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In CME/CPD, a significant part of research is about effectiveness. Attention to the development process can be vital to understand how it impacts progress and results. This study aims to explore an innovative process of applying a combined approach using design-based research, collaborative innovation, and program theory to develop CPD about type 2 diabetes for GPs and clinic nurses with a group of interprofessional stakeholders. In particular, the development process of the combined approach and how it impacts the progress and the activities. We applied two qualitative methods. First, we analysed 159 documents from the development process, and second, eight semi-structured key informant interviews. Data were deductively analysed using 15 predefined elements derived from the combined approach combined with open coding analyses. The analysis showed how the combined approach structured the process. And the interviews broadened our understanding of the relationship between the process and the activities. Four additional themes were constructed from the open coding, including surrender to the process. Surrendering was a central part of the interviewees' participation in the process. The combined approach facilitated this unfamiliar experience of surrender. By supporting participants to surrender, the combined approach enabled an expansion of interprofessional collaboration and the development of innovative activities and learning methods in CPD on type 2 diabetes.

Background and Aim: In today’s digital world, people with type 1 and 2 diabetes turn to peers on social media to exchange information and support. However, little is known about what the online sharing of diabetes-related information implies for the clinical encounter. This study examines how information that stems from social media is discussed in clinical encounters between healthcare professionals (HCPs) and people with diabetes (PWD) . Methods: We conducted semi-structured interviews with 25 PWD aged 22-76 (type 1: n= 17, type 2: n=8) and HCPs (nurses n=9, medical doctors n=7, dieticians n=3) . The participants were recruited from the diabetes outpatient care setting in Denmark. Two researchers independently developed a thematic coding framework that was compared, revised, and then applied to analyze each interview. Subsequently, overarching themes were identified across the whole data set. Results: The first theme suggests that HCPs tend to have a ‘blind spot’ towards information that stems from social media: Most HCPs have not asked whether PWD retrieve information from social media and most PWD present information that is accessed on social media without naming their source. The second theme reflects that clinical dialogues about online information rest upon trustful relationships: PWD find online peer exchanges valuable and request for HCPs to acknowledge this. Still, PWD navigate large amounts of information and treatment advice online, and while PWD may seek to discuss their information in clinical encounters, initiating these dialogues is sensitive to the reactions of HCPs. Discussion: The results suggest that HCPs should encourage curious dialogues about how PWD retrieve diabetes-related information. This serves for HCPs to learn what PWD gain from peers online and for HCPs to be able to offer their expertise to support PWD who are navigating large flows of information and advice online. Disclosure E.M.Kjærulff: None. M.A.Nexo: None. U.Bjerre-christensen: None. H.Langstrup: None. Funding Innovation Fund Denmark (Ref.no. 9163-00016B)

Malaysia seeks to transform its public healthcare sector to manage the growing number of people with diabetes. Patient engagement is a critical clinical competency for healthcare providers treating people with diabetes. In this study, we investigate the perceptions of and ability to practice patient engagement among doctors and nurses working in Malaysia’s primary healthcare system. Semi-structured interviews were conducted with nine non-specialist doctors and ten nurses working in primary healthcare clinics. Further, 12 key informants with specialist knowledge about diabetes care and the healthcare system in Malaysia were interviewed. The interviews were analyzed using qualitative content analysis. Three main themes emerged: 1) understanding barriers to self-care and treatment, 2) perceived training needs and skills within patient engagement and empowerment, and 3) challenges to the practice of patient engagement. A range of barriers was identified in healthcare providers’ ability to practice patient engagement. Future efforts should seek to improve competencies within patient engagement, identification of especially psychosocial barriers to self-care and empowerment. Yet, available manpower and time also influence whether patient engagement is practiced.

Hyperglycaemia during hospitalisation is associated with a longer and more complicated admission and with increased mortality. Therefore, guidelines suggest that blood glucose should be less than 10 mmol/l. In this audit, we aimed to describe the prevalence of diabetes patients at four orthopaedic departments in the Capital Region of Denmark and to measure the quality of in-hospital diabetes management.We conducted audits of medical records in the electronic health record system for two months in 2019. All patients admitted were included in the audit. We gathered information on diabetes status, orthopaedic diagnosis, glycosylated haemoglobin and diabetes management.Among 2,463 included patients, 10% had diabetes. The three most frequent diagnosis groups were infection, fracture of lower extremity and hospitalised for alloplastic surgery. The number of blood glucose measurements during 24-hour perioperative care was 6.5. Among patients analysed, 10-20% did not have their blood glucose measured in the days following surgery. Among patients, 64% received insulin 1-50% of the required times.We demonstrated that 10% of hospitalised patients suffer from diabetes. The audit also showed that blood glucose is generally measured according to guidelines, whereas the treatment of an elevated blood glucose is far from being given according to guidelines. This may potentially delay recovery and prolong hospitalisation.none.not relevant.

Background: The article describes variations in the organization of clinical services for diabetes patients in 10 public primary health clinics in Malaysia with the view to learn from current innovations and improve diabetes service provision. Methods: This study combined the use of secondary data and a qualitative multicase study approach applying observations in 10 randomly selected Ministry of Health (MOH) health clinics in Kuala Lumpur and Selangor and semistructured interviews of the family medicine specialists from the same clinics. Results: Although there are specific MOH guidelines for diabetes care, some clinics had introduced innovations for diabetes care such as the novel ‘personalized care’, ‘one-stop-centre’ and utilization of patients’ waiting time for health education. Analysis showed that there was room for improvement in terms of task shifting to free precious time of staff with specialized functions, streamlining appointments for various examinations, increasing continuity of consultations with same doctors, and monitoring of performance. Conclusion: We contend that there is a potential for increased effectiveness and efficiency of primary diabetes care in Malaysia without increasing the resources – a potential that may be tapped into by systematic learning from ongoing innovation.

