RAND Corporation, Santa Monica, California, USA.
Health Aff (Millwood). 2012 Jan;31(1):168-76. doi: 10.1377/hlthaff.2011.0930.
Health care providers serving vulnerable patients in Los Angeles have developed programs intended to increase diabetes control through more-intensive patient education and engagement. We examined two programs, the first using a short-term intensive intervention by a care team including nurses and a specialist, and the second integrating case management and clinical pharmacy programs into primary care in a community clinic. We show evidence that both models improved short-term disease control, as measured by reductions in HbA1c and low-density lipoprotein (sometimes referred to as "bad" cholesterol). However, integrating case management and clinical pharmacy programs into a primary care setting was less labor-intensive and potentially less expensive than the care team intervention. The challenge is to understand the essential aspects of these interventions; refine their design so that they are more cost-effective and fiscally feasible; and identify long-term health and cost effects.
在洛杉矶为弱势患者提供医疗服务的医护人员制定了旨在通过更强化的患者教育和参与来提高糖尿病控制水平的计划。我们研究了两个计划，第一个计划是由护理团队（包括护士和专家）进行短期强化干预，第二个计划是将病例管理和临床药学计划整合到社区诊所的初级保健中。我们有证据表明，这两种模式都改善了短期疾病控制，表现为糖化血红蛋白和低密度脂蛋白（有时称为“坏”胆固醇）的降低。然而，将病例管理和临床药学计划整合到初级保健环境中比护理团队干预的劳动强度更低，潜在成本更低。挑战在于了解这些干预措施的基本方面；改进其设计，使其更具成本效益和财政可行性；并确定长期的健康和成本影响。
