Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, U.K.
Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, U.K.
Diabetes Care. 2019 May;42(5):705-712. doi: 10.2337/dc18-2005.
Group clinics are becoming popular as a new care model in diabetes care. This evidence synthesis, using realist review methodology, examined the role of group clinics in meeting the complex needs of young people living with diabetes. Following Realist And Meta-narrative Evidence Synthesis-Evolving Standards (RAMESES) quality standards, we conducted a systematic search across 10 databases. A total of 131 articles met inclusion criteria and were analyzed to develop theoretically informed explanations of how and why group clinics could work (or not) for young people with diabetes. Models of group-based care in the literature varied significantly and incorporated different degrees of clinical and educational content. Our analysis identified four overarching principles that can be applied in different contexts to drive sustained engagement of young people in group clinics: ) emphasizing self-management as practical knowledge; ) developing a sense of affinity between patients; ) providing safe, developmentally appropriate care; and ) balancing group and individual needs. Implementation of group clinics was not always straightforward; numerous adjustments to operational and clinical processes were required to establish and deliver high-quality care. Group clinics for young people with diabetes offer the potential to complement individualized care but are not a panacea and may generate as well as solve problems.
小组诊所作为一种新的糖尿病护理模式正变得越来越流行。本证据综合运用现实主义审查方法，考察了小组诊所在满足年轻糖尿病患者复杂需求方面的作用。根据现实主义和元叙述证据综合（RAMESES）质量标准，我们在 10 个数据库中进行了系统检索。共有 131 篇文章符合纳入标准，并进行了分析，以制定关于小组诊所如何以及为何能够为糖尿病青少年发挥作用（或不发挥作用）的理论知情解释。文献中基于小组的护理模式差异很大，纳入了不同程度的临床和教育内容。我们的分析确定了四项总体原则，可以在不同情况下应用，以推动年轻人持续参与小组诊所：）强调自我管理作为实践知识；）在患者之间建立亲和力；）提供安全、适合发展阶段的护理；以及）平衡小组和个人的需求。小组诊所的实施并不总是一帆风顺的；需要对运营和临床流程进行多次调整，以建立和提供高质量的护理。小组诊所为年轻的糖尿病患者提供了补充个体化护理的潜力，但不是万灵药，可能会产生问题，也可能会解决问题。
