The Outpatient Clinic Visit: Expectations and Fulfilment of Perceived Needs in Adolescents with Type 1 Diabetes

Background: To make outpatient visits for adolescents with diabetes successful, it is important for health care professionals to meet the adolescents’ needs and wishes. Aims: The aim is to investigate adolescents’ expectations of an outpatient diabetes clinic visit in comparison to what was deemed to be delivered and contrast this outcome in adolescents with self-reported high- and low-diabetes distress respectively. Methods: All adolescents in Sweden with type 1 diabetes, aged 15 to 18 years, were identified via The National Pediatric Diabetes Registry (SWEDIABKIDS) and asked to complete an online questionnaire regarding their expectations and the support received during the outpatient diabetes clinic visit. Results: 453 adolescents completed the survey. Boys’ expectations of discussion topics were mainly met while girls, especially those with diabetes distress, felt their discussion needs were not met regarding quality-of-life aspects. Conclusions: Although adolescents’ expectations are in general met during the diabetes outpatient clinic visit, aspects related to living with diabetes are not being met especially among female adolescents who reported diabetes distress. This study shows a gender difference both regarding expected discussion topics and what was deemed covered. Practice Implications: A multi-professional, individual person-centred care approach is needed at the diabetes outpatient clinic. This paper proposes that agenda setting performed by the adolescent, and agreed by the physician, prior to the outpatient clinic visit could facilitate individualized care and better meet the adolescents’ needs in a shared decision-making process.

Treatment satisfaction and medication adherence among hypertensive patients in a teaching hospital in Ekiti State, Nigeria

Objective:This study investigates treatment satisfaction and medication adherence among hypertensive patients attending the medical outpatient clinic of a teaching hospital in Ekiti State,Nigeria.Materials and Methods:The study design was descriptive and cross-sectional using quantitative research strategy.A systematic sampling technique was used in selecting 270 participants;a structured questionnaire was used for data collection.Medication adherence was assessed using the 8-item Morisky Medication Adherence Scale,and treatment satisfaction was assessed using the 14-item Treatment Satisfaction Questionnaire for Medication.Results:The study findings revealed that majority(73.7%)of the study participants had good knowledge of hypertension,while 44.4%had a good level of treatment satisfaction.Test of association of participants’sociodemographic characteristics revealed age(χ^(2)=23.773,P=0.003)and occupation(χ^(2)=21.251,P=0.019)to be significantly associated with treatment satisfaction.The level of medication adherence by the participants was observed to be relatively poor(50.4%).The educational status(χ^(2)=23.914,P=0.001)and monthly income(χ^(2)=10.406,P=0.034)of the participants showed significant association with medication adherence.Conclusion:The study recommends that improving patients’understanding of their disease and treatment with subsidizing hypertensive medications by the government will enhance medication adherence.

What factors influence patient experience in orthopedic oncology office visits?

BACKGROUND Patient satisfaction and reported outcomes are becoming increasingly important in determining the efficacy of clinical care.To date no study has evaluated the patient experience in the orthopedic oncology outpatient setting to determine which factors of the encounter are priorities to the patient.AIM To evaluate what factors impact patient experience and report satisfaction in an outpatient orthopedic oncology clinic.METHODS Press Ganey®patient surveys from a single outpatient orthopedic oncology clinic at a tertiary care setting were prospectively collected per routine medical care.All orthopedic oncology patients who were seen in clinic and received electronic survey were included.All survey responses were submitted within one month of clinic appointment.IRB approval was obtained to retrospectively collect survey responses from 2015 to 2016.Basic demographic data along with survey category responses were collected and statistically analyzed.RESULTS One hundred sixty-two patient surveys were collected.Average patient age was 54.4 years(SD=16.2 years)and were comprised of 51.2% female and 48.4%male.64.2%of patients were from in-state.Out of state residents were more likely to recommend both the practice and attending physician.The likelihood to recommend attending physician was positively associated with MD friendliness/courtesy(OR=14.4,95%CI:2.5-84.3),MD confidence(OR=48.2,95%CI:6.2-376.5),MD instructions follow-up care(OR=2.5,95%CI:0.4-17.4),and sensitivity to needs(OR=16.1,95%CI:1-262.5).Clinic operations performed well in the categories of courtesy of staff(76%)and cleanliness(75%)and less well in ease of getting on the phone(49%),information about delays(36%),and wait time(37%).CONCLUSION Orthopedic specialties can utilize information from this study to improve care from the patient perspective.Future studies may be directed at how to improve these areas of care which are most valued by the patient.

What Happens to Modifiable Cardiovascular Risk Factors over Time in Type 2 Diabetes? Experience from a Developing Country under Standard of Care Conditions

Introduction: The complications of diabetes mellitus are the main reason for the morbidity associated with this condition, its cost, and its effect on quality of life. We have previously reported on the high prevalence of complications on a cohort of diabetic subjects. In the current study, we inquire what happens to the risk factors associated with these complications over time. Methods: The study is a prospective observational report over a two-year period where patients presented to the outpatient clinic for their usual care and had laboratory tests, retinal exams, and clinical assessment. They were treated as per American Diabetes Association guidelines in the outpatient department of the American University of Beirut. Results: Out of 220 subjects, 200 completed the two-year evaluation. There was no change in metabolic indices such as HbA1C, BMI, or smoking rates. However, there was mild, but significant improvement in LDL-C levels and blood pressure control. In parallel, there was an increase in the use of statins and ARB/ACEI category. However, their use remained much lower than in the reported literature. The population fared worse than the National Health Assessment and Nutrition Examination Survey (NHANES) population in most diabetes quality of care measures. The predicted 10-year vascular risk was 19%, similar to the calculated risk in a German population study. Conclusion: The lack of significant metabolic improvement points to a lack of effective lifestyle implementation measures, as well as to an under utilization of medical therapy. The approach to complications prevention needs to be more intense and multidisciplinary in nature in order to improve the patients’ outcome.