Schnakenberg R, Rothe M, Bleckwenn M
Gesundheitswesen. 2017 Aug;79(8-09):633-637. doi: 10.1055/s-0035-1548858. Epub 2015 Apr 28.
We investigated whether patients who belong to the high risk group to develop type-2 diabetes can be identified by medical assistants (MFA) in the everyday routine of the general practice by means of a few characteristics. The effectiveness of a diabetes-risk screening could be improved by a selective approach to patients who are at risk. As part of the feasibility study 'SeRiFIN', patients who were between 20 and 50 years old and/or had a positive family history were approached by trained MFA in 6 general practices. To determine the risk of diabetes, the selected patients should complete the FINDRISK questionnaire. In the 5 control practices, patients of the same age group without known type 2 diabetes, were also asked to perform a risk analysis with the help of the FINDRISK questionnaire. 916 FINDRISK questionnaires were evaluated. In the selection group, 62% of surveyed patients indicated that there were cases of diabetes in the family. In 86% of patients the waist circumference was increased. A 30% risk or higher to develop type 2 diabetes in the next ten years was found in 22% of the addressed patients. In the unselected group only 7% of patients had a risk that had to be investigated. In addition there was a significant difference in the eating behaviour and the level of daily exercise between the selection an the control group. The training of MFA as well as the implementation of the intervention were well received and considered feasible to conduct in addition to the routine work of MFA. Furthermore MFA expressed their astonishment at the effectiveness of this pre-selection. After training MFA recognise patients at risk for type 2 diabetes reliably in their everyday practice routine. The targeted approach to patients at risk can be delegated to the MFA. Thus, the time resources of general practitioners can be more effectively used for prevention treatment. Especially cardiovascular risk patients should benefit from the earliest possible identification and intervention.
我们调查了在普通诊所的日常工作中，医学助理（MFA）能否通过一些特征识别出属于2型糖尿病高危组的患者。通过对高危患者采用选择性方法，可提高糖尿病风险筛查的有效性。作为可行性研究“SeRiFIN”的一部分，6家普通诊所中经过培训的医学助理对年龄在20至50岁之间和/或有家族病史的患者进行了调查。为确定糖尿病风险，选定的患者应完成芬兰糖尿病风险评估问卷（FINDRISK）。在5家对照诊所中，年龄相同且无2型糖尿病的患者也被要求借助芬兰糖尿病风险评估问卷进行风险分析。共评估了916份芬兰糖尿病风险评估问卷。在选择组中，62%的受调查患者表示家族中有糖尿病病例。86%的患者腰围增加。在接受调查的患者中，22%的人在未来十年患2型糖尿病的风险为30%或更高。在未选定组中，只有7%的患者有需要调查的风险。此外，选择组和对照组在饮食行为和日常运动量方面存在显著差异。医学助理的培训以及干预措施的实施受到好评，并被认为除医学助理的日常工作外开展是可行的。此外，医学助理对这种预选的有效性表示惊讶。经过培训后，医学助理在日常工作中能够可靠地识别出2型糖尿病高危患者。针对高危患者的定向方法可委托给医学助理。因此，全科医生的时间资源可更有效地用于预防治疗。尤其是心血管疾病风险患者应能从尽早识别和干预中受益。
