The document analyzes healthcare access for diabetes patients during the COVID-19 pandemic using datasets from hospitals and general practices in western Sydney, Australia. It finds that the rate of diabetes-consistent HbA1c tests in emergency department patients fell significantly from a pre-pandemic average of 17.3% to 13.1% after lockdown measures began. This decline correlated with COVID-19 outbreaks and was larger for females and younger patients. However, general practice diabetes patient attendance and HbA1c testing rates increased slightly during the pandemic. This suggests patients avoided hospital care but community care including virtual care replaced it for less severe cases.
REAL WORLD DATA SOURCES AND APPLICATIONS IN HEALTH OUTCOMES RESEARCH ClinosolIndia
Health outcomes research aims to assess the real-world effectiveness, safety, and value of healthcare interventions. In recent years, the availability and utilization of real-world data (RWD) have significantly contributed to advancing health outcomes research. This paper explores the various sources of real-world data and their applications in health outcomes research.
Real-world data refers to data collected outside of controlled clinical trials, often generated through routine healthcare delivery, electronic health records (EHRs), claims databases, registries, wearable devices, and patient-reported outcomes. These data sources provide a wealth of information on patient characteristics, treatment patterns, healthcare utilization, and clinical outcomes in real-world settings.
Role of the Biochemistry Labs in Promoting the Health Care Services for the I...IJERA Editor
The health care in the State of Kuwait depends to a greater extent on the biochemical and clinical labs attached
at each hospital. The data obtained from these laboratories will facilitate the process of diagnosing the disease
accurately. This will have a positive impact on the selection of appropriate treatment for the patients in general
and for diabetics specifically.
The main objective of this research was to build a profile for lab analysis and a database for building a
comprehensive system of integrated activities to raise health care for diabetic patients in Kuwait. The study
revealed the burden of admitted diabetic cases on the blood chemistry laboratory in Sabah Hospital (in relation
to length of stay and total numbers of lab requests). The aim was fulfilled by designing a model of the
biochemical tests for diabetics; filling in forms from the reality of patient data, completing and analyzing the
results electronically.
The study showed the importance of biochemical and clinical labs since they act as the link of patient's
information at the secondary health care level.
Remote Patient Monitoring (RPM) is becoming an essential part of future healthcare. Read this guide, to learn more about remote patient monitoring. Click here :https://bluestartelehealth.com/
Repurposed existing drugs and updated global health policy and clinical guidelines will be essential for limiting the social and economic devastation caused by this virus. So, we are leading a three-phase multinational Network Medicine clinical study (MNM COVID-19 study). The study will apply Network Medicine methodologies to repurpose existing drugs for SARS-CoV-2 infected patients and update global health policy and clinical guidelines.
Real world Evidence and Precision medicine bridging the gapClinosolIndia
Real-world evidence and precision medicine represent complementary forces reshaping the healthcare landscape. The synergy between these realms offers a pathway to more personalized, effective, and patient-centered care. As technology, data analytics, and collaborative initiatives advance, the integration of real-world evidence into precision medicine practices holds the promise of revolutionizing how healthcare is delivered, ensuring that treatments are not only scientifically sound but also tailored to the unique characteristics and experiences of individual patients.
REAL WORLD DATA SOURCES AND APPLICATIONS IN HEALTH OUTCOMES RESEARCH ClinosolIndia
Health outcomes research aims to assess the real-world effectiveness, safety, and value of healthcare interventions. In recent years, the availability and utilization of real-world data (RWD) have significantly contributed to advancing health outcomes research. This paper explores the various sources of real-world data and their applications in health outcomes research.
Real-world data refers to data collected outside of controlled clinical trials, often generated through routine healthcare delivery, electronic health records (EHRs), claims databases, registries, wearable devices, and patient-reported outcomes. These data sources provide a wealth of information on patient characteristics, treatment patterns, healthcare utilization, and clinical outcomes in real-world settings.
Role of the Biochemistry Labs in Promoting the Health Care Services for the I...IJERA Editor
The health care in the State of Kuwait depends to a greater extent on the biochemical and clinical labs attached
at each hospital. The data obtained from these laboratories will facilitate the process of diagnosing the disease
accurately. This will have a positive impact on the selection of appropriate treatment for the patients in general
and for diabetics specifically.
The main objective of this research was to build a profile for lab analysis and a database for building a
comprehensive system of integrated activities to raise health care for diabetic patients in Kuwait. The study
revealed the burden of admitted diabetic cases on the blood chemistry laboratory in Sabah Hospital (in relation
to length of stay and total numbers of lab requests). The aim was fulfilled by designing a model of the
biochemical tests for diabetics; filling in forms from the reality of patient data, completing and analyzing the
results electronically.
The study showed the importance of biochemical and clinical labs since they act as the link of patient's
information at the secondary health care level.
Remote Patient Monitoring (RPM) is becoming an essential part of future healthcare. Read this guide, to learn more about remote patient monitoring. Click here :https://bluestartelehealth.com/
Repurposed existing drugs and updated global health policy and clinical guidelines will be essential for limiting the social and economic devastation caused by this virus. So, we are leading a three-phase multinational Network Medicine clinical study (MNM COVID-19 study). The study will apply Network Medicine methodologies to repurpose existing drugs for SARS-CoV-2 infected patients and update global health policy and clinical guidelines.
Real world Evidence and Precision medicine bridging the gapClinosolIndia
Real-world evidence and precision medicine represent complementary forces reshaping the healthcare landscape. The synergy between these realms offers a pathway to more personalized, effective, and patient-centered care. As technology, data analytics, and collaborative initiatives advance, the integration of real-world evidence into precision medicine practices holds the promise of revolutionizing how healthcare is delivered, ensuring that treatments are not only scientifically sound but also tailored to the unique characteristics and experiences of individual patients.
