Wong Carlos K H, Lam Cindy L K, Wan Eric Y F, Chan Anca K C, Pak C H, Chan Frank W K, Wong William C W
Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China.
Integrated Care Programs, Hospital Authority Head Office, Hong Kong Hospital Authority, Hong Kong, China.
Endocrine. 2016 Nov;54(2):422-432. doi: 10.1007/s12020-016-1015-5. Epub 2016 Sep 13.
To examine the effects of a structured group-based education programme, patient empowerment programme (PEP), compared with usual care on 2-year changes in patient-reported outcomes (PRO) in patients with diabetes mellitus (DM). A prospective observational study of 715 patients (PEP/non-PEP: 390/325) was conducted to complete the baseline PRO survey and followed up for 2 years. Health-related quality of life (HRQOL) was measured using the short-form 12 at baseline and annually at two follow-up assessments, which yielded physical and mental component summary and SF-6D preference-based scores. Perceived control over diabetes and general health status were measured using the patient enablement instrument (PEI) and global rating scale (GRS) at follow-ups. When compared with non-PEP, PEP participants significantly reported improvement in health condition (GRS score > 0; 24.55 % vs 10.16 %; odds ratio = 2.502; P = 0.018) in 2 years and enabled the self-perceived control over diabetes (PEI score > 0; 72.20 % vs 38.40 %; odds ratio = 3.25; P < 0.001) in 1-year follow-up but no sustained effects in year 2 (52.65 % vs 39.04 %; odds ratio = 1.366; P = 0.265). There were no significant differences between PEP and non-PEP groups in the changes in quality of life scores (all P > 0.05) at 1 year. Although HRQOL scores deteriorated over 2-year period in both groups, PEP participants reported similar changes in HRQOL scores to that of non-PEP. PEP for DM patients preserved self-perceived disease control and health condition, whereas PEP participants perceived their HRQOL similar to that of non-PEP participants. Findings of PRO should be considered alongside clinical outcomes when evaluating the overall benefits of PEP.
为研究结构化的基于小组的教育项目（患者赋权项目，PEP）与常规护理相比，对糖尿病（DM）患者患者报告结局（PRO）2年变化的影响。对715例患者（PEP/非PEP：390/325）进行了一项前瞻性观察研究，以完成基线PRO调查并随访2年。在基线时以及在两次随访评估中每年使用简短健康调查问卷12来测量健康相关生活质量（HRQOL），该问卷产生身体和心理成分汇总得分以及基于SF-6D偏好的得分。在随访时使用患者赋能工具（PEI）和总体评定量表（GRS）来测量对糖尿病的感知控制和总体健康状况。与非PEP组相比，PEP参与者在2年时显著报告健康状况改善（GRS评分>0；24.55%对10.16%；优势比=2.502；P=0.018），并且在1年随访时能够实现对糖尿病的自我感知控制（PEI评分>0；72.20%对38.40%；优势比=3.25；P<0.001），但在第2年没有持续效果（52.65%对39.04%；优势比=1.366；P=0.265）。1年时，PEP组和非PEP组在生活质量得分变化方面无显著差异（所有P>0.05）。尽管两组的HRQOL得分在2年期间均有所恶化，但PEP参与者报告的HRQOL得分变化与非PEP参与者相似。糖尿病患者的PEP保留了自我感知的疾病控制和健康状况，而PEP参与者认为他们的HRQOL与非PEP参与者相似。在评估PEP的总体益处时，应将PRO的结果与临床结局一并考虑。
