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Biomedical subjects

D G Marrero

Publications and source records attributed to D G Marrero.

At least 19 recordsLinked to original sources
PubMed2001

Pharmaceutical care program for patients with reactive airways disease.

A pharmaceutical care program for patients with reactive airways disease (RAD) is described. A pharmaceutical care program for patients with RAD was developed and implemented at 36 CVS pharmacies. The impact on patient outcomes, pharmacist job satisfaction, and other variables is currently being evaluated in a controlled trial with more than 1100 patient enrollees. Guiding the program are the beliefs that pharmacists must have clinically relevant, patient-specific data to provide appropriate care; that pharmacists must have adequate training to provide pharmaceutical care; that the program must be sensitive to organizational barriers, particularly time demands; and that there must be ongoing support for the program. The program has five components: (1) computer display of patient-specific data for patients enrolled in the study, (2) distribution of tailored patient education materials, (3) use of a resource guide to facilitate the implementation of pharmaceutical care, (4) strategies to reinforce and facilitate the program, and (5) pharmacist training. While developed for community pharmacies, the program is applicable to most ambulatory care pharmacy practices. A pharmaceutical care program for patients with RAD was developed for use in community pharmacies.

Community Pharmacy Services↗
PubMed2001

Report of the health care delivery work group: behavioral research related to the establishment of a chronic disease model for diabetes care.

As one of four work groups for the November 1999 conference on Behavioral Science Research in Diabetes, sponsored by the National Institute on Diabetes and Digestive and Kidney Diseases, the health care delivery work group evaluated the status of research on quality of care, patient-provider interactions, and health care systems' innovations related to improved diabetes outcomes. In addition, we made recommendations for future research. In this article, which was developed and modified at the November conference by experts in health care delivery, diabetes and behavioral science, we summarize the literature on patient-provider interactions, diabetes care and self-management support among underserved and minority populations, and implementation of chronic care management systems for diabetes. We conclude that, although the quality of care provided to the vast majority of diabetic patients is problematic, this is principally not the fault of either individual patients or health care professionals. Rather, it is a systems issue emanating from the acute illness model of care, which still predominates. Examples of proactive population-based chronic care management programs incorporating behavioral principles are discussed. The article concludes by identifying barriers to the establishment of a chronic care model (e.g., lack of supportive policies, understanding of population-based management, and information systems) and priorities for future research in this area needed to overcome these barriers.

Behavioral Medicine↗
PubMed2000

Nutrition management of type 2 diabetes by primary care physicians: reported use and barriers.

A survey was mailed to a probability sample of primary care physicians in Indiana to assess their use of and barriers to nutritional therapy for patients with type 2 diabetes. Most (62%) primary care physicians reported referring their type 2 diabetes patients for nutrition counseling, while 38% reported providing counseling themselves. Patient-centered barriers were most frequently cited as reasons for poor effectiveness of nutrition therapy. This differs from previous research that cites system-level factors as barriers.

Counseling↗
PubMed2000

The Diabetes Empowerment Scale: a measure of psychosocial self-efficacy.

OBJECTIVE: The purpose of this study was to assess the validity, reliability, and utility of the Diabetes Empowerment Scale (DES), which is a measure of diabetes-related psychosocial self-efficacy. RESEARCH DESIGN AND METHODS: In this study (n = 375), the psychometric properties of the DES were calculated. To establish validity, DES subscales were compared with 2 previously validated subscales of the Diabetes Care Profile (DCP). Factor and item analyses were conducted to develop subscales that were coherent, meaningful, and had an acceptable coefficient alpha. RESULTS: The psychometric analyses resulted in a 28-item DES (alpha = 0.96) with 3 subscales: Managing the Psychosocial Aspects of Diabetes (alpha = 0.93), Assessing Dissatisfaction and Readiness To Change (alpha = 0.81), and Setting and Achieving Diabetes Goals (alpha = 0.91). Consistent correlations in the expected direction between DES subscales and DCP subscales provided evidence of concurrent validity. CONCLUSIONS: This study provides preliminary evidence that the DES is a valid and reliable measure of diabetes-related psychosocial self-efficacy. The DES should be a useful outcome measure for various educational and psychosocial interventions related to diabetes.

Adult↗
PubMed1999

Screening and treatment of diabetic nephropathy by primary care physicians.

