Dataset Information

Quality of diabetes care in cancer: a systematic review.

ABSTRACT: PURPOSE:Overlooking other conditions during cancer could undermine gains associated with early detection and improved cancer treatment. We conducted a systematic review on the quality of diabetes care in cancer. DATA SOURCES:Systematic searches of Medline and Embase, from 1996 to present, were conducted to identify studies on the quality of diabetes care in patients diagnosed with cancer. STUDY SELECTION:Studies were selected if they met the following criteria: longitudinal or cross-sectional observational study; population consisted of diabetes patients; exposure consisted of cancer of any type and outcomes consisted of diabetes quality of care indicators, including healthcare visits, monitoring and testing, control of biologic parameters, or use of diabetes and other related medications. DATA EXTRACTION:Structured data collection forms were developed to extract information on the study design and four types of quality indicators: physician visits, exams or diabetes education (collectively 'healthcare visits'); monitoring and testing; control of biologic parameters; and medication use and adherence. RESULTS OF DATA SYNTHESIS:There were 15 studies from five countries. There was no consistent evidence that cancer was associated with fewer healthcare visits, lower monitoring and testing of biologic parameters or poorer control of biologic parameters, including glucose. However, the weight of the evidence suggests cancer was associated with lower adherence to diabetes medications and other medications, such as anti-hypertensives and cholesterol-lowering agents. CONCLUSION:Evidence indicates cancer is associated with poorer adherence to diabetes and other medications. Further primary research could clarify cancer's impact on other diabetes quality indicators.

SUBMITTER: Griffiths RI

PROVIDER: S-EPMC6419905 | biostudies-other | 2019 Mar

REPOSITORIES: biostudies-other

ACCESS DATA

Publications

Quality of diabetes care in cancer: a systematic review.

Griffiths Robert I RI Keating Nancy L NL Bankhead Clare R CR

International journal for quality in health care : journal of the International Society for Quality in Health Care 20190301 2

<h4>Purpose</h4>Overlooking other conditions during cancer could undermine gains associated with early detection and improved cancer treatment. We conducted a systematic review on the quality of diabetes care in cancer.<h4>Data sources</h4>Systematic searches of Medline and Embase, from 1996 to present, were conducted to identify studies on the quality of diabetes care in patients diagnosed with cancer.<h4>Study selection</h4>Studies were selected if they met the following criteria: longitudinal ...[more]

PMID: 29912446

Similar Datasets

Project description:BACKGROUND:Socially disadvantaged populations carry a disproportionate burden of diabetes-related morbidity and mortality. There is an emerging interest in quality improvement (QI) strategies in the care of patients with diabetes, however, the effect of these interventions on disadvantaged groups remains unclear. OBJECTIVE:This is a secondary analysis of a systematic review that seeks to examine the extent of equity considerations in diabetes QI studies, specifically quantifying the proportion of studies that target interventions toward disadvantaged populations and conduct analyses on the impact of interventions on disadvantaged groups. RESEARCH DESIGN AND METHODS:Studies were identified using Medline, HealthStar and the Cochrane Effective Practice and Organisation of Care database. Randomised controlled trials assessing 12 QI strategies targeting health systems, healthcare professionals and/or patients for the management of adult outpatients with diabetes were eligible. The place of residence, race/ethnicity/culture/language, occupational status, gender/sexual identity, religious affiliations, education level, socioeconomic status, social capital, plus age, disability, sexual preferences and relationships (PROGRESS-Plus) framework was used to identify trials that focused on disadvantaged patient populations, to examine the types of equity-relevant factors that are being considered and to explore temporal trends in equity-relevant diabetes QI trials. RESULTS:Of the 278 trials that met the inclusion criteria, 95 trials had equity-relevant considerations. These include 64 targeted trials that focused on a disadvantaged population with the aim to improve the health status of that population and 31 general trials that undertook subgroup analyses to assess the extent to which their interventions may have had differential impacts on disadvantaged subgroups. Trials predominantly focused on race/ethnicity, socioeconomic status and place of residence as potential factors for disadvantage in patients receiving diabetes care. CONCLUSIONS:Less than one-third of diabetes QI trials included equity-relevant considerations, limiting the relevance and applicability of their data to disadvantaged populations. There is a need for better data collection, reporting, analysis and interventions on the social determinants of health that may influence the health outcomes of patients with diabetes. PROSPERO REGISTRATION NUMBER:CRD42013005165.

Project description:BackgroundThere is evidence that disparities exist in diabetes prevalence, access to diabetes care, diabetes-related complications, and the quality of diabetes care. A wide range of interventions has been implemented and evaluated to improve diabetes care. We aimed to review trials of quality improvement (QI) interventions aimed to reduce health inequities among people with diabetes in primary care and to explore the extent to which experimental studies addressed and reported equity issues.MethodsPubmed, EMBASE, CINAHL, and the Cochrane Library were searched to identify randomized controlled studies published between January 2005 and May 2016. We adopted the PROGRESS Plus framework, as a tool to explore differential effects of QI interventions across sociodemographic and economic factors.ResultsFrom 1903 references fifty-eight randomized trials met the inclusion criteria (with 17.786 participants), mostly carried out in USA. The methodological quality was good for all studies. Almost all studies reported the age, gender/sex and race distribution of study participants. The majority of trials additionally used at least one further PROGRESS-Plus factor at baseline, with education being the most commonly used, followed by income (55%). Large variation was observed between these studies for type of interventions, target populations, and outcomes evaluated. Few studies examined differential intervention effects by PROGRESS-plus factors. Existing evidence suggests that some QI intervention delivered in primary care can improve diabetes-related health outcomes in social disadvantaged population subgroups such as ethnic minorities. However, we found very few studies comparing health outcomes between population subgroups and reporting differential effect estimates of QI interventions.ConclusionsThis review provides evidence that QI interventions for people with diabetes is feasible to implement and highly acceptable. However, more research is needed to understand their effective components as well as the adoption of an equity-oriented approach in conducting primary studies. Moreover, a wider variety of socio-economic characteristics such as social capital, place of residence, occupation, education, and religion should be addressed.

