基于心血管风险评估,优化2型糖尿病患者在初级保健中的医生接触频率:一个向试验仿真研究
Wanchun Xu1, Yuan Wang1, Peter Tanuseputro2,3
1Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
Diabetes, obesity & metabolism
|August 29, 2024
概括
延长2型糖尿病 (T2D) 患者与低心血管疾病 (CVD) 风险的医生访问间隔从2-3到4-6个月是安全的. 这种变化不会影响长期结果,可以优化初级保健资源.
科学领域:
- 内分泌学 在内分泌学.
- 心脏病学 心脏病学
- 公共卫生 公共卫生
背景情况:
- 2型糖尿病 (T2D) 的管理需要定期与医生接触.
- 优化对低风险T2D患者的访问频率可以改善资源配置.
- 心血管疾病 (CVD) 风险分层对于定制患者护理间隔至关重要.
研究的目的:
- 评估将医生接触间隔延长到4-6个月对于T2D患者的10年心血管疾病风险<20%,是否安全.
- 为了确定较长的间隔是否会影响患者的长期结果,而不是2-3个月的间隔.
- 评估对医疗保健资源利用和临床参数的影响.
主要方法:
- 一个全境电子医疗记录分析在香港模拟一个目标试验.
- 倾向性得分匹配包括42,154名T2D患者,他们之前没有心血管疾病,并且10年心血管疾病风险低于20%.
- 边际结构模型估计了心脏病发病率,全因死亡率和护理利用率的危险比率.
主要成果:
- 没有显著增加心血管疾病风险 (HR: 1.01 [0.90,1.14]) 或所有原因死亡率 (HR: 1.00 [0.84,1.20]) 在4-6个月间隔.
- 对心血管疾病和死亡率的标准化10年风险差异很小 (-0.1%).
- 在二级/三级护理利用率或关键临床参数 (HbA1c,BP,胆固醇) 中没有观察到差异.
结论:
- 10年心血管疾病风险<20%的T2D患者的医生接触间隔可以安全地从2-3-6个月延长到4-6个月.
- 这种优化不会影响患者的长期治疗结果.
- 延长间隔可以大大节省初级保健资源.
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