Ralston James D, Hirsch Irl B, Hoath James, Mullen Mary, Cheadle Allen, Goldberg Harold I
Center for Health Studies, Group Health Cooperative, Seattle, Washington, USA.
Diabetes Care. 2009 Feb;32(2):234-9. doi: 10.2337/dc08-1220. Epub 2008 Nov 18.
To test Web-based care management of glycemic control using a shared electronic medical record with patients who have type 2 diabetes.
We conducted a trial of 83 adults with type 2 diabetes randomized to receive usual care plus Web-based care management or usual care alone between August 2002 and May 2004. All patients had GHb > or =7.0%, had Web access from home, and could use a computer with English language-based programs. Intervention patients received 12 months of Web-based care management. The Web-based program included patient access to electronic medical records, secure e-mail with providers, feedback on blood glucose readings, an educational Web site, and an interactive online diary for entering information about exercise, diet, and medication. The primary outcome was change in GHb.
GHb levels declined by 0.7% (95% CI 0.2-1.3) on average among intervention patients compared with usual-care patients. Systolic blood pressure, diastolic blood pressure, total cholesterol levels, and use of in-person health care services did not differ between the two groups.
Care management delivered through secure patient Web communications improved glycemic control in type 2 diabetes.
使用共享电子病历对2型糖尿病患者进行基于网络的血糖控制护理管理测试。
我们对83名2型糖尿病成年患者进行了一项试验，这些患者在2002年8月至2004年5月期间被随机分配接受常规护理加基于网络的护理管理或仅接受常规护理。所有患者的糖化血红蛋白（GHb）≥7.0%，在家可上网，且能使用装有基于英语程序的计算机。干预组患者接受为期12个月的基于网络的护理管理。该网络程序包括患者访问电子病历、与医护人员进行安全电子邮件通信、血糖读数反馈、一个教育网站以及一个用于输入运动、饮食和用药信息的交互式在线日记。主要结局指标是糖化血红蛋白的变化。
与常规护理患者相比，干预组患者的糖化血红蛋白水平平均下降了0.7%（95%置信区间0.2 - 1.3）。两组患者的收缩压、舒张压、总胆固醇水平以及面对面医疗服务的使用情况并无差异。
通过安全的患者网络通信进行护理管理可改善2型糖尿病患者的血糖控制。
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