Vidant Health (formerly University Health System), Greenville, NC 27834, USA.
Ann Fam Med. 2013 Mar-Apr;11(2):145-50. doi: 10.1370/afm.1470.
Rural low-income African American patients with diabetes have traditionally poorer clinical outcomes and limited access to state-of-the-art diabetes care. We determined the effectiveness of a redesigned primary care model on patients' glycemic, blood pressure, and lipid level control.
In 3 purposively selected, rural, fee-for-service, primary care practices, African American patients with type 2 diabetes received point-of-care education, coaching, and medication intensification from a diabetes care management team made up of a nurse, pharmacist, and dietitian. In 5 randomly selected control practices matched for practice and patient characteristics, African American patients received usual care. Using univariate and multivariate adjusted models, we evaluated the effects of the intervention on intermediate (median 18 months) and long-term (median 36 months) changes in glycated hemoglobin (hemoglobin A1c) levels, blood pressure, and lipid levels, as well as the proportion of patients meeting target values.
Among 727 randomly selected rural African American diabetic patients (368 intervention, 359 control), intervention patients had a significantly greater reduction in mean hemoglobin A1c levels at intermediate (-0.5 % vs -0.2%; P <.05) and long-term (-0.5% vs -0.10%; P <.005) follow-up in univariate and multivariate models. The proportion of patients achieving a hemoglobin A1c level of less than 7.5% (68% vs 59%, P <.01) and/or a systolic blood pressure of less than 140 mm Hg (69% vs 57%, P <.01) was also significantly greater in intervention practices in multivariate models.
Redesigning care strategies in rural fee-for-service primary care practices for African American patients with established diabetes results in significantly improved glycemic control relative to usual care.
农村低收入非裔美国糖尿病患者的临床结局历来较差，获得最先进的糖尿病治疗的机会有限。我们旨在确定重新设计的初级保健模式对患者血糖、血压和血脂水平控制的效果。
在 3 个有目的选择的农村自费初级保健实践中，2 型糖尿病的非裔美国患者接受了来自由护士、药剂师和营养师组成的糖尿病护理管理团队的即时护理教育、辅导和药物强化。在 5 个随机选择的匹配实践和患者特征的对照实践中，非裔美国患者接受了常规护理。使用单变量和多变量调整模型，我们评估了干预对糖化血红蛋白（血红蛋白 A1c）水平、血压和血脂水平的中期（中位数 18 个月）和长期（中位数 36 个月）变化的影响，以及达到目标值的患者比例。
在 727 名随机选择的农村非裔美国糖尿病患者（368 名干预，359 名对照）中，干预组在单变量和多变量模型中，中期（-0.5%比-0.2%；P <.05）和长期（-0.5%比-0.10%；P <.005）随访时平均血红蛋白 A1c 水平的下降幅度明显更大。在多变量模型中，达到血红蛋白 A1c 水平<7.5%（68%比 59%，P <.01）和/或收缩压<140mmHg（69%比 57%，P <.01）的患者比例在干预实践中也明显更大。
在既定糖尿病的农村自费初级保健实践中重新设计护理策略，与常规护理相比，可显著改善血糖控制。
