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Article Critique: The effectiveness of nurse practitioner coordinated team group visits for type 2 diabetes

Updated on July 6, 2017

Jessee, B. T., & Rutledge, C. M. (December 01, 2012). The effectiveness of nurse practitioner coordinated team group visits for type 2 diabetes in medically und

Research purpose

The article by Jessee & Rutledge, (2012) explains the value of a multidisciplinary nurse practitioner coordinated team (NPCT) group visits to populations with limited medical service. Also, the study evaluates the self-efficacy and knowledge among type 2 diabetes patients. The reason behind the study arose from the recommendations of type-2 diabetes experts that teams led by general practitioners deliver a combined effort and a united front in the fight against type-2 diabetes (DM). Further, the experts advise that diabetes self-management education (DMSE) have a significant role to play in regulating glycemia.

The authors set to find out the reasons behind patients failure to join diabetes programs. They also wanted to establish if an NPCT program would lead to better results for blood sugar self-efficacy and knowledge regarding type 2 DM. They put forward two research questions. Firstly, “Is there a significant difference between the usual care comparison group and the NPCT group related to blood sugar, glycosylated hemoglobin (A1Cs), self-efficacy, and knowledge regarding type 2 DM?”. Secondly, “the significant difference between the two groups NPCT and usual care in pre- and post-intervention measures related to blood sugars, A1Cs, knowledge, and self-efficacy?” The researchers focused on Appalachia, one of the poorest locations in America for the study (Gabriel, 2014). The choice of the site justifies the requirement of the survey as a medically underserved area.

Research design

The researchers conducted a qualitative research by employing experiments, testing, and well-thought-out content analysis, interviews, and scrutiny. Objectively, the authors assigned the test subjects regarding willingness to participate. As is the case with many types of research of this nature, the researchers observed a high degree of order. The team involved an adviser, dietitians, nurses, pharmacists, lab technicians, and doctors indicating the depth of the team conducting the study. As an ethical obligation, the researchers obtained the necessary approvals and consents from the authorities and the participants respectively. The qualitative nature of the research by the authors of this article becomes clear from the detailed empirical data acquired.

The enrolling of the study subjects appears to have taken place within the first week of the research period. Now, the researchers sought consent from the authorities and patients for access to medical records; the participants chose to enroll as control subjects or the comparison group. To motivate people to join the study, the researchers provided incentives through a glucometer and supplies. The action represented an opportunity to acquire a large sample base for better data and results.

The study variables used by authors show detailed coverage of the topics under investigation. For instance, the separation of the test group into two groups gave the researchers the best control of the results. The control group which was under DMSE showed marked improvements on the variables. Through this group, the researchers hoped to prove that DMSE works best with NPCT involvement. Also, the group receiving normal care was a measure to find out patients refuse care.

Sampling and sample size

Data indicates that the Appalachian region exhibits high prevalence rates of diabetes and on this basis, the researchers sought to develop their hypothesis. They developed a plan to test patients in this area and educate them on the best ways to manage diabetes. The authors aimed at establishing how a combined effort between the nurses and a program educating the patients would be efficient in managing diabetes. Twenty-six patients participated in the study.

According to Armitage & Matthews, (2010), qualitative research is often impersonal and distant to the subject. This type of the investigation provides an explanation as to why the researchers were unable to attract a larger sample.

Limitations of the study

This research had a small size of the sample, and perhaps this could indicate the reason why results between the two groups show significant variance. However, it is important to mention that the authors justify the small sample by showing age. The research time limits for a short period may imply that a longer period would have presented different results.

Data collection and analysis

During the study, the examiners collected data from the patients and patient’s records. This primary data is the best source of evidence of any research. The use of lab analysis provided the authors with firsthand information answers to the questions they asked. (Armitage & Matthews, 2010).

