Patient-reported barriers and outcomes associated with poor glycaemic and blood pressure control in co-morbid diabetes and chronic kidney disease

Clement Lo, Edward Zimbudzi, Helena J. Teede, Peter G. Kerr, Sanjeeva Ranasinha, Alan Cass, Gregory Fulcher, Martin Gallagher, Kevan R. Polkinghorne, Grant Russell, Tim Usherwood, Rowan Walker, Sophia Zoungas

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Aims: In patients with comorbid diabetes and chronic kidney disease, the extent to which patient-reported barriers to health-care and patient reported outcomes influence the quality of health care is not well established. This study explored the association between patient-reported barriers to health-care, patient activation, quality of life and diabetes self-care, with attainment of glycaemic and blood pressure (BP) targets. 

    Methods: This cross-sectional study recruited adults with diabetes and CKD (eGFR 20 to <60 ml/min/1.73m2) across four hospitals. We combined clinical data with results from a questionnaire comprising measures of patient-identified barriers to care, the Patient Activation Measure (PAM), 12-Item Short Form Survey (SF-12), and the Summary of Diabetes Self-Care Activity (SDSCA). 

    Results: 199 patients, mean age 68.7 (SD 9.6), 70.4% male and 90.0% with type 2 diabetes were studied. Poor glycaemic control was associated with increased odds of patient reported “poor family support” (OR 4.90; 95% CI 1.80 to 13.32, p < 0.002). Poor BP control was associated with increased odds of patient reported, “not having a good primary care physician” (OR 6.01; 2.42 to 14.95, p < 0.001). The number of barriers was not associated with increased odds of poor control (all p > 0.05). 

    Conclusions: Specific patient-reported barriers, lack of patient perceived family and primary care physician support, are associated with increased odds of poor glycaemic and blood pressure control respectively. Interventions addressing these barriers may improve treatment target attainment.

    Original languageEnglish
    Pages (from-to)63-68
    Number of pages6
    JournalJournal of Diabetes and Its Complications
    Volume33
    Issue number1
    Early online date12 Oct 2018
    DOIs
    Publication statusPublished - Jan 2019

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    Chronic Renal Insufficiency
    Blood Pressure
    Delivery of Health Care
    Patient Participation
    Quality of Health Care
    Primary Care Physicians
    Self Care
    Cross-Sectional Studies
    Quality of Life
    Patient Reported Outcome Measures
    Therapeutics

    Cite this

    Lo, Clement ; Zimbudzi, Edward ; Teede, Helena J. ; Kerr, Peter G. ; Ranasinha, Sanjeeva ; Cass, Alan ; Fulcher, Gregory ; Gallagher, Martin ; Polkinghorne, Kevan R. ; Russell, Grant ; Usherwood, Tim ; Walker, Rowan ; Zoungas, Sophia. / Patient-reported barriers and outcomes associated with poor glycaemic and blood pressure control in co-morbid diabetes and chronic kidney disease. In: Journal of Diabetes and Its Complications. 2019 ; Vol. 33, No. 1. pp. 63-68.
    @article{928654b5e4e241b0885bb9d72c4a6bbb,
    title = "Patient-reported barriers and outcomes associated with poor glycaemic and blood pressure control in co-morbid diabetes and chronic kidney disease",
    abstract = "Aims: In patients with comorbid diabetes and chronic kidney disease, the extent to which patient-reported barriers to health-care and patient reported outcomes influence the quality of health care is not well established. This study explored the association between patient-reported barriers to health-care, patient activation, quality of life and diabetes self-care, with attainment of glycaemic and blood pressure (BP) targets. Methods: This cross-sectional study recruited adults with diabetes and CKD (eGFR 20 to <60 ml/min/1.73m2) across four hospitals. We combined clinical data with results from a questionnaire comprising measures of patient-identified barriers to care, the Patient Activation Measure (PAM), 12-Item Short Form Survey (SF-12), and the Summary of Diabetes Self-Care Activity (SDSCA). Results: 199 patients, mean age 68.7 (SD 9.6), 70.4{\%} male and 90.0{\%} with type 2 diabetes were studied. Poor glycaemic control was associated with increased odds of patient reported “poor family support” (OR 4.90; 95{\%} CI 1.80 to 13.32, p < 0.002). Poor BP control was associated with increased odds of patient reported, “not having a good primary care physician” (OR 6.01; 2.42 to 14.95, p < 0.001). The number of barriers was not associated with increased odds of poor control (all p > 0.05). Conclusions: Specific patient-reported barriers, lack of patient perceived family and primary care physician support, are associated with increased odds of poor glycaemic and blood pressure control respectively. Interventions addressing these barriers may improve treatment target attainment.",
    keywords = "Chronic kidney disease, Diabetes, Health-related quality of life, Patient activation, Patient-reported outcomes, Treatment targets",
    author = "Clement Lo and Edward Zimbudzi and Teede, {Helena J.} and Kerr, {Peter G.} and Sanjeeva Ranasinha and Alan Cass and Gregory Fulcher and Martin Gallagher and Polkinghorne, {Kevan R.} and Grant Russell and Tim Usherwood and Rowan Walker and Sophia Zoungas",
    year = "2019",
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    Lo, C, Zimbudzi, E, Teede, HJ, Kerr, PG, Ranasinha, S, Cass, A, Fulcher, G, Gallagher, M, Polkinghorne, KR, Russell, G, Usherwood, T, Walker, R & Zoungas, S 2019, 'Patient-reported barriers and outcomes associated with poor glycaemic and blood pressure control in co-morbid diabetes and chronic kidney disease', Journal of Diabetes and Its Complications, vol. 33, no. 1, pp. 63-68. https://doi.org/10.1016/j.jdiacomp.2018.09.020

