Drake Connor, Meade Caroline, Hull Sharon K, Price Ashley, Snyderman Ralph
From the Duke Center for Personalized Health Care, the Department of Community and Family Medicine, and the Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
South Med J. 2018 Nov;111(11):674-682. doi: 10.14423/SMJ.0000000000000892.
This study describes the feasibility of implementing personalized health planning (PHP) within shared medical appointments (SMAs) for patients with type 2 diabetes mellitus. The PHP-SMA approach was designed to synergize the benefits of SMAs with those of PHP, enabling greater patient engagement focused on meeting individualized therapeutic goals in a group setting.
Patients were assigned randomly to a PHP-SMA or a standard eight-session SMA series. Standard SMAs included an interactive educational curriculum delivered in group medical encounters. The PHP-SMA included the addition of a patient self-assessment, health risk assessment, shared patient-provider goal setting, creation of a personal health plan, and follow-up on clinical progress. Clinical and patient-reported outcomes and qualitative data from focus groups with patients, providers, and administrative staff were used for evaluation. Qualitative data explored facilitators and barriers to implementation of the PHP-SMA. The Consolidated Framework for Implementation Research was used to provide insight into implementation factors.
PHP was successfully integrated into SMAs in a primary care setting. Patients in the PHP-SMA (n = 12) were more likely to attend ≥5 sessions than patients assigned to the standard SMA (n = 7; 58% PHP, 28.5% control). Qualitative data evaluation described the advantages and barriers to PHP, the team-based approach to care, and patient participation. The PHP-SMA group experienced reductions in hemoglobin A1c, low-density lipoprotein, blood pressure, and body mass index, as well as successful attainment of health goals.
The PHP-SMA is a proactive and participatory approach to chronic care delivery that synergizes the benefits of PHP within SMAs. This study describes the components of this intervention; collects evidence on feasibility, acceptability, and clinical outcomes; and identifies implementation barriers and facilitators. The PHP-SMA warrants further evaluation as an approach to improve health outcomes in patients with common chronic conditions.
本研究描述了在2型糖尿病患者的共享医疗预约（SMA）中实施个性化健康规划（PHP）的可行性。PHP-SMA方法旨在将SMA的益处与PHP的益处相结合，使患者在团体环境中更积极地参与，专注于实现个性化治疗目标。
患者被随机分配到PHP-SMA组或标准的八节SMA系列组。标准SMA包括在团体医疗会诊中提供的互动教育课程。PHP-SMA还包括患者自我评估、健康风险评估、患者与提供者共同设定目标、制定个人健康计划以及临床进展跟踪。使用临床和患者报告的结果以及来自患者、提供者和行政人员焦点小组的定性数据进行评估。定性数据探讨了PHP-SMA实施的促进因素和障碍。采用实施研究综合框架来深入了解实施因素。
PHP在初级保健环境中成功整合到SMA中。PHP-SMA组（n = 12）的患者比分配到标准SMA组（n = 7；PHP组为58%，对照组为28.5%）更有可能参加≥5节课程。定性数据评估描述了PHP的优势和障碍、基于团队的护理方法以及患者参与情况。PHP-SMA组的糖化血红蛋白、低密度脂蛋白、血压和体重指数有所降低，并且成功实现了健康目标。
PHP-SMA是一种积极主动且参与性强的慢性护理提供方法，它将PHP的益处与SMA相结合。本研究描述了该干预措施的组成部分；收集了关于可行性、可接受性和临床结果的证据；并确定了实施障碍和促进因素。PHP-SMA作为一种改善常见慢性病患者健康结局的方法值得进一步评估。
