利用团队模型改善学术基层医疗实践中的慢性病护理。
Using the Teamlet Model to improve chronic care in an academic primary care practice.
机构信息
Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA 94110, USA.
出版信息
J Gen Intern Med. 2010 Sep;25 Suppl 4(Suppl 4):S610-4. doi: 10.1007/s11606-010-1390-1.
BACKGROUND
Team care can improve management of chronic conditions, but implementing a team approach in an academic primary care clinic presents unique challenges.
OBJECTIVES
To implement and evaluate the Teamlet Model, which uses health coaches working with primary care physicians to improve care for patients with diabetes and/or hypertension in an academic practice.
DESIGN
Process and outcome measures were compared before and during the intervention in patients seen with the Teamlet Model and in a comparison patient group.
PARTICIPANTS
First year family medicine residents, medical assistants, health workers, and adult patients with either type 2 diabetes or hypertension in a large public health clinic.
INTERVENTION
Health coaches, in coordination with resident primary care physicians, met with patients before and after clinic visits and called patients between visits.
MEASUREMENTS
Measurement of body mass index, assessment of smoking status, and formulation of a self-management plan prior to and during the intervention period for patients in the Teamlet Model group. Testing for LDL and HbA1C and the proportion of patients at goal for blood pressure, LDL, and HbA1C in the Teamlet Model and comparison groups in the year prior to and during implementation.
RESULTS
Teamlet patients showed improvement in all measures, though improvement was significant only for smoking, BMI, and self-management plan documentation and testing for LDL (p = 0.02), with a trend towards significance for LDL at goal (p = 0.07). Teamlet patients showed a greater, but non-significant, increase in the proportion of patients tested for HbA1C and proportion reaching goal for blood pressure, HgbA1C, and LDL compared to the comparison group patients. The difference for blood pressure was marginally significant (p = 0.06). In contrast, patients in the comparison group were significantly more likely to have had testing for LDL (P = 0.001).
CONCLUSIONS
The Teamlet Model may improve chronic care in academic primary care practices.
背景
团队护理可以改善慢性病的管理，但在学术性基层医疗诊所实施团队方法会带来独特的挑战。
目的
实施并评估 Teamlet 模式，该模式使用健康指导员与基层医疗医生合作，为学术实践中的糖尿病和/或高血压患者提供更好的护理。
设计
在 Teamlet 模式患者和对照组患者就诊前和就诊期间比较过程和结果测量值。
参与者
第一年家庭医学住院医师、医疗助理、健康工作者以及大型公共卫生诊所的 2 型糖尿病或高血压成年患者。
干预措施
健康指导员与住院基层医疗医生协调，在就诊前和就诊后与患者会面，并在就诊之间给患者打电话。
测量
在 Teamlet 模式组患者就诊前和就诊期间测量体重指数，评估吸烟状况，并制定自我管理计划。在 Teamlet 模式组和对照组患者就诊前和实施期间检测 LDL 和 HbA1C 以及血压、LDL 和 HbA1C 达标患者的比例。
结果
Teamlet 患者的所有指标均有所改善，但仅在吸烟、BMI 和自我管理计划记录以及 LDL 检测方面（p = 0.02）有显著改善，LDL 达标方面也有显著趋势（p = 0.07）。与对照组患者相比，Teamlet 患者检测 HbA1C 的患者比例和血压、HgbA1C 和 LDL 达标患者比例有所增加，但差异无统计学意义。血压差异具有边缘统计学意义（p = 0.06）。相比之下，对照组患者进行 LDL 检测的可能性明显更高（P = 0.001）。
结论
Teamlet 模式可能会改善学术性基层医疗实践中的慢性病护理。
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