Project description:BackgroundTo identify the strategies and contextual factors that enable optimal engagement of patients in the design, delivery, and evaluation of health services.MethodsWe searched MEDLINE, EMBASE, CINAHL, Cochrane, Scopus, PsychINFO, Social Science Abstracts, EBSCO, and ISI Web of Science from 1990 to 2016 for empirical studies addressing the active participation of patients, caregivers, or families in the design, delivery and evaluation of health services to improve quality of care. Thematic analysis was used to identify (1) strategies and contextual factors that enable optimal engagement of patients, (2) outcomes of patient engagement, and (3) patients' experiences of being engaged.ResultsForty-eight studies were included. Strategies and contextual factors that enable patient engagement were thematically grouped and related to techniques to enhance design, recruitment, involvement and leadership action, and those aimed to creating a receptive context. Reported outcomes ranged from educational or tool development and informed policy or planning documents (discrete products) to enhanced care processes or service delivery and governance (care process or structural outcomes). The level of engagement appears to influence the outcomes of service redesign-discrete products largely derived from low-level engagement (consultative unidirectional feedback)-whereas care process or structural outcomes mainly derived from high-level engagement (co-design or partnership strategies). A minority of studies formally evaluated patients' experiences of the engagement process (n?=?12; 25%). While most experiences were positive-increased self-esteem, feeling empowered, or independent-some patients sought greater involvement and felt that their involvement was important but tokenistic, especially when their requests were denied or decisions had already been made.ConclusionsPatient engagement can inform patient and provider education and policies, as well as enhance service delivery and governance. Additional evidence is needed to understand patients' experiences of the engagement process and whether these outcomes translate into improved quality of care.RegistrationN/A (data extraction completed prior to registration on PROSPERO).

Project description:BackgroundDespite the growing interest in assessing the quality of care for depression, there is little evidence to support measurement of the quality of primary care for depression. This study identified evidence-based quality indicators for monitoring, evaluating and improving the quality of care for depression in primary care settings.MethodsOvid MEDLINE and Ovid PsycINFO databases, and grey literature, including relevant organizational websites, were searched from 2000 to 2015. Two reviewers independently selected studies if (1) the study methodology combined a systematic literature search with assessment of quality indicators by an expert panel and (2) quality indicators were applicable to assessment of care for adults with depression in primary care settings. Included studies were appraised using the Appraisal of Indicators through Research and Evaluation (AIRE) instrument, which contains four domains and 20 items. A narrative synthesis was used to combine the indicators within themes. Quality indicators applicable to care for adults with depression in primary care settings were extracted using a structured form. The extracted quality indicators were categorized according to Donabedian's 'structure-process-outcome' framework.ResultsThe search revealed 3838 studies. Four additional publications were identified through grey literature searching. Thirty-nine articles were reviewed in detail and seven met the inclusion criteria. According to the AIRE domains, all studies were clear on purpose and stakeholder involvement, while formal endorsement and usage of indicators in practice were scarcely described. A total of 53 quality indicators were identified from the included studies, many of which overlap conceptually or in content: 15 structure, 33 process and four outcome indicators. This study identified quality indicators for evaluating primary care for depression among adult patients.ConclusionsThe identified set of indicators address multiple dimensions of depression care and provide an excellent starting point for further development and use in primary care settings.

Project description:Background and aimsDespite well documented disparities in health and healthcare in rural communities, evidence in relation to quality improvement (QI) interventions in those settings is still lacking. The main goals of this work were to assess the effectiveness of QI strategies designed to improve diabetes care in rural areas, and identify characteristics associated with greater success.MethodsWe conducted a systematic review and meta-analysis. Systematic electronic searches were conducted in MEDLINE, EMBASE, CINAHL, and 12 additional bibliographic sources. Experimental studies carried out in the OECD member countries assessing the effectiveness of QI interventions aiming to improve diabetes care in rural areas were included. The effect of the interventions and their impact on glycated hemoglobin was pooled using a random-effects meta-analysis.ResultsTwenty-six studies assessing the effectiveness of twenty QI interventions were included. Interventions targeted patients (45%), clinicians (5%), the health system (15%), or several targets (35%), and consisted of the implementation of one or multiple QI strategies. Most of the interventions produced a positive impact on processes of care or diabetes self-management, but a lower effect on health outcomes was observed. Interventions with multiple strategies and targeting the health system and/or clinicians were more likely to be effective. Six QI interventions were included in the meta-analysis (1,496 patients), which showed a significant reduction in overall glycated hemoglobin of 0.41 points from baseline in those patients receiving the interventions (95% CI -0.75% to -0.07%).ConclusionsThis work identified several characteristics associated with successful interventions to improve the quality of diabetes care in rural areas. Efforts to improve diabetes care in rural communities should focus on interventions with multiple strategies targeted at clinicians and/or the health system, rather than on traditional patient-oriented interventions.

Dataset Information

Quality of diabetes care in cancer: a systematic review.

Publications

Quality of diabetes care in cancer: a systematic review.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets