Methods and Analysis Section of the EBP Proposal
Introduction
The following paper will introduce the methods and analysis technics employed in achieving the evidence-based proposal. It is the final part of the project which aims at implementing various findings arrived at during the project period. At the end of this section, we will determine where the project was a success or a failure. The EBP proposal will be put on trial and the implementation tactics are considered here.
Evidence-based techniques have become very common in the recent past especially in the healthcare sector. Data appraisal methods, systematic review and meta-analysis and their application to clinical services as well as in the preventive medicine through clinical guidelines and economic analysis and establishment. The strategies have been mainly applicable in the occupational health risk and interventions. Proper compliance with the regulations provided by the above methods improves the quality of disease prevention. The advice provided by the practitioners is more reliable and helpful. The nurses also secure their jobs due to the quality assured information. Recently financial resources are channeled towards the development of EBPs. Such Professionals methods are pre-requisite for success.
Problem Statement or Research Question
As much as the Internet-based incentive methods for blood sugar level determination among the diabetic patients come with only short-term benefits. The youth who have any knowledge of how to use the smart equipment can adequately monitor their sugar levels without visiting the hospital. Its application in long-term solution is still under questioning. A lot of information on the improvement of adherence of patient with self-monitoring blood glucose testing present short-term effects. The materials are void of important information whether the practice triggers any long-term effects. The tests which can be easily carried out through this practice is the Diabetes Mellitus type 1. This study will help us show the long-term equivalent effects brought about by the Internet-based incentive for blood glucose testing on the improvement of teens’ adherence to the self-monitoring blood glucose testing.
Problem Statement
- What is the effectiveness of Internet-based incentive approach for achieving the long-term adherence of teenagers/adolescents with the self-monitoring blood glucose testing for Diabetes Type I?
- How best can we implement this practice in our medical facilities?
Background and Clinical Significance of the Project
The efficiency of blood sugar testing is on the decline especially the self-monitoring which is common among the youth.
In regards to performing blood glucose testing at least four times in a day, adherence among teenagers with self-monitoring blood glucose testing of diabetes Type I is challenging and has been found to decline because of several influencing factors, including psychosocial or environmental barriers and reduced involvement of parents (Fitzpatrick, Schumann, and Hill-Briggs, 2013; Alzaid, Schlaeger, and Hinzmann, 2013). Several already statement ótesting among diabetic teens such as meta-analysis conducted by Lustria et al. (2013), provides evidence of short-term effects of Internet-based incentive approach on the adherence management of teens with blood glucose testing. The findings of the study conducted by Raiff et al. (2016) supported these results and found that Internet-based incentive gives only short-term results in the improvement of adherence among diabetic teens with the self-monitoring blood glucose testing. There were no statistically significant differences in demographic and diabetes characteristics among NS and CS groups. Participants were predominantly male minorities (Hispanic or African-American). About half of participants were living in a household with an annual income of $45,000 or less. Mean participant age was 15.20 (±1.43) and mean age of diagnosis was 7.89 (±3.96). Average HbA1C at intake was 9.60 (±1.71). The average amount of monetary incentives earned was similar across groups (M = $64.77, range $0–162). (Transl Behav Med. 2016 Jun; 6(2): 179–188.)
Researchers have found that a deeper study needs to be conducted by health care practitioners to provide concrete evidence that supports the statement which states that; long-term effects of adherence with self-monitoring blood glucose testing among teenagers can be achieved through adopting internet-based incentive approach for testing blood glucose in the practice. Therefore it is not just a matter of one day but it is a whole process which should be monitored day in day out. The results are then implemented thereafter.
Benefits from the Findings
Nurses face numerous challenges in their line of work. But if the challenged are in line with the enhancing the comfort of the patient then the suffering is worthwhile. The tests trigger the development of advanced curative and preventive mechanisms. From the Orem’s model of nursing, a nurse is encouraged to find the solution which can heal the conditions they are in. a better explanation is stated in the self-care theory in nursing that encouraged the patient to contribute actively to his or her recovery process. The theory if mainly applicable where the patient is facing a chronic condition.
The choice of the self-care theory in nursing is in line with the need for the patients to have a web-based platform from where they can carry out basic self-administration and care to the chronic cases. The following project is important for clinicians as well as for future research to acquire sufficient knowledge and information regarding the long-term effects of internet-based incentives, privileges and/or money on adherence among teenagers/adolescents with blood glucose testing in Diabetes mellitus Type 1.
Literature Review
The need to have convenient tools for the management of the chronic conditions like diabetes is very useful. Many practitioners believe that it is the next frontier that will change the course of the medical service provision. Using the web-based portals to monitor the patient’s condition is a critical way in which the conditions can be contained and controlled. This section addresses the existing research articles that attempt to explain the position of the web-based platforms for the management of type 1 diabetes.
