Pediatric, Adolescent, and Young Adult Section, and the Section on Genetics and Epidemiology, Joslin Diabetes Center, Boston, MA.
Pediatric, Adolescent, and Young Adult Section, and the Section on Genetics and Epidemiology, Joslin Diabetes Center, Boston, MA.
J Pediatr. 2014 Jun;164(6):1384-9. doi: 10.1016/j.jpeds.2014.01.045. Epub 2014 Mar 6.
To examine care utilization, family attendance, and hemoglobin A1c levels in a multidisciplinary pediatric diabetes clinic.
This retrospective electronic record review of deidentified data included patients (99% with type 1 diabetes) with established diabetes care, aged <30 years (mean age, 15 ± 5.2 years), and duration of diabetes >1 year (mean 8.5 ± 5.1 years) at first visit during a 2-year period. Outcomes included care utilization, family attendance, and glycemic control, as indicated by hemoglobin A1c level. Analyses included t tests, ANOVA, χ2 tests, ORs and 95% CIs, and multivariate analyses.
The study cohort comprised 1771 patients, with a mean of 5.8 ± 2.8 visits per patient. Roughly 15% of the scheduled appointments resulted in a cancellation or no-show; 61% of patients missed ≥1 visit. Patients with ≥2 missed appointments had higher A1c values and were older than those with <2 missed visits. Almost one-half of visits were attended by mothers alone; fathers attended 22% of visits. Patients whose fathers attended ≥1 visit had lower A1c values than patients whose fathers never attended. Eighteen percent of patients had onsite mental health visits. Patients with ≥1 mental health visit had higher mean A1c values, shorter duration of diabetes, and were younger compared with those with no mental health visits.
Our observations suggest the need to encourage attendance at diabetes visits and to include fathers to improve A1c values. The high rate of missed visits, especially in patients with poor glycemic control, identifies wasted provider effort when late cancellations/no-shows result in vacant clinic time. It is important to explore reasons for missed visits and to identify approaches to maximizing attendance, such as extended evening/weekend clinic hours and virtual visits.
考察多学科儿科糖尿病诊所的护理利用、家庭参与度和糖化血红蛋白水平。
这是一项回顾性电子病历数据匿名审查，纳入了在 2 年内首次就诊时已建立糖尿病护理、年龄<30 岁（平均年龄 15±5.2 岁）且糖尿病病程>1 年（平均 8.5±5.1 年）的患者（99%为 1 型糖尿病）。结果包括护理利用、家庭参与度和糖化血红蛋白水平所指示的血糖控制情况。分析包括 t 检验、方差分析、χ2 检验、比值比和 95%置信区间以及多变量分析。
研究队列包括 1771 例患者，每位患者平均就诊 5.8±2.8 次。大约 15%的预约取消或未到场；61%的患者漏诊≥1 次。漏诊≥2 次的患者 A1c 值更高，且年龄大于漏诊<2 次的患者。近一半的就诊由母亲单独陪同；父亲仅参加了 22%的就诊。父亲至少参加 1 次就诊的患者 A1c 值低于从未参加过就诊的患者。18%的患者进行了现场心理健康就诊。就诊≥1 次心理健康的患者 A1c 值更高，糖尿病病程更短，且年龄小于未进行心理健康就诊的患者。
我们的观察结果表明，需要鼓励患者参加糖尿病就诊，并邀请父亲参与，以改善 A1c 值。错过就诊的比例较高，尤其是血糖控制不佳的患者，这表明当晚到取消/未到场导致诊所时间浪费时，浪费了提供者的努力。重要的是要探讨错过就诊的原因，并确定如何最大限度地提高就诊率，例如延长晚间/周末门诊时间和虚拟就诊。
