PICO (T) Questions and Evidence-Based Approach
The PICOT framework is used in evidence-based healthcare research to formulate an evidence-based research question. By using the PICOT framework, researchers can create a clear and specific research question that can be used to guide the study design, search for relevant literature, and evaluate the effectiveness of the intervention or treatment being studied. The framework can be used in both quantitative and qualitative research studies. PICOT refers to Patient, Intervention, Comparison, Outcomes, and Timeframe. This assessment highlights the PICOT question related to misdiagnosing or delayed diagnosis of diabetes. Early diagnosis and proper management of diabetes can avoid serious complications among individuals (David Brown, 2019). NURS FPX 4030 Assessment 3 PICO (T) Questions and Evidence-Based Approach.
Use of the PICO (T) Approach for Analyzing Possible Treatment of Diabetes Disease
Misdiagnosed and delayed diagnosis of diabetes can cause serious complications like high death rates, readmission rates, and high treatment costs (Verhestraeten et al., 2020). According to the Centers for Disease Control and Prevention (CDC), Diabetes is considered the seventh leading cause of morbidity around the globe (Centers for Disease Control and Prevention, 2022). The PICOT method is essential as it will help to know about patient concerns and the best possible intervention to help the patient recover from the illness. Along with this, it will also guide evidence-based treatment regarding diabetes prevention and control. PICOT question deal with the best possible solution to improve the welfare of patients and avoid serious complications regarding diabetes. A possible PICOT question could be:
In patients with diabetes (P), does the implementation of advanced screening techniques (such as continuous glucose monitoring) (I) compared to standard diagnostic methods (C) result in early detection of diabetes, reduce treatment cost, readmission rate, serious complications and improve patients outcomes (O), in 2 years (T)?
Benefit from a PICO (T) Approach
Utilizing a PICOT approach, a well-structured research question can be developed that helps to identify relevant studies, gather evidence, and conclude the impact of misdiagnosis or delayed diagnosis of diabetes on patient outcomes. This can lead to the development of better diagnostic tools, more effective treatments, and improved patient outcomes (Kloda et al., 2020).
Firstly, the PICOT question helps to define the patient population of interest, which in our case is the patient’s misdiagnosis or delayed diagnosis of diabetes. PICO (T) question is beneficial as it will help to identify the efficacy of advanced techniques over standard techniques to diagnose diabetes (Kloda et al., 2020).
NURS FPX 4030 Assessment 3 PICO (T) Questions and Evidence-Based Approach
Secondly, it will provide relevant intervention regarding issues like, in our case, by implementing advanced screening techniques (such as continuous glucose monitoring), healthcare staff can easily diagnose diabetes in its early stages. Another benefit of the PICO (T) question is that it will help to compare interventions with older methods. In our case, CGM or HgbA1c test strategy is an advanced way to diagnose diabetes in its early stages, while the standard diagnostic way is fasting plasma glucose.
PICOT approach helps specify the outcome of interest, including morbidity, mortality, quality of life, and healthcare costs. Along with this, PICOT questions also help to access specific time frames in which these interventions will help to achieve desired outcomes, like in our case, within 2 years through proper monitoring; diabetes can be managed and controlled (Kloda et al., 2020).
Sources of Evidence
PICOT analyzes the importance of advanced diabetes monitoring methods like (CGM or HgbA1c testing) over standard methods to control diabetes within 2 years.
CGM strategy is a widely used strategy to detect diabetes in the early stages. Various systematic reviews and randomized controlled trials have provided evidence that CGM is an effective method for self-monitoring diabetes in its early stages to avoid serious complications. Almost 21 studies prove CGM’s effectiveness in monitoring diabetes (Teo et al., 2022). Randomized controlled trials (RCTs) are one of the best sources of evidence as they will assist in evaluating the effectiveness of early detection and intervention strategies, such as screening tests, lifestyle interventions, and medications. Additionally, systematic reviews and meta-analyses of RCTs and observational studies examine the impact of early detection and intervention on diabetes progression and outcomes. Another journal review also focuses on the CGM strategy, which is a cost-effective way. To diagnose and manage diabetes in the early stages (Skoufalos et al., 2022).
Various practice guidelines and recommendations from reputable organizations such as the American Diabetes Association (ADA), the World Health Organization (WHO), and the National Institute for Health and Care Excellence can also help to provide intervention to detect diabetes in its early stages. Additionally, Electronic health records (EHR) and administrative databases can provide real-world data on the implementation and outcomes of diabetes screening programs (Kent et al., 2021).
Patient-reported outcomes and qualitative studies can provide insights into the patient experience of diabetes screening, early detection, and barriers and facilitators to implementation (Shunmuga Sundaram et al., 2022). Moreover, PubMed and Medline journal articles are some sources that could effectively define evidence-based PICOT questions.
