Biomedical subjects

Sheri L Maddigan

Publications and source records attributed to Sheri L Maddigan.

10 recordsLinked to original sources

PubMed2006

Understanding the determinants of health for people with type 2 diabetes.

OBJECTIVE: We assessed which of a broad range of determinants of health are most strongly associated with health-related quality of life (HRQL) among people with type 2 diabetes. METHODS: Our analysis included respondents from the Canadian Community Health Survey Cycle 1.1 (2000-2001) who were aged 18 years and older and who were identified as having type 2 diabetes. We used regression analyses to assess the associations between the Health Utilities Index Mark 3 and determinants of health. RESULTS: Comorbidities had the largest impact on HRQL, with stroke (-0.11; 95% confidence interval [CI] = -0.17, -0.06) and depression (-0.11; 95% CI = -0.15, -0.06) being associated with the largest deficits. Large differences in HRQL were observed for 2 markers of socioeconomic status: social assistance (-0.07; 95% CI=-0.12, -0.03) and food insecurity (-0.07; 95% CI=-0.10, -0.04). Stress, physical activity, and sense of belonging also were important determinants. Overall, 36% of the variance in the Health Utilities Index Mark 3 was explained. CONCLUSION: Social and environmental factors are important, but comorbidities have the largest impact on HRQL among people with type 2 diabetes.

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PubMed2006

Health Utilities Index mark 3 demonstrated construct validity in a population-based sample with type 2 diabetes.

OBJECTIVE: To assess the cross-sectional construct validity of the Health Utilities Index mark 3 (HUI3) in type 2 diabetes using population health survey data. STUDY DESIGN AND SETTING: Data used were from 5,134 adult respondents of Cycle 1.1 (2000-2001) of the Canadian Community Health Survey (CCHS) with type 2 diabetes. Analyses of covariance models were used to assess differences in overall and single-attribute HUI3 scores between groups hypothesized a priori to differ in HRQL. The association between health-care resource use (i.e., hospitalizations and physician and emergency room visits) and overall HUI3 scores was assessed using logistic regression models. RESULTS: For overall HUI3 scores, clinically important and statistically significant differences were observed between all groups expected to differ in HRQL. Depression was the comorbidity associated with the largest deficit (-0.17; 95% confidence interval CI=-0.22, -0.12), followed by stroke (-0.15; 95% CI=-0.21, -0.10) and heart disease (-0.08; 95% CI=-0.11, -0.05). Insulin use and comorbidities were associated with clinically important deficits in pain. Overall HUI3 scores were significantly predictive of all three categories of health-care resource use. CONCLUSION: Observed differences between groups contribute further evidence of the construct validity of the HUI3 in type 2 diabetes.

Canada↗

PubMed2005

Health-related quality of life deficits associated with diabetes and comorbidities in a Canadian National Population Health Survey.

OBJECTIVE: To assess the impact of comorbid heart disease, stroke and arthritis on health-related quality of life (HRQL) in people with diabetes in the general Canadian population. METHODS: Data were collected as part of the 1996-1997 Canadian National Population Health Survey. HRQL was assessed using overall Health Utilities Index Mark 3 (HUI3) and single attribute utility scores. Respondents (N = 66,093) were classified into 1 of 16 groups based on the presence or absence of diabetes, heart disease, stroke, and arthritis, in all possible combinations and HRQL scores were compared using analysis of covariance. RESULTS: Overall HUI3 scores for respondents with diabetes alone (0.88, 95% CI: 0.87-0.89) were lower than controls (0.92: 95% CI: 0.92-0.92, p < 0.001). Overall HUI3 scores for diabetes in combination with heart disease (0.77, 95% CI: 0.74-0.79), arthritis (0.78, 95% CI: 0.77-0.79) or stroke (0.79, 95% CI: 0.74-0.85) were considerably lower than diabetes alone. Triplets of comorbidities were associated with overall HRQL deficits of approximately 0.26-0.30, relative to controls. CONCLUSIONS: The illness burden experienced by individuals with diabetes is not only associated with diabetes itself, but largely with comorbid medical conditions.

Activities of Daily Living↗

PubMed2005

Understanding the complex associations between patient-provider relationships, self-care behaviours, and health-related quality of life in type 2 diabetes: a structural equation modeling approach.

