Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Department of Medicine, Leiden University Medical Center, Leiden, the Netherlands.
PLoS One. 2019 Jul 24;14(7):e0219702. doi: 10.1371/journal.pone.0219702. eCollection 2019.
To assess the planned diabetes care for the coming year and its associated factors in patients with Type 2 diabetes who have a person-centered annual consultation.
Implementation study of a new consultation model in 47 general practices (primary care) and 6 outpatient clinics (secondary care); 1200 patients from primary and 166 from secondary care participated. Data collection took place between November 2015 and February 2017. Outcomes: preferred monitoring frequency; referral to other health care provider(s); medication change. One measurement at the end of the consultation. We performed logistic regression analyses. Differences between primary and secondary care were analyzed.
Many patients arranged a monitoring frequency <4 times per year (general practices 19.5%, outpatient clinics 40%, p < .001). Type of provider (physician/nurse, OR 3.83, p < .001), baseline HbA1c (OR 1.02, p = .017), glucose lowering medication; and setting treatment goals (OR .65, p = .048) were associated with the chosen frequency. Independently associated with a referral were age (OR .99, p = .039), baseline glucose lowering medication and patients' goal setting (OR 1.52, p = .016). Medication change was associated with type of provider, baseline HbA1c, blood glucose lowering medication, quality of life (OR .80, p = .037) and setting treatment goals (OR 2.64, p = .001).
Not only disease but also person related factors, especially setting treatment goals, are independently associated with planned care use in person-centered diabetes care.
评估在进行以患者为中心的年度咨询后,2 型糖尿病患者未来一年的计划糖尿病护理及其相关因素。
在 47 家普通诊所(初级保健)和 6 家门诊诊所(二级保健)中实施新的咨询模式的实施研究;初级保健有 1200 名患者和二级保健有 166 名患者参与。数据收集于 2015 年 11 月至 2017 年 2 月进行。结局:首选监测频率;转介给其他医疗保健提供者;药物改变。在咨询结束时进行一次测量。我们进行了逻辑回归分析。分析初级保健和二级保健之间的差异。
许多患者安排的监测频率<4 次/年(普通诊所 19.5%,门诊诊所 40%,p<0.001)。提供者类型(医生/护士,OR 3.83,p<0.001)、基线糖化血红蛋白(OR 1.02,p=0.017)、降血糖药物和设定治疗目标(OR.65,p=0.048)与所选频率相关。与转诊独立相关的是年龄(OR 0.99,p=0.039)、基线降血糖药物和患者的目标设定(OR 1.52,p=0.016)。药物改变与提供者类型、基线糖化血红蛋白、降血糖药物、生活质量(OR 0.80,p=0.037)和设定治疗目标(OR 2.64,p=0.001)相关。
不仅与疾病相关,而且与患者相关的因素,尤其是设定治疗目标,与以患者为中心的糖尿病护理中计划护理的使用独立相关。