Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229, GT, Maastricht, the Netherlands.
Department of Internal Medicine, Division of Endocrinology and Metabolic Diseases, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands.
BMC Health Serv Res. 2019 Aug 16;19(1):575. doi: 10.1186/s12913-019-4371-z.
Recently, there has been growing interest in providing more tailored, patient-centered care for the treatment of type 2 diabetes mellitus (T2DM). Yet it remains unclear which patient characteristics should be determined to guide such an approach. Therefore, the opinions of healthcare providers (HCP) and people with T2DM about relevant patient characteristics for estimating healthcare needs of people with T2DM were assessed and compared.
Two separate online Delphi studies were conducted according to the RAND-UCLA Appropriateness Method: one with HCPs (n = 22) from Dutch primary and secondary care and one with people with T2DM treated in Dutch primary care (n = 46). The relevance of patient characteristics for estimating healthcare needs, defined as the number of yearly consultations, was assessed on a 5-point Likert scale. Characteristics with a median of 4 or 5 and an interquartile range ≤ 1.5 were considered relevant with consensus. Participants were also asked to select the top 5 of most relevant patient characteristics. To determine the overall top 5, the mean relative importance score of each characteristic was calculated.
In two Delphi rounds, 28 and 15 patient characteristics were rated by HCPs and people with T2DM, respectively. Both HCPs and people with T2DM found health-related characteristics relevant for estimating healthcare needs of people with T2DM. However, HCPs preferred to estimate healthcare needs using person- and context-related characteristics. They ranked self-efficacy as the most relevant estimator. In contrast, people with T2DM were more in favor of health-related characteristics and ranked HbA1c as the most relevant estimator.
The findings show that there is discrepancy in opinions on relevant patient characteristics for estimating healthcare needs between HCPs and people with T2DM. To achieve more tailored, patient-centered care, it is important that both groups agree on the topics to be discussed during patient consultations.
最近，人们对提供更具针对性、以患者为中心的 2 型糖尿病（T2DM）治疗方法越来越感兴趣。然而，目前尚不清楚应该确定哪些患者特征来指导这种方法。因此，评估并比较了医疗保健提供者（HCP）和 T2DM 患者对估计 T2DM 患者医疗需求的相关患者特征的意见。
根据 RAND-UCLA 适宜性方法，进行了两项独立的在线 Delphi 研究：一项是针对荷兰初级和二级保健的 HCP（n=22），另一项是针对在荷兰初级保健中接受治疗的 T2DM 患者（n=46）。使用 5 分李克特量表评估患者特征对估计医疗需求（定义为每年就诊次数）的相关性。特征的中位数为 4 或 5，四分位距≤1.5，则认为具有共识的相关性。参与者还被要求选择最相关的前 5 个患者特征。为了确定总体前 5 名，计算了每个特征的平均相对重要性得分。
在两轮 Delphi 研究中，HCP 和 T2DM 分别对 28 种和 15 种患者特征进行了评分。HCP 和 T2DM 均认为与健康相关的特征与估计 T2DM 患者的医疗需求相关。然而，HCP 更倾向于使用人与环境相关的特征来估计医疗需求。他们将自我效能感列为最相关的估计指标。相比之下，T2DM 患者更倾向于与健康相关的特征，并将 HbA1c 列为最相关的估计指标。
研究结果表明，HCP 和 T2DM 对估计医疗需求的相关患者特征的意见存在差异。为了实现更具针对性、以患者为中心的护理，重要的是两组都同意在患者咨询期间讨论的主题。
