Measuring continuity of care for diabetes: which visits to include?

Objectives: Continuity of care measures are widely used to evaluate the quality of health care delivery, but which visits are included vary across studies. Our objective was to determine how the provider specialties included affect continuity values, year-to-year stability, and association with emergency department (ED) visits.

Study Design: Retrospective study of Alabama Medicaid administrative data.

Trends and Predictors of Glycemic Control Among Adults With Type 2 Diabetes Covered by Alabama Medicaid, 2011-2019.

Introduction: Despite advances in diabetes management, only one-quarter of people with diabetes in the US achieve optimal targets for glycated hemoglobin A (HbA), blood pressure, and cholesterol. We sought to evaluate temporal trends and predictors of achieving glycemic control among adults with type 2 diabetes covered by Alabama Medicaid from 2011 through 2019.

Methods: We completed a retrospective analysis of Medicaid claims and laboratory data, using person-years as the unit of analysis.

Perceived discrimination in primary care: Does Payer mix matter?

Introduction: Previous literature has explored patient perceptions of discrimination by race and insurance status, but little is known about whether the payer mix of the primary care clinic (i.e., that is majority public insurance vs.

Diabetes distress and self-reported health in a sample of Alabama Medicaid-covered adults before and during the COVID-19 pandemic.

Unlabelled: Temporary closures of outpatient health facilities and transitions to virtual care during the COVID-19 pandemic interrupted the care of millions of patients with diabetes contributing to worsening psychosocial factors and enhanced difficulty in managing type 2 diabetes mellitus. We explored associations between COVID time period and self-reported diabetes distress on self-reported health among a sample of Alabama Medicaid-covered adults with diabetes pre-COVID (2017-2019) and during-COVID (2020-2021).

Method: In this cross-sectional study, we surveyed a population-based sample of adults with type 2 diabetes covered by the Alabama Medicaid Agency.

Development of a Multicomponent Intervention to Decrease Racial Bias Among Healthcare Staff.

Background: Real or perceived discrimination contributes to lower quality of care for Black compared to white patients. Some forms of discrimination come from non-physician and non-nursing (non-MD/RN) staff members (e.g.

Assessing Hispanic/Latino and Non-Hispanic White Social Determinants of Obesity Among a Community Sample of Residents in the Rural Southeast US.

Employing an ecological approach, we sought to identify social determinants of obesity among Hispanics/Latinos and non-Hispanic whites living in the Southeast US. Data on social determinants of obesity (individual, family, community and cultural/contextual) were collected from 217 participants [106 Hispanics/Latinos; 111 non-Hispanic whites]; height and weight  were objectively measured. We compared prevalence of overweight and obese between ethnic groups and BMI values within each group by social determinants.

Primary care visits and ambulatory care sensitive diabetes hospitalizations among adult Alabama Medicaid beneficiaries.

Purpose: To describe patterns of care use for Alabama Medicaid adult beneficiaries with diabetes and the association between primary care utilization and ambulatory care sensitive (ACS) diabetes hospitalizations.

Methods: This retrospective cohort study analyzes Alabama Medicaid claims data from January 2010 to April 2018 for 52,549 covered adults ages 19-64 with diabetes. Individuals were characterized by demographics, comorbidities, and health care use including primary, specialty, mental health and hospital care.

The Mediating Role of Self-Efficacy in the Association Between Diabetes Education and Support and Self-Care Management.

Results: A total of 1,318 participants were included in the study (mean age = 52.9 years, = 9.6; 72.

Social support and diabetes distress among adults with type 2 diabetes covered by Alabama Medicaid.

Aims: Diabetes distress affects approximately 36% of adults with diabetes and is associated with worse diabetes self-management and poor glycaemic control. We characterized participants' diabetes distress and studied the relationship between social support and diabetes distress.

Methods: In this cross-sectional study, we surveyed a population-based sample of adults with type 2 diabetes covered by Alabama Medicaid.

Area based stratified random sampling using geospatial technology in a community-based survey.

Background: Most studies among Hispanics have focused on individual risk factors of obesity, with less attention on interpersonal, community and environmental determinants. Conducting community based surveys to study these determinants must ensure representativeness of disparate populations. We describe the use of a novel Geographic Information System (GIS)-based population based sampling to minimize selection bias in a rural community based study.

Diabetes risk scores for Hispanics living in the United States: A systematic review.

Aim: Undiagnosed diabetes is more prevalent among racial/ethnic minorities in the United States (U.S.).

Effectiveness of Non-Primary Care-Based Smoking Cessation Interventions for Adults with Diabetes: A Systematic Literature Review.

