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患者驱动与标准化糖尿病共享医疗预约的比较有效性:实用集群随机试验
Bethany M Kwan1,2,3, L Miriam Dickinson4,5, Jennifer Dailey-Vail6
1Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA. bethany.kwan@cuanschutz.edu.
Journal of general internal medicine
|June 28, 2024
概括
分享医疗预约 (SMA) 改善了糖尿病护理. 标准化的SMA在减少痛苦和血压方面比患者驱动的模型略有优势,但两者都有效地改善了关键的糖尿病结果.
科学领域:
- 内分泌学 在内分泌学.
- 主要护理医学 医疗保健
- 医疗保健服务研究 医疗服务研究
背景情况:
- 糖尿病自我管理教育和支持 (DSMES) 对患者的治疗结果至关重要.
- 共享医疗预约 (SMA) 为初级保健机构的DSMES提供了一种高效的交付模式.
- 不同的SMA交付特征的比较有效性仍未得到充分研究.
研究的目的:
- 为了比较标准化与患者驱动型糖尿病共享医疗预约 (SMA) 在患者结果上的有效性.
- 评估不同SMA模型对糖尿病困扰,自我护理行为,HbA1c,BMI和血压的影响.
主要方法:
- 一个实用的集群随机试验,涉及22个初级保健实践中的1060名2型糖尿病成年人.
- 干预措施包括通过标准化或患者驱动的SMA提供6个会议的疾病管理目标培训 (TTIM) 课程.
- 通过调查和电子健康记录来评估结果,分析自我报告的痛苦,自我护理,HbA1c,BMI和血压.
主要成果:
- 标准化和患者驱动的SMA都显著改善了糖尿病困扰,自我护理行为,BMI和HbA1c.
- 标准化的SMA在降低整体糖尿病痛苦,特别是情绪和饮食方案子级别方面表现出了小但显著的优势.
- 标准化SMA对腹压血压也观察到一个小而显著的好处;没有发现其他显著差异.
结论:
- 使用TTIM课程的标准化和患者驱动的SMA模型都有效地改善了与糖尿病相关的结果.
- 在患者驱动的SMA中,包括多学科团队和患者主导的主题选择,与标准化的SMA相比,没有产生优异的临床或患者报告的结果.
- 标准化的SMA可能在管理糖尿病困扰和腹筋血压方面提供轻微的优势.
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