Reducing Stroke Readmissions in Acute Care Setting.docxdanas19
Reducing Stroke Readmissions in Acute Care Setting
Contents
Introduction: 2
Objective of the study: 3
Readmission Factors: 3
Statins: 3
Long term care: 4
Demographics: 4
Personal Reflections: 4
Events: 4
Empirical Evidence: 6
Interventions for discharged patients: 6
TRACS: 7
COMPASS: 7
MISTT: 8
Clinical requirement: 8
Timeline: 8
Collaboration with the preceptor: 8
Proposed evaluative criteria: 9
Evaluative criteria discussed: 9
Conclusion: 9
Bibliography 10
Introduction:
Stroke refers to a cardiovascular disease which has been one of the leading reasons for deaths and long term disability. A stroke is an abrupt onset of a neurological deficit led by a vascular rupture or blockage that reduces the blood flow to brain. Subsequently, causing death to the tissue in the brain region if interruption of the blood flow persists. The indications of stroke vary, but may include the loss of function to one side of the body, the inability to speak or talk, and reduced vision or severe headache (Poston, 2018).
Issue: Discovery Research
Over time, the financial penalties on readmissions to the hospital have been taking place, which is promoting hospitals to take measures to reduce the instance of readmissions. A variety of interventions are taking place on different levels to ensure that pre and post discharge care is in place to avoid readmissions. The efficacy of interventions is dependent on the variety of components. Single component interventions are least effective and tend to have no effect on readmissions to the hospitals. Patients that are discharged to post-acute care accommodations are subjected to multi-component interventions and readmissions have dropped drastically. These interventions work through communication, advanced planning of care, and training to tackle simple medical issues that might cause readmissions. The availability of risk stratification methods have made it easier for the hospitals to give more care and attention to the patients that are more likely to get readmitted. Home based services are provided to ensure proper medical care for the patients.
This capstone project attempts to discuss the factors causing the readmissions of stroke patients to the hospitals. The past 20 years have proven to be important in acute and inpatient stroke care however, quality of post-acute care varies specially for the patients that are discharged to home. (Condon, Lycan, & Duncan, 2016). Different reasons for stroke readmissions are to be examined in this capstone project. Expected Outcomes: Discovery Research
This project aims to take into account the reasons of stroke and readmissions after being treated for stroke. Stroke is the second primary reason of readmissions in the hospital. Major readmissions comprise of elderly people. 20-70% people who survive stroke are readmitted in the first year of their treatment (Bravata, Ho, Meehan, & Brass, 2006). Poor health conditions and high treatment costs both account for the l.
DASHBOARD BENCHMARK
Miatta Teasley
Capella University
Running Head: DASHBOARD BENCHMARK
DASHBOARD BENCHMARK
April 19,2022
DASHBOARD BENCHMARK
Second Quarter Hypertension Intervention Compliance at Med for adults presenting with Diabetes
Intervention
Needed
Completed
Compliance Percentage
Initial Lactate within 3 hours
30
30
100%
Blood cultures were drawn before antibiotics
22
17
77%
Antibiotics administered within 3 hours
22
20
91%
Fluid resuscitation if in septic shock within 2hours
19
12
63%
Vasopressors if hypertension persists after fluid or lactate >4mmoL/L within 6 hours
12
7
58%
Overall
105
86
82%
Second Quarter Dialysis Intervention
Compliance and Inpatient Mortality
Patient ID
Number of Interventions needed
Number of Interventions completed
Inpatient Mortality
2000
4
2
0
2014
3
3
1
2098
2
1
0
2134
5
4
0
2156
3
4
1
2245
4
2
0
2345
3
3
1
2567
5
4
1
2676
4
1
1
2935
3
2
0
Note: The Staffing benchmark for the nurse staffing unit is 3 patients per nurse. The average monthly staffing for the unit is 3 nurse workloads. The average number of patients in the unit per month in the third quarter was 5.75.
The data above is a review regarding the compliance of Dialysis measures and interventions compliance and the sample of the second quarter inpatient mortality. The information below entails evaluating the data, which indicates that various departments need to be improved, and a proposal for a specific area and target for improvement.
Evaluation of Dashboard Metrics
There are several inefficiencies in regards to dialysis measures at Med. From the dashboard concerning the compliance of executing the arranged measures and procedures, the two stand out at the 77% compliance rate on drawing blood cultures before running antibiotics and 58% compliance rate on administering vasopressors for those patients that require them. As per Medicare.Gov (n.d), the national average for meeting dialysis guidelines is 72%, and the state of Minnesota is 60% which indicates that Med is performing at 82% overall testing. Higher percentages are required to ensure the advanced quality of life for residents of the healthcare institution (Morfín et al., 2018).
Failure to complete blood draws for cultures before running broad-spectrum antibiotics; there will be an incapability to authorize contamination and the responsible pathogen. This can result in an inefficient or ineffective intervention for aiding a patient. Moreover, by failing to confirm infection from the start, unnecessary and wasteful care interventions could be performed or ordered for patients (Morfín et al., 2018). As per the failure to administer vasopressors, the institution is gambling with the patient's life. As the reinforcement for the dialysis unit states, vasopressor therapy is needed to sustain and uphold perfusion in the wake of life-threatening hypertension. The needed nature of compliance concerning administering this intervention can be seen in the samp.
Digital Transformation In Healthcare_ Trends, Challenges And Solutions.pdfLucas Lagone
Explore digital transformation in Healthcare, Trends, face challenges, and discover effective solutions for a seamless transition in the healthcare industry.
Vast oil wealth in the Gulf has led to lifestyle changes which, in turn, have given rise to increased incidence of non-communicable diseases (NCDs). Healthy traditional diets have been almost entirely replaced by a high-sugar, low-nutrient diet. Tobacco smoking has been taken up by men, women and children. An active lifestyle, which came naturally to the self-sufficient nomadic forebears of Gulf Arabs, has largely been replaced by desk-bound jobs. This has led to an evolution in the disease profile of the region from a preponderance of infectious diseases to chronic diseases spanning obesity, diabetes, heart disease and cancer.
