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  • 1
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  51. Kongress für Allgemeinmedizin und Familienmedizin; 20170921-20170923; Düsseldorf; DOC17degam155 /20170905/
    Publication Date: 2017-09-05
    Keywords: HbA1C ; Mortalität ; Typ 2 Diabetes Mellitus beim Hausarzt ; ddc: 610
    Language: German
    Type: conferenceObject
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  • 2
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  86. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie; 20150513-20150516; Berlin; DOC15hnod595 /20150326/
    Publication Date: 2015-03-27
    Keywords: ddc: 610
    Language: German
    Type: conferenceObject
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  • 3
    Keywords: INTERVENTION ; VALIDITY ; GLYCEMIC CONTROL ; MELLITUS ; MEDICATION
    Abstract: The care of diabetes patients is mostly undertaken by general practitioners. In order to achieve sufficient control of blood sugar levels and blood pressure in patients and thus to avoid complications and secondary diseases, a patient-centered disease management and support of patient self-management are essential. These functions can be partially delegated. The DIANA study is an epidemiological physician-based prospective cohort study on new approaches for optimization of general practitioner care. The objectives were to investigate the current status of diabetes care as well as the consequences of a patient-centered treatment approach on the course of diabetes. Furthermore, the effectiveness of a supportive telephone counseling service over 12 months by trained medical practice personnel was investigated. The DIANA study consists of a basic survey and an interventional study. A total of 38 general medical practices with 1,146 patients diagnosed with type 2 diabetes were included. For the basic survey standardized questionnaires were completed by the patients and their physicians. Furthermore, blood samples were taken from patients for determination of HbA1c levels in a certified laboratory. Patients with HbA1c levels 〉 7.5 % in the basic survey were eligible for inclusion in the interventional study. In this subpopulation of 204 patients the effectiveness of an intervention with telephone support by trained personnel from the medical practices in the study was investigated. The patients who agreed to participate were randomized to either the intervention group or the control group. The control group received usual care. Mean HbA1c was 6.9 % in this sample and thus within the target corridor of the new German clinical practice guidelines on type 2 diabetes of 6.5-7.5 %. Nevertheless, about one fifth of the patients' values were above the corridor and thus in a dissatisfactory zone. In addition, participating patients had considerable comorbidities, such as hypertension, coronary heart disease, cardiac insufficiency, and depression. Another problem was medication adherence among patients. Self-reported medication adherence was associated with poor glycemic control, especially in men. Young, employed and unmarried patients and those with depression symptoms were particularly at risk. The intervention had only limited effects. The primary outcome HbA1c decreased likewise in both groups. A decrease of systolic blood pressure was observed in the intervention group, but which was not sustained after the end of the intervention. It was only after the end of the intervention that health-related quality of life improved in the intervention group. There is a large problem group of diabetes patients with an unsatisfactory metabolic situation. General practitioners should concentrate on these patients and be aware that younger, employed and single as well as depressive patients are particularly affected. A long-term accompaniment by trained personnel could be useful.
    Type of Publication: Journal article published
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  • 4
    Publication Date: 2012-08-01
    Description: Objective: Social support is an important element of family medicine within a primary care setting, delivered by general practitioners and practice nurses in addition to usual clinical care. The aim of the study was to explore general practitioner's, practice nurse's and people with type 2 diabetes' views, experiences and perspectives of the importance of social support in caring for people with type 2 diabetes and their role in providing social support. Methods: Interviews with general practitioners (n=10) and focus groups with practice nurses (n=10) and people with diabetes (n=9). All data were audio-recorded, fully transcribed and thematically analysed using qualitative content analysis by Mayring.Results: All participants emphasized the importance of the concept of social support and its impacts on well-being of people with type 2 diabetes. Social support is perceived helpful for people with diabetes in order to improve diabetes control and give support for changes in lifestyle habits (physical activity and dietary changes). General practitioners identified a lack of information about facilities in the community like sports or self-help groups. Practice nurses emphasized that they need more training, such as in dietary counselling. Conclusions: Social support given by general practitioners and practice nurses plays a crucial role for people with type 2 diabetes and is an additional component of social care. However there is a need for an increased awareness by general practitioners and practice nurses about the influence social support could have on the individual's diabetes management.
    Description: Zielsetzung: Soziale Unterstützung stellt ein wichtiges und ergänzendes Element in der hausärztlichen Versorgung dar. In der vorliegende Studie wurden die Einstellungen zu und Erfahrungen mit sozialer Unterstützung sowie deren Bedeutung im hausärztlichen Setting von Allgemeinärzten, Medizinischen Fachangestellten (MFA) und Patienten mit Diabetes mellitus Typ 2 erfasst.Methodik: Es wurden Interviews mit Allgemeinärzten (n=10) sowie Fokusgruppen mit MFAs (n=10) und Patienten mit Diabetes mellitus Typ 2 (n=9) durchgeführt. Die Daten wurden aufgezeichnet, transkribiert und thematisch unter Verwendung der qualitativen Inhaltsanalyse nach Mayring analysiert.Ergebnisse: Alle Teilnehmer betonen die Relevanz des Konzepts der sozialen Unterstützung und vor allem den daraus resultierenden Einfluss auf das Wohlbefinden von Patienten mit Diabetes mellitus Typ 2. Soziale Unterstützung wird von den befragten Patienten als hilfreiches Konzept empfunden, um die eigenen Werte zu verbessern und um Lebensstilveränderungen umzusetzen (körperliche Aktivität oder Ernährungsumstellung). Allgemeinärzte nehmen ihrerseits einen Mangel an Informationen über kommunale Angebote wie zum Beispiel Sportkurse oder auch Selbsthilfegruppen wahr. MFAs wünschen sich mehr Fortbildungsmöglichkeiten, um in der Praxis zum Beispiel Ernährungsberatung durchführen zu können. Fazit: Soziale Unterstützung durch Praxisteams in der hausärztlichen Versorgung spielt eine wichtige Rolle für Patienten mit Diabetes mellitus Typ 2. Allerdings sollten sich sowohl Allgemeinärzte als auch MFAs noch mehr darüber bewusst werden, welchen Einfluss und Nutzen soziale Unterstützung auf das individuelle Diabetesmanagement haben kann.
