Neumark Ann-Sofie Nilsson, Brudin Lars, Neumark Thomas
Blå Kustens Primary Health Care Centre, Rösvägen4, S-57251 Oskarshamn, Sweden.
Department of Clinical Physiology, Kalmar County Hospital, Kalmar, Sweden.
Prim Care Diabetes. 2015 Aug;9(4):253-60. doi: 10.1016/j.pcd.2015.03.002. Epub 2015 Apr 9.
To compare adherence to Swedish guidelines for diabetes care between elderly people living at home with or without home health care, and residents of nursing homes.
Medical records of 277 elderly people aged 80 and older, with known diabetes in a Swedish municipality, were monitored using quality indicators to evaluate processes and outcomes.
Monitoring, in accordance to diabetes guidelines, of HbA1c, lipids, blood pressure and foot examinations was lower among residents of nursing homes (p < 0.001). The HbA1c value of ≤ 6.9% (52 mmol/mol) was achieved for 48% of those in nursing homes with medication, 35% and 39%, for those living at home with or without home health care, respectively. Insulin was used to a greater extent in nursing homes. Metformin was frequently used, even at reduced e-GFR. Systolic BP ≤ 140 mmHg was achieved by 71% vs 80% and 85% of those living at home, those with home health care and residents of nursing homes in the respective groups.
Adherence to guidelines was deficient particularly in nursing homes. Clearer guidelines and interventions aimed at the improvement of quality in diabetes care in elderly people and sustainable coordination between health care providers is needed.
比较在家中接受或未接受家庭医疗护理的老年人与养老院居民对瑞典糖尿病护理指南的遵循情况。
使用质量指标对瑞典一个市的277名80岁及以上患有糖尿病的老年人的病历进行监测，以评估过程和结果。
养老院居民对糖化血红蛋白（HbA1c）、血脂、血压和足部检查按照糖尿病指南进行监测的比例较低（p < 0.001）。在养老院中，使用药物治疗的患者有48%的糖化血红蛋白值≤6.9%（52 mmol/mol），在家中接受或未接受家庭医疗护理的患者这一比例分别为35%和39%。养老院中胰岛素的使用更为广泛。即使估算肾小球滤过率（e-GFR）降低时也经常使用二甲双胍。收缩压≤140 mmHg的比例在各相应组中，在家居住者为85%，接受家庭医疗护理者为80%，养老院居民为71%。
对指南的遵循情况尤其在养老院中不足。需要更明确的指南以及旨在改善老年人糖尿病护理质量和医疗服务提供者之间可持续协调的干预措施。
