Simmons D
Department of Rural Health, University of Melbourne, Melbourne, Australia.
Intern Med J. 2003 Dec;33(12):581-5. doi: 10.1111/j.1445-5994.2003.00491.x.
To describe the effectiveness of an integrated primary-secondary care diabetes clinic on metabolic control among indigenous patients in a rural community.
A retrospective audit of attendance to the clinic over 2 years (2 August 1999 to 31 August 2001). The service included a weekly specialist diabetes clinic integrated with the primary care team at the Rumbalara Aboriginal Health Service, Mooroopna, Victoria, Australia. Between clinics, follow up was provided by the Aboriginal health worker and other members of the integrated care team. Of the 47 patients seen, 20 had an HbA1c persistently > or =9.0% (of 21 patients identified in the community) and seven had gestational diabetes.
Among 40 patients without gestational diabetes, microalbuminuria or proteinuria were present in 62%, retinopathy was present in 50%, neuropathy was present in 50% and at least one past cardiac or vascular event/surgical procedure had occurred in 25%. Of these, the 30 patients seen more than once increased their self glucose monitoring (baseline (53.3%) vs. last visit (90%); P = 0.003) and reduced their HbA1c (10.4 +/- 2.2%vs. 7.9 +/- 1.9%; P < 0.001), systolic blood pressure (138 +/- 20 vs. 127 +/- 18 mmHg; P = 0.003) and diastolic blood pressure (78 +/- 11 vs. 73 +/- 12 mmHg; P = 0.037) and total cholesterol (6.1 +/- 1.7 vs. 5.1 +/- 1.6 mmol/L; P = 0.002), but not their weight, smoking or triglycerides.
The introduction of an integrated diabetes care service in an Aboriginal health service can overcome many of the pre-existing barriers to achieving metabolic targets. Poor metabolic control in Aboriginal patients is often due to lack of resources and inappropriateness of approach, rather than "compliance".
描述一家整合了初级和二级护理的糖尿病诊所对农村社区原住民患者代谢控制的有效性。
对该诊所两年（1999年8月2日至2001年8月31日）的就诊情况进行回顾性审计。该服务包括在澳大利亚维多利亚州穆鲁普纳的伦巴拉拉原住民健康服务中心，每周一次的专科糖尿病诊所与初级护理团队相结合。在诊所就诊期间，由原住民健康工作者和综合护理团队的其他成员提供随访。在就诊的47名患者中，20名患者的糖化血红蛋白（HbA1c）持续≥9.0%（在社区中识别出的21名患者），7名患有妊娠期糖尿病。
在40名非妊娠期糖尿病患者中，62%存在微量白蛋白尿或蛋白尿，50%存在视网膜病变，50%存在神经病变，25%至少发生过一次既往心脏或血管事件/手术。其中，就诊不止一次的30名患者增加了自我血糖监测（基线时为53.3%，最后一次就诊时为90%；P = 0.003），并降低了糖化血红蛋白（10.4±2.2%对7.9±1.9%；P < 0.001）、收缩压（138±20对127±18 mmHg；P = 0.003）、舒张压（78±11对73±12 mmHg；P = 0.037）和总胆固醇（6.1±1.7对5.1±1.6 mmol/L；P = 0.002），但体重、吸烟或甘油三酯没有变化。
在原住民健康服务中心引入整合式糖尿病护理服务可以克服许多先前存在的实现代谢目标的障碍。原住民患者代谢控制不佳往往是由于资源缺乏和方法不当，而非“依从性”问题。