The growing prevalence of these lifestyle-related diseases also has wider economicimplications. It is therefore essential that these health issues are diagnosed and tackled before they progress and become chronic if the region is to develop a well-educated, skilled and diversified workforce and thereby achieve its economic potential. To do this, healthcare systems in the region need to adapt to changes in the disease profile. This paper examines the current state of healthcare delivery in the Gulf Co-operation Council (GCC), with a focus on the diagnostic process, and identifies strategies for the way forward.
Clinical eHealth 3 (2020) 40–48Contents lists available at SWilheminaRossi174
Clinical eHealth 3 (2020) 40–48
Contents lists available at ScienceDirect
Clinical eHealth
journal homepage: ww.keaipublishing.com/CEH
Long-term effects of telemonitoring on healthcare usage in patients with
heart failure or COPD q
https://doi.org/10.1016/j.ceh.2020.05.001
2588-9141/� 2020 The Authors. Publishing services by Elsevier B.V. on behalf of KeAi Communications Co., Ltd.
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
q In collaboration with the Slingeland Hospital in Doetinchem, The Netherlands,
and Stichting Sensire in Varsseveld (‘InBeeld’ program), The Netherlands.
⇑ Corresponding author.
E-mail address: [email protected] (J.M.M. van der Burg).
Jorien M.M. van der Burg a,⇑, N. Ahmad Aziz b,c, Maurits C. Kaptein d, Martine J.M. Breteler e,f,
Joris H. Janssen e, Lisa van Vliet a, Daniel Winkeler g, Anneke van Anken h, Marise J. Kasteleyn a,i,
Niels H. Chavannes a
a Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
b Department of Neurology, University of Bonn, Bonn, Germany
c Population Health Sciences, German Centre for Neurodegenerative Diseases (DZNE), Bonn, Germany
d Jheronimus Academy of Data Science, Den Bosch, The Netherlands & Department of Statistics and Research Methods, Tilburg University, Tilburg, The Netherlands
e FocusCura, Driebergen-Rijssenburg, The Netherlands
f Department of Anesthesiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
g Room To, De Meern, The Netherlands
h Department of Cardiology, Slingeland Hospital, Doetinchem, The Netherlands
i Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
a r t i c l e i n f o
Article history:
Received 5 November 2019
Revised 29 April 2020
Available online 20 May 2020
Keywords:
Heart failure
Chronic Obstructive Pulmonary Disease
(COPD)
Telemonitoring
Remote patient monitoring (RPM)
Home monitoring
Home telemonitoring
Telemedicine
eHealth
a b s t r a c t
Background: Heart failure and chronic obstructive pulmonary disease (COPD) are leading causes of dis-
ability and lead to substantial healthcare costs. The aim of this study was to evaluate the effectiveness
of home telemonitoring in reducing healthcare usage and costs in patients with heart failure or COPD.
Methods: The study was a retrospective observational study with a follow-up duration of up to 3 years in
which for all participants data before and after enrollment in the telemonitoring program was compared.
Hundred seventy-seven patients with heart failure (NYHA functional class 3 or 4) and 83 patients with
COPD (GOLD stage 3 or 4) enrolled in a home telemonitoring program in addition to receiving usual hos-
pital care. The primary outcome was the number of hospitalizations; the secondary outcomes were total
number of hospitalization days and healthcare costs during the follow-up period. Generalized Estimating
Equations w ...
Great article on how to integrate machine learning and optimization technique.
One group of researchers was able to reduce heart failure readmissions by 35% by combining machine learning and decision science technique, see "Data-driven decisions for reducing readmissions for heart failure: general methodology and case study" (Bayati, et. al., 2014).
Description This is a continuation of the health promotion pro.docxmecklenburgstrelitzh
Description
This is a continuation of the health promotion program proposal, part one, which you submitted previously. Please approach this assignment as an opportunity to integrate instructor feedback from part I and expand on ideas adhering to the components of the MAP-IT strategy. Include necessary levels of detail you feel appropriate to assure stakeholder buy-in.
Directions
For this assignment add criteria 5-8 as detailed below:
5. Propose a health promotion program using an evidence-based intervention found in your literature search to address the problem in the selected population/setting. Include a thorough discussion of the specifics of this intervention which include resources necessary, those involved, and feasibility for a nurse in an advanced role. Be certain to include a timeline. ( 3 paragraph. You may use bullets if appropriate).
6. Thoroughly describe the intended outcomes. Describe the outcomes in detail concurrent with the SMART goal approach. (1 paragraph).
7. Provide a detailed plan for evaluation for each outcome. (1 paragraph).
8. Thoroughly describe possible barriers/challenges to implementing the proposed project as well as strategies to address these barriers/challenges. (1 paragraph).
9. Conclude the paper with a Conclusion paragraph. Don’t type the word “Conclusion”. Here you will share your insights about this strategy and your expectations regarding achieving your goals. (1 paragraph).
Paper Requirements
Your assignment should be 3 pages (excluding title page, references, and appendices), following APA standards.
Remember, your Proposal must be a scholarly paper demonstrating graduate school level writing and critical analysis of existing nursing knowledge about health promotion.
Please add this section to the PART 1 ATTACHED , must be one document for the entire work, AGAIN this 4 pages you will do now, please add it to the PART 1 ATTACHED, add references for this section and put them properly in APA style with the previously in the PART 1.
[removed]
Running head: CONGESTIVE HEART FAILURE Page 2
Patients with Congestive Heart failure and Increased Readmission Rates
Florida National University
NGR 6638
Professor Alexander Garcia Salas DNP, MSN, ARNP, FNP-C
Congestive heart failure (CHF), which affects millions of people, especially the elderly, is a significant and expanding public health concern. According to research, CHF accounts for between 12 and 15 million office visits and 6.5 million inpatient days annually (Hollier, 2021). Unfortunately, this approach leads to disease progression and rehospitalizations for many CHF patients because of insufficient care, unclear discharge instructions, and a lack of follow-up visits. These higher rehospitalization rates are driving up expenses and indicating that existing care strategies for CHF are not the most effective. Therefore, evidence-based t.
