通过利用远程医疗生态系统 (ACCTIVATE) 实现慢性护理公平:一个多级随机控制试验协议
Adenike Omomukuyo1, Andy Ramirez1, Aliyah Davis1
1Department of Medicine, Division of Nephrology, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, United States.
Medical research archives
|December 16, 2024
概括
本研究通过测试数字指导干预来解决糖尿病护理中的种族差异,以改善低收入患者的远程医疗公平. 研究结果旨在缩小数字沟,增强慢性疾病管理.
科学领域:
- 公共卫生 公共卫生
- 健康 公平 卫生 公平
- 数字健康数字健康
背景情况:
- 美国糖尿病和高血压结果持续存在的种族/种族和社会经济差异在COVID-19大流行中加剧.
- 远程医疗的非最佳实施和数字沟限制了边缘化社区对数字工具的访问,加剧了健康不平等.
- 整合数字和健康素养对于美国卫生系统中公平的慢性疾病管理至关重要.
研究的目的:
- 评估一项多层次干预 (ACCTiVATE试验),旨在解决低收入糖尿病患者中公平使用远程医疗的障碍.
- 评估患者层面 (数字指导) 和临床层面干预措施对临床和过程措施的个人和协同影响.
- 为面临进入障碍的边缘化种族/民族群体改善慢性健康结果和远程医疗公平.
主要方法:
- 一个2x2因子随机受控试验,涉及600名低收入,种族/种族多样性的患有失控糖尿病的患者和11个公共卫生初级保健诊所.
- 患者层面的干预:数字指导 (健康指导和数字导航) 与3个月的通常护理.
- 临床层面的干预:公平仪表板,患者咨询委员会,以及24个月的实践便利与常规护理.
主要成果:
- 主要临床结局:血红蛋白A1c (A1c) 的变化. 主要过程结果:患者门户的使用.
- 二次临床结局:在患者和诊所水平上,缩血压 (SBP) 和微专尿 (UACR) 的变化.
- 二级过程结果:患者水平的数字素养,药物坚持,患者激活,参观率和临床水平的远程医疗采用.
结论:
- ACCTiVATE试验采用利益相关者参与的,以用户为中心的设计,以确保受影响社区的可行性和可接受性.
- 如果有效,干预提供了一个可扩展的模型,以提高慢性疾病的结果和边缘化人口的远程医疗公平.
- 该研究旨在提供关于整合数字健康策略的证据,以克服结构性和人际接入障碍.
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