By examining barriers to care, health professionals can better understand what disparities exist between groups and who may be at greater risk for poor primary care. Researchers have highlighted the need for additional research that focuses on the extent of unmet needs for U.S. children with sickle cell disease (SCD). The purpose of this quantitative study was to compare the differences between parents who are in a SCD support group and those who are not. The theoretical framework of this study is based on the chronic care model and social support theory. A total of 128 parents of children with SCD completed the study survey. The sampling occurred by e-mail, phone, and face-to-face conversations. Selection criteria for potential participants in both groups were based on their children being diagnosed with SCD. Seventy-four participants (57.8%) were members of a SCD support group, and 54 participants (42.4%) were not members of a SCD support group. In this study, the independent variables were parents attending or not a SCD support group. The t test and MANCOVA was used to assessed the association between perceptions of barriers to care and support group status. However, statistical analysis showed no significant results. The null hypothesis was not rejected. Therefore, the positive social change implication is to further explore potential factors that may shape perceptions of barriers to care for those with SCD so that perceived barriers to care can be overcome.

Approximately 8.3% of the U. S. population has type 2 diabetes. Preventing the onset and improving the management type 2 diabetes are crucial for health care professionals. The purpose of this project was to develop and evaluate a type 2 diabetes prevention and management education program in a primary care setting using group medical appointments (GMAs). The chronic care model provided the framework for the study. The education program consisted of information from the Centers for Disease Control on the management of type 2 diabetes to be delivered by clinic staff using a GMA approach, a timeline for implementing the education program, and evaluation strategies for assessing patient health outcomes. Staff participants included 9 females and 1 male. One week after the presentation, staff responded to open-ended questions addressing the plan for prevention and management of type 2 diabetes. Findings indicated that staff unanimously approved the content of the program, thought the program could realistically be implemented, thought the proposed evaluation methods were appropriate, and thought the program would have a positive influence on patient health outcomes. Prevention and management education programs using a GMA approach may be used to reduce incidence and improve management of type 2 diabetes.

En 2011, l’Agence de la santé et des services sociaux de Montréal (ASSSM), en partenariat avec les Centres de santé et services sociaux (CSSS) de la région, a coordonné la mise en œuvre d’un programme de prévention et de prise en charge intégré sur le risque cardiométabolique. Ce programme, s’inspirant du Chronic Care Model et s’adressant aux patients atteints de diabète et d’hypertension artérielle, est d’une durée de deux ans et comporte une séquence de suivis individuels avec l’infirmière et la nutritionniste, de cours de groupe et de séances d’activité physique. L’objectif de ce mémoire est d’évaluer, à l’aide d’un devis quasi-expérimental, l’impact de la variation dans l’implantation de certains aspects du programme dans les six CSSS participant à l’étude sur les résultats de santé des patients. Cinq aspects du programme ont été retenus : les ressources, la conformité au processus clinique prévu dans le programme régional, la maturité du programme, la coordination interne au sein de l’équipe de soins et la coordination externe avec les médecins de 1re ligne. Des analyses de différence de différences, incluant des scores de propension afin de rendre les groupes comparables, ont été effectuées dans le but d’évaluer l’influence de ces aspects sur quatre indicateurs de santé : l’hémoglobine glyquée, l’atteinte de la cible de tension artérielle et l’atteinte de deux cibles d’habitudes de vie concernant la répartition des glucides alimentaires et la pratique d’activité physique. Les résultats indiquent que les indicateurs de santé sélectionnés se sont améliorés chez les patients participant au programme et ce, indépendamment des variations dans son implantation entre les CSSS participant à l’étude. Très peu d’analyses de différence de différences ont en effet relevé un impact significatif des variables d’implantation étudiées sur ces indicateurs. Les résultats suggèrent que les effets bénéfiques d’un tel programme sont davantage tributaires de la prestation des interventions auprès des patients que d’aspects organisationnels liés à son implantation. / In 2011, the Agence de la santé et des services sociaux de Montréal (ASSSM), in partnership with the Health and social service centres (CSSS) of the region, coordinated implementation of an integrated and interdisciplinary program for prevention and management of cardiometabolic risk. The program, based on the Chronic Care Model and designed for patients with diabetes and hypertension, consists of a two-year sequence of individual follow-ups with a nurse and a nutritionist, group classes and physical activity sessions. The objective of this master’s thesis is to assess the impact of variations in implementation of some aspects of the program in the six CSSS participating in this study on patients’ health outcomes. Five aspects of implementation have been selected: resources, conformity to the clinical process proposed in the regional program, maturity of the program, internal coordination within the CSSS team and external coordination with primary care physicians. Analysis of difference in differences, including propensity scores that make the groups comparable, have been calculated to assess the impact of those aspects on four health outcomes: glycated hemoglobin, reaching the blood pressure level target and reaching two targets of lifestyle habits regarding the distribution of dietary carbohydrates and the practice of physical activity. The results show that the program yielded expected effects in regard to patients’ selected health outcomes, regardless of implementation variations among the studied CSSS. Indeed, few analysis revealed a significant impact of the implementation variables on those outcomes. Results suggest that beneficial effects of this program depend more on services provided to patients than on specific organisational aspects of its implementation.