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More Related Content
Similar to Diabetes during the COVID‑19 pandemic.pdf
Reducing Stroke Readmissions in Acute Care Setting.docxdanas19
Reducing Stroke Readmissions in Acute Care Setting
Contents
Introduction: 2
Objective of the study: 3
Readmission Factors: 3
Statins: 3
Long term care: 4
Demographics: 4
Personal Reflections: 4
Events: 4
Empirical Evidence: 6
Interventions for discharged patients: 6
TRACS: 7
COMPASS: 7
MISTT: 8
Clinical requirement: 8
Timeline: 8
Collaboration with the preceptor: 8
Proposed evaluative criteria: 9
Evaluative criteria discussed: 9
Conclusion: 9
Bibliography 10
Introduction:
Stroke refers to a cardiovascular disease which has been one of the leading reasons for deaths and long term disability. A stroke is an abrupt onset of a neurological deficit led by a vascular rupture or blockage that reduces the blood flow to brain. Subsequently, causing death to the tissue in the brain region if interruption of the blood flow persists. The indications of stroke vary, but may include the loss of function to one side of the body, the inability to speak or talk, and reduced vision or severe headache (Poston, 2018).
Issue: Discovery Research
Over time, the financial penalties on readmissions to the hospital have been taking place, which is promoting hospitals to take measures to reduce the instance of readmissions. A variety of interventions are taking place on different levels to ensure that pre and post discharge care is in place to avoid readmissions. The efficacy of interventions is dependent on the variety of components. Single component interventions are least effective and tend to have no effect on readmissions to the hospitals. Patients that are discharged to post-acute care accommodations are subjected to multi-component interventions and readmissions have dropped drastically. These interventions work through communication, advanced planning of care, and training to tackle simple medical issues that might cause readmissions. The availability of risk stratification methods have made it easier for the hospitals to give more care and attention to the patients that are more likely to get readmitted. Home based services are provided to ensure proper medical care for the patients.
This capstone project attempts to discuss the factors causing the readmissions of stroke patients to the hospitals. The past 20 years have proven to be important in acute and inpatient stroke care however, quality of post-acute care varies specially for the patients that are discharged to home. (Condon, Lycan, & Duncan, 2016). Different reasons for stroke readmissions are to be examined in this capstone project. Expected Outcomes: Discovery Research
This project aims to take into account the reasons of stroke and readmissions after being treated for stroke. Stroke is the second primary reason of readmissions in the hospital. Major readmissions comprise of elderly people. 20-70% people who survive stroke are readmitted in the first year of their treatment (Bravata, Ho, Meehan, & Brass, 2006). Poor health conditions and high treatment costs both account for the l.
DASHBOARD BENCHMARK
Miatta Teasley
Capella University
Running Head: DASHBOARD BENCHMARK
DASHBOARD BENCHMARK
April 19,2022
DASHBOARD BENCHMARK
Second Quarter Hypertension Intervention Compliance at Med for adults presenting with Diabetes
Intervention
Needed
Completed
Compliance Percentage
Initial Lactate within 3 hours
30
30
100%
Blood cultures were drawn before antibiotics
22
17
77%
Antibiotics administered within 3 hours
22
20
91%
Fluid resuscitation if in septic shock within 2hours
19
12
63%
Vasopressors if hypertension persists after fluid or lactate >4mmoL/L within 6 hours
12
7
58%
Overall
105
86
82%
Second Quarter Dialysis Intervention
Compliance and Inpatient Mortality
Patient ID
Number of Interventions needed
Number of Interventions completed
Inpatient Mortality
2000
4
2
0
2014
3
3
1
2098
2
1
0
2134
5
4
0
2156
3
4
1
2245
4
2
0
2345
3
3
1
2567
5
4
1
2676
4
1
1
2935
3
2
0
Note: The Staffing benchmark for the nurse staffing unit is 3 patients per nurse. The average monthly staffing for the unit is 3 nurse workloads. The average number of patients in the unit per month in the third quarter was 5.75.
The data above is a review regarding the compliance of Dialysis measures and interventions compliance and the sample of the second quarter inpatient mortality. The information below entails evaluating the data, which indicates that various departments need to be improved, and a proposal for a specific area and target for improvement.
Evaluation of Dashboard Metrics
There are several inefficiencies in regards to dialysis measures at Med. From the dashboard concerning the compliance of executing the arranged measures and procedures, the two stand out at the 77% compliance rate on drawing blood cultures before running antibiotics and 58% compliance rate on administering vasopressors for those patients that require them. As per Medicare.Gov (n.d), the national average for meeting dialysis guidelines is 72%, and the state of Minnesota is 60% which indicates that Med is performing at 82% overall testing. Higher percentages are required to ensure the advanced quality of life for residents of the healthcare institution (Morfín et al., 2018).
Failure to complete blood draws for cultures before running broad-spectrum antibiotics; there will be an incapability to authorize contamination and the responsible pathogen. This can result in an inefficient or ineffective intervention for aiding a patient. Moreover, by failing to confirm infection from the start, unnecessary and wasteful care interventions could be performed or ordered for patients (Morfín et al., 2018). As per the failure to administer vasopressors, the institution is gambling with the patient's life. As the reinforcement for the dialysis unit states, vasopressor therapy is needed to sustain and uphold perfusion in the wake of life-threatening hypertension. The needed nature of compliance concerning administering this intervention can be seen in the samp.
Digital Transformation In Healthcare_ Trends, Challenges And Solutions.pdfLucas Lagone
Explore digital transformation in Healthcare, Trends, face challenges, and discover effective solutions for a seamless transition in the healthcare industry.
Vast oil wealth in the Gulf has led to lifestyle changes which, in turn, have given rise to increased incidence of non-communicable diseases (NCDs). Healthy traditional diets have been almost entirely replaced by a high-sugar, low-nutrient diet. Tobacco smoking has been taken up by men, women and children. An active lifestyle, which came naturally to the self-sufficient nomadic forebears of Gulf Arabs, has largely been replaced by desk-bound jobs. This has led to an evolution in the disease profile of the region from a preponderance of infectious diseases to chronic diseases spanning obesity, diabetes, heart disease and cancer.
