Diagnosis And Management Of Diabetes: A Comparative Study

A1QuantitativeArticle:

Background or Introduction

The study was implemented in order to find out the relationship of the intensity of participation and prior indication of uncontrolled diabetes to the use of overall health care of the patients enrolled in diabetes management program of TRICARE’s. TRICARE is a US based healthcare agency catering to the health requirements of US military personals, their families and their beneficiaries.

Review of the Literature

The program was implemented to compare the healthcare costs of the US based nationals in the diabetes management program prior and after the enrolment process. The patients enrolled in the diabetes management program were further divided into active and passive groups depending on their interaction with the baseline telephone counseling services for diabetes management.

Evidence applied – The patients with inclination towards self management of their uncontrolled diabetes had the major scope of improvement from the program. The active participants were seen to have reduced inpatient days.

Discussion of Methodology

                   A quasi experimental approach was used over here to access the impact of diabetes management program for beneficiaries of us militants within the age group of 18-64. The inclusion criteria included frequent hospitalizations owing to diabetes. The participants were divided into controlled, uncontrolled groups based upon medical claims for uncontrolled diabetes from the year before the program was implemented for which prior consent was taken though e-mails. This was in accordance with the Data protection and confidentiality act (1998). A regression analysis was performed for comparing and estimation of the patient data (Dall et al., 2011).

One of the greatest contributions of the study was that patient with prior indications of uncontrolled diabetes appeared to experience greater benefits than the ones without ant prior indications.

The voluntary nature of the program helped the researcher in applying caution when making comparisons.

Strengths –

a)  Patients with prior indications of uncontrolled diabetes actively participated in the program.

b) Tricare’s education based diabetes management program was associated with modest reductions in annual healthcare costs.

Limitations-

a) Secular trends continue to change healthcare delivery pattern.

b) Inability to precisely identify patients whose diabetes is controlled.

Data Analysis

It was found that cost of diabetes management dropped by 11 % and the other costs dropped by a total of 17% from the pre-identification to the post-identification period.  A larger decline was noted for the participants of the program who noted 35% and 20% post program declines.  The decline in the rate of cost due to diabetes management was found to be largest for patient with previous indications of uncontrolled diabetes (Murphy, Staffileno and Foreman, M.D, 2017).  The regression coefficients based upon Historical control group (HCG) analysis was used to analyze the annual health related costs of the participants of the program.

The comparison of observed outcomes to outcomes predicted in the absence of diabetes management helped the researcher in removing the biases.

Researcher’s Conclusion

The findings of the experiment were found to be consistent with some of the prior published work. However, being at an arm’s length from the focus group made the analysis difficult for the researcher.

Discussion

Reduced inpatient days as observed from the literature review support’s the researcher’s conclusion regarding consistency with previous findings. Researcher’s conclusion is also supported by accordance of the methodology with the data protection and confidentiality act, and the limitations of the study related to secular trends and inability of precise identification. 

A1QuantitativeArticle:

Background or Introduction

        The study aims at analyzing the different dimensions of attitudes of type 2 diabetes patients attending two different medical centers in Tehran regarding their diseases.

Review of the Literature

        The article highlights the importance of patient education and self care in comprehensive diabetes management. The article analyzes the attitude of individual persons for knowing their behavior towards their diseases. Importance has been placed upon the attitude and beliefs of the patients for designing of the therapeutic interventions and programs. In order to get a comprehensive view patients suffering from diabetes mellitus (DM) for over a year had been taken into consideration.

Attitude has direct influence upon the behavior of people. Any change in belief about things can cause a change in behavior. The different themes achieved through the research helped the researcher focus upon multiple aspects of belief for arriving at a conclusive thought.

       Validity and reliability were done using two kinds of information- interview and direct observation.          

   Strength- 

a) Phenomenology method had been rarely used for analyzing the attitudes of the patients in diabetes. Therefore, the research has been done in a new style.

b) The response rates for the individual interviews were high.

Limitations –

a) However, no measure of diabetes control in the informants was done which restricted the findings of the research.

b) Any measure of diabetes control in the informants was not accessed.

Discussion of Methodology

            In the current articles a semi-structured interview with open-ended questionnaire was conducted. The attitudes of the patients affected with DM were accessed across the four domains which are –physical state, mental states, spiritual states and social state. The patients were allowed to tell their stories in their own words.  However, no participants were forced to participate in the interview process and were intimated beforehand as a part of protections and research considerations.

The phenomenology approach encouraged the participants to tell the story in their own words, which kept the conversation flowing and allowed the researcher to gather sufficient views which were later made into themes.

Data Analysis

            A face sheet was used to record information such as data, time, place, personal medical history and demographic history of the participants.   Each question and responses were transcribed from audio verbatim and completed with the help of handwritten notes. The interview was analyzed using Colaizzi’s method of phenomenological inquiry.      

Semi-structured open ended questions were undertaken by each participant to ensure that domains specified by WHO for analysis of patient attitude in diabetes were covered.

Researcher’s Conclusion

           The phenomenological method of inquiry chosen over here is relatively new. It was found that knowledge creates direct impact on the attitudes of all individuals. One of the major identified areas was information-related knowledge of illness. However, there were a number of administration gaps. Additionally, the wide extension in the attitudes of the participants led to asymmetrical results which made analysis difficult for the researcher.

Evidence applied -Additionally, it was found that patients with a positive attitude fared well in the control and management of their diabetes in the long run

Discussion

The Researcher’s conclusion was supported by the literature review which stated that attitude has a direct influence in people’s behaviour. Further support was provided by the research methodology that lack of evidence of the phenomenology method in the research context. Moreover, administration gaps and assymetrical results were also supported by the weakness of the article.