One of the major challenges that the medical administrators have in the controlling of the patient conditions in chronic healthcare is the commitment. Petry et al conducted a sampled study to determine the impacts of introducing rewards to those people who have proven excellence in keeping consistency when working with their conditions in self-monitoring blood glucose (SMBG). The 12-week program saw the participants remunerated $0.10 per test with the amount increasing after 4 consistency tests, and reaching as high as $251 (Petry & et al., 2015). The research found out that SMBG among the adolescents increased from 1.8 ± 1.0 to 4.9 ± 1.0 tests per day (P < 0.001) with over 90% completing four or more tests every day. It can be concluded based on the research that the use of reinforcements can make the web-based platforms for the management of diabetes 1 more effective (Petry & et al., 2015).
Another challenge that most health practitioners face in the administration of the medical support services to the chronic conditions is the knowledge about the system functionality. When the technological interventions like the web-based platforms are applied in the control of the chronic conditions, it becomes challenging to create valuable usability efficiency. In an attempt to understand how various providers have navigated the need to have usability efficiency in the chronic conditions, Lyles, Sarkar, and Osborn conducted a research between 2009 and 2013 to evaluate the approach models that medical support have taken. The research found out that majority of the medical technology models take the form of mixed models that were reported by 11 research studies. There were 9 research studies that used descriptive models and three that used qualitative models out of the 23 research studies that were reviewed. They suggested that there is need to have more support services in the introduction of the mobile/ web-based support services to the chronic conditions.
Methods and analysis
Technological innovations like the use of consumer-oriented health information technologies (CHITs) have been fronted as a useful measure for the development of the increased efficiency of managing the chronic cases. Through the use of the systematic reviews and meta-analysis, it was found out that there is a possibility that the application of consumer-oriented health information technologies (CHITs) on glycemic control by at least −0.31%, using a 95% confidence interval and a further −0.38 to −0.23, when P < .001 (Tao & et al., 2017). Therefore, for the diabetic patients, the use of the consumer-oriented health information technologies (CHITs) as a way of improving glycemic control appears to be a better way to stabilize the condition when compared to the natural and normal methods. When applying the web-based platform to the control of the Type 1 diabetes, the use of the consumer-oriented health information technologies (CHITs) therefore, can be put into consideration.
The enthusiasm that comes with the implementation of the web-based platforms can be highly attributed to the medical team who are interested in rolling out efficient plans to ease the doctors and nurses workload. However, the implementation of the web-based portal has played little interested in the development of the patient experiences. In 2017, Cerdan et al conducted a research model to make out the possible patient experiences in using the web-based platforms for the management of the chronic cases in Denmark. From the study, it was found out that the web-based models are a very effective way to administer care to the chronic conditions but their design needs to incorporate the requirements of the patients’ experiences (Cerdan & et al., 2017). Patients reported problems with the patients’ experiences’ caused by the usability challenges. In some cases, the needs to navigate the web-based portals require advanced knowledge that many patients lack. Further, the web portal’s technical aspects became a significant impediment to the efficient roll out of the web platforms. Moreover, some other patients reported that there are various areas for improvement and elements of digitalization that should be core components of the web-based portals to make them more useful. Therefore, the research study recommends that web portals should not be used as independent avenues, but as service addition to the normal patient and doctor physical interactions (Cerdan & et al., 2017).
The need to roll out and provide the online web-based platform for the self-management by the patients with the type 1 diabetes may face challenges with the behavior change techniques. Similar approaches have been undertaken for the analysis and development of the type 2 diabetes. The challenges that existed in the understanding of the requirements of the type 2 diabetes emanated from the need to show industriousness and self-modification of Behaviour, further, it becomes difficult for the patients to be honest in reporting their conditions consistently, thus creating the consistency problems in the monitoring of their conditions (Van et al., 2013). A similar implementation of the type 1 diabetes is likely to experience the same kind of problems unless intervention measures are in place to help improve the uptake of the services from the patient’s perspective. The remote monitoring creates a sense of contentment and laxity in many clients that may subvert the effectiveness of the online web-based care to chronic conditions like in type 1 diabetes.
The use of the technological interventions is also useful in the improvement of the consumer behavior change. However, the effectiveness of the platform can only be improved when the customer gets alerts that act as reminders on what they should do at any given time. This was effective when applied throu8gh the use of a mobile phone that created a useful platform for the development of the patient self-administered care to the chronic conditions(Free & et al. , 2013).
It is true that technological interventions can improve the level of the patient care, even in the remote patient care provided through the web-based platforms (Gayar & et al, 2013). However, a number of factors still remain gray areas in the study and deployment of the information technology models. Key among the research gaps include the need to incorporate the user perceptions in the development of the web-based platforms, the need to have alert systems, the value of the system feedback and data management as well as the need to make the platforms user-centered (Gayar & et al, 2013).
