A QUALITATIVE STUDY ON THE IMPROVEMENT OF DISEASE MANAGEMENT POLICIES IN DIABETES IN TURKEY

Öz

This study, it was aimed to determine the need for disease management in diabetes in Turkey and to reveal the recommendations for diabetes disease management policies as part of the identified needs. In this study, the research design was planned as a case study and, the snowball sampling method was used as part of the scope of qualitative research. A total of 21 individuals, 6 doctors, 3 diabetic nurses, 6 academics, and 6 adult diabetics were actualized using semi-structured forms with a thorough interview technique. The data collected were evaluated with descriptive analysis and content analysis methods. In the analysis of the data, the “Nvivo 12. Program” was used. The findings were discussed based on the relevant literature, and conclusions and recommendations were reached in line with the research purposes. The participants stated that the practices related to disease management in diabetes have improved compared to the past, but that the development process should continue. The participants stated that there is a need for a multidisciplinary systematic process structuring that will prioritize the patient and their needs and that will help patients to live their lives healthy and free from complications. In terms of the burden of disease, diabetes is a significant issue that affects both Turkey and the rest of the world. We propose that the health policy, health service delivery, health system structure, and multidisciplinary work related to the disease management approach in diabetes in Turkey should be determined and steps should be taken to improve it.

Anahtar Kelimeler

• Diabetes
• diabetes management
• disease management

Türkiye'de diyabette hastalık yönetimi politikalarının iyileştirilmesi üzerine nitel bir çalışma

Öz

Çalışmada Türkiye’de diyabette hastalık yönetimi ihtiyacının belirlenmesi ve belirlenen ihtiyaçlar kapsamında diyabette hastalık yönetimi politikaları için öneriler ortaya koymak amaçlanmıştır. Bu çalışmada araştırma deseni durum çalışması olarak planmlış ve nitel araştırma kapsamında kartopu örnekleme yöntemi kullanılmıştır. 6 hekim, 3 diyabet hemşiresi, 6 akademisyen ve 6 yetişkin diyabet hastası olmak üzere toplam 21 kişi ile yarı yapılandırılmış formlar aracılığıyla derinlemesine görüşme tekniği ile mülakat gerçekleştirilmiştir. Toplam veriler betimsel analiz ve içerik analizi yöntemleri ile değerlendirilmiştir. Verilerin analizinde “Nvivo 12. Programı” kullanılmıştır. Çözümleme sonucu elde edilen bulgular, ilgili literatüre dayalı olarak tartışılmış ve araştırma amaçları doğrultusunda sonuç ve önerilere ulaşılmıştır. Katılımcılar tarafından diyabette hastalık yönetimine ilişkin uygulamaların eskiye oranla iyileştiği, fakat gelişim sürecine devam etmesi gerektiği belirtilmiştir. Katılımcılar, hastayı ve ihtiyaçlarını ön planda tutan, hastaların hayatlarını sağlıklı ve komplikasyondan uzak bir şekilde geçirmelerine yardımcı olacak, multidisipliner sistematik süreç yapılandırılmasına ihtiyaç duyulduğunu ifade etmişlerdir. Diyabet hem dünyada hem de Türkiye’de var olan global bir sorundur ve hastalık yükü açısından önem arz eden bir noktadadır. Türkiye’de diyabette hastalık yönetimi yaklaşımına ilişkin politika, sağlık hizmeti sunumu, sağlık sistemi, multidisipliner çalışma ile ilgili ihtiyaçların belirlenmesini ve iyileştirmeye yönelik adımlar atılmasını öneriyoruz.

Anahtar Kelimeler

• Diyabet
• Diyabet Yönetimi
• Hastalık Yönetimi

Kaynakça

1. WHO. Management of Diabetes Mellitus: Standards of Care and Clinical Practice Guidelines (No. WHO-EM/DIN/6/E/G), 1994. Regional Office for the Eastern Mediterranean. Available from: Management of diabetes mellitus: standards of care and clinical practice guidelines (who.int)
2. TUİK. Health Expenditure Statistics, 2020. Turkish Statistical Institute. Available from: https://data.tuik.gov.tr/ Bulten/Index?p=Health-Expenditure-Stat istics-2020-37192
3. IDF. Diabetes Data Portal, 2022. International Diabetes Federation. Available from: https://www.diabetesatlas.org/data/en/
4. McElfish PA, Long CR, Scott AJ, Hudson JS, Haggard-Duff L, Holland A, et al. Pilot implementation of adapted-family diabetes self-management education into a clinical setting. J Prim Care Community Health. 2020 Jan-Dec;11: 2150132720931289. Medlline: 32517573 DOI:10.1177/2150132720 931289.
5. Bratina, N, Forsander G, Annan F, Wysocki T, Pierce J, Calliari, Pacaud D, et all. ISPAD Clinical Practice Consensus Guidelines 2018: Management and support of children and adolescents with type 1 diabetes in school. Pediatr Diabetes. 2018 Oct;19:64-74. Medline: 30084519 DOI:10.1111/pedi.12743.
6. CDC. National Prediabetes Awareness Campaign. Atlanta: Centers for Disease Control and Prevention 2021 [cited 2021 May 1]. Available from: https://www.cdc. gov/diabetes/campaigns/national-predia betes-awarenesscampaign.html
7. Koyucu R. Pregnant women’s attitudes towards glucose tolerance test in the context of gestational diabetes risk factors. Health and Society. 2018; 28:65-76.
8. Diabetes UK London: Know Diabetes Fight Diabetes; c2021. Available from: https://www.diabetes.org.uk/how_we_he lp/helpline.