The growing prevalence of these lifestyle-related diseases also has wider economicimplications. It is therefore essential that these health issues are diagnosed and tackled before they progress and become chronic if the region is to develop a well-educated, skilled and diversified workforce and thereby achieve its economic potential. To do this, healthcare systems in the region need to adapt to changes in the disease profile. This paper examines the current state of healthcare delivery in the Gulf Co-operation Council (GCC), with a focus on the diagnostic process, and identifies strategies for the way forward.
Clinical eHealth 3 (2020) 40–48Contents lists available at SWilheminaRossi174
Clinical eHealth 3 (2020) 40–48
Contents lists available at ScienceDirect
Clinical eHealth
journal homepage: ww.keaipublishing.com/CEH
Long-term effects of telemonitoring on healthcare usage in patients with
heart failure or COPD q
https://doi.org/10.1016/j.ceh.2020.05.001
2588-9141/� 2020 The Authors. Publishing services by Elsevier B.V. on behalf of KeAi Communications Co., Ltd.
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
q In collaboration with the Slingeland Hospital in Doetinchem, The Netherlands,
and Stichting Sensire in Varsseveld (‘InBeeld’ program), The Netherlands.
⇑ Corresponding author.
E-mail address: [email protected] (J.M.M. van der Burg).
Jorien M.M. van der Burg a,⇑, N. Ahmad Aziz b,c, Maurits C. Kaptein d, Martine J.M. Breteler e,f,
Joris H. Janssen e, Lisa van Vliet a, Daniel Winkeler g, Anneke van Anken h, Marise J. Kasteleyn a,i,
Niels H. Chavannes a
a Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
b Department of Neurology, University of Bonn, Bonn, Germany
c Population Health Sciences, German Centre for Neurodegenerative Diseases (DZNE), Bonn, Germany
d Jheronimus Academy of Data Science, Den Bosch, The Netherlands & Department of Statistics and Research Methods, Tilburg University, Tilburg, The Netherlands
e FocusCura, Driebergen-Rijssenburg, The Netherlands
f Department of Anesthesiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
g Room To, De Meern, The Netherlands
h Department of Cardiology, Slingeland Hospital, Doetinchem, The Netherlands
i Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
a r t i c l e i n f o
Article history:
Received 5 November 2019
Revised 29 April 2020
Available online 20 May 2020
Keywords:
Heart failure
Chronic Obstructive Pulmonary Disease
(COPD)
Telemonitoring
Remote patient monitoring (RPM)
Home monitoring
Home telemonitoring
Telemedicine
eHealth
a b s t r a c t
Background: Heart failure and chronic obstructive pulmonary disease (COPD) are leading causes of dis-
ability and lead to substantial healthcare costs. The aim of this study was to evaluate the effectiveness
of home telemonitoring in reducing healthcare usage and costs in patients with heart failure or COPD.
Methods: The study was a retrospective observational study with a follow-up duration of up to 3 years in
which for all participants data before and after enrollment in the telemonitoring program was compared.
Hundred seventy-seven patients with heart failure (NYHA functional class 3 or 4) and 83 patients with
COPD (GOLD stage 3 or 4) enrolled in a home telemonitoring program in addition to receiving usual hos-
pital care. The primary outcome was the number of hospitalizations; the secondary outcomes were total
number of hospitalization days and healthcare costs during the follow-up period. Generalized Estimating
Equations w ...
Great article on how to integrate machine learning and optimization technique.
One group of researchers was able to reduce heart failure readmissions by 35% by combining machine learning and decision science technique, see "Data-driven decisions for reducing readmissions for heart failure: general methodology and case study" (Bayati, et. al., 2014).
Description This is a continuation of the health promotion pro.docxmecklenburgstrelitzh
Description
This is a continuation of the health promotion program proposal, part one, which you submitted previously. Please approach this assignment as an opportunity to integrate instructor feedback from part I and expand on ideas adhering to the components of the MAP-IT strategy. Include necessary levels of detail you feel appropriate to assure stakeholder buy-in.
Directions
For this assignment add criteria 5-8 as detailed below:
5. Propose a health promotion program using an evidence-based intervention found in your literature search to address the problem in the selected population/setting. Include a thorough discussion of the specifics of this intervention which include resources necessary, those involved, and feasibility for a nurse in an advanced role. Be certain to include a timeline. ( 3 paragraph. You may use bullets if appropriate).
6. Thoroughly describe the intended outcomes. Describe the outcomes in detail concurrent with the SMART goal approach. (1 paragraph).
7. Provide a detailed plan for evaluation for each outcome. (1 paragraph).
8. Thoroughly describe possible barriers/challenges to implementing the proposed project as well as strategies to address these barriers/challenges. (1 paragraph).
9. Conclude the paper with a Conclusion paragraph. Don’t type the word “Conclusion”. Here you will share your insights about this strategy and your expectations regarding achieving your goals. (1 paragraph).
Paper Requirements
Your assignment should be 3 pages (excluding title page, references, and appendices), following APA standards.
Remember, your Proposal must be a scholarly paper demonstrating graduate school level writing and critical analysis of existing nursing knowledge about health promotion.
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
2. Page 2 of 9
Meyerowitz‑Katz et al. BMC Health Services Research (2023) 23:167
having been born overseas [5], and it also has the
numerically largest population of Aboriginal people
of any local health area in Australia. The region is also
home to very disadvantaged neighbourhoods, including
the most disadvantaged postcode in the city of Sydney.
Given these characteristics, Western Sydney is a dia-
betes ‘hotspot’ with rates of diabetes double that of the
less disadvantaged areas in the city [6, 7].
To improve care in this locality, routine testing to
detect diabetes in patients attending the Emergency
Department (ED) has been established in some of the
local hospitals [8]. Using this protocol,
HbA1c testing is
undertaken in all patients over the age of 18 who had
blood sampled in ED. This protocol confirmed the find-
ings of high rates of diabetes undertaken in a previous
study [9]. A recent study looking at a similar protocol in
nearby community general practice clinics identified a
similar burden of diabetes in this setting, with the rate
of HbA1c consistent with diabetes estimated at 17% in
both of these studies [8]. HbA1c levels consistent with
pre-diabetes based on American Diabetes Association
criteria [10] was found to be 30% using this testing pro-
tocol. Since the start of the hospital testing methodol-
ogy, over 170,000 tests have been performed on more
than 100,000 patients, providing a large dataset for
analyses in this study.
