Simmons D, Hartnell S, Watts J, Ward C, Davenport K, Gunn E, Jenaway A
Institute of Metabolic Science, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.
Diabet Med. 2015 Oct;32(10):1361-7. doi: 10.1111/dme.12779. Epub 2015 Apr 27.
To describe the effect of a combined diabetes specialist/mental health team approach to prevent readmissions for acute glycaemic events among patients with diabetes.
Consecutive patients with diabetes, readmitted to a single hospital for an acute glycaemic condition, were offered one or more diabetes (including assessment, education, medication, technology use and intensive support) and mental health (including assessment, training and therapies) interventions. The pilot service took place over 11 months, with the preceding 24 months and subsequent 8 months serving as control periods.
Of the 58 patients admitted, 50 had Type 1 diabetes and were from within the hospital catchment area, and were discharged home. Of these, 32 (64%) had a pre-existing mental health issue and 14 (28%) had a complex social situation. In all, 96% of patients were met as an inpatient by a team member, and 94% accepted at least one intervention. The mean ±sd number of admissions per patient/month dropped from 0.12 ± 0.10 to 0.05 ± 0.10 (P < 0.001) during the intervention, increasing, once the intervention ended, to 0.16 ± 0.36 (P = 0.002). The mean ± sd length of stay similarly decreased and increased (0.6 ± 0.9 to 0.2 ± 0.7 days; P < 0.001 to 0.006) to 0.6 ± 1.4 days (P = 0.003) per patient/month) across the three periods, as did the mean ±sd tariff paid per patient/month (₤258.0 ± 374.0 vs ₤92.1 ± 245.0 vs ₤287.3 ± 563.8; P < 0.001 and P = 0.018, respectively). The mean ± sd HbA1c level dropped from 99 ± 22 to 92 ± 24 mmol/mol (11.2 ± 4.2% vs 10.6 ± 4.3%; P = 0.014) but did not increase after the intervention [89 ± 26 mmol/mol (10.4 ± 4.5%)].
The cost and long-term risks of hospitalization among patients with Type 1 diabetes and recurrent admissions can be reduced by a combined specialist diabetes/mental health team approach.
描述糖尿病专科医生/心理健康团队联合干预方法对预防糖尿病患者急性血糖事件再入院的效果。
连续收治因急性血糖状况再次入住同一家医院的糖尿病患者，为其提供一项或多项糖尿病干预措施（包括评估、教育、药物治疗、技术使用和强化支持）以及心理健康干预措施（包括评估、培训和治疗）。试点服务为期11个月，将前24个月和后8个月作为对照期。
在58例入院患者中，50例为1型糖尿病患者，均来自医院服务区域内，且均已出院回家。其中，32例（64%）患者既往有心理健康问题，14例（28%）患者社会情况复杂。总体而言，96%的患者在住院时与团队成员进行了接触，94%的患者接受了至少一项干预措施。干预期间，每位患者每月的平均住院次数±标准差从0.12±0.10降至0.05±0.10（P<0.001），干预结束后增加至0.16±0.36（P=0.002）。每位患者每月的平均住院天数±标准差在三个阶段同样呈现先下降后上升的趋势（从0.6±0.9天降至0.2±0.7天；P<0.001至0.006），最终升至0.6±1.4天（P=0.003），每位患者每月支付的平均费用±标准差情况类似（分别为258.0±374.0英镑、92.1±245.0英镑、287.3±563.8英镑；P<0.001和P=0.018）。平均糖化血红蛋白（HbA1c）水平从99±22降至92±24 mmol/mol（从11.2±4.2%降至10.6±4.3%；P=0.014），但干预后未升高[89±26 mmol/mol（10.4±4.5%）]。
糖尿病专科医生/心理健康团队联合干预方法可降低1型糖尿病患者住院的费用及长期风险，并减少再次入院情况。
