Wan Eric Yuk Fai, Fung Colman Siu Cheung, Wong Carlos King Ho, Choi Edmond Pui Hang, Jiao Fang Fang, Chan Anca Ka Chun, Chan Karina Hiu Yen, Lam Cindy Lo Kuen
Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau Clinic, 3/F., 161 Main Street, Ap Lei Chau, Hong Kong.
School of Nursing, The University of Hong Kong, 4/F William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong.
Endocrine. 2017 Feb;55(2):416-426. doi: 10.1007/s12020-016-1124-1. Epub 2016 Oct 3.
Little is known about how the patient-reported outcomes is influenced by multidisciplinary-risk-assessment-and-management-programme for patients with diabetes mellitus (RAMP-DM). This paper aims to evaluate the effectiveness of RAMP-DM on patient-reported outcomes. This was a prospective longitudinal study on 1039 diabetes mellitus patients (714/325 RAMP-DM/non-RAMP-DM) managed in primary care setting. 536 and 402 RAMP-DM participants, and 237 and 187 non-RAMP-DM participants were followed up at 12 and 24 months with completed survey, respectively. Patient-reported outcomes included health-related quality of life, change in global health condition and patient enablement measured by Short Form-12 Health Survey version-2 (SF-12v2), Global Rating Scale, Patient Enablement Instrument respectively. The effects of RAMP-DM on patient-reported outcomes were evaluated by mixed effect models. Subgroup analysis was performed by stratifying haemoglobin A1c (HbA1c) (optimal HbA1c < 7 % and suboptimal HbA1c ≥ 7 %). RAMP-DM with suboptimal HbA1c was associated with greater improvement in SF-12v2 physical component summary score at 12-month (coefficient:3.80; P-value < 0.05) and 24-month (coefficient:3.82;P-value < 0.05), more likely to feel more enabled at 12-month (odds ratio: 2.57; P-value < 0.05), and have improved in GRS at 24-month (odds ratio:4.05; P-value < 0.05) compared to non-RAMP-DM participants. However, there was no significant difference in patient-reported outcomes between RAMP-DM and non-RAMP-DM participants with optimal HbA1c. Participation in RAMP-DM is effective in improving physical component of HRQOL, Global Rating Scale and patient enablement among diabetes mellitus patients with suboptimal HbA1c, but not in those with optimal HbA1c. Patients with sub-optimal diabetes mellitus control should be the priority target population for RAMP-DM. This observational study design may have potential bias in the characteristics between groups, and randomized clinical trial is needed to confirm the results.
关于多学科风险评估与管理项目（RAMP-DM）如何影响糖尿病患者的患者报告结局，目前所知甚少。本文旨在评估RAMP-DM对患者报告结局的有效性。这是一项针对1039例在基层医疗环境中管理的糖尿病患者（714例/325例RAMP-DM/非RAMP-DM）的前瞻性纵向研究。分别在12个月和24个月时对536例和402例RAMP-DM参与者以及237例和187例非RAMP-DM参与者进行了随访，并完成了调查。患者报告结局包括健康相关生活质量、总体健康状况变化以及通过简明健康调查简表第2版（SF-12v2）、总体评定量表、患者赋能工具分别测量的患者赋能。通过混合效应模型评估RAMP-DM对患者报告结局的影响。通过对糖化血红蛋白（HbA1c）进行分层（最佳HbA1c＜7%和次优HbA1c≥7%）进行亚组分析。与非RAMP-DM参与者相比，HbA1c次优的RAMP-DM在12个月时（系数：3.80；P值＜0.05）和24个月时（系数：3.82；P值＜0.05）的SF-12v2身体成分汇总评分改善更大，在12个月时更有可能感觉赋能增强（优势比： 2.57；P值＜0.05），并且在24个月时GRS有所改善（优势比：4.05；P值＜0.05）。然而，最佳HbA1c的RAMP-DM参与者和非RAMP-DM参与者之间的患者报告结局没有显著差异。参与RAMP-DM对改善HbA1c次优的糖尿病患者的健康相关生活质量身体成分、总体评定量表和患者赋能有效，但对最佳HbA1c的患者无效。糖尿病控制不佳的患者应是RAMP-DM的优先目标人群。这种观察性研究设计在组间特征方面可能存在潜在偏差，需要进行随机临床试验来证实结果。