Another extremely valuable source of information in
this local area is the accumulation of general practice
data in aggregate form by the primary health network,
Wentwest. This represents the de-identified data of all
patients attending 188 general practices (GP) across the
region. While not as granular as the testing information
from EDs, this dataset is extremely large, with close to
2 million patients – including historical data—included
overall.
Another useful facet of the healthcare relationship to
consider is the potential switch from face-to-face (FTF)
services during the pandemic to virtual care (VC)
modalities. During times where social distancing was
of key importance and health services often could not
offer FTF services, VC became the primary modality
through which patients with diabetes accessed ongo-
ing services for their chronic condition [11]. Where
previously VC was one option of many, it became the
method of access for most outpatient and ongoing
healthcare services during both lockdowns and periods
of high transmission.
This study presents an analysis of the rate of
HbA1c
tests consistent with diabetes in patients presenting to
Blacktown/Mount Druitt emergency departments before
and since the COVID-19 pandemic has begun, with a
similar examination of diagnosed COVID-19 cases in GP
clinics, as well as some interrogation of the reasons that
this rate may have changed with a particular focus on a
switch to VC. We hypothesize that the rates have varied
substantially due to the pandemic, and that this has had
an impact on the reasons for using VC.
Methods
This analysis used an existing dataset of those who
have had
HbA1c tests through the ED in Blacktown and
Mount Druitt Hospitals in western Sydney. The detailed
methodology for this testing has previously been pub-
lished [8]. Briefly, all patients who attend the ED and
have a blood test irrespective of reason for presentation
undergo HbA1c testing on the proviso that there is suf-
ficient sample to undertake this measurement. Patients
are not re-tested if they represent within 3 months of a
previous test. This dataset represents 173,805 tests per-
formed between
1st
June 2016 and
12th
November 2021.
75 HbA1c tests were missing in this population, leaving
120,083 to be analysed in this study.
There were no specific inclusion criteria beyond being
included in this dataset, and only patients with missing
data on
HbA1c tests were excluded. This methodology
allows for both those already diagnosed with diabetes
and those newly diagnosed through this screening pro-
gram to be included.
We also analysed a sample of all patients attend-
ing selected General Practice clinics in western Sydney.
This represented the de-identified aggregate informa-
tion of 188 individual clinics, and a total of 1.8 million
patients. Within this dataset, we looked at the proportion
of patients with diabetes attending GP clinics before and
during the implementation of lockdown measures. This
also included an examination of
HbA1c testing rates in
GP clinics, as a measure of the care that was being offered
during this time. Diabetes in this dataset is defined as a
GP flag of diabetes, excluding gestational diabetes. The
dataset included data from the start of collection for
these 188 clinics, September 2019, until the most recent
extract date at the end of October 2021. Prior to Septem-
ber 2019, a smaller number of GP clinics were included
in this dataset, with about 130 as of the start of 2019.
Finally, we retrospectively reviewed routinely-collected
hospital data from Blacktown/Mt Druitt hospitals, two
hospitals in western Sydney with a total of 600 beds. We
also reviewed the VC provision using routinely-collected
data from the Western Sydney Diabetes (WSD) clinics,
which service both of these hospitals.
WSD is an integrated care program spanning primary
and secondary prevention, with an aim to both prevent
people from getting diabetes, targeting high-risk indi-
viduals to improve their health, and preventing further
complications for those who already have diabetes. WSD
has a series of clinics including a joint case-conferencing
3. Page 3 of 9
Meyerowitz‑Katz et al. BMC Health Services Research (2023) 23:167
service [12], complex diabetes clinics, post-discharge
clinics, insulin stabilisation services, app-based health-
care provision, and various other VC services. These
provide around 5,500 occasions of service to over 1,000
patients per year. Services were classified into either
those provided by VC (including telehealth, audiovisual
consultations, email, and mHealth) or those provided
FTF.
All analysis was performed using Stata 15.1. In the
hospital dataset, we computed the average weekly pro-
portion of people with an
HbA1c meeting the American
Diabetes Association criteria for a test consistent with
diabetes [10] of 6.5% (48 mmol/mol), as well as the 95%
confidence interval for this figure. We then compared this
to the observed proportion of people presenting since the
state of New South Wales (NSW) began its lockdown on
the week beginning
16th
March. We also stratified this by
age and sex to examine whether these factors were influ-
encing the rate of diabetes in this population. We com-
pared the average rate of diabetes in the population both
using the 95% confidence intervals and performing a sim-
ple t-test comparing the rates before and during the pan-
demic to gauge statistical significance.
Results
Demographics for the ED population are presented in
Table 1. The mean age of the entire sample was 51 years,
with the average age increasing with
HbA1c. There was
a slightly higher proportion of females to males in the
sample, with 55% of the overall sample being female.
Men made up a larger proportion of those with elevated
HbA1c.
In the time period since the week beginning March
16th
, the number of tests performed in these EDs has
declined, from an average just below 642 per week to
556 per week. This appears to correspond to a decline
in the rate of ED attendances, with roughly half the
expected attendances per week in late March and April
of 2020 compared to 2019. There have also been differ-
ences in the people attending ED, with fewer people
over the age of 65, and a decline in the proportion who
are female. This is shown in Table 2.
The primary findings are presented in Fig. 1. During
the time period from when NSW began legally enforc-
ing isolation measures due to the epidemic of COVID-
19, there was a significant decrease in the rate of people
attending ED with elevated
HbA1c consistent with dia-
betes. As can be seen in Fig. 1, in most weeks this was
below the 95% confidence interval from previous years.
The rate has decreased from a mean varying between
a low of 15% and a high of 25% to an average of just
over 11% consistent with diabetes during this pandemic
period.