Further, measurement through rated questionnaires provided the researchers with precise information. In observing the groups, the researchers noted all the changes in happening and came up with quality data. For instance, they asked patients who refused to participate, and they found the reasons as to why. In fact, they had assumed that patients would refuse participation for work reasons, but after analysis, the authors realized this would have no effect on the decision to participate in the study. Through regular health check by the doctors collected information that was relevant and accurate. The data collected helped in coming up with the collect illustration of the situation.

The researchers moved on to the initial data gathering to establish the stage diabetes progression. The participants underwent testing for blood sugar and A1Cs. They filled questionnaires and provided their knowledge on self-management and the reasons for refusing medical help. The NPCT phase with the control group started after the collection of the baseline data to allow researchers familiarize themselves with the patients. The interventions at this stage included advice on diet, lab tests, and counseling to manage behavioral changes. Patients learned self-efficacy from the nurses while the doctors provided treatment.

The final phase began after 12 weeks with a review of the results from the data collected. This stage forms the last part of interaction with the patients. The levels of knowledge on diabetes evaluation happened to assess the impacts of NPCT interventions with the patients in the control group. These involvements allowed the researchers compare the data collected at the beginning of the study with the present health data of the patients.

The authors conducted a thorough literature review on the need for NPCT and DMSE in the control of diabetes. All sources in this section agree for the need to raise this practice. Many organizations recognize and offer help quality DMSE as an essential element of diabetes treatment. DMSE is a constant practice of enabling the knowledge, expertise, and ability necessary aimed at prediabetes as well as diabetes self-management. This relationship integrates the needs, objectives, and the life of diabetic people or prediabetes directed through solid principles. Primarily, DMSE aids in making educated decisions, self-care actions, solution based, and active collaboration with the healthcare team and to rise proven effects, health standing, and superior living (Haas et al., 2014). This total agreement on this issue by many scholars surprises the reader since it is common to find opinions to the contrary on a subject matter. Nevertheless, the research conducted leads the authors in defining the parameters of the study.

The study identified the major health challenges related to diabetes with obesity because of eating patterns and lifestyle. Also, hypertension, hyperlipidemia, and limited education levels prevail among the study subjects. The article highlights that previous studies indicated that A1Cs below 7.0 had improved outcomes with less than 10% of patients facing ideal levels of blood pressure, fats, and glycemia.

Group members had lived with diabetes for different years. This data indicates the degree of confidence of each team member on sharing their information concerning how they lived with diabetes. The authors established a scale of 1 to 10 on the level of asking questions, and the average rank came to the assumption would be, that those who had more experience with diabetes would be open to sharing more quickly. After setting up the control group and the others unwilling to participate actively, establishing a statistical enumeration required to determine the patient care needs.

The study found that 46% of the patients had lived with diabetes for less or equal to five years. In the comparison group, the period under which the same category of participants had lived with diabetes was at 27%. The study established that only 5% had received training in diabetes management. The information could be a representation of the number of patients without any training in the South West Virginia.

Both groups had a similar demographic characteristic averaging 57 years of age. This similarity is a clear indication the prevalence of diabetics according to age. The study noted a higher number of women than males with the women taking over 50% in comparison to male. However, the control group had a larger percentage of women than in the comparison group.

The study examined the effects of diabetes on the daily life of patients with 46% indicating that they faced problems with the condition. This admission is an authoritative guide to the researcher in determining the care the patient should receive. The investigator’s ability to offer solutions to alleviating these challenges provides a clear goal accomplishment.

The majority of the affected patients, (55%) participated in the comparison group. The majority of patients within the control group expressed confidence in handling daily activities without any problems. Most of the team members in both the control and comparison groups had a diabetes drug prescription. Some patient’s medication administration occurred through insulin injection. The medical status meant that the majority of the test subjects had advanced diabetes and at a higher risk of complications. The study established some patients with oral medication indicating progression of diabetes to critical levels. Intervention measures ensuring limited progress happen at this stage.

