Cátedra de Medicina de Familia, Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain.
Int J Clin Pract. 2013 Sep;67(9):888-94. doi: 10.1111/ijcp.12160. Epub 2013 Jun 12.
Delphi technique allows developing a multidisciplinary consensus to establish solutions.
To identify barriers and solutions to improve control in patients with Type-2 Diabetes Mellitus (DM2).
An observational study using the 2-round Delphi technique (June-August 2011). A panel of 108 experts in DM2 from medical and nursing fields (primary care providers and specialists) from different regions completed via email a questionnaire with 41 Likert statements and 9 scores for each one. Level of agreement was assessed using measures of central tendency and dispersion. We analysed commonalities/differences between the two groups (Kappa index and McNemar chi-square).
Response rate: 65%. Degree of agreement: 63.4% (95% CI 48.7-78.1%) in medicine, and 78.1% (95% CI 65.4-90.8) in nursing (p > 0.05). Overall level of agreement: Kappa = 0.43, (χ(2) = 2.5 p > 0.05). Regarding non-compliance with therapy, it improves with: the information to the partner/family/caregiver, patient education degree in diabetes, patient motivation and ability to share and agree on decisions with the patient. Clinical inertia improves with: motivation degree of healthcare professionals and the calculation of cardiovascular risk; and gets worse with: the shortage of time in consultation, absence of data in medical record, border high limits measurements accepted as normal readings, lack of a treatment goals, lack of teamwork (Physician/Nurse), scarcity of resources and lack of alarm systems in the electronic medical record on goals to achieve.
The participants achieved an agreement in interventions in non-therapeutic compliance and clinical inertia to improve DM2 control.
德尔菲技术允许制定多学科共识以确定解决方案。
确定 2 型糖尿病（DM2）患者控制障碍和解决方案。
采用 2 轮德尔菲技术（2011 年 6 月至 8 月）进行观察性研究。一个由来自不同地区的医学和护理领域（初级保健提供者和专家）的 108 名 DM2 专家组成的小组通过电子邮件完成了一份包含 41 个李克特陈述和每个陈述 9 个分数的问卷。使用集中趋势和离散度的测量方法评估一致性程度。我们分析了两组之间的共同点/差异（Kappa 指数和 McNemar 卡方）。
响应率：65%。医学领域的共识程度为 63.4%（95%CI 48.7-78.1%），护理领域为 78.1%（95%CI 65.4-90.8%）（p>0.05）。总体一致性水平：Kappa=0.43，（χ²=2.5，p>0.05）。关于治疗不依从，通过以下措施可以改善：向伴侣/家人/照顾者提供信息、提高患者糖尿病教育程度、提高患者的积极性和与患者共同决策的能力。临床惰性通过提高医护人员的积极性和计算心血管风险而改善；由于咨询时间短、医疗记录中缺乏数据、边界高限值测量被接受为正常读数、缺乏治疗目标、缺乏医生/护士之间的团队合作、资源匮乏以及电子病历中缺乏目标警报系统而恶化。
参与者在改善 DM2 控制方面的非治疗依从性和临床惰性干预方面达成了一致。