OBJECTIVE: To describe the practices of Indiana primary care physicians related to diabetic nephropathy screening and management. DESIGN: Cross-sectional, observational. SETTING: The state of Indiana. PARTICIPANTS: Active primary care physicians (defined as general internists, family practitioners, and general practitioners) in Indiana who provided care for diabetic patients at the time of the survey (n = 1,018) MEASUREMENTS AND MAIN RESULTS: Practice patterns relevant to microalbuminuria and overt albuminuria screening and management were assessed along two dimensions: the percentage of patients to whom the practices were applied and the frequency with which the practices were performed. Of 1,141 physicians who responded to the survey, 1,018 were eligible for analysis. Eighty-six percent of physicians reported screening more than half of their patients with type 1 diabetes for overt albuminuria, as did 82% of physicians for their patients with type 2 diabetes. Only 17% of physicians indicated performing microalbuminuria testing on more than half of their type 1 patients. Angiotensin-converting enzyme inhibitor agents were used frequently to treat abnormal urinary albumin excretion when hypertension was present, but less often when hypertension was absent. Physician specialty, year of graduation from medical school, practice location, and familiarity with the results of the Diabetes Control and Complications Trial were significant predictors of screening and treatment practice patterns. CONCLUSIONS: Primary care physicians report practices that allow them to detect overt albuminuria but not microalbuminuria. Angiotensin-converting enzyme inhibitors are frequently used by physicians who test for microalbuminuria, but efforts to increase the detection of early renal damage are needed so that these agents and other therapeutic strategies may be employed at the earliest opportunity.

Clinical Competence↗
PubMed1997

Same eyes, different doctors: differences in primary care physician referrals for diabetic retinopathy screening.

OBJECTIVE: To analyze eye care specialist referral patterns for the diabetic patients of primary care physicians. RESEARCH DESIGN AND METHODS: In 1993, we conducted a census of primary care physicians to evaluate practice patterns relating to diabetes care in the state of Indiana. Using a logistic regression model and data from this census, we compared 1) physicians' odds of referring type II diabetic patients to an optometrist, as opposed to an ophthalmologist, with those of type I diabetic patients and 2) the referral odds ratios of type II to type I diabetic patients between metropolitan and nonmetropolitan counties. RESULTS: Overall, 10% of the physicians in our study most often refer some patients to an optometrist. Physicians are more likely to refer their type II diabetic patients to an optometrist, as opposed to an ophthalmologist, than they are to refer type I diabetic patients, both before and after adjustment for covariates. Physicians who practice in metropolitan counties are 1.55 times more likely to refer their type II diabetic patients than their type I diabetic patients to an optometrist. In nonmetropolitan counties, physicians are 2.5 times more likely to refer their type II diabetic patients to an optometrist. The difference between metropolitan and nonmetropolitan physicians is significant (P = 0.027). CONCLUSIONS: Some physicians mostly refer their diabetic patients to optometrists, instead of ophthalmologists, for eye examinations intended to discover early signs of diabetic eye disease. Type II diabetic patients are more likely to be referred to an optometrist, instead of an ophthalmologist, than are type I diabetic patients. In nonmetropolitan areas, the difference in referral patterns becomes even more marked.

Censuses↗
PubMed1997

The SOCRATES curriculum: an innovative integration of technology and theory in medical education.

This article describes the pilot study of an innovative medical school curriculum module that utilizes a modified problem-based learning (PBL) approach to teach medical students about management of diabetes mellitus. The PBL-based curriculum incorporated computer simulations and analysis of videotaped patient encounters in addition to independent study and group discussion. At the conclusion of the study, student knowledge and clinical decision-making skills were evaluated via questionnaires and examinations. Twenty-three students completed the workshop and all evaluation assessments. Students performed well on the case-study examinations (mean score of 3.39 out of 4) but not on the short answer essay examination, which assessed basic knowledge. Students rated the quality and appeal of the activities using Likert-type scales. In general, students perceived the activities as very worthwhile, with reasonable complexity and adequate time devoted to each activity. Students were very positive about the workshop and preceptor; 15 of the 16 items used to rate workshop appeal yielded mean scores greater than 4 (on a scale of 1 to 5, with 5 being the highest). The results of the pilot study suggest future enhancements that would further improve the outcomes of the training.

Adult↗
PubMed1996

Prevention of IDDM: a public health perspective.

Insulin dependent diabetes mellitus (IDDM) poses a large social and economic burden on society. There are now methods for identifying persons at risk for IDDM and increasing evidence suggest that it may be possible to delay or even prevent the clinical presentation of the disease. This raises the question of whether a prevention program for IDDM should be initiated through public health channels. Review of the literature suggests that in spite of the considerable societal burden associated with diabetes, there are currently no broadly applicable, effective methods for identifying persons at increased risk of developing IDDM nor are there proven strategies for its prevention when risk is established. Until strategies to identify persons at risk of IDDM and methods to prevent the onset of disease are established, a better use of limited resources may be the secondary and tertiary prevention of complications of the disease.

