Beth M. Costa

Effectiveness of IT-based diabetes management interventions: a review of the literature.

BackgroundInformation technology (IT) is increasingly being used in general practice to manage health care including type 2 diabetes. However, there is conflicting evidence about whether IT improves diabetes outcomes. This review of the literature about IT-based diabetes management interventions explores whether methodological issues such as sample characteristics, outcome measures, and mechanisms causing change in the outcome measures could explain some of the inconsistent findings evident in IT-based diabetes management studies.MethodsDatabases were searched using terms related to IT and diabetes management. Articles eligible for review evaluated an IT-based diabetes management intervention in general practice and were published between 1999 and 2009 inclusive in English. Studies that did not include outcome measures were excluded.ResultsFour hundred and twenty-five articles were identified, sixteen met the inclusion criteria: eleven GP focussed and five patient focused interventions were evaluated. Nine were RCTs, five non-randomised control trials, and two single-sample before and after designs. Important sample characteristics such as diabetes type, familiarity with IT, and baseline diabetes knowledge were not addressed in any of the studies reviewed. All studies used HbA1c as a primary outcome measure, and nine reported a significant improvement in mean HbA1c over the study period; only two studies reported the HbA1c assay method. Five studies measured diabetes medications and two measured psychological outcomes. Patient lifestyle variables were not included in any of the studies reviewed. IT was the intervention method considered to effect changes in the outcome measures. Only two studies mentioned alternative possible causal mechanisms.ConclusionSeveral limitations could affect the outcomes of IT-based diabetes management interventions to an unknown degree. These limitations make it difficult to attribute changes solely to such interventions.

QUALITATIVE EXPLORATION OF THE NATURE OF GRIEF-RELATED BELIEFS AND EXPECTATIONS*

Societal expectations of grief impact the experience of bereavement. The congruence of societal expectations with current scientific understanding of grief is unknown. Therefore two qualitative studies explored community perceptions of grief. In study one, three small focus groups (N = 9) examined grief-related expectations associated with hypothetical scenarios of bereavement. In study two, the impact of grief-related perceptions on the lived experience of bereavement for 11 individuals was explored through semi-structured interviews. Across both studies, elements of a traditional stage model view of grief were evident, with participants viewing emotional expression of grief as important. An avoidant coping style in the bereaved was considered problematic. Findings of study two suggested that grief-related beliefs may impact the bereavement experience via appraisal of the grief response and willingness to support bereaved individuals. The studies suggested that stage model assumptions in the beliefs of the general population persist, although there was a recognition of diversity in the grief response.

The CDM-Net Project: The Development, Implementation and Evaluation of a Broadband-Based Network for Managing Chronic Disease

Background. In Australia most chronic disease management is funded by Medicare Australia through General Practitioner Management Plans (GPMPs) and Team Care Arrangements (TCAs). Identified barriers may be reduced effectively using a broadband-based network known as the Chronic Disease Management Service (CDMS). Aims. To measure the uptake and adherence to CDMS, test CDMS, and assess the adherence of health providers and patients to GPMPs and TCAs generated through CDMS. Methods. A single cohort before and after study. Results. GPMPs and TCAs increased. There was no change to prescribed medicines or psychological quality of life. Attendance at allied health professionals increased, but decreased at pharmacies. Overall satisfaction with CDMS was high among GPs, allied health professionals, and patients. Conclusion. This study demonstrates proof of concept, but replication or continuation of the study is desirable to enable the impact of CDMS on diabetes outcomes to be determined.

Refinement and validation of the Work Readiness Scale for graduate nurses

The transition from student to registered nurse is often stressful and has been attributed to a lack of work readiness. Understanding what comprises work readiness for newly registered nurses, or graduate nurses as they are referred to in Australia, may reduce attrition and improve transition into the workplace. The 64-item Work Readiness Scale (WRS), developed with a generic population of graduates, has yet to be validated against specific disciplines to confirm applicability as a measure of work readiness. This study adapted the original WRS for use with a graduate nurse population (WRS-GN). The aim was to refine and validate the WRS-GN and determine whether the original four factor construct was supported. The WRS-GN was completed by 450 graduate nurses. Exploratory factor analyses supported the original four-factor solution (social intelligence, personal work characteristics, organizational acumen, and work competence). The final WRS-GN consisted of 46 items, showed excellent reliability, and explained 73.55% of the variance.

Transition into the workplace: comparing health graduates’ and organisational perspectives

Background: Health graduates face personal and work-related stressors during the graduate year. The extent to which employers and health graduates have a shared understanding of graduate stressors is unclear but may impact graduate support and transition into the health profession. Aim and design: The aim of this exploratory qualitative study was to identify factors that impact health graduates’ transition and integration into the workplace, comparing the perspectives of health graduates and organisational representatives. Method: Individual and small group semi-structured interviews were conducted with 15 medical and 26 nursing graduates and five organisational representatives from a regional health organisation in Victoria, Australia. A thematic analysis was undertaken on the data. Findings: Five main categories were identified: dealing with change, dealing with conflict, workload, taking responsibility and factors that influence performance. Conclusion: Similarities and differences in the perspectives of health graduates and organisational representatives were identified. These findings have implications for current graduate support programs.

Development of readiness to change and self-efficacy in anorexia nervosa clients: personal perspectives

ABSTRACT Objective: Anorexia nervosa is a significant cause of physical and psychological morbidity. The Transtheoretical Model (TTM) is frequently used to conceptualise the process of intentional behaviour change. Instability and inconsistency of the TTM stages of change exist across anorexia symptom dimensions. The current study qualitatively explored readiness for change and self-efficacy in relation to six related but distinct anorexic symptom dimensions. Method: Fifteen individuals currently diagnosed with or recently recovered from anorexia participated in a semi-structured interview. Findings: Participants in the central stages of the TTM reported variability and instability in their readiness to change and self-efficacy across the six dimensions. Participants were most prepared to address cognitive/emotional issues and least prepared to alter their weight and avoidance of specific foods. Discussion: These findings extend previous quantitative research to suggest readiness for change and self-efficacy resemble motivational states rather than stages. The implications for clinicians are discussed.