Hertroijs Dorijn F L, Elissen Arianne M J, Brouwers Martijn C G J, Schaper Nicolaas C, Ruwaard Dirk
1Department of Health Services Research,CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences,Maastricht University,Maastricht,The Netherlands.
2Department of Internal Medicine,Division of Endocrinology,CARIM School for Cardiovascular Diseases,Maastricht University Medical Centre,Maastricht,The Netherlands.
Prim Health Care Res Dev. 2018 Sep;19(5):424-447. doi: 10.1017/S146342361800004X. Epub 2018 Feb 6.
AimTo identify which patient-related effect modifiers influence the outcomes of integrated care programs for type 2 diabetes in primary care.
Integrated care is a widespread management strategy for the treatment of type 2 diabetes. However, most integrated care programs are not tailored to patients' needs, preferences and abilities. There is increasing consensus that such a patient-centered approach could improve the management of type 2 diabetes. Thus far, it remains unclear which patient-related effect modifiers should guide such an approach.
PubMed, CINAHL and EMBASE were searched for empirical studies published after 1998. A systematic literature review was conducted according to the PRISMA guidelines.FindingsIn total, 23 out of 1015 studies were included. A total of 21 studies measured the effects of integrated diabetes care programs on hemoglobin A1c (HbA1c) and three on low-density lipoprotein cholesterol, systolic blood pressure and health-care utilization. In total, 49 patient characteristics were assessed as potential effect modifiers with HbA1c as an outcome, of which 46 were person or health-related and only three were context-related. Younger age, insulin therapy and longer disease duration were associated with higher HbA1c levels in cross-sectional and longitudinal studies. Higher baseline HbA1c was associated with higher HbA1c at follow-up in longitudinal studies. Information on context- and person-related characteristics was limited, but is necessary to help identify the care needs of individual patients and implement an effective integrated type 2 diabetes tailored care program.
目的确定哪些患者相关效应修饰因素会影响基层医疗中2型糖尿病综合护理项目的效果。
综合护理是治疗2型糖尿病广泛采用的管理策略。然而，大多数综合护理项目并未根据患者的需求、偏好和能力进行定制。越来越多的人达成共识，认为这种以患者为中心的方法可以改善2型糖尿病的管理。到目前为止，尚不清楚哪些患者相关效应修饰因素应指导这种方法。
检索PubMed、CINAHL和EMBASE中1998年后发表的实证研究。根据PRISMA指南进行系统的文献综述。
总共1015项研究中纳入了23项。共有21项研究测量了糖尿病综合护理项目对糖化血红蛋白（HbA1c）的影响，3项研究测量了对低密度脂蛋白胆固醇、收缩压和医疗保健利用的影响。总共评估了49项患者特征作为以HbA1c为结果的潜在效应修饰因素，其中46项与人或健康相关，只有3项与背景相关。在横断面和纵向研究中，年龄较小、胰岛素治疗和病程较长与较高的HbA1c水平相关。在纵向研究中，较高的基线HbA1c与随访时较高的HbA1c相关。关于背景和人相关特征的信息有限，但对于帮助确定个体患者的护理需求和实施有效的2型糖尿病定制综合护理项目是必要的。
