Mitigating the Prevalence of Diabetic Retinopathy in the United States: Utilization of the Chronic Care Model as a Public Health Framework

As the prevalence of diabetic retinopathy continues to be on the rise, the Chronic Care Model (CCM) offers a transformative, patient-focused approach for efficient diabetic retinopathy care, emphasizing the need for urgent and innovative strategies in the United States. The model integrates community resources, healthcare organizations, self-management support, delivery system design, decision support, and clinical information systems. Addressing challenges and solutions, the model emphasizes proactive and preventive measures, collaborative multidisciplinary care, technological integration, and overcoming resistance to change. This paper proposes the utilization of the Chronic Care Model (CCM) as a possible public health framework for comprehensive management of diabetic retinopathy in the United States. Implementing the CCM offers a comprehensive approach to diabetic retinopathy care, addressing both individual and systemic factors, essential for improving public health outcomes.

The‘experimental public’in longitudinal health research:views of local leaders and service providers in rural South Africa

Background:The concept of‘experimental public’has been recently applied to publics involved in clinical trials.This term could also be applied to publics involved in longitudinal research such as health and demographic surveillance systems.The ethics of practice and public engagement with these experimental publics are of key importance and include issues of informed consent,confidentiality,collection of body tissue samples and fair local benefit.Methods:Individual(n=11)and focus group(n=5)qualitative semi-structured interviews were conducted with 56 local leaders and service providers regarding their views about research activities in a longitudinal health research study site run by the MRC/Wits Rural Public Health and Health Transitions Research Unit(Agincourt)in rural South Africa.Deductive and inductive thematic analysis was undertaken using NVivo software to identify the emergent themes.Results:There was an understanding of the usefulness of collecting demographic data,but reasons for gathering other contextual data such as on food security,as well as the reasons for collection of blood was less clear.While appreciation was expressed for feedback of individual results such as blood pressure levels during home-based data collection,there were requests for more results from biomarkers,and for these to be given at home,rather than at the clinic.There were reports of indirect refusals,and offers by leaders to assist in reducing refusal rates.There were concerns about confidentiality,especially in the publication of results.Some leaders would have liked to receive more individual level data for planning of services,although they understood this would breach confidentiality.Service providers were concerned about the withdrawal of some services post intervention trials.Conclusions:This experimental public has,over time,developed a nuanced understanding of the reasons for research and the procedures undertaken.Discussions concerning fair benefit ranged from requests for more individual clinically-relevant results for participants,to understanding how research results could assist in planning of public health services at local and national levels.The concerns illustrate the complexity of the ethics of practice which has implications for policy,practice and governance for those working in longitudinal health research sites globally.