    Patient-reported barriers and outcomes associated with poor glycaemic and blood pressure control in co-morbid diabetes and chronic kidney disease. / Lo, Clement; Zimbudzi, Edward; Teede, Helena J.; Kerr, Peter G.; Ranasinha, Sanjeeva; Cass, Alan; Fulcher, Gregory; Gallagher, Martin; Polkinghorne, Kevan R.; Russell, Grant; Usherwood, Tim; Walker, Rowan; Zoungas, Sophia.

    In: Journal of Diabetes and Its Complications, Vol. 33, No. 1, 01.2019, p. 63-68.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Patient-reported barriers and outcomes associated with poor glycaemic and blood pressure control in co-morbid diabetes and chronic kidney disease

    AU - Lo, Clement

    AU - Zimbudzi, Edward

    AU - Teede, Helena J.

    AU - Kerr, Peter G.

    AU - Ranasinha, Sanjeeva

    AU - Cass, Alan

    AU - Fulcher, Gregory

    AU - Gallagher, Martin

    AU - Polkinghorne, Kevan R.

    AU - Russell, Grant

    AU - Usherwood, Tim

    AU - Walker, Rowan

    AU - Zoungas, Sophia

    PY - 2019/1

    Y1 - 2019/1

    N2 - Aims: In patients with comorbid diabetes and chronic kidney disease, the extent to which patient-reported barriers to health-care and patient reported outcomes influence the quality of health care is not well established. This study explored the association between patient-reported barriers to health-care, patient activation, quality of life and diabetes self-care, with attainment of glycaemic and blood pressure (BP) targets. Methods: This cross-sectional study recruited adults with diabetes and CKD (eGFR 20 to <60 ml/min/1.73m2) across four hospitals. We combined clinical data with results from a questionnaire comprising measures of patient-identified barriers to care, the Patient Activation Measure (PAM), 12-Item Short Form Survey (SF-12), and the Summary of Diabetes Self-Care Activity (SDSCA). Results: 199 patients, mean age 68.7 (SD 9.6), 70.4% male and 90.0% with type 2 diabetes were studied. Poor glycaemic control was associated with increased odds of patient reported “poor family support” (OR 4.90; 95% CI 1.80 to 13.32, p < 0.002). Poor BP control was associated with increased odds of patient reported, “not having a good primary care physician” (OR 6.01; 2.42 to 14.95, p < 0.001). The number of barriers was not associated with increased odds of poor control (all p > 0.05). Conclusions: Specific patient-reported barriers, lack of patient perceived family and primary care physician support, are associated with increased odds of poor glycaemic and blood pressure control respectively. Interventions addressing these barriers may improve treatment target attainment.

    AB - Aims: In patients with comorbid diabetes and chronic kidney disease, the extent to which patient-reported barriers to health-care and patient reported outcomes influence the quality of health care is not well established. This study explored the association between patient-reported barriers to health-care, patient activation, quality of life and diabetes self-care, with attainment of glycaemic and blood pressure (BP) targets. Methods: This cross-sectional study recruited adults with diabetes and CKD (eGFR 20 to <60 ml/min/1.73m2) across four hospitals. We combined clinical data with results from a questionnaire comprising measures of patient-identified barriers to care, the Patient Activation Measure (PAM), 12-Item Short Form Survey (SF-12), and the Summary of Diabetes Self-Care Activity (SDSCA). Results: 199 patients, mean age 68.7 (SD 9.6), 70.4% male and 90.0% with type 2 diabetes were studied. Poor glycaemic control was associated with increased odds of patient reported “poor family support” (OR 4.90; 95% CI 1.80 to 13.32, p < 0.002). Poor BP control was associated with increased odds of patient reported, “not having a good primary care physician” (OR 6.01; 2.42 to 14.95, p < 0.001). The number of barriers was not associated with increased odds of poor control (all p > 0.05). Conclusions: Specific patient-reported barriers, lack of patient perceived family and primary care physician support, are associated with increased odds of poor glycaemic and blood pressure control respectively. Interventions addressing these barriers may improve treatment target attainment.

    KW - Chronic kidney disease

    KW - Diabetes

    KW - Health-related quality of life

    KW - Patient activation

    KW - Patient-reported outcomes

    KW - Treatment targets

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    JO - Journal of Diabetes and Its Complications

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    SN - 1056-8727

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