农村基层医疗中跨学科糖尿病诊所的治疗效果
Outcomes in an Interdisciplinary Diabetes Clinic in Rural Primary Care.
作者信息
King Dana E, Petrone Ashley B, Alcantara Frederick M, Elavsky Megan M, Prestoza Michelle O, Siebart Judy, Castelli Greg
机构信息
From the Department of Family Medicine, West Virginia University, Morgantown, West Virginia, and University of Pittsburgh Medical Center (UPMC), St. Margaret, Pittsburgh, Pennsylvania.
出版信息
South Med J. 2019 Apr;112(4):205-209. doi: 10.14423/SMJ.0000000000000960.
OBJECTIVE
The purpose of this study was to evaluate the effectiveness of an interdisciplinary diabetes team model of care in assisting patients to achieve improved glucose control in a primary care rural setting.
METHODS
A family medicine clinic at a rural university medical center developed an interdisciplinary diabetes team clinic composed of a certified diabetes educator/dietitian, a case manager, a pharmacist, nursing staff, a family medicine resident, a psychologist, and a board-certified family medicine attending physician. Patients were referred if their hemoglobin A1c (HbA1c) was ≥9% (75 mmol/mol); patients were seen for an initial consultation and for additional visits as needed.
RESULTS
A total of 94 patients attended an initial visit and at least 1 follow-up within 6 months. Mean age was 57 ± 13 years, and 54% were female. Median time from the initial intensive diabetes clinic visit to a follow-up visit was 2.8 months. There was a significant reduction in median HbA1c percentage from 10.25% (88.5 mmol/mol) ± 1.4% (range 73-104 mmol/mol) at the initial intensive diabetes clinic visit to 8.7% (72 mmol/mol) ± 1.8% (range 52-92 mmol/mol) at a 1- to 6-month follow-up ( = -7.161, < 0.001) and a significant difference between baseline HbA1c (10.25% [88.5 mmol/mol] ± 1.4% [range 73-104 mmol/mol]) and latest HBA1c (1-18 months later) 8.4% (68 mmol/mol) ± 2.2% (range 44-92 mmol/mol; = -7.022, < 0.001). Overall, 86% of patients had a lower HbA1c at follow-up, and 33% had an HbA1c <8% (64 mmol/mol). There were no differences in patients' blood pressure, immunization rates, or lipid values between baseline and follow-up visits ( > 0.05).
CONCLUSIONS
An interdisciplinary team approach to glycemic control can achieve significant reductions in HbA1c in the rural primary care setting.
目的
本研究旨在评估跨学科糖尿病团队护理模式在协助农村基层医疗环境中的患者改善血糖控制方面的有效性。
方法
一所农村大学医学中心的家庭医学诊所组建了一个跨学科糖尿病团队诊所，成员包括一名认证糖尿病教育者/营养师、一名病例管理员、一名药剂师、护理人员、一名家庭医学住院医师、一名心理学家以及一名获得董事会认证的家庭医学主治医师。如果患者的糖化血红蛋白（HbA1c）≥9%（75 mmol/mol），则会被转诊；患者会接受初次咨询，并根据需要进行后续就诊。
结果
共有94名患者在6个月内参加了初次就诊并至少进行了1次随访。平均年龄为57±13岁，54%为女性。从初次强化糖尿病诊所就诊到随访就诊的中位时间为2.8个月。中位HbA1c百分比从初次强化糖尿病诊所就诊时的10.25%（88.5 mmol/mol）±1.4%（范围73 - 104 mmol/mol）显著降至1至6个月随访时的8.7%（72 mmol/mol）±1.8%（范围52 - 92 mmol/mol）（P = -7.161，P < 0.001），且基线HbA1c（10.25% [88.5 mmol/mol] ± 1.4% [范围73 - 104 mmol/mol]）与最新HbA1c（1 - 18个月后）8.4%（68 mmol/mol）±2.2%（范围44 - 92 mmol/mol）之间存在显著差异（P = -7.022，P < 0.001）。总体而言，86%的患者在随访时HbA1c降低，33%的患者HbA1c <8%（64 mmol/mol）。基线和随访就诊之间患者的血压、免疫接种率或血脂值无差异（P > 0.05）。
结论
在农村基层医疗环境中，采用跨学科团队方法进行血糖控制可使HbA1c显著降低。
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