Diabetes Mellitus, Type 1↗
PubMed1995

Patterns of diabetic eye care by primary care physicians in the state of Indiana.

Diabetic retinopathy is the leading cause of new blindness in the 20 to 74-age group in the United States. The American Academy of Ophthalmology (AAO) and American Diabetes Association (ADA) have recommended guidelines for eye examination to assist primary care physicians in managing these patients. The purpose of this study is to investigate the patterns of diabetic eye care offered by primary care physicians in the State of Indiana. A survey questionnaire was sent to 1279 primary care physicians in central Indiana. Of those surveyed, 259 (20%) responded. Thirty-five percent of respondents stated that they never refer patients for ocular examination while 26% refer all patients. The remainder refer on a case-by-case basis. Patients who are not referred have their fundus examined only 70% of the time by the primary care physician and 96% of these examinations are performed with an undilated pupil. When referred, 20% of Type I patients are referred at the time of diagnosis and 50% by one year. Of the Type II patients, only 2% are referred at the time of diagnosis and 70% by one year. Ophthalmologists receive 75% of the referrals while optometrists receive 20%. Our results show that a significant number of primary care physicians in the State of Indiana do not follow the recommended guidelines set forth for diabetic eye care.

Adult↗
PubMed1995

Patterns of referral and examination for retinopathy in pregnant women with diabetes by primary care physicians.

PURPOSE: Family practice (FP), General Practice (GP) and obstetrics-gynecology (OB/GYN) physicians were surveyed to determine whether they routinely referred pregnant patients with diabetes to an ophthalmologist, looked into the patient's eyes to screen for retinopathy, and dilated the eyes for fundi examination. METHODS: Hospitals providing obstetrical services were contacted to identify primary-care physicians. Physicians identified as having obstetrical privileges were surveyed by mail to determine if they were actively providing obstetrical care. Physicians who provided both obstetrical and diabetes care were mailed a survey. RESULTS: Of 668 physicians surveyed, 429 responded: 224 FPS, 184 OB/GYNS and 21 GPS. A relatively small percentage (27%) of physicians in both groups routinely refer all of their pregnant patients with pre-existing diabetes to an ophthalmologist. Family practice physicians were more likely to perform an eye exam to screen for retinopathy in patients with both pre-existing and gestational diabetes than OB/GYNS (p < .0005). Only 11% of FPS and no OB/GYNS reported that they dilated the eyes when performing a fundus examination (p = .04). CONCLUSION: The physicians surveyed under-utilize recommended strategies for eye care of pregnant women with pre-existing diabetes. Based upon these results, we call for a recommitment to partnership of primary-care physicians and ophthalmologists in the detection and treatment of diabetic retinopathy during pregnancy.

Adult↗
PubMed1992

Care of diabetic pregnant women by primary-care physicians. Reported strategies for managing pregestational and gestational diabetes.

OBJECTIVE: To ascertain the strategies used by primary-care physicians for treating pregestational and gestational diabetes mellitus (GDM) during pregnancy, because many women with pregnancies complicated by these types of diabetes are treated by physicians who have no special training in intensive diabetes management. RESEARCH DESIGN AND METHODS: Two hundred twenty-four family-practice (FP) physicians and 184 obstetrics/gynecology (OB/GYN) physicians were surveyed by mail. RESULTS: When compared with OB/GYNs, FPs were less likely to screen all pregnant women for GDM (P = 0.03), use multiple-injection insulin regimens (P = 0.004) or self-monitoring of blood glucose (SMBG) (P = 0.01) for Pre-GDM patients, and refer these patients to a specialist for medical (P = 0.01) or ophthalmologic (P less than 0.001) care. FPs were more likely to implement insulin therapy (P = 0.003), SMBG (P = 0.02), and examine eyes for retinopathy (P less than 0.001) when treating gestational patients. CONCLUSIONS: These data show that there are considerable discrepancies between the strategies used by FPs and OB/GYNs and also suggest that physicians in both groups are under-utilizing recommended treatment strategies described in publications targeted specifically to primary-care physicians. Increased exposure to and dissemination of guidelines for diabetes management and additional medical school and postgraduate education programs are recommended as methods to improve utilization of these strategies.

Blood Glucose Self-Monitoring↗
PubMed1992

Immediate HbA1c results. Performance of new HbA1c system in pediatric outpatient population.

