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This study uses ethnographic data from two diabetes clinics to examine how some organizational features of medical settings are connected to the daily cognitive and interactional work of medical providers – specifically, the process of assessing patient adherence and using such assessments to make treatment decisions. I address continuity of care, scheduling and time constraints, team management, provider interaction, and medical recordkeeping as organizational-level issues that impact individual-level providers’ work. More than a top-down model of how “macro” influences “micro,” this study highlights how organizational influences are accounted for in terms of variation in patients’ behavior.

In 2002 the Singapore Ministry of Health (MOH) audited doctors' compliance with diabetes clinical practice guidelines in public healthcare institutions and attempted to postulate factors that influenced the degree of conformity. This study aims to address this issue

A retrospective cross‐sectional chart review of diabetes patient records sampled from hospital specialist outpatient clinics (SOCs) and polyclinics was performed. Childhood, gestational and secondary diabetes cases were excluded. The nine audit parameters used were process measures concerning the assessment of HbA1c, weight, blood pressure, urinary protein, serum creatinine, serum lipids, electrocardiography, retina and feet. Age‐standardised prevalence rate ratios of parameter adherence were calculated. Of the SOC cases, 89 per cent were analysed. Of the polyclinic cases, 94 per cent were analysed.

Adherence to ECG and foot assessment parameters was poor among SOC cases, while poor adherence to weight and foot assessment parameters was seen in the polyclinics. There was poorer adherence to blood pressure and ECG parameters in the SOCs, but better adherence was seen for weight assessment. Among the SOC cases, Cluster A fared better than Cluster B in ECG monitoring. In the polyclinics, better adherence was seen in Cluster A for urinary protein, serum creatinine, lipids, ECG, retinal and foot assessment parameters.

Based on pre‐existing information on local diabetes care, certain system, physician, patient and guideline factors are postulated to explain clinical practice guideline non‐compliance among doctors.

Diabetes is one of the major healthcare challenges in India. The chronic nature of the disease makes the lifetime cost of the treatment exorbitantly high. The medicine cost contributes a major size of expense in diabetes management. To make healthcare available to poorest of the poor, it is imperative to control the rising cost of diabetes treatment. The earlier research works done in this area focuses more on inventory management techniques to control the cost of healthcare. Less interest is shown in the role of better supply chain partnership (SCP) in reducing the cost of procurement of medicine. The purpose of this paper is to develop and use the SCP assessment framework for a diabetes clinic. The approach is generalized enough to be adopted for other similar organization.

This paper adopts self-assessment criteria of the European Foundation for Quality Management (EFQM) business excellence model for analysis of SCP in the supply chain of a private diabetes clinic in Varanasi. The paper uses analytic hierarchy process (AHP) method for calculation of weights of criteria.

The EFQM-based framework can be adopted as easy-to-use tool to make an objective assessment of the SCP. The proposed model in the study is a balanced model between enablers and results, which includes multiple assessment dimensions. The supply chain performance score of the diabetes clinic under study was found as the Tool Pusher, which means the effort in direction of SCP is not too good. The organization needs to clearly define the SCP goal and analyze the results to identify the gap areas.

The study is first of its kind and contributes to the literature by providing non-prescriptive and easy-to-use SCP assessment framework, for chronic disease care. The case study approach provides a procedure for the healthcare organization willing to adopt this approach.

This paper aims to examine the effect of customer-to-customer (C2C) interaction while using a service on the willingness of consumers to engage in altruistic customer participation (CP) or co-production efforts aimed at helping other customers. It further examines the role of consumer skepticism toward the service category in moderating the effects of C2C interaction on altruistic CP and customer satisfaction.

A survey methodology was used to collect data from 374 consumers of health-care services in India. The data collection involved interviews of patients visiting diabetes clinics and focused primarily on the interaction between customers and their willingness to participate in educating members of the community on diabetic self-care.

The analysis shows that C2C interaction positively affects customer satisfaction and willingness to engage in altruistic CP. Consumer category skepticism does not moderate the effect of C2C interaction on customer willingness to engage in altruistic CP. However, category skepticism does have the moderating effect of significantly reducing the positive effect of C2C interaction on customer satisfaction.

Data for this study were collected via interviews of consumers in India. Each consumer was interviewed by a trained interviewer. Although the authors do not detect any systematic influence in the results, the possibility of bias is acknowledged. Regarding the research implications, the finding that category skepticism does not moderate the effect of C2C interaction on willingness to engage in altruistic CP suggest that ultimately consumers may have stronger commitment and loyalty to themselves and that their relationships with the firm’s might be peripheral.

The study finds that consumer skepticism toward a service category can have adverse effects for service co-creation. The authors advise managers in troubled industries not to focus exclusively on improving brand differentiation but to also consider working with major industry players and regulators to address the deepest fears of consumers.