    Keywords: social support ; type 2 diabetes ; qualitative approach ; primary health care ; soziale Unterstützung ; Diabetes mellitus Typ 2 ; qualitativer Forschungsansatz ; hausärztliche Versorgung ; ddc: 610
    Language: English
    Type: article
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  • 5
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  48. Kongress für Allgemeinmedizin und Familienmedizin; 20140918-20140920; Hamburg; DOC14degam167 /20140911/
    Publication Date: 2014-09-12
    Keywords: Diabetes mellitus 2 ; Hausärztliche Versorgung ; Identifizierung von Risikopatienten ; ddc: 610
    Language: German
    Type: conferenceObject
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  • 6
    Keywords: RISK ; HEALTH ; RELIABILITY ; VALIDITY ; ASSOCIATIONS ; depression ; CONCORDANCE ; PRIMARY-CARE ; ADHERENCE ; IMPAIRED FASTING GLUCOSE
    Abstract: Aims: Our main aim was to analyse gender differences in the association of adherence and poor glycaemic control (PGC) in a cohort of patients with type 2 diabetes mellitus in Germany. Methods: Baseline data of the DIANA-study, a prospective cohort study of type 2 diabetes mellitus patients in South-West Germany, were analysed. Information on medication adherence and factors related to PGC was obtained by self-administered questionnaire. PGC was defined as HbA(1c) 〉= 7.5%. Bivariate and multivariate analyses using log-binomial regression were employed to assess overall and gender-specific associations of non-adherence and PGC. Results: 624 men and 518 women were included in the analyses. In total, 147 men (24%) and 114 women (23%) reported non-adherence to medication. In men, PGC was found in 37% of the participants reporting non-adherence and in 19% reporting adherence (adjusted prevalence ratio (PR) = 1.90, 95%-CI: 1.46-2.49). In women, PGC was found in 19% of the participants reporting non-adherence and in 18% reporting adherence (adjusted PR = 0.97, 95%-CI: 0.65-1.46). Conclusions: Our results show gender-specific differences in the association of adherence and PGC. This underlines the need for efforts to improve glycaemic control in patients with type 2 diabetes mellitus with a particular focus on men.
    Type of Publication: Journal article published
    PubMed ID: 22763108
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  • 7
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  45. Kongress für Allgemeinmedizin und Familienmedizin, Forum Medizin 21; 20110922-20110924; Salzburg; DOC11fom171 /20110914/
    Publication Date: 2011-09-14
    Keywords: ddc: 610
    Language: German
    Type: conferenceObject
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  • 8
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  50. Kongress für Allgemeinmedizin und Familienmedizin; 20160929-20161001; Frankfurt am Main; DOC16degam249 /20160919/
    Publication Date: 2016-09-19
    Keywords: Evidenzbasierte Medizin ; Hausärztliche Behandlungskunst ; ddc: 610
    Language: German
    Type: conferenceObject
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  • 9
    Keywords: DISEASE ; MORTALITY ; POPULATION ; IMPACT ; CENTERS ; BEHAVIOR ; QUALITY-OF-LIFE ; SEX-DIFFERENCES
    Abstract: Objectives: To examine gender differences in healthcare utilization including outpatient and inpatient medical care for patients with type 2 diabetes mellitus (T2DM) despite participation in T2DM-specific disease management programs (DMP-DM). Study Design: Baseline data from a cohort study in southwest Germany including 1146 patients with T2DM recruited between October 2008 and March 2010 were used. Methods: After bivariate analyses, multivariate Poisson and logistic regression models were used to estimate the effect of sex on the number of general practitioner (GP) and medical specialist appointments, prescribed medications, hospitalizations, and inpatient rehabilitations, with additional consideration of glycemic control levels. Poor glycemic control (PGC) was defined as glycated hemoglobin 〉= 7.5%. Results: In total, 905 participants had acceptable glycemic control and 237 participants had poor glycemic control. PGC was more prevalent in men than in women (23% vs 18%). Bivariate analyses among participants with PGC showed significantly fewer GP and medical specialist appointments, a lower number of medications, and longer rehabilitation stays in men than in women. Multivariate regression analyses among participants with PGC confirmed statistically significant gender differences for GP appointments and number of prescribed medications (P 〈.05) for men compared with women. Gender differences regarding inpatient care were less evident. Conclusions: Our data disclosed major gender differences in healthcare utilization of diabetes patients in Germany despite a high DMP-DM rate. Future research should focus attention on gender-specific approaches to healthcare delivery to improve quality and access to care.
    Type of Publication: Journal article published
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  • 10
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