OBJECTIVE: This study compared the performance of a new device that uses an IA to measure HbA1c in 9 min with a 1-microliter capillary blood sample with AC and CE methods in both nondiabetic and diabetic pediatric patients. RESEARCH DESIGN AND METHODS: Two hundred seven pediatric subjects (103 nondiabetic, 104 with insulin-dependent diabetes mellitus) had HbA1c measured with the IA method and compared with total GHb values determined by AC and HbA1 by the CE method with the same whole-blood capillary aliquot. Glucose values were also obtained from the same blood samples. RESULTS: Correlations and regression analyses show excellent correspondence between the three assays. The correlation between the AC and CE methods is 0.98 (P less than 0.001) with a slope of 1.615 +/- 0.0125 and intercept of 4.00 +/- 0.20. The correlation between the IA and AC methods is 0.99 (P less than 0.001) with a slope of 0.608 +/- 0.007 and intercept of 1.326 +/- 0.066. The correlation between the IA and CE methods is 0.97 (P less than 0.001), with a slope of 0.983 +/- 0.018 and intercept of 1.122 +/- 0.153. The average difference and average percentage difference between methods were also significant (P less than 0.001), reflecting the differences in GHb components measured. There was a significant correlation (P less than 0.001) between each method and glucose values (IA r = 0.72, AC r = 0.70, CE r = 0.73). Within-run precision for IA ranged from 1.7 to 3.5% and between-run precision 2.7 to 4.1%. CONCLUSIONS: Study results suggest that the IA method gives extremely accurate and reliable values over the clinical range of interest. The instrument is small, portable, easy to use, and provides information within 9 min for both physicians and patients.

Agglutination Tests↗
PubMed1991

The treatment of patients with insulin-requiring diabetes mellitus by primary care physicians.

The extent to which a sample of community based, primary care physicians follow current standards of care for the treatment of non-obese, insulin-requiring patients as defined and recently published by the American Diabetes Association (ADA) was studied. A total of 212 physicians responded with 191 indicating that they treat one or more non-obese, insulin-requiring patients. Of this sample, 97% used multiple injection, mixed insulin regimens. However, over 70% also used single injection regimens. Whereas 94% prescribed self-monitoring blood glucose (SMBG), only 31% did so for more than 75% of their patients and 37% did so for less than 50%. Twenty-five percent of respondents did not obtain HbA1 values on their patients. For respondents who do collect HbA1, only 28% did so for over 75% of their patients and 30% for less than 50%. Physicians with fewer patients were more likely to prescribe single injection insulin regimens (P = .02). Recent graduates from medical school also used HbA1's more frequently than earlier graduates (p = .001). These data suggest that while care practices recommended by the ADA are being implemented by primary care physicians, they are significantly underutilized.

Adult↗
PubMed1990

Pediatrics residents' attitudes about insulin-dependent diabetes mellitus and children with diabetes.

Nationwide, pediatricians provide a substantial portion of the health care of children with diabetes. Their beliefs and attitudes about diabetes and children with the illness have an important influence on their treatment decisions. The attitudes and beliefs of a 1988 sample of pediatrics residents were compared with data from a 1987 national survey of practicing pediatricians' beliefs and attitudes about children with insulin-dependent diabetes mellitus and about the disease itself. Pediatrics residents in their second and third years of training were considerably more negative about diabetes and diabetic children than were either the members of the national sample of practicing pediatricians or the residents' first-year colleagues.

Attitude of Health Personnel↗
PubMed1990

Mail-in paper strip vs. microcolumn technique for measurement of glycosylated hemoglobin.

We compared glycosylated hemoglobin (GHb) determined from capillary blood samples on paper strips with a standard microcolumn technique in a cross-sectional observational study with laboratories blinded to duplicate samples. Both the standard and the filter strip laboratories were provided with 80 uniquely identified blood samples from 40 individuals. Each laboratory ran duplicate analyses on each sample, yielding 160 GHb values. The within-laboratory correlations between blinded duplicates were 0.98 for the standard (microcolumn technique) and 0.94 for the filter paper (affinity technique) laboratories. The between-laboratory correlations ranged from 0.69 to 0.77. When classifying patients by quartile of glycemic control, the laboratories agreed on 60% of the patients. In an effort to identify sources of between-laboratory variability, varying quantities of blood were applied to strips and reanalyzed. Five microliter drops always yielded inflated estimates of GHb. These data suggest that the estimates of GHb obtained from mail-in paper strips, although internally consistent, differ in important ways from standard laboratory values, reemphasizing the need for caution in the interpretation of interlaboratory and intermethod comparisons.

Blood Glucose Self-Monitoring↗