Examining this rate by gender and age, there are some
important findings. The reduction in the rate of tests
consistent with diabetes appears to be largely driven
by a decrease in the median age of people presenting.
Once age-stratified, there appears to be some difference
in diabetes percentages by age group. This is shown in
Table 1 Demographics by diabetes status
a
mean with standard deviation in brackets b
proportion of total. Diabetes/pre-diabetes defined using ADA criteria of>6.5% and 5.7–6.4% as above
No Diabetes Pre-diabetes Diabetes
All (n) 62,473 (52%) 36,751 (31%) 20,859 (17%)
Agea
42.3 (19.3) 59.1 (19.0) 64.2 (16.0)
HbA1c
a
HbA1c (%) 5.3 (0.3) 6.0 (0.2) 8.0 (1.6)
HbA1c (mmol/mol) 34 42 64
Sexa
Female 36,321 (58.1%) 19,256 (52.4%) 10,151 (48.7%)
Male 26,152 (41.9%) 17,495 (47.6%) 10,708 (51.3%)
BMI (Kg/ma
2)a
27.5 (7.2) 29.1 (8.0) 31.2 (8.8)
Aboriginalitya
Aboriginal or Torres Strait Islander 3559 (5.7%) 1275 (3.5%) 863 (4.1%)
Neither Aboriginal nor Torres Strait Islander 58,914 (94.3%) 35,476 (96.5%) 19,996 (95.9%)
Table 2 Comparison of before/after COVID values for testing for
the entire time period
Pre-COVID During COVID
Tests per week 642 556
Median age 50 47
% male 45.0 46.4
% over 65 years old 29.5 26.9
% under 40 years old 37.0 40.9
4. Page 4 of 9
Meyerowitz‑Katz et al. BMC Health Services Research (2023) 23:167
Fig. 2. There is also indication of a significant interac-
tion with gender, with females in this sample showing
a downward trend in high
Hba1c results, however this
trend was not apparent in the male population until the
second wave in NSW. This is shown in Fig. 3.
Comparing the pre-COVID-19 rates of diabetes with
the pandemic rate using t-test gives a p-value<0.001,
Fig. 1 Percentage of patients with tests consistent with diabetes tested in ED by week since 2016. The 4-year average is for the years preceding the
pandemic
Fig. 2 Percentage of patients with tests consistent with diabetes tested in ED by week since 2016 by sex
5. Page 5 of 9
Meyerowitz‑Katz et al. BMC Health Services Research (2023) 23:167
with the average rate of diabetes-consistent tests at 17.3%
prior to COVID-19 and only 13.1% now.
These findings were not matched in the GP data. The
mean rate of diabetes patient attendance in adults in the
GP dataset prior to March in 2020 was 11.3%, which
rose slightly to 11.8% during the pandemic period as
seen in Fig. 4. This then continued to rise throughout
the pandemic, with the rate stabilizing at 12% towards
the end of 2021. However, the average number of adults
active in the system fell slightly from 633,228 to 609,936,
a drop of 3.7%.
Moreover, there did not appear to be a greater rate of
diabetes in hospitalized adults, with similar trends both
before and during the pandemic.
During the pandemic, the proportion of services
offered through VC rose sharply from an average of 9.1%
prior to March 2020 to 76.8% after that time (p<0.0001),
despite the average monthly number of consultations
remaining steady during this time-period. This can be
seen quite clearly in Fig. 5, which shows the stark divide
between the proportion of services used before and dur-
ing the pandemic. There was something of an initial lag
during March/April 2020 as VC was being set up. Virtual
Care had been temporarily halted at these clinics before
Fig. 3 Percentage of patients with tests consistent with diabetes tested in ED by week since 2016 by age
Fig. 4 Proportion of adults attending GP clinics with diagnosed diabetes (n=615 k per month)
6. Page 6 of 9
Meyerowitz‑Katz et al. BMC Health Services Research (2023) 23:167
March 2020 due to the setting up of a new service that
was due to begin mid-2020 – the pandemic brought for-
ward this new service substantially.
There was also a noticeable change in the proportion
of services used when there were outbreaks compared to
none. The first lockdown in NSW occurred at the point
of the red line, with a second wave of restrictions coming
through due to an outbreak in October 2020. These were
relaxed in January 2020, at which point VC fell dramati-
cally, and then reinstated during the 2021 lockdown in
July 2021. Looking at the proportion of services provided
through VC, where there were interventions in place to
control outbreaks (April, May, June, November, Decem-
ber in 2020 and January, July, August, September, Octo-
ber in 2021) the average use of virtual care was 90.3%
compared to 65.8% in non-outbreak months (p=0.0014).
All services continued to be provided during the pan-
demic period, although the denominator increased mod-
estly as a new clinic was started in May 2020.
Hospital services appeared to be unaffected, with simi-
lar numbers pre and during pandemic for admissions due
to hypoglycaemia, retinopathy, and diabetic chronic kid-
ney disease (p>0.05) in these hospitals.
Finally, there was an interesting trend whereby during
periods where NSW experienced lockdowns (see Fig. 6),
there were fewer patients who attended the ED with tests
consistent with diabetes. Comparing the average rate of
diabetes using a t-test between the times where the state
was locked down and those it was not produces a p-value
below 0.001.
Discussion
In this study, we demonstrate that there is a significant
trend in established datasets towards reduced proportion
of people having tests consistent with diabetes in ED but
not in GP. Indeed, in contrast to the effect seen in ED,
there appear to be more people attending GP with diabe-
tes in 2021 than the prior rate in adults during 2019/20.
While this may be related to increased testing, it is also
likely to be some evidence of replacement of services as
people have avoided hospitals and instead attended GP
clinics for their chronic disease during COVID-19.
Moreover, at the onset of the COVID-19 pandemic,
there was a steep increase in use of VC services in two
hospitals in western Sydney. From a very low baseline
of less than 10% of services provided through VC, clin-
ics pivoted to provide many or even most appointments
through VC modalities. This has allowed these outpatient
chronic care services to continue despite ongoing restric-
tions during the pandemic, and has no noticeable acutely
negative impact on patient care.