Background: Diabetes mellitus (DM) affects more than 29.1 million Americans. Standardized clinical practice guidelines recommended by regulatory healthcare agencies are the standard of care for diabetic patients and must be adhered to by healthcare professionals providing care. Purpose: The purpose of this quality improvement project was to identify Centers for Medicare and Medicaid Services’, Joint Commission on Accreditation of Healthcare Organization’s, and other professional healthcare organizations’ guidelines for nurses’ knowledge of evidence-based discharge practices; determine level of nurses’ knowledge on evidence-based discharge practice process; develop a quality improvement plan, including development of an evidence-based guideline for diabetic discharge instructions; present guideline to stakeholders; implement the guideline in fall of 2017; and evaluate nursing compliance with the guideline at a for-profit adult care hospital in South Florida. Theoretical Framework: The chronic care model was utilized as the framework. This model has been used for improving practice and preventing many chronic illnesses. Methods: Two quantitative nonparametric descriptive designs were used, the Wilcoxon signed- rank test and a paired t test. An online demographic survey and pre- and posttest surveys were administered to determine nurses’ knowledge of diabetes discharge guideline practices. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) evaluation tool evaluated the guideline, and data were analyzed with Wilcoxon and paired t tests. Results: A statistically significant difference was found in the pre-posttest survey responses for question 5 (p=0.046 Wilcoxon; p=0.041t test), and question 13 (p= 0.022 Wilcoxon; p=0.018 t test), indicating improvement. With the AGREE II tool, the multidisciplinary team evaluated the guideline at 100%, and 76% of Advanced Practice Registered Nurses (APRNs) and Registered Nurses (RNs) demonstrated compliance with guideline use. Conclusion: A standardized diabetic discharge guideline incorporated into the hospital’s discharge process provided APRNs and RNs with tools for educating and providing diabetic patients for increase in quality of life after discharge. The guideline was recommended by the administrative team for continued use throughout the hospital. Implementation of an evidence-based standardized diabetic discharge guideline to promote nurses’ adherence results in effective nursing practices and an informed patient population.

Les systèmes de santé accordent une attention croissante au point de vue des usagers dans l’organisation de l’offre de soins. L’instauration d’une offre de soins sensible aux besoins et préférences des patients constitue un enjeu majeur de qualité et d’efficacité des soins. Ce travail analyse le point de vue des patients pour l’offre de soins de médecine générale en utilisant différentes méthodes permettant d’obtenir des informations complémentaires en termes d’expérience de soins, de satisfaction, d’importance ou encore de préférences. Il s’agit des méthodes Delphi, de classement du meilleur au pire et de révélation des préférences par les choix discrets. Ces méthodes sont appliquées sur deux échantillons : en population générale pour la première et chez des patients poly-pathologiques pour les 2 autres afin d’identifier les principaux enjeux actuels et à venir de la réorganisation de l’offre de soins de médecine générale du point de vue des patients. Les résultats montrent le rôle central de la relation médecin-patient et plus particulièrement de l’échange d‘informations entre le médecin et le patient. Cependant une relation médecin-patient de qualité ne doit pas pour autant être réalisée au détriment de la qualité technique du soin et de la coordination de la prise en charge du patient. Ce travail montre également l’importance de prendre en compte l’expérience de soins des patients lors de l’analyse de leur point de vue, et plus particulièrement de leur disposition au changement. L’évaluation systématique et régulière des préférences des patients en pratique quotidienne peut permettre d’améliorer la communication médecin-patient ainsi que le contenu de l’offre de soins du point de vue des patients. / The healthcare systems are paying a great interest to the patients’ perspective for the organization of health care provision. Healthcare system which is accountable and responsive of patients’ needs and preferences is a major issue for the quality and efficiency of care. In this thesis, we analyze the views of patients for the supply of GP care in using different complementary methods about patients’ experience, satisfaction, importance or preferences. These methods are applied to a sample of patients in GP and to a sample of chronically ill patients in order to identify current and future major issues for the reorganization of GP care from the patients’ perspective. The results show the main role of the doctor-patient relationship and especially of the information exchange between doctor and patient and between patient and doctor. However the quality of the doctor-patient relationship is not enough. The technical quality of care (i.e. thoroughness) and the coordination are of high importance for patients. This work highlights that it is necessary to take into account the patients’ experiences in the analysis of their perspective (e.g. preferences) to fully and appropriately understand the results, especially in terms of willingness to change. The systematic and regular screening of patient preferences in daily GP practice can improve the doctor-patient communication and the content of the provision of care from the perspective of patients.