对全科医疗管理计划、团队护理安排和审查对糖尿病管理的影响。

Impact on diabetes management of General Practice Management Plans, Team Care Arrangements and reviews.

机构信息

Department of General Practice, Monash University, Melbourne, VIC, Australia.

出版信息

Med J Aust. 2013 Aug 19;199(4):261-5. doi: 10.5694/mja13.10161.

DOI:10.5694/mja13.10161

PMID:23984783

Abstract

OBJECTIVES

To investigate whether General Practice Management Plans (GPMPs), Team Care Arrangements (TCAs) and reviews of these improve the management and outcomes of patients with diabetes when supported by cdmNet, a web-based chronic disease management system; and to investigate adherence to the annual cycle of care (ACOC), as recommended in diabetes guidelines.

DESIGN, PARTICIPANTS AND SETTING: A before-and-after study to analyse prospectively collected data on 577 patients with type 1 or 2 diabetes mellitus who were managed with a GPMP created using cdmNet between June 2008 and November 2012.

MAIN OUTCOME MEASURES

Completion of the clinical tests in the ACOC (process outcome) and values of six of these clinical measurements (clinical outcomes).

RESULTS

Significant improvements were seen after creation of a GPMP in the proportion of ACOC clinical tests completed (57.9% v 74.8%, P < 0.001), total cholesterol level (P < 0.01), low-density lipoprotein (LDL) cholesterol level (P < 0.001) and body mass index (BMI) (P < 0.01). Patients using GPMPs and TCAs also improved their glycated haemoglobin (HbA1c) level (P < 0.05). Patients followed up with irregular reviews had significant improvements in the proportion of ACOC clinical tests completed (59.2% v 77.6%, P < 0.001), total cholesterol level (P < 0.05), and BMI (P < 0.01), but patients with regular reviews had greater improvements in the proportion of ACOC clinical tests completed (58.9% v 85.0%, P < 0.001), HbA(1c) level (57.7 v 53.0 mmol/mol, P < 0.05), total cholesterol level (4.8 v 4.5 mmol/L, P < 0.05), LDL cholesterol level (2.8 v 2.4 mmol/L, P < 0.01) and diastolic blood pressure (76.0 v 74.0 mmHg, P < 0.05).

CONCLUSION

There were significant improvements in process and clinical outcomes for patients on a GPMP or a GPMP and TCA, particularly when these were followed up by regular reviews. Patients using cdmNet were four times more likely to have their GPMP or TCA followed up through regular reviews than the national average.

摘要

目的

研究在使用基于网络的慢性病管理系统 cdmNet 支持下，全科医疗管理计划（GPMP）、团队护理安排（TCA）和这些计划的审查是否能改善糖尿病患者的管理和结果；并研究是否符合糖尿病指南推荐的年度护理周期（ACOC）。

设计、参与者和设置：一项前瞻性研究，分析了 2008 年 6 月至 2012 年 11 月期间使用 cdmNet 创建的 577 名 1 型或 2 型糖尿病患者的临床数据，这些患者接受了 GPMP 管理。

主要观察指标

ACOC 中的临床检查完成情况（过程结果）和这 6 项临床测量值中的 5 项（临床结果）的实际值。

结果

在创建 GPMP 后，ACOC 临床检查完成率（57.9%比 74.8%，P<0.001）、总胆固醇水平（P<0.01）、低密度脂蛋白（LDL）胆固醇水平（P<0.001）和体质指数（BMI）（P<0.01）均显著提高。使用 GPMP 和 TCA 的患者糖化血红蛋白（HbA1c）水平也有所改善（P<0.05）。不规律复查的患者 ACOC 临床检查完成率（59.2%比 77.6%，P<0.001）、总胆固醇水平（P<0.05）和 BMI（P<0.01）显著提高，但规律复查的患者 ACOC 临床检查完成率（58.9%比 85.0%，P<0.001）、HbA1c 水平（57.7 比 53.0 mmol/mol，P<0.05）、总胆固醇水平（4.8 比 4.5 mmol/L，P<0.05）、LDL 胆固醇水平（2.8 比 2.4 mmol/L，P<0.01）和舒张压（76.0 比 74.0 mmHg，P<0.05）改善更为显著。