biostudies-literature
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2015-10-26 | GSE53522 | GEO
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2015-10-26 | E-GEOD-53522 | biostudies-arrayexpress
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2017-01-07 | GSE87825 | GEO
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Project description:Controlling the regional re-emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) after its initial spread in ever-changing personal contact networks and disease landscapes is a challenging task. In a landscape context, contact opportunities within and between populations are changing rapidly as lockdown measures are relaxed and a number of social activities re-activated. Using an individual-based metapopulation model, we explored the efficacy of different control strategies across an urban-rural gradient in Wales, UK. Our model shows that isolation of symptomatic cases or regional lockdowns in response to local outbreaks have limited efficacy unless the overall transmission rate is kept persistently low. Additional isolation of non-symptomatic infected individuals, who may be detected by effective test-and-trace strategies, is pivotal to reducing the overall epidemic size over a wider range of transmission scenarios. We define an 'urban-rural gradient in epidemic size' as a correlation between regional epidemic size and connectivity within the region, with more highly connected urban populations experiencing relatively larger outbreaks. For interventions focused on regional lockdowns, the strength of such gradients in epidemic size increased with higher travel frequencies, indicating a reduced efficacy of the control measure in the urban regions under these conditions. When both non-symptomatic and symptomatic individuals are isolated or regional lockdown strategies are enforced, we further found the strongest urban-rural epidemic gradients at high transmission rates. This effect was reversed for strategies targeted at symptomatic individuals only. Our results emphasize the importance of test-and-trace strategies and maintaining low transmission rates for efficiently controlling SARS-CoV-2 spread, both at landscape scale and in urban areas.
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Project description:PurposeCOVID-19 mortality rates are higher in rural versus urban areas in the United States, threatening to exacerbate the existing rural mortality penalty. To save lives and facilitate economic recovery, we must achieve widespread vaccination coverage. This study compared adult COVID-19 vaccination rates across the US rural-urban continuum and across different types of rural counties.MethodsWe retrieved vaccination rates as of August 11, 2021, for adults aged 18+ for the 2,869 counties for which data were available from the CDC. We merged these with county-level data on demographic and socioeconomic composition, health care infrastructure, 2020 Trump vote share, and USDA labor market type. We then used regression models to examine predictors of COVID-19 vaccination rates across the USDA's 9-category rural-urban continuum codes and separately within rural counties by labor market type.FindingsAs of August 11, 45.8% of adults in rural counties had been fully vaccinated, compared to 59.8% in urban counties. In unadjusted regression models, average rates declined monotonically with increasing rurality. Lower rural rates are explained by a combination of lower educational attainment and higher Trump vote share. Within rural counties, rates are lowest in farming and mining-dependent counties and highest in recreation-dependent counties, with differences explained by a combination of educational attainment, health care infrastructure, and Trump vote share.ConclusionLower vaccination rates in rural areas is concerning given higher rural COVID-19 mortality rates and recent surges in cases. At this point, mandates may be the most effective strategy for increasing vaccination rates.
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Project description:ObjectiveEffective diabetes self-management can prevent long-term health complications but is often complex and difficult to achieve. Health care professionals' support for patients' autonomy (autonomy support) in managing their diabetes contributes to better diabetes self-care and glycemic control. Most adults with diabetes also receive self-management support from informal health supporters. Yet, the role of autonomy support from these informal health supporters has not been explored. We examined patients' perceived autonomy support from their main health supporter (family member or friend) in relation to their diabetes distress, self-efficacy, self-monitoring of blood glucose (SMBG), medication adherence, and hemoglobin A1c (HbA1c).MethodThree hundred twenty-six veterans with Type 2 diabetes at high risk for complications, who identified a main health supporter, were surveyed using self-report measures of social support, diabetes distress, self-efficacy, and self-care. HbA1c and prescription fill data were extracted from VA electronic records for the 12-months before and after the survey. Linear regression and linear mixed models examined the associations of autonomy support with diabetes distress, self-efficacy, SMBG, medication adherence, and glycemic control, controlling for participant-supporter relationship characteristics and patient-factors.ResultsIn adjusted models, greater autonomy support was associated with lower diabetes distress (B = -.323, SE = .098, p = .001), greater self-efficacy (B = .819, SE = .148, p < .001), more frequent SMBG (B = .297, SE = .082, p < .001), and better subsequent 12-month glycemic control (B = .257, SE = .085, p = .003) but not with medication adherence (B = .001, SE = .020, p = .994).ConclusionsAutonomy support from main health supporters is significantly associated better diabetes related attitudes, self-care, and glycemic control after adjusting for relationship and patient characteristics. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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