Diabetes is a chronic disease that affects over 25 million adults, many of whom are smokers. The negative health impact of diabetes and comorbid smoking is significant and requires comprehensive interdisciplinary management. The National Diabetes Education Program has identified specific providers, known as PPOD, who include pharmacists, podiatrists, optometrists, and dentists, as key individuals to improve diabetes-related clinical outcomes.

Evaluation of a workshop to improve residents' patient-centred obesity counselling skills.

Background: Primary care physicians are being asked to counsel their patients on obesity and weight management. Few physicians conduct weight loss counselling citing barriers, among them a lack of training and confidence. Our objective was to pilot test the effectiveness of a 3-h interactive obesity-counselling workshop for resident physicians based on motivational interviewing (MI) techniques.

Challenges to Healthy Eating Practices: A Qualitative Study of Non-Hispanic Black Men Living With Diabetes.

Purpose: The purpose of this study was to explore current dietary practices and perceived barriers to healthy eating in non-Hispanic black men with type 2 diabetes.

Methods: Four 90-minute focus groups held in September and October 2011 were led by a trained moderator with a written guide to facilitate discussion on dietary practices and barriers to healthy eating. Participants were recruited from the diabetes database at a public safety-net health system in Jefferson County, Alabama.

Physical Activity Patterns of Latina Immigrants Living in Alabama.

Background: Latinos are the fastest growing minority group in the Southeastern USA. Latinos living in the USA have a higher prevalence of obesity, metabolic diseases, and physical inactivity compared to non-Latino Whites, particularly Latina women. The objective of this study is to assess the patterns of physical activity (PA) in overweight Latina immigrants in Alabama using a self-report and an accelerometer.

Diabetes Connect: Developing a Mobile Health Intervention to Link Diabetes Community Health Workers With Primary Care.

Community health worker (CHW) interventions can help improve diabetes self-management and health outcomes. There is limited evidence on how to effectively integrate CHW programs with primary care efforts. Mobile health technology (mHealth) can connect CHWs to members of the health care team and enhance care.

Development of a theory-based, peer support intervention to promote weight loss among Latina immigrants.

Background: Obesity rates are disproportionately high among Latinas living in the United States. Few community-based weight management studies have focused on Latina immigrants living in emerging Latino communities. The purpose of this study was to develop and pilot test a theory-based, promotora-delivered, peer support weight loss intervention for Latina immigrants to be administered in a community setting.

Diabetes self-management interventions for adults with type 2 diabetes living in rural areas: a systematic literature review.

In rural communities, high rates of diabetes and its complications are compounded by limited access to health care and scarce community resources. We systematically reviewed the evidence for the impact of diabetes self-management education interventions designed for patients living in rural areas on glycemic control and other diabetes outcomes. Fifteen studies met inclusion criteria.

Diabetes Connect: African American Women's Perceptions of the Community Health Worker Model for Diabetes Care.

Community health worker (CHW) interventions have potential to improve diabetes outcomes and reduce health disparities. However, few studies have explored patient perspectives of peer-delivered diabetes programs. The purpose of this qualitative study is to investigate possible benefits as well as risks of CHW-delivered peer support for diabetes from the perspectives of African American women living with type 2 diabetes in Jefferson County, Alabama.

Internet interventions to support lifestyle modification for diabetes management: a systematic review of the evidence.

Background: The Internet presents a widely accessible, 24-h means to promote chronic disease management. The objective of this review is to identify studies that used Internet based interventions to promote lifestyle modification among adults with type 2 diabetes.

Methods: We searched PubMed using the terms: [internet, computer, phone, smartphone, mhealth, mobile health, web based, telehealth, social media, text messages] combined with [diabetes management and diabetes control] through January 2013.

Training residents in obesity counseling: incorporating principles of motivational interviewing to enhance patient centeredness.

Background: The US Preventive Services Task Force and the American Academy of Pediatrics recommend that physicians screen patients for obesity and practice counseling interventions to achieve modest (4%-8%) weight loss. Despite this, physicians frequently do not document obesity and/or counsel on weight loss. Our goal was to develop an innovative, easily disseminated workshop to improve resident physicians' skills and confidence in weight-loss counseling.

The cultural context of obesity: exploring perceptions of obesity and weight loss among Latina immigrants.

This study used focus group methodology to examine perceptions of obesity and weight management among Latina immigrant women in Alabama. Four focus groups (N = 25) were conducted in Spanish as part of a participatory intervention development process. Participants were obese/overweight Latina immigrant women (BMI > 25) primarily recruited from a community hospital.