OBJECTIVES: To assess associations between perceptions of the patient-provider relationship (PPR), BMI, and adherence to diet and exercise in a rural population with type 2 diabetes and determine how these variables relate to HRQL. METHODS: A model of the hypothesized relationships between the constructs was proposed and tested using structural equation modeling (SEM) and data collected as part of a controlled study to improve care for individuals with type 2 diabetes in rural health regions. RESULTS: In the final model, positive perceptions of the PPR had a direct impact on adherence to diet (beta = 0.23; p < 0.05), exercise (beta = 0.13; p < 0.05) and diabetes management attitudes (beta = 0.33; p < 0.05). The direct path from management attitudes to exercise was also significant (beta = 0.12; p < 0.05). Direct predictors of HRQL included management attitudes (beta = 0.16; p < 0.05), exercise adherence (beta = 0.14, p < 0.05) and BMI (beta = -0.23; p < 0.05). Exercise adherence predicted BMI, whereas adherence to diet did not. The final model had an acceptable fit with the measured data (chi2 = 30.6 (26, N = 372), p = 0.25; RMSEA = 0.02; TLI = 0.98; SRMR = 0.02). CONCLUSION: Patient-provider relationship and exercise adherence appeared to be key constructs in the model. HRQL in people with type 2 diabetes was positively associated with exercise adherence, which was related to a positive PPR. Adherence to diet was also related to a positive PPR, but diet adherence had no association with HRQL.

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PubMed2004

Performance of the RAND-12 and SF-12 summary scores in type 2 diabetes.

OBJECTIVES: To compare the performance of the RAND-12 and SF-12 physical and mental health summary scores, in a sample of people with type 2 diabetes, in distinguishing groups of differing disease severity. METHODS: Summary scores from RAND-12 and SF-12 were compared between known subgroups defined in terms of treatment intensity, duration of diabetes, time lost from work and emergency room visits for diabetes. Multiple regression analyses were used to compare known groups. RESULTS: Statistically significant and clinically important differences were observed across comparisons of the RAND-12 physical health composite (PHC), that were not apparent on the physical component score (PCS-12). RAND-12 mental health composite (MHC) scores were statistically significant according to treatment intensity and days off work due to diabetes, but differences in mental component score (MCS-12) scores failed to reach statistical significance for any of these comparisons. CONCLUSION: Interpretation of the SF-12 summary scores in our study would have overlooked seemingly important differences in health that were picked up by the RAND-12 summary scores.

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PubMed2004

Construct validity of the RAND-12 and Health Utilities Index Mark 2 and 3 in type 2 diabetes.

OBJECTIVE: To assess the cross-sectional construct validity of the RAND-12 and the Health Utilities Index Mark 2 (HUI2) and Mark 3 (HUI3) in type 2 diabetes. METHODS: Parametric tests were used to test for differences in HRQL scores between known groups with type 2 diabetes, defined in terms of treatment intensity, duration of diabetes and glycemic control. RESULTS: The PHC of the RAND-12 was significantly lower for individuals treated with insulin (40.28 +/- 10.97) than diet alone (45.18 +/- 12.02, p < 0.01), as was the MHC (42.83 +/- 10.75 vs. 46.87 +/- 10.89, p < 0.05). MHC (43.56 +/- 10.20 vs. 46.18 +/- 9.94, p < 0.05) and PHC (41.04 +/- 10.64 vs. 45.62 +/- 10.48, p < 0.001) were both lower for those with longer duration of diabetes. Overall HUI3 scores were lower in individuals above the median duration of diabetes (5.0 years) as compared to those with a shorter duration (0.60 +/- 0.29 vs. 0.67 +/- 0.29, p < 0.01) and for individuals whose diabetes was managed using insulin compared to diet alone (0.59 +/- 0.30 vs. 0.69 +/- 0.30, p < 0.05). Disease severity was associated with impairment on the ambulation, dexterity and pain attributes of the HUI3. Similar results were found for the HUI2. Overall HUI2 scores were highest for individuals managed with diet alone compared to those managed with insulin. Disease severity was associated with the mobility and self-care attributes of the HUI2. No relationship was found between any of the measures of HRQL and glycemic control. CONCLUSIONS: Scores for individuals presumed to have more severe or advanced disease were significantly lower for many comparisons using the RAND-12, HUI2 and HUI3. The results of this study contribute evidence of construct validity of the HUI2, HUI3 and RAND-12 in type 2 diabetes.

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PubMed2004

Improvements in patient-reported outcomes associated with an intervention to enhance quality of care for rural patients with type 2 diabetes: results of a controlled trial.

OBJECTIVE: The aim of this study was to examine patient-reported outcomes in a controlled trial of a multifaceted provider-level intervention to improve quality of care for rural patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: We conducted a before/after intervention study with concurrent controls in two rural regions in Alberta, Canada. The intervention consisted of six monthly visits by a multidisciplinary health care team and was primarily directed at primary care providers. Clinical and patient-reported outcomes were assessed after 6 months. Patient-reported outcomes included changes in health-related quality of life (Health Utilities Index Mark 3 [HUI3]), satisfaction with care, lifestyle (Diabetes Lifestyle Form), and adherence to self-care activities. Analysis of covariance was used to assess differences over time between the control and intervention regions. RESULTS: A total of 200 intervention and 172 control subjects were included in this analysis. After adjusting for important clinical and demographic differences, a statistically significant and clinically important improvement in the overall HUI3 score was seen at the 6-month follow-up in the intervention region (0.06 [95% CI 0.02-0.10]) compared with the control region (0.01 [-0.04 to 0.04]) (P = 0.03 for the difference between groups). Satisfaction with general medical care (P < 0.001 between groups) and diabetes care (P < 0.001 between groups) increased among patients in the intervention region compared with the control region. Self-efficacy, attitudes, and beliefs about diabetes control all increased in the intervention region when compared with the control region, but adherence to self-care activities did not. CONCLUSIONS: A provider-level intervention directed at improving quality of clinical care for patients with type 2 diabetes also had a favorable impact on overall health-related quality of life, satisfaction with care, and other humanistic outcomes.

