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利用电子病历识别糖尿病自我管理教育和支持计划不参加的预测因素。

Leveraging the Electronic Medical Record to Identify Predictors of Nonattendance to a Diabetes Self-Management Education and Support Program.

机构信息

Pacific University Oregon School of Pharmacy, Hillsboro, Oregon.

Department of Pharmaceutical Sciences, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado.

出版信息

Diabetes Educ. 2019 Oct;45(5):544-552. doi: 10.1177/0145721719873066. Epub 2019 Sep 5.

Abstract

PURPOSE

The purpose of this study is to identify patient-specific factors, easily obtainable from the electronic medical record (EMR), that are associated with nonattendance to a group Diabetes Self-Management Education and Support (DSMES) program among an adult population with type 2 diabetes.

METHODS

This study used a retrospective cohort design, with attendance to a group DSMES session as the primary outcome. The study included adult patients with diagnosed type 2 diabetes who were scheduled for a group DSMES session between March 1, 2013, and June 30, 2017. Patients who were pregnant or who had other types of diabetes (eg, type 1 diabetes, prediabetes, gestational diabetes) were excluded.

RESULTS

A higher A1C, required copay for DSMES, low socioeconomic status, increased number of diabetes medications prescribed, the presence of a prescription for any insulin, and a higher calculated total daily dose of insulin were all associated with a decreased likelihood of attendