随机评估远程管理程序以改善指导医学治疗:DRIVE试验
Alexander J Blood1,2,3, Lee-Shing Chang4,3, Shahzad Hassan1,2
1Accelerator for Clinical Transformation (A.J.B., S.H., J.C., G.S., D.G., D.Z., S.J.A., C.F., E.C., R.R., J.P., T.A.G., C.P.C., B.M.S.), Brigham and Women's Hospital, Boston, MA.
Circulation
|April 7, 2024
概括
在2型糖尿病患者中,远程处方的-葡萄糖运输蛋白2抑制剂 (SGLT2i) 或类似葡萄糖-1受体激活剂 (GLP1-RA) 显著增加了药物摄入量. 同时教育和处方方法被证明比教育更有效改善指南导向的医疗治疗.
科学领域:
- 内分泌学和新陈代谢
- 心血管医学
- 肝脏病学
背景情况:
- 建议在2型糖尿病 (T2D) 患者中使用-葡萄糖运输蛋白2抑制剂 (SGLT2i) 和类似葡萄糖-1受体激活剂 (GLP1-RA),以减少心血管和事件.
- 尽管已证明有好处,但SGLT2i和GLP1-RA在符合条件的T2D患者中的使用仍然不足.
- 解决这一差距需要创新的策略来改善T2D管理中的指导医学治疗 (GDMT).
研究的目的:
- 评估基于团队的远程实施策略的有效性,以增加高心血管或风险的T2D患者的SGLT2i和GLP1-RA处方.
- 比较虚拟患者教育和药物处方方法与教育优先模式的有效性.
- 评估该计划在现实临床环境中对指导性医疗疗优化的影响.
主要方法:
- 在Mass General Brigham网络中进行了一项随机的远程实施试验,招募了符合条件但未处方SGLT2i或GLP1-RA的T2D患者.
- 参与者被随机分配到"同时"组 (与处方同时进行虚拟教育) 或"教育优先"组 (处方之前的2个月的教育).
- 一个多学科团队,包括未经许可的导航员和临床药剂师,使用标准化算法来处方SGLT2i或GLP1-RA. 主要结局是6个月处方患者的比例.
主要成果:
- 与"教育优先"方法相比",同时使用"方法导致SGLT2i或GLP1-RA的处方率在2个月 (53. 4% vs. 8. 3%) 和6个月 (69. 8% vs.
- 总体而言,所有随机选择的患者中有64. 0%在6个月内获得新处方,同时治疗组的中位时间为24天,而教育优先治疗组的中位时间为85天.
- 患者对药物使用的自我报告也有利于"同时使用"组 (59. 5%对44. 0%),表明治疗的坚持和开始有所改善.
结论:
- 一个以团队为基础的远程计划有效地识别高风险的T2D患者,并促进SGLT2i和GLP1-RA的处方,从而改善GDMT.
- 同时提供虚拟教育和处方药是一种比教育优先方法更有效的策略,
- 这些发现支持更广泛地采用基于团队的虚拟护理模式,以加强慢性疾病管理和优化T2D治疗结果.
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