Alberta↗

PubMed2003

Health-related quality of life deficits associated with varying degrees of disease severity in type 2 diabetes.

BACKGROUND: Diabetes is a chronic medical condition accompanied by a considerable health-related quality of life (HRQL) burden. The purpose of this analysis was to use generic measures of HRQL to describe HRQL deficits associated with varying degrees of severity of type 2 diabetes. METHODS: The RAND-12 physical and mental health composites (PHC and MHC, respectively) and Health Utilities Index Mark 3 (HUI3) were self-completed by 372 subjects enrolled in a prospective, controlled study of an intervention to improve care for individuals with type 2 diabetes in rural communities. Analysis of covariance was used to assess differences in HRQL according to disease severity and control of blood glucose. Disease severity was defined in terms of treatment intensity, emergency room visits and absenteeism from work specifically attributable to diabetes. To control for potential confounding, the analysis was adjusted for important sociodemographic and clinical characteristics. RESULTS: The PHC and MHC were significantly lower for individuals treated with insulin as compared to diet alone (PHC: 41.01 vs 45.11, MHC: 43.23 vs 47.00, p < 0.05). Individuals treated with insulin had lower scores on the vision, emotion and pain attributes of the HUI3 than individuals managed with oral medication or diet. The PHC, MHC, pain attribute and overall score on the HUI3 captured substantial decrements in HRQL associated with absenteeism from work due to diabetes, while the burden associated with emergency room utilization for diabetes was seen in the PHC and HUI3 pain attribute. CONCLUSIONS: We concluded that generic measures of HRQL captured deficits associated with more severe disease in type 2 diabetes.

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PubMed2003

Predictors of older adults' capacity for medication management in a self-medication program: a retrospective chart review.

UNLABELLED: The aim of this project was to identify variables that predicted older adults' ability to manage medications. METHODS: The study used a retrospective cohort design and was set in a self-medication program within a rehabilitation hospital. A random sample of charts from 301 participants in the self-medication program was reviewed. RESULTS: Logistic regression models accounted for 26.7% and 55.8% of the variance in the probability of making one or more self-medication errors during the initial and final weeks of the program, respectively. The importance of cognition in predicting medication management capacity was seen in bivariate and multivariate analyses and through a number of interactions with other predictors. Statistically significant predictors in one or both analyses included medication regimen complexity, Mini-Mental State Exam (MMSE) score, duration of institutionalization, depression, and interactions between (a) medication regimen complexity and MMSE score and (b) ability to cook and MMSE score. DISCUSSION: The direct effects of cognition and medication regimen complexity were important predictors of medication management capacity.

Activities of Daily Living↗

PubMedDate not supplied

A comparison of the health utilities indices Mark 2 and Mark 3 in type 2 diabetes.

PURPOSE: Past research into health-related quality of life (HRQL) in diabetes using preference-based measures, such as the Health Utilities Index Mark 2 (HUI2) or the Health Utilities Index Mark 3 (HUI3), is sparse. Important differences between the HUI2 and HUI3 could lead to differences in their abilities to capture HRQL deficits in type 2 diabetes. This analysis compared the extent to which the HUI2 and HUI3 detect differences associated with varying levels of disease severity or advancement in type 2 diabetes. METHODS. This analysis was conducted as part of using baseline, cross-sectional data from a larger, prospective, controlled study of an intervention to improve care for individuals with type 2 diabetes in rural communities in Alberta, Canada. The HU12 and HUI3 were self-administered to 372 community-dwelling individuals with type 2 diabetes. RESULTS: Relative to HUI2 scores, larger differences in overall HUI3 scores were seen for comparisons for individuals presumed to have more advanced disease. The pain attribute of the HUI3 categorized a larger proportion of individuals as moderately to severely impaired (41.5% v. 24.2%, P < 0.001), as did the emotion attribute (20.5% v. 7.7%, P < 0.001). For individuals with negative overall HUI3 scores, differences between overall HUI2 and HUI3 scores persisted after rescaling (mean difference = 0.33, P = 0.009). CONCLUSIONS: The greater range of possible scores on the HUI3, its relative ability to assess the utility of states worse than dead, and its relative superiority in discriminating moderate to severe impairment from mild or no impairment might favor its use over the HUI2 in type 2 diabetes.

Absenteeism↗