一项旨在改善巴西初级医疗保健专业人员诊所中糖尿病管理的干预措施的影响。

The impact of an intervention to improve diabetes management in primary healthcare professionals' practices in Brazil.

作者信息

da Silva Marinho Michelly Georgia, Fontbonne Annick, Vasconcelos Barbosa Jessyka Mary, de Melo Rodrigues Heloisa, Freese de Carvalho Eduardo, Vieira de Souza Wayner, Pessoa Cesse Eduarda Angela

机构信息

Department of Community Health, Aggeu Magalhães Research Centre, Oswaldo Cruz Foundation (Fiocruz), Recife, Brazil.

UMR 204 Nutripass, Institute of Research for Development (IRD), Montpellier University, Montpellier, France.

出版信息

Prim Care Diabetes. 2017 Dec;11(6):538-545. doi: 10.1016/j.pcd.2017.06.002. Epub 2017 Jun 26.

DOI:10.1016/j.pcd.2017.06.002

PMID:28663022

Abstract

AIMS

To evaluate the results of a structured intervention in primary healthcare to improve type 2 diabetes management.

METHODS

The intervention was implemented in 2011-2012 in two cities in the State of Pernambuco, Brazil, and evaluated in 2013 by interviewing healthcare professionals about their practices in all primary care facilities of these two cities (intervention group), and of two paired control cities (control group). Comparisons between the intervention and control groups were made using standard parametric tests.

RESULTS

The percentage of professionals who measured adherence to treatment, developed educational actions to control high-risk situations or prevent complications, or declared that they "explained" the disease to the patients, was higher in the control group (p<0.05). Multidisciplinary involvement, requests for electrocardiograms and referrals to specialists were also more frequent in the control group (p<0.01). The only differences favoring the intervention group were the higher proportion of nurses (p<0.05) and community health workers (p<0.01) trained for diabetes management and a greater frequency of discussing the cases of diabetic patients at team meetings (p<0.01).

CONCLUSIONS

These negative results raise questions about the effectiveness of actions aiming to improve diabetes management in primary care, and reinforce the need for careful evaluation of their impact.

摘要

目的

评估基层医疗保健中结构化干预措施对改善2型糖尿病管理的效果。

方法

2011年至2012年在巴西伯南布哥州的两个城市实施该干预措施，并于2013年通过访谈医疗保健专业人员，了解他们在这两个城市所有基层医疗设施（干预组）以及两个配对对照城市（对照组）中的实践情况进行评估。干预组和对照组之间的比较采用标准参数检验。

结果

对照组中测量治疗依从性、开展控制高风险情况或预防并发症的教育行动，或宣称向患者“解释”疾病的专业人员百分比更高（p<0.05）。对照组中多学科参与、心电图检查请求和转介给专科医生的情况也更频繁（p<0.01）。唯一有利于干预组的差异是接受糖尿病管理培训的护士比例更高（p<0.05）和社区卫生工作者比例更高（p<0.01），以及在团队会议上讨论糖尿病患者病例的频率更高（p<0.01）。