Introduction: Studies from many parts of the world have explored factors associated with poor diabetes self-management including Diabetes Self-Management Education (DSME). Research Methodology: This study was conducted among 162 diabetes patients at primary healthcare clinics in Malaysia using semi-structured exit-interviews to explore their perceptions, attitudes and practices in relation to self-care and encounters with primary health care providers. Results and Discussion: Generally, the patients had limited knowledge, lack of motivation and encountered difficulties in diabetes self-management. The DSME was inadequate due to limited time allocated for consultations with doctors, language barriers and the lack of interpersonal and communication skills of HCPs. Conclusion: In view of the positive effects of quality DSME on the health outcomes and quality of life among diabetes patients, it is important for the primary healthcare clinics in Malaysia to strengthen the diabetes services through training in communication of all HCPs, awareness of language difference and task shifting.

Background: Continuing Medical Education (CME) is a cornerstone of improving competencies and ensuring high-quality patient care by nurses and physicians. The Ministry of Health (MOH) Malaysia collaborated with Steno Diabetes Centre to improve diabetes-related competencies of general physicians and nurses working in primary care through a six-month training programme called the Steno REACH Certificate Course in Clinical Diabetes Care (SRCC). Objective: This impact evaluation aimed to assess the effect of participation of general physicians and nurses in the SRCC in selected public primary healthcare clinics in Kuala Lumpur and Selangor, Malaysia. Design: The quasi-experimental, embedded, mixed-methods study used concurrent data collection and the Solomon four-group design. Participants in an intervention group (Arm 1) and control group (Arm 3) were assessed by pre-and post-test, and participants in separate intervention (Arm 2) and control (Arm 4) groups were assessed by post-test only. Quantitative and qualitative methods were used to assess the effect of the programme. Results: Thirty-four of the 39 participants in the intervention groups (Arms 1 and 2) completed the SRCC and were included in the analysis. All 35 participants in the control groups (Arms 3 and 4) remained at the end of the study period. Significant improvements in diabetes-related knowledge, skills and clinical practise were found among general physicians and nurses in the intervention group after the six-month SRCC, after controlling the pretest effects. No clear changes could be traced regarding attitudes. Conclusion: SRCC participants had significant improvements in knowledge, skills and clinical practice that meet the current needs of general physicians and nurses working in primary care in Malaysia. Thus, SRCC is an effective CME approach to improving clinical diabetes care that can be scaled up to the rest of the country and, with some modification, beyond Malaysia.

The burden of diabetes continues to increase in Malaysia, and the public primary health sector has an insufficient number of health care providers well-trained in diabetes care. The Ministry of Health Malaysia collaborated with Steno Diabetes Center to educate primary care doctors and nurses on the fundamentals of clinical diabetes care using a competency-based approach that blends e-learning, classroom-based learning, and clinic-based group work. This programme is called Steno REACH Certificate Course in Clinical Diabetes Care (SRCC). The aim of this study was to assess the effectiveness of the SRCC intervention in improving diabetes-related knowledge, attitudes, skills and clinical practices among non-specialised doctors and general nurses working in public health clinics in Malaysia. This paper presents the study protocol. A quasi-experimental, mixed-methods study based on Solomon’s Four Group Design was applied. Non-specialist doctors and general nurses from ten health clinics were randomly selected to receive the educational intervention. Comparison clinics were purposive selected matching on proxy indicators for quality of diabetes care. The intervention consisted of 50 hours of e-learning, 48 hours of classroom-based learning and approximately 25 hours of work-based learning that covered all main aspects of clinical diabetes care and delivered over a six-month period. Primary outcomes were changes in diabetes-related knowledge, attitudes, skills, and clinical practice. Patients’ perceptions regarding the quality of care provided were classified as a secondary outcome. Other outcome measures included patients' assessment of their chronic disease care and providers' perceptions, attitudes and perceived barriers in care delivery. Results from this study will inform future educational approaches within the Malaysian health system. The study is unique because it evaluated a pertinent public health topic using a very robust methodology.

The Practical Diabetology (PD) course for multidisciplinary health care professionals (HCPs) is directed at building a team-based approach to diabetes care delivery. Participants were asked to apply course learning to identify deficiencies in care delivery in their own settings and develop action plans to improve care and continuing self-development. The objective of the study was to evaluate the short- and mid-term impact of seven PD courses held between March 2011 and March 2012. Three methods of assessment were carried out: an end of course evaluation; pre- and post-tests to assess gain in knowledge and change in attitudes; and self-assessment of action plan implementation at six months to determine level of behaviour change. In total, 327 multidisciplinary HCPs participated in the seven PD courses. End of course evaluation indicated that the PD course was valued by course participants in terms of relevance of the topics and learning experience. A significant gain in knowledge and positive changes in attitudes were seen immediately post course in both groups. Of the 160 action plans prepared by participating teams (consisting of at least two members each – one medical and one non-medical HCP), 68 (42.5%) were implemented. At six months, continued positive change was demonstrated through self-assessment of action plan implementation. PD courses were appreciated by the participants; significant gain in knowledge and positive change in selected attitudes were seen in the short term. Implementation of action plans helped enhance participants’ competency for teamwork, problem solving and self-development skills. Copyright © 2015 John Wiley & Sons.