This is similar to trends seen elsewhere during the pan-
demic. Numerous studies have demonstrated reduced
use of hospital and GP services during lockdowns and
other high-transmission periods internationally [13, 14].
Moreover, there has been a hypothesized impact on dia-
betes-specific services during COVID-19 from patients
Fig. 5 Proportion of services provided through Virtual Care before and during COVID-19 pandemic with onset of pandemic outlined in red
7. Page 7 of 9
Meyerowitz‑Katz et al. BMC Health Services Research (2023) 23:167
wary of infection or unable to attend services due to
lockdowns [15, 16]. We have now proven that these wor-
ries may be well-founded, as people with diabetes have
substantially reduced their interaction with hospital
services during the pandemic, especially during high-
transmission periods. Similarly large studies elsewhere in
the world have found varying levels of concern over this
important issue in the past [15].
These findings have important implications to cur-
rent and future practice. While it may be difficult to
manage diabetes during a pandemic, the fact that peo-
ple with diabetes were on average a lower proportion
of the population attending hospital and community
services well before cases peaked in various waves has
some potential negative connotations. While NSW
began locking down on the
16th
of March, there were
at this point few deaths in the state. However, there was
a marked decline in both the number and proportion
of people with
HbA1c consistent with diabetes attend-
ing ED, and fewer people attending their GP, perhaps
indicating an undercurrent of fear in the general pop-
ulation of being infected with the virus, in terms of
accessing health services. This was compounded by an
additional ‘lockdown effect’, where people with diabe-
tes were substantially less likely to attend ED during the
state’s lockdowns. The concern here is that individuals
with diabetes may become unwell independent of fac-
tors directly related to the pandemic; any delay in them
presenting to hospital may result in a more severe and
complicated illness.
However, there is also a positive reading of these data.
If this represents a replacement of services, it may actu-
ally be a good outcome, by reducing the usage of high-
cost tertiary services and pushing people towards more
care in the community [12, 17]. This is also noticeable
in the massively increased use of VC in hospital clinics
that has continued even after restrictions were lifted.
This may also be seen in a positive light. During this
time of increased activity within the health facilities pre-
paring to combat COVID-19, a reduction in presenta-
tions of individuals with chronic disease to higher risk
facilities is possibly ideal to reduce the risk of viral infec-
tion. The fact that GP attendance for the management of
diabetes has not dropped, and appear to have increased
slightly, may represent a shift towards telemedicine dur-
ing this time, although the data is not yet in to demon-
strate this.
However, this reluctance to attend ED and GP has led to
the rapid development and maturation of services to sup-
port community based management with the availability
of new funding through the Medicare Benefits Scheme
(MBS) facilitating the process. In Blacktown Hospital, the
majority of ambulatory care services, including clinics for
complex type 2 diabetes have been converted from face-
to-face encounters to telephone and telehealth services,
which persisted in some form throughout the pandemic
period. This includes the provision of video consultations
Fig. 6 Proportion of those testing positive with lockdown periods shaded
8. Page 8 of 9
Meyerowitz‑Katz et al. BMC Health Services Research (2023) 23:167
for joint GP-specialist case conferencing and diabetes
education, the establishment of pathways for flash glu-
cose monitoring utilizing local pharmacies and a package
of app-based interventions, to ensure that people with
diabetes are still able to access care during this period.
Indeed, the potential replacement of ED with other
service echoes international evidence demonstrating
that patients have often switched from existing services
to virtual care modalities to avoid in-person consulta-
tions during the pandemic [18]. This change in the use of
healthcare services has the potential to improve diabetes
care, insofar as it reduces reliance on high-cost emer-
gency services and provides more sustainable chronic
care for patients who have long-term chronic disease
[19]. However, this approach may also have drawbacks –
these primary care services do not always have sufficient
resources to treat severe or complex cases [20], and the
reduction in presentations to ED does not perfectly mir-
ror the increases seen in GP. It is likely that some indi-
viduals have missed out on needed care even if some
replacement took place, which may represent a burden in
terms of untreated chronic disease as time goes on [4].
Conclusions
Overall, we demonstrated that during a during the
COVID-19 pandemic, the rate of presentations consist-
ent with diabetes in a busy ED declined significantly from
17.4% to 13.1% per week. The rate of attendances to GP
clinics for diabetes in the same area was not similarly
impacted, with the proportion of patients diagnosed with
diabetes actually increasing, however the total number
of presentations was reduced. This was primarily driven
by a smaller proportion of older patients presenting, with
a younger median age in the group attending the ED
than in previous periods and a significant age interac-
tion with the trend, and may indicate a less acute patient
population overall in the hospital outside of COVID-19
presentations. This complex interaction requires further
exploration, and may have both costs and benefits for
the healthcare system. A key future goal will be to iden-
tify whether people have replaced their missed ED care
through GP services, or if this represents a worrying
increase in diabetes service use in the healthcare system
more broadly.
Acknowledgements
we would like to acknowledge the staff and patients of WSLHD.
Authors’contributions
GMK designed the study and ran all analyses. GMK and SF collected all data.
All authors assisted in drafting and editing the manuscript. The author(s) read
and approved the final manuscript.
Funding
This work was supported by NSW Health. TAB was supported by a National
Health and Medical Research Council Boosting Dementia Research Leader
Fellowship (#1140317).
Availability of data and materials
The data that support the findings of this study are available from NSW Health
but restrictions apply to the availability of these data, which were used under
license for the current study, and so are not publicly available. Data may be
available from GMK Gideon.meyerowitzkatz@health.nsw.gov.au upon reason‑
able request and with permission of NSW Health as well as relevant ethics
bodies governing the use of this data for research and other purposes.
Declarations
Ethics approval and consent to participate
All methods were carried out in accordance with relevant guidelines and
regulations. This study was approved by the Western Sydney LHD HREC,
approval ETH01985, with consent to participate waived due to the retrospec‑
tive and deidentified nature of the study.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Received: 15 August 2022 Accepted: 10 February 2023
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