A qualitative study of processes used to implement evidence-based care in a primary care practice.

Background: Evidence-based guidelines for care of coronary heart disease patients are not fully implemented. Primary care practices provide most of the care for these patients.

Objective: To learn how providers and staff in a busy primary care practice implement interventions to provide evidence-based care of coronary heart disease patients.

Are benefits from diabetes self-management education sustained?

Objectives: To evaluate whether outcomes from diabetes self-management education for patients with suboptimal control were sustained.

Study Design: A randomized controlled trial of 623 adults with type 2 diabetes and glycated hemoglobin (A1C) > 7% assigned to receive conventional individual education (IE), group education (GE) using US Diabetes Conversation Maps, or usual care (UC) with no education.

Methods: A1C tests, Problem Areas in Diabetes (PAID), Diabetes Self-Efficacy (DES), Recommended Food Score (RFS), physical activity, and medication use were quantified at baseline and 1 year of follow-up through electronic health records and quarterly mailed surveys.

Comparative effectiveness of patient education methods for type 2 diabetes: a randomized controlled trial.

Background: Group education for patients with suboptimally controlled diabetes has not been rigorously studied.

Methods: A total of 623 adults from Minnesota and New Mexico with type 2 diabetes and glycosylated hemoglobin (HbA(1c)) concentrations of 7% or higher were randomized to (1) group education (using the US Diabetes Conversation Map program), (2) individual education, or (3) usual care (UC; ie, no assigned education). Both education methods covered content as needed to meet national standards for diabetes self-management education and were delivered through accredited programs from 2008 to 2009.

A comparative analysis of recruitment methods used in a randomized trial of diabetes education interventions.

Recruitment methods heavily impact budget and outcomes in clinical trials. We conducted a post-hoc examination of the efficiency and cost of three different recruitment methods used in Journey for Control of Diabetes: the IDEA Study, a randomized controlled trial evaluating outcomes of group and individual diabetes education in New Mexico and Minnesota. Electronic databases were used to identify health plan members with diabetes and then one of the following three methods was used to recruit study participants: 1.

Doctors' literacy and papyri of medical content.

The Hippocratic Corpus testifies to the existence of literate doctors, as well as to literate laymen interested in medicine, by the close of the fifth century BC. It is only in later Antiquity, however, that one can begin to speak with confidence about medical literacy encompassing a wide range of specific physicians and a lay public with valetudinarian interests. Evidence from the Roman province of Egypt, when coupled with testimony from Galen and others, is particularly helpful in the effort to sketch a portrait of writers and readers for medical texts.

Does diabetes double the risk of depression?

Purpose: In this study, we compared the rate of depression diagnoses in adults with and without diabetes mellitus, while carefully controlling for number of primary care visits.

Methods: We matched adults with incident diabetes (n = 2,932) or prevalent diabetes (n = 14,144) to nondiabetic control patients based on (1) age and sex, or (2) age, sex, and number of outpatient primary care visits. Logistic regression analysis was used to assess the association between various predictors and a diagnosis of depression in each diabetes cohort relative to matched nondiabetic control patients.

Greek medical papyri from the Fayum village of Tebtunis: patient involvement in a local health-care system?

The Greek papyri of medical content from Tebtunis are conspicuous for their quantity and quality, when compared with neighbouring villages. By isolating another feature in which Tebtunis is also unique--namely, in the relatively large number of those of privileged status who maintained residences and left important documents in the village, it would appear that these outsiders were instrumental in interesting the local priests in sophisticated Greek medicine and in bringing medical texts into the village. Tebtunis may thus provide an ancient example of patients influencing the health care available to them and their families when resident in the village.

Predictors of health care costs in adults with diabetes.

Objective: The purpose of this study was to assess the impact of baseline A1c, cardiovascular disease, and depression on subsequent health care costs among adults with diabetes.

Research Design And Methods: A prospective analysis was performed of data from a patient survey and medical record review merged with 3 years of medical claims. Costs were estimated using detailed data on resource use and Medicare payment methodologies.