Pre-intervention and post-intervention analyses through ranking indicate a well thought out method of interpreting the data. Instances of informative charts and tables appear throughout the article. This presentation of final data is crucial, and the reader can fully understand the issues under discussion. The authors have made an elaborate effort to remain consistent throughout the paper about the points of investigation and the result of the study. Patient’s statuses before the research had documented sugar levels, knowledge, A1Cs, and education levels forming the analysis. The comparison in the groups shows that for those in the control group, the blood sugars levels varied positively by a margin of 1.53 of the mean of the group with primary health care. The authors observed similar positive results for HbA1C, knowledge, and self-efficacy. During nurses’ visits, weak variables improved as opposed to when the patients preferred limited contact with the nurses.

The data indicate substantial effort in gathering the information making this a hugely scholarly and practical resource. The authors justify that diabetes management needs a different approach to the one in use currently. The study has shown the benefits associated with working in a multilevel team to work with patients suffering from diabetes type-2.

Recommendations

The authors offer an alternative topic for future research to show the various ways to improve self-efficacy and diabetes management. A scientific researcher in pursuit of knowledge that can effect change in the world is a priority. The article highlights the impact of diabetes on society and demands cognizance of the current leadership of the dangers posed by diabetes on populations. The article provides that by finding solutions to diabetes is a step in the right direction. The authors contend that eliminating diabetes would also reduce the prevalence of hypertension, hyperlipidemia, and obesity. Also, they recommend the use of group visits to achieve better management of diabetes.

Furthermore, the researchers urge a change of the current policy on diabetes management. They found that the legal framework on insurance and health benefits. Management of diabetes remains a challenge, and the authors would be disappointed. The Affordable Care Act authorized, but failed to fund, the Primary Care Extension Program (PCEP) (Phillips, et al., 2013). The article’s bias towards the education of patients as a necessary tool in managing diabetes raises questions in the available means of diabetes drug administration and availability of other methods apart from injections.

The authors show that patients need sensitization on the advantages of accepting help when offered. The article asserts that patients were reluctant to join the study with incentives.

Reflection

The authors had various issues regarding the prevalent diabetes cases among people with limited financial resources. The scope of the survey was constrictive, and the sample size selected fails to capture enough representative data. The article misrepresented the data collection pyramid by selecting such a small number of patients in respect to the assertion that the location holds a vast number of diabetic patients. Another notable discrepancy is that rural populations are at very high risk of obesity. In contrast, people living in the city are at an increased risk of obesity because of lifestyle. The justification for this claim is disputable from the nutritional, and physical activity observed outside the towns (Brill, 2015).

In the identification of the research topic, the author’s choice of the subject remains unrealistic. Numerous studies as established in the literature review show that all previous studies come to the same conclusion the authors of this article did. That groups of medical professionals guide patients in managing diabetes on their own. Also, they authors failed to provide a substantial relationship between education levels and the risk of diabetes. The authors had expected resistance to group sampling assuming that patients would be busy at work to participate in the study. The qualification parameters for participation in the study failed to capture the demographical requirements of people with diabetes.

In closing, quality of the work at the data analysis forms a good opinion of the authors. The authors were thorough in the limited data present. In the end, the data submitted is crucial to the treatment of diabetic patients. Another researcher should conduct a different study in diet and nutrition. The current debate on access to funding outreach programs and the cost to the economy will continue until a lasting solution towards preventative measures to causes of diabetes. This excellent insight may lead to new discoveries on the topic in the future.

Conclusion

In conclusion, the article makes a strong case for the inclusion of NPCT, in the management of diabetes. From the onset, the writers made clear arguments on the need for the study. The article flow of thoughts and ideas on the management of diabetes type-2 leads to a well-researched article. The author’s analysis of the literature review highlights the depth of the work. Further, the methods of data collection employed by the authors illustrate the resources needed in the management of diabetes.

The main findings and the process it took to arrive at the answers show the understanding of the topic by the authors. Except for a few inconsistent data variables, a small sample size and limited scope, the authors provide excellent paper. Conclusions by the writers and suggestions for future studies show professionalism and responsibility to the future of diabetes management.

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