9. Brown-Deacon C, Brown T, Creech C, McFarland M, Nair A, Whitlow K. Can follow-up phone calls improve patients self-monitoring of blood glucose? J Clin Nurs. 2017 Jan;26:61-7. Medline: 27862497 DOI:10.1111/jocn.13367.
10. Dickinson, JK. The experience of diabetes-related language in diabetes care. Diabetes Spectr. 2018 Feb;31:58-64. Medline: 29456427 DOI:10.2337/ds16-0082.
11. Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002 Feb 7;346:393-403. Medline: 11832527 DOI:10.1056/NEJMoa012512.
12. Ritholz MD, Beverly EA, Abrahamson MJ, Brooks KM, Hultgren BA, Weinger K. Physicians’ perceptions of the type 2 diabetes multi-disciplinary treatment team: a qualitative study. Diabetes Educ. 2011 Nov-Dec;37:794-800. Medline: 22002972 DOI:10.1177/0145721711 423320.
13. Szafran O, Kennett SL, Bell NR, Torti JM. Interprofessional collaboration in diabetes care: perceptions of family physicians practicing in or not in a primary health care team. BMC Fam Pract. 2019 Mar 13;20:44. Medline: 30871513 DOI:10.1186/s12875-019- 0932-9.
14. Radwan H, Hasan H, Hamadeh R, Hashim M, AbdulWahid Z, Gerashi MH, et all. Complementary and alternative medicine use among patients with type 2 diabetes living in the United Arab Emirates. BMC Complement Med Ther. 2020 Jul 10;20:216. Medline: 32650773 DOI:10.1186/s12906-020-03011-5.
15. Bowen ME, Rothman RL. Multidisciplinary management of type 2 diabetes in children and adolescents. J Multidiscip Healthc. 2010;3:113–24. Medline: 21197360 DOI:10.2147/jmdh. s7840.
16. Zupa MF, Lee A, Piette JD, Trivedi R, Youk A, Heisler M, et all. Impact of a a Dyadic Intervention on Family Supporter Involvement in Helping Adults Manage Type 2 Diabetes. J Gen Intern Med. 2022 Mar;37:761-8. Medline: 34240285 DOI: 10.1007/s11606-021- 06946-8.
17. Freudenberg N, Franzosa E, Sohler N, Li R, Devlin H, Albu J. Peer Reviewed: The State of Evaluation Research on Food Policies to Reduce Obesity and Diabetes Among Adults in the United States, 2000–2011. Prev Chronic Dis. 2015 Oct;12:E182. Medline: 26513438 DOI: 10.5888/pcd12.150237.
18. Modarresi M, Gholami S, Habibi P, Ghadiri-Anari A. Relationship between self care management with glycemic control in type 2 diabetic patients. Int J Prev Med. 2020 Aug 19;11:127. Medline: 33088455 DOI:10.4103/ijpvm.IJPVM_ 207_19.
19. Chen RY, Huang LC, Su CT, Chang YT, Chu CL, Chang CL, et al. Effectiveness of short-term health coaching on diabetes control and self-management efficacy: a quasi-experimental trial. Front Public Health. 2019 Oct 30;7:314. Medline: 31737593 DOI:10.3389/fpubh. 2019.00314.
20. Faruque LI, Wiebe N, Ehteshami-Afshar A, Liu Y, Dianati-Maleki N, Hemmelgarn BR, et al. Effect of telemedicine on glycated hemoglobin in diabetes: a systematic review and meta-analysis of randomized trials. CMAJ. 2017 Mar;189:E341-E364. Medline: 27799615 DOI:10.1503/cmaj.150885.
21. Liu CT, Yeh YT, Lee TI, Li YC. Observations on online services for diabetes management. Diabetes Care. 2005 Nov;28:2807-8. Medline: 16249564 DOI:10.2337/diacare.28. 11.2807a.
22. Goff SL, Murphy L, Knee AB, Guhn-Knight H, Guhn A, Lindenauer PK. Effects of an enhanced primary care program on diabetes outcomes. Am J Manag Care. 2017 Mar;23:e75-e81. Medline: 28385028
23. Ghazanfar H, Rizvi SW, Khurram A, Orooj F, Qaiser I. Impact of insulin pump on quality of life of diabetic patients. Indian J Endocrinol Metab. 2016 Jul-Aug;20:506-11. Medline: 27366717 DOI:10.4103/2230-8210.183472.
24. O'Connor PJ, Bodkin NL, Fradkin J, Glasgow RE, Greenfield S, Gregg E, et all. Diabetes performance measures: current status and future directions. Diabetes Care. 2011 Jul;34:1651-9. Medline: 21709298 DOI:10.2337/dc11- 0735.