Parchman Michael L, Pugh Jacqueline A, Wang Chen-Pin, Romero Raquel L
Department of Family & Community Medicine/University of Texas Health Science Center-San Antonio, San Antonio, Texas, USA.
Diabetes Care. 2007 Nov;30(11):2849-54. doi: 10.2337/dc06-2516. Epub 2007 Aug 6.
The purpose of this study was to examine the relationship between A1C and the extent to which care delivered to patients with type 2 diabetes in primary care clinics is consistent with the chronic care model (CCM), after controlling for self-care behaviors.
This was a cross-sectional, observational study of care provided to 618 patients with type 2 diabetes across 20 small, autonomous primary care clinics in South Texas. Subjects completed an exit survey. The medical record was abstracted for A1C values. Clinicians completed the Assessment of Chronic Illness Care (ACIC) survey, a validated measure of the extent to which care delivered is consistent with the CCM.
There was a significant relationship between ACIC score and A1C, but this relationship varied according to self-care behavior for exercise and was strongest for those who did not adhere to exercise recommendations: for every 1-point increase in ACIC score, A1C was 0.144% lower (P < 0.001). The relationship between ACIC score and A1C for those who adhered to their diet was similar to that for those who did not, after adjusting for exercise, but the overall level of control was better for those who adhered to their diet.
Characteristics of the primary care clinic where one receives care are an important predictor of glucose control. If resources for implementing the CCM are limited, one might want to focus on clinics with low ACIC scores that serve a population of patients who are sedentary because this population may be likely to realize the most benefit from improved glucose control.
本研究的目的是在控制自我护理行为后，探讨糖化血红蛋白（A1C）与基层医疗诊所为2型糖尿病患者提供的护理与慢性病护理模式（CCM）的符合程度之间的关系。
这是一项横断面观察性研究，研究对象为南德克萨斯州20家小型独立基层医疗诊所的618例2型糖尿病患者所接受的护理。受试者完成了一份出院调查问卷。提取病历中的A1C值。临床医生完成了慢性病护理评估（ACIC）调查，这是一种验证过的衡量所提供护理与CCM符合程度的方法。
ACIC评分与A1C之间存在显著关系，但这种关系因运动的自我护理行为而异，对于那些未遵循运动建议的患者最为显著：ACIC评分每增加1分，A1C降低0.144%（P<0.001）。在调整运动因素后，坚持饮食的患者的ACIC评分与A1C之间的关系与不坚持饮食的患者相似，但坚持饮食的患者的总体控制水平更好。
接受护理的基层医疗诊所的特征是血糖控制的重要预测因素。如果实施CCM的资源有限，可能需要关注ACIC评分低且服务久坐不动患者群体的诊所，因为这一群体可能最能从改善血糖控制中获益。