The findings have implications for the service dominant logic of marketing in that it suggests that category skepticism is disruptive to the value integration process on which service co-creation relies for value creation. This has strong implications for how managers should structure their interaction processes with customers and for future research that seeks to them prove customer productivity.

Considers the impact of recent government policy on the organization of primary care in England and Wales. Discusses the notion and practice of “teamworking” currently in vogue, and analyses implications for doctors, nurses and managers working in/attached to general practices. Draws on the findings of a study of primary care team building which took place in a UK health authority (here referred to as “Weston”), and focuses on the experiences of four general practices as they have attempted to develop as multidisciplinary partnerships. Gives consideration to the “new managerialism” evident in the NHS and its attempt to redefine professionalism and professional autonomy.

Women experience a triple burden of ill-health spanning non-communicable diseases (NCDs), reproductive and maternal health conditions and human immunodeficiency virus (HIV) in sub-Saharan Africa. Whilst there is research on integrated service experiences of women living with HIV (WLHIV) and cancer, little is known regarding those of WLHIV, diabetes and/or hypertension when accessing integrated care. Our research responds to this gap.

The INTE-AFRICA project conducted a pragmatic parallel arm cluster randomised trial to scale up and evaluate “one-stop” integrated care clinics for HIV-infection, diabetes and hypertension at selected primary care centres in Uganda. A qualitative process evaluation explored and documented patient experiences of integrated care for HIV, diabetes and/or hypertension. In-depth interviews were conducted using a phenomenological approach with six WLHIV with diabetes and/or hypertension accessing a “one stop” clinic. Thematic analysis of narratives revealed five themes: lay health knowledge and alternative medicine, community stigma, experiences of integrated care, navigating personal challenges and health service constraints.

WLHIV described patient pathways navigating HIV and diabetes/hypertension, with caregiving responsibilities, poverty, travel time and cost and personal ill health impacting on their ability to adhere to multi-morbid integrated treatment. Health service barriers to optimal integrated care included unreliable drug supply for diabetes/hypertension and HIV linked stigma. Comprehensive integrated care is recommended to further consider gender sensitive aspects of care.

This study whilst small scale, provides a unique insight into the lived experience of WLHIV navigating care for HIV and diabetes and/or hypertension, and how a “one stop” integrated care clinic can support them (and their children) in their treatment journeys.

The purpose of this paper is to explore physical environmental, medical environmental, and individual factors in a sample of ethnic minority adults with or at-risk for type 2 diabetes (T2D) on the Atlantic Coast of Nicaragua.

The study used a cross-sectional descriptive design guided by a community-based participatory research framework. Three coastal communities in the South Atlantic Autonomous Region (RAAS) of Nicaragua were sampled. Inclusion criteria were: lay adult with or at-risk for T2D, ⩾21 years of age, self-identification as Creole or Miskito, and not pregnant. Convenience sampling procedures were followed. Data were collected via objective (A1C, height, and weight) and self-report (Pan American Health Organization surveys, Diabetes Care Profile subscales, and Medical Outcomes Survey Short Form-12 (MOS SF-12) measures. Univariate and bivariate statistics were computed according to level of measurement.

The sample (N=112) was predominately comprised of Creoles (72 percent), females (78 percent), and mid-age (M=54.9, SD±16.4) adults with T2D (63 percent). For participants with T2D, A1C levels, on average, tended to be elevated (M=10.6, SD±2.5). Those with or at-risk for T2D tended to be obese with elevated body mass indices (M=31.7, SD±8.1; M=30.2, SD±6.0, respectively). For many participants, fresh vegetables (63 percent) and fruit (65 percent) were reported as ordinarily available but difficult to afford (91 and 90 percent, respectively). A majority reported that prescribed medication(s) were available without difficulty (56 percent), although most indicated difficulty in affording them (73 percent). A minority of participants with T2D reported receipt of diabetes education (46 percent). A1C levels did not significantly vary according to diabetes education received or not (M=10.9, SD±2.9; M=10.4, SD±2.5; t=−0.4, p=0.71). Participants at-risk for T2D were infrequently instructed, by a provider, to follow an exercise program (4.8 percent) or meal plan (4.8 percent) and receive diabetes education (2.38 percent). MOS SF-12 findings revealed participants with T2D (M=41.84, SD=8.9; M=37.8, SD±8.5) had significantly poorer mental and physical health quality of life relative to at-risk participants (M=45.6, SD±8.4; M=48.1, SD±9.5) (t=−2.9, p<0.01; t=−2.5, p=0.01).

Salient physical environmental, medical environmental, and individual factors were identified in a sample of adults with or at-risk for T2D on Nicaragua’s Atlantic Coast.

Findings informed the development of community-based clinics to address the problem of T2D locally.

The community-based clinics, housed in trusted church settings, provide culturally competent care for underserved ethnic minority populations with or at-risk for T2D.