New advancements included
The current methods for self-testing are losing ground with time. The youth tend to forget the purpose of performing the tests. As a result, the abandon them gradually. Severe effects come with this negligence, therefore there is a need to monitor all the equipment dispersed for the purpose of self-testing. Tracking the frequency at which these types of equipment are used will help know who is using them and who is not.
The improvement I will bring on board includes creating a database that stores the information sent through the devices. The database should include the fields l name of the device, DNA of the patient, location of the patient, time of use, and a number of tests carried out in a day. After gathering this information, it is analyzed and then a report is sent to every patient weekly to inform him or her of his progress. Some recommendation of how to make the best of the self-testing practice will also be provided to all subscribers.
Design implementation
Chronic conditions such as diabetes can only be managed or prevented since they have no cure once you are diagnosed with the same. The two strategies need to be implemented across all health facilities and homes for better results in developing a healthy nation. At homes, the prevention mechanisms should be put in place as well as the management tactics to the patients.
At the hospitals, the nurses should provide free diabetes test equipment to any patient visiting the facility. In so doing the health of the community is improved. Any patient living with the condition unknowingly will have the opportunity to live a healthy life to prevent succumbing to the disease. Those yet to be attacked are also advised accordingly on how to prevent future attacks.
On the other hand, the medical facilities should launch a program which will educate the public on the condition. During the rally, all willing members should be provided with free medication and guidelines to healthy living. Such programs create awareness and bring the reality to the members of the public.
References
Alzaid, A., Schlaeger, C., & Hinzmann, R. (2013). 6th annual symposium on self-monitoring of blood glucose (SMBG) applications and beyond, April 25–27, 2013, Riga, Latvia.
Cerdan, J., & et al. (2017). Online communication in a rehabilitation setting: Experiences of patients with chronic conditions using a web portal in Denmark. Patients Educational Counselling Journal, 2283–2289.
Fitzpatrick, S. L., Schumann, K. P., & Hill-Briggs, F. (2013). Problem-solving interventions for diabetes self-management and control: a systematic review of the literature. Diabetes research and clinical practice, 100(2), 145-161.
Free, C., & et al. (2013, January 15). The Effectiveness of Mobile-Health Technology-Based Health Behaviour Change or Disease Management Interventions for Health Care Consumers: A Systematic Review. Retrieved November 14, 2017, from PLOS Medicine: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001362
Gayar, O. E., & et al. (2013). A systematic review of IT for diabetes self-management: Are we there yet? International Journal of Medical Informatics, 637-652.
Kelly P. McCarrier, James D. Ralston, Irl B. Hirsch, Ginny Lewis, Diane P. Martin, Frederick J. Zimmerman, and Harold I. Goldberg. Diabetes Technology & Therapeutics. April 2013, 11(4): 211-217. https://doi.org/10.1089/dia.2008.0063
Lustria, M. L. A., Noar, S. M., Cortese, J., Van Stee, S. K., Glueckauf, R. L., & Lee, J. (2013). A meta-analysis of web-delivered tailored health behavior change interventions. Journal of health communication, 18(9), 1039-1069.
Lyles, C.R., Sarkar, U. & Osborn, C.Y. Curr Diab Rep (2014) 14: 534. https://doi.org/10.1007/s11892-014-0534-9
Petry, N. M., et al. (2015, October). Testing for Rewards: A Pilot Study to Improve Type 1 Diabetes Management in Adolescents. Retrieved November 14, 2017, from American Diabetes Association: http://care.diabetesjournals.org/content/38/10/1952.short
Petry, N. M., Cengiz, E., Wagner, J. A., Hood, K. K., Carria, L., & Tamborlane, W. V. (2013). Incentivizing behavior change to improve diabetes care. Diabetes, Obesity and Metabolism, 15(12), 1071-1076.
Rachel Hess, Cindy L. Bryce, Suzanne Paone, Gary Fischer, Kathleen M. McTigue, Ellen Olshansky, Susan Zickmund, Katharine Fitzgerald, and Linda Siminerio. Telemedicine and e-Health. November 2007, 13(5): 509-518.https://doi.org/10.1089/tmj.2006.0089
Raiff, B. R., Barrry, V. B., Ridenour, T. A., & Jitnarin, N. (2016). Internet-based incentives increase blood glucose testing with a non-adherent, diverse sample of teens with type 1 diabetes mellitus: a randomized controlled Trial. Translational behavioral medicine, 6(2), 179-188. Retrieved online on https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4927454/
Tao, D., & et al. (2017). Effects of consumer-oriented health information technologies in diabetes management over time: a systematic review and meta-analysis of randomized controlled trials. Journal of the American Medical Informatics Association, 1014–1023.
Van Vugt, M., de Wit, M., Cleijne, W. H., & Snoek, F. J. (2013). Use of Behavioral Change Techniques in Web-Based Self-Management Programs for Type 2 Diabetes Patients: Systematic Review. Journal of Medical Internet Research, 15(12), e279. http://doi.org/10.2196/jmir.2800
