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.
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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",
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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.

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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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