Criteria or Rationale
CRAAP test will help to evaluate the rationale and criteria behind relevant sources. CRAAP test focuses on currency, relevancy, accuracy, authority, and purpose. All the selected sources are related to our topic and contain up-to-date information. All the sources are from the last 5 years and provide guidelines regarding diabetes early detection and management, meaning that sources are fulfilling currency (Esparrago-Kalidas, 2021). Additionally, sources are also relevant to our topic as they will provide knowledge about CGM and HgbA1c testing for early detection of diabetes, which will help to control mortality, readmission, and overall well-being of patients. Moreover, all the sources are well-authorized and written by scholars. ADA and WHO are considered to be authorized websites and reputable organizations. These sources provide accurate and up-to-date information to detect and control diabetes early to avoid complications.
Findings from Articles
According to a study published in the Journal of PLOS ONE, misdiagnosis of diabetes is a significant problem, with approximately 21% of patients being misdiagnosed. Misdiagnosis can lead to inappropriate treatment, delayed treatment, and worse patient health outcomes (Kasujja et al., 2021).
To overcome this issue, continuous glucose monitoring (CGM) and HgbA1c testing are recommended for the early detection of diabetes. CGM allows for real-time monitoring of blood glucose levels, providing more accurate and detailed data than traditional finger-stick tests (Galindo & Aleppo, 2020). HgbA1c testing measures a patient’s average blood glucose level over the previous three months, providing a more comprehensive picture of their diabetes control. Along with this, another study explains that patients can focus on the early detection of diabetes through HER, with which the mortality rate and overall financial cost of patients will be reduced (Lessing & Hayman, 2018). It is a self-management technique to control and detect diabetes.
A study published in the Journal of Diabetes Science and Technology found that patients who use CGM and receive regular HgbA1c testing have better diabetes control, lower hospital readmission rates, and improved overall well-being. The study also found that the use of these tools can lead to a reduction in mortality rates among diabetic patients (Galindo et al., 2022).
NURS FPX 4030 Assessment 3 PICO (T) Questions and Evidence-Based Approach
Another study published in Diabetes Care found that early detection and intervention through CGM and HgbA1c testing can improve glycemic control and reduce the risk of complications associated with diabetes, such as cardiovascular disease, kidney disease, and neuropathy (Thabit et al., 2020).
Most Credible Source
The most credible source is Thabit et al., 2020 because it is high-quality peer-reviewed and available on American Diabetes Association, a well-reputed website. Moreover, this source provides relevant and accurate data because this source is related to diabetes management and control.
Relevance of these Findings
A research study focuses on the best intervention to detect diabetes in the early stages of CGM. Within one year, an early diagnosis of diabetes can improve glycemic outcomes in patients. Moreover, it will also reduce the mortality rates. In this study, patients will be followed for 7 years, and it is proved that CGM can help to improve the HgbA1c test report and patients’ well-being in the long term (Champakanath et al., 2022). It is stated that patients have to go for an HgbA1c test twice a year to avoid serious complications.
There are several explanations related to CGM, one of which is that CGM will help reduce serious complications and readmission rates among individuals. CGM will help to avoid diabetes-related adverse events in hospitals. Flash CGM is considered the best method as it has a sensor that continuously measures patients’ interstitial blood sugar levels compared to the standard fasting plasma glucose method to detect diabetes. It is stated that the number of adverse events and readmission rate can be reduced within 6 months of the post-acquisition period (Bergenstal et al., 2021).
These two findings are related to our PICOT questions as these are also related to diabetes early detection through advanced CGM rather than the standard method. Along with this, within one or two years, this method will help to manage or control diabetes symptoms among people as relevant to our PICOT time period.
Relevant Finding Lead to Positive Outcomes
It is confirmed that CGM strategy and HgbA1c testing are important interventions to detect diabetes in the early stages. This method is a cost-effective way to detect diabetes and helps reduce hospital mortality and readmission rates. Moreover, early detection will help patients control and manage diabetes frequently to avoid serious consequences.
Conclusion
Diabetes is considered to be a fatal disease, but early detection of diabetes can help to manage diabetes frequently; otherwise, it will cause a high morbidity rate and high readmission rate. The PICOT framework will help identify evidence-based questions about your issue and provide interventions to help you cope up with the problem. Moreover, the credibility and relevancy of resources can be detected through the CRAAP test.
