Mohiddin Abdu, Naithani Smriti, Robotham Dan, Ajakaiye Olubukola, Costa Dominic, Carey Steve, Jones Richard H, Gulliford Martin C
Division of Health and Social Care Research, King's College London, London, UK.
J Eval Clin Pract. 2006 Oct;12(5):583-90. doi: 10.1111/j.1365-2753.2006.00723.x.
To evaluate the effects of organizational change and sharing of specialist skills and information technology for diabetes in two primary care groups (PCGs) over 4 years.
In PCG-A, an intervention comprised dedicated specialist sessions in primary care, clinical guidelines, educational meetings for professionals and a shared diabetes electronic patient record (EPR). Comparison was made with the neighbouring PCG-B as control. In intervention and control PCGs, practice development work was undertaken for a new contract for family doctors. Data were collected for clinical measures, practice organizational characteristics and professional and patient views.
Data were analysed for 26 general practices including 17 in PCG-A and nine in PCG-B. The median practice-specific proportions of patients with HbA1c recorded annually increased in both areas: PCG-A from median 65% to 77%, while PCG-B from 53% to 84%. For cholesterol recording, PCG-A increased from 50% to 76%, and PCG-B from 56% to 80%. Organizational changes in both PCGs included the establishment of recall systems, dedicated clinics and educational sessions for patients. In both PCGs, practices performing poorly at baseline showed the greatest improvements in organization and clinical practice. Primary care professionals' satisfaction with access and communication with diabetes specialist doctors and nurses increased, more so in the intervention PCG. Only 16% of primary care professional respondents used the diabetes EPR at least monthly. Patient satisfaction and knowledge did not change.
Improvements in practices' organizational arrangements were associated with improvements in clinical care in both PCGs. Sharing specialist skills in one PCG was associated with increased professional satisfaction but no net improvement in clinical measures. A shared diabetes EPR is unlikely to be used, unless integrated with practice information systems.
评估两个基层医疗组（PCG）在4年时间里组织变革以及糖尿病专科技能与信息技术共享所产生的影响。
在PCG-A中，干预措施包括在基层医疗中开展专门的专家会诊、临床指南、专业人员教育会议以及共享糖尿病电子病历（EPR）。将其与相邻的PCG-B作为对照进行比较。在干预组和对照组PCG中，针对家庭医生的新合同开展了实践发展工作。收集了临床指标、实践组织特征以及专业人员和患者意见的数据。
对26家全科诊所的数据进行了分析，其中PCG-A有17家，PCG-B有9家。两个地区每年记录糖化血红蛋白（HbA1c）的患者在各诊所的中位数比例均有所增加：PCG-A从65%的中位数增至77%，而PCG-B从53%增至84%。对于胆固醇记录，PCG-A从50%增至76%，PCG-B从56%增至80%。两个PCG的组织变革都包括建立召回系统、专门诊所和患者教育课程。在两个PCG中，基线表现较差的诊所组织和临床实践改善最大。基层医疗专业人员对与糖尿病专科医生和护士的接触及沟通的满意度有所提高，干预组PCG提高得更多。只有16%的基层医疗专业受访者至少每月使用糖尿病EPR。患者满意度和知识水平没有变化。
两个PCG中实践组织安排的改善与临床护理的改善相关。在一个PCG中共享专科技能与专业满意度的提高相关，但临床指标没有净改善。除非与实践信息系统集成，否则共享糖尿病EPR不太可能被使用。
