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Diabetes Related Quality of Life in An Ambulatory Care Clinic. Presented by: Douglas Jennings, Pharm.D. Pharmacy Practice Resident. Background. Diabetes is extremely prevalent and costly Over 20 million Americans afflicted Total economic costs above $130 billion

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diabetes related quality of life in an ambulatory care clinic

Diabetes Related Quality of Life in An Ambulatory Care Clinic

Presented by:

Douglas Jennings, Pharm.D.

Pharmacy Practice Resident

background
Background
  • Diabetes is extremely prevalent and costly
    • Over 20 million Americans afflicted
    • Total economic costs above $130 billion
  • Pharmacists have impacted clinical outcomes
    • Lower A1C, cholesterol and blood pressure
    • Higher rates of aspirin use and health screenings
  • Humanistic outcomes also important

http://www.diabetes.org/diabetes-statistics.jsp - Website for the American Diabetes Association, Accessed December 27, 2006

Ragucci KR et al. Pharmacotherapy 2005;25:1809-1816.

previous musc study
Previous MUSC Study

Ragucci KR et al. Pharmacotherapy 2005;25:1809-1816.

purpose
Purpose
  • Evaluate the diabetes related quality of life and satisfaction with services of patients with diabetes being followed by clinical pharmacist diabetes educators at the Family Medicine Center at the Medical University of South Carolina
  • Determine if any correlation exists between the diabetes related quality of life and clinical outcomes such as the hemoglobin A1C, blood pressure, aspirin use and fasting lipid values
methods
Methods
  • Telephone survey to assess diabetes-related quality of life using a modified version of a validated assessment tool
  • Retrospective review of the electronic medical record to identify most recent hemoglobin A1C, blood pressure, fasting lipid values and aspirin use in these patients
  • Statistics: Correlation and logistic regression analysis

The DCCT Research Group. Diabetes Care 1988; 11:725-31.

survey
Satisfaction:

Patients will choose from one of five possible answers:

Very satisfied, Somewhat satisfied, Neither, Somewhat dissatisfied, Very dissatisfied (1-5)

How satisfied are you with:

1. The amount of time it takes to manage your diabetes?

2. The amount of time you spend getting checkups?

3. The time it takes to determine your sugar level?

4. Your current treatment?

5. The flexibility you have in your diet?

6. The burden your diabetes is placing on your family?

7. Your knowledge about your diabetes?

8. Your sleep?

9. Your social relationships and friendships?

10. Your sex life?

11. Your work, school, and household activities?

12. The appearance of your body?

13. The time you spend exercising?

14. Your leisure time?

15. Life in general?

Survey
survey7
Impact:

Patients will choose from one of five possible answers:

Never, Rarely, Sometimes, Often, Always (1-5)

How often do you:

16. Feel pain associated with the treatment for your diabetes?

17. Feel embarrassed by having to deal with your diabetes in public?

18. Have low blood sugar?

19. Feel physically ill?

20. Find your diabetes interfering with your family life?

21. Feel good about yourself?

22. Feel interference with your ability to drive or use a machine?

23. Miss work, school or household duties because of your diabetes?

24. Find yourself explaining what it means to have diabetes?

25. Tell others about your diabetes?

26. Find that because of your diabetes you go to the bathroom more than others?

27. Find that you eat something that your shouldn’t rather than tell someone that you have diabetes?

28. Hide from others the fact that you are having and insulin reaction?

Survey
survey8
Survey

Worry:

Patients will choose from one of five possible answers:

Never, Rarely, Sometimes, Often, Always (1-5)

How often do you worry:

29. About whether you will pass out?

30. That your body looks different because you have diabetes?

31. That you will get complications from your diabetes?

32. About whether someone will not go out with you because you have diabetes?

results
Results
  • Total of 127 eligible patients: 47 completed
  • Mean age – 58 years, 74% female
  • Mean A1C – 7.6%, 47% at goal A1C <7
  • Mean number of clinic visits – 5.4
  • Median overall score was 1 (very satisfied)
    • Satisfaction median: 1 (very satisfied)
    • Impact median: 2 (rarely felt impact)
    • Worry median: 1 (never worried)
results11
Results

Centers for Disease Control and Prevention. Self-rated fair or poor health among adults with diabetes--United States,

1996-2005. MMWR Morb Mortal Wkly Rep 2006;55(45):1224-7.

results12
Results
  • Interesting correlations
    • Number of medications and satisfaction with time spent managing disease (p=0.04)
    • Number of medications and pain associated with treatment of diabetes (p=0.02)
    • Number of medications and worry about body looking different from diabetes (p=0.01)
    • Satisfaction with current treatment and A1C, LDL, blood pressure (p=NS)
limitations
Limitations
  • Selection bias
  • Recall bias
  • Interviewer bias
  • Duration of study
  • Lack of a standardized control group
conclusions
Conclusions
  • Patients in our clinic reported an excellent quality of life
  • Increasing number of medications was associated with worsening quality of life
  • Trends exist for relationships between several important clinical parameters and quality of life
acknowledgements
Acknowledgements
  • Thanks to:
    • Dr. Kelly Ragucci, Pharm.D.
    • Dr. Andrea Wessell, Pharm.D.
    • Dr. Sarah Shrader, Pharm.D.
    • Dr. Amy Thompson, Pharm.D.
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