References
Bergenstal, R. M., Kerr, M. S. D., Roberts, G. J., Souto, D., Nabutovsky, Y., & Hirsch, I. B. (2021). Flash CGM is associated with reduced diabetes events and hospitalizations in insulin-treated type 2 diabetes. Journal of the Endocrine Society, 5(4).
https://doi.org/10.1210/jendso/bvab013
Centers for Disease Control and Prevention. (2022, July 7). What is Diabetes? Centers for Disease Control and Prevention.
https://www.cdc.gov/diabetes/basics/diabetes.html
Champakanath, A., Akturk, H. K., Alonso, G. T., Snell-Bergeon, J. K., & Shah, V. N. (2022). Continuous glucose monitoring initiation within first year of type 1 diabetes diagnosis is associated with improved glycemic outcomes: 7-year follow-up study. Diabetes Care.
https://doi.org/10.2337/dc21-2004
David Brown. (2019). A Review of the PubMed PICO Tool: Using Evidence-Based Practice in Health Education. SAGE Journals.
https://journals.sagepub.com/doi/abs/10.1177/1524839919893361?journalCode=hppa
Esparrago-Kalidas, A. J. (2021). The effectiveness of CRAAP test in evaluating credibility of sources. International Journal of TESOL & Education, 1(2), 1–14.
https://i-jte.org/index.php/journal/article/view/25
Galindo, R. J., & Aleppo, G. (2020). Continuous glucose monitoring: The achievement of 100 years of innovation in diabetes technology. Diabetes Research and Clinical Practice, 170, 108502.
https://doi.org/10.1016/j.diabres.2020.108502
Galindo, R. J., Aleppo, G., Parkin, C. G., Baidal, D. A., Carlson, A. L., Cengiz, E., Forlenza, G. P., Kruger, D. F., Levy, C., McGill, J. B., & Umpierrez, G. E. (2022). Increase access, reduce disparities: Recommendations for modifying Medicaid CGM coverage eligibility criteria. Journal of Diabetes Science and Technology, 193229682211440.
https://doi.org/10.1177/19322968221144052
Kasujja, F. X., Nuwaha, F., Daivadanam, M., Kiguli, J., Etajak, S., & Mayega, R. W. (2021). Understanding the diagnostic delays and pathways for diabetes in eastern Uganda: A qualitative study. PLOS ONE, 16(4), 0250421.
https://doi.org/10.1371/journal.pone.0250421
Kent, D. M., Nelson, J., Pittas, A., Colangelo, F., Koenig, C., van Klaveren, D., Ciemins, E., & Cuddeback, J. (2021). An electronic health record–compatible model to predict personalized treatment effects from the diabetes prevention program: A cross-evidence synthesis approach using clinical trial and real-world data. Mayo Clinic Proceedings.
https://doi.org/10.1016/j.mayocp.2021.09.012
Kloda, L. A., Boruff, J. T., & Soares Cavalcante, A. (2020). A comparison of patient, intervention, comparison, outcome (PICO) to a new, alternative clinical question framework for search skills, search results, and self-efficacy: A randomized controlled trial. Journal of the Medical Library Association, 108(2).
https://doi.org/10.5195/jmla.2020.739
Lessing, S. E., & Hayman, L. L. (2018). Diabetes care and management using electronic medical records: A systematic review. Journal of Diabetes Science and Technology, 13(4), 774–782.
https://doi.org/10.1177/1932296818815507
Shunmuga Sundaram, C., Campbell, R., Ju, A., King, M. T., & Rutherford, C. (2022). Patient and healthcare provider perceptions on using patient-reported experience measures (PREMs) in routine clinical care: A systematic review of qualitative studies. Journal of Patient-Reported Outcomes, 6(1).
https://doi.org/10.1186/s41687-022-00524-0
Skoufalos, A., Thomas, R., Patel, R., Mei, C., & Clarke, J. L. (2022). Continuous glucose monitoring: An opportunity for population-based diabetes management. Population Health Management, 25(5), 583–591.
https://doi.org/10.1089/pop.2022.0196
Teo, E., Hassan, N., Tam, W., & Koh, S. (2022). Effectiveness of continuous glucose monitoring in maintaining glycaemic control among people with type 1 diabetes mellitus: A systematic review of randomised controlled trials and meta-analysis. Diabetologia.
https://doi.org/10.1007/s00125-021-05648-4
Thabit, H., Prabhu, J. N., Mubita, W., Fullwood, C., Azmi, S., Urwin, A., Doughty, I., & Leelarathna, L. (2020). Use of factory-calibrated real-time continuous glucose monitoring improves time in target and hba1c in a multiethnic cohort of adolescents and young adults with type 1 diabetes: The millennials study. Diabetes Care, 43(10), 2537–2543.
https://doi.org/10.2337/dc20-0736
Verhestraeten, C., Heggermont, W. A., & Maris, M. (2020). Clinical inertia in the treatment of heart failure: a major issue to tackle. Heart Failure Reviews.
https://doi.org/10.1007/s10741-020-09979-z