Limited evidence to assess the impact of primary health care system or service level attributes on health outcomes of Indigenous people with type 2 diabetes: a systematic review
| Autor: | Leonie Segal, Odette Gibson |
|---|---|
| Přispěvatelé: | Gibson, Odette R, Segal, Leonie |
| Rok vydání: | 2015 |
| Předmět: |
Adult
Male Canada medicine.medical_specialty Health informatics Health administration Diabetes mellitus Population Groups Nursing Health care Hospitalisation medicine Humans Disease management (health) Aged Aged 80 and over Primary Health Care Indigenous people hospitalisation business.industry Health Policy Public health Nursing research Australia Disease Management Middle Aged United States primary health care Critical appraisal Treatment Outcome Systematic review Diabetes Mellitus Type 2 disease management diabetes mellitus Female business Research Article New Zealand |
| Zdroj: | BMC Health Services Research |
| ISSN: | 1472-6963 |
| DOI: | 10.1186/s12913-015-0803-6 |
| Popis: | Background: To describe reported studies of the impact on HbA1C levels, diabetes-related hospitalisations, andother primary care health endpoints of initiatives aimed at improving the management of diabetes in Indigenousadult populations of Australia, Canada, New Zealand and the United States. Method: Systematic literature review using data sources of MEDLINE, Embase, the Cochrane Library, CINHAL andPsycInfo from January 1985 to March 2012. Inclusion criteria were a clearly described primary care intervention,model of care or service, delivered to Indigenous adults with type 2 diabetes reporting a program impact on atleast one quantitative diabetes-related health outcome, and where results were reported separately for Indigenouspersons. Joanna Briggs Institute critical appraisal tools were used to assess the study quality. PRISMA guidelineswere used for reporting. Results: The search strategy retrieved 2714 articles. Of these, 13 studies met the review inclusion criteria. Three levels ofprimary care initiatives were identified: 1) addition of a single service component to the existing service, 2) system-levelimprovement processes to enhance the quality of diabetes care, 3) change in primary health funding to support betteraccess to care. Initiatives included in the review were diverse and included comprehensive multi-disciplinary diabetes care,specific workforce development, systematic foot care and intensive individual hypertension management. Twelve studiesreported HbA1C, of those one also reported hospitalisations and one reported the incidence of lower limb amputation.The methodological quality of the four comparable cohort and seven observational studies was good, and moderate forthe two randomised control trials. Conclusions: The current literature provides an inadequate evidence base for making important policy and practicedecisions in relation to primary care initiatives for Indigenous persons with type 2 diabetes. This reflects a very smallnumber of published studies, the general reliance on intermediate health outcomes and the predominance ofobservational studies. Additional studies of the impacts of primary care need to consider carefully research design and thereporting of hospital outcomes or other primary end points. This is an important question for policy makers and furtherhigh quality research is needed to contribute to an evidence-base to inform decision making. Refereed/Peer-reviewed |
| Databáze: | OpenAIRE |
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