This is the first quantitative assessment of the T2D problem among diverse ethnic groups in Nicaragua’s underserved RAAS.

This paper's aim is to identify whether community‐level socioeconomic status (SES) predicts: screening test for pre‐diabetes; actual diagnosis of pre‐diabetes; or nutritional counseling.

This is an analysis of 1,348,124 insured adults receiving medical care from Maccabi Healthcare Services (MHS) in 107 MHS clinics throughout Israel. The research population comprised 79 percent of the MHS members over 18 years of age in 2004‐2006. Area level socioeconomic data were drawn from the Israel Central Bureau of Statistics SES index for every geographical area and each MHS clinic in the study was coded from: −1.03 to 2.73 (−1.03 indicating low SES and 2.73+ high SES) according to the SES index for the location. The fasting glucose laboratory test was used for analysis. Pre‐diabetes diagnosis was based on a fasting glucose above 100 mg/dl. Nutritional counseling was defined by dietitian visits in the claims database.

The percentage of insured individuals who underwent blood glucose testing during the study increased with age from 67 percent at ages 18‐45 to 92 percent for age 65 and over. The percentage of individuals diagnosed with pre‐diabetes also increased with age, rising from 4 percent in the younger group to 14 percent in those aged 46‐65 and to 14‐16 percent of 65 and older. The percentage of individuals with pre‐diabetes who visited a dietitian was 16‐27 percent for those under 65 and 14‐17 percent for those over 65 (males and females, respectively). Individuals living in lower socioeconomic areas were less likely to have blood tests. Among tested patients, the prevalence of pre‐diabetes was higher in areas of lower SES and their dietitian visits were less frequent.

In lower SES index areas, there is a need for better identification and treatment of patients.

The paper shows that a proactive approach is needed both to detect pre‐diabetes and to encourage patients to receive nutritional treatment.

Diabetes mellitus (DM) is an important health problem throughout the world. Association between DM and oral diseases has been reported and dental clinic is indicated to be one of the suitable venues for the screening of DM. The purpose of this paper is to determine patients’ attitude toward DM screening in dental clinics.

The anonymous, self-administered questionnaires of five-point response scale questions were distributed to convenience samples of adult patients (⩾25 years) attending one of the dental settings. These dental settings were divided into the university/hospital-based dental clinics (encompassing two university-based and five hospital-based dental clinics) or the private dental clinics (encompassing two private, and one special (after office hour) clinic of a faculty of dentistry). The questions could be categorized into three groups regarding importance, willingness, and agreement of DM screening in dental settings. Results are presented as percentage by respondents based upon the number of responses for each question. The favorable outcomes which were defined as responses of either scale of 4 or 5 were also summarized according to dental settings. The χ² test for comparison was used to compare the favorable outcomes between the two settings.

A total of 601 completed questionnaires were collected; 394 from university/hospital-based dental clinics and 207 from two private clinics and a special (after office hour) clinic of a faculty of dentistry. Overall, the majority of respondents in both university/hospital-based and private practice settings felt that it is important to have a dentist conduct a screening (84.8 vs 79.5 percent). The majority of patients in both groups were willing to receive blood pressure examination (95.0 vs 92.0 percent), weight and height measurements (94.7 vs 94.0 percent), saliva/oral fluid investigation (86.4 and 86.9 percent) and finger-stick blood test (83.8 vs 83.9 percent). More than 75 percent of all respondents agreed with diabetes screening in dental clinics.

The majority of respondents supported the screening of DM in dental settings and they were willing to have a screening test by the dentist. Patient acceptance is an important key to be successful in the screening of DM in dental settings.

The purpose of this paper is the investigation of type 2 diabetes patients' information seeking behavior in terms of their information needs, sources and barriers faced by patients when seeking information. The information seeking behavior is associated with clinical patient data.

The relevant literature is reviewed, and the results of a cross-sectional survey informed by Wilson's macro-model of information seeking behavior are reported. The survey includes 106 outpatients from the diabetes clinic of a Greek major university hospital and includes information seeking behaviors and patient's clinical evidence.

The most important health information needs are related to the complications, symptoms and causes of diabetes, to the proper diet for diabetics and the measures adopted to avoid foot complications. Furthermore, the most important information resources were physicians, ophthalmologists, books, broadcast media and family members. Obstacles encountered during information seeking include the complicated nature of health information, which involves scientific terms as well as psychological issues. The diabetes stage is correlated with information needs for diabetes medication, while the years from the first diagnosis are negatively correlated with the use of informal sources.

The information needs and sources of diabetic patients, as well as the main obstacles to this pursuit, could potentially have important implications in designing a future information campaign and information services for diabetes patients.

The Wilson's macro-model of information seeking has been applied to the diabetic patients' information seeking behavior; while information needs, information sources and information obstacles are correlated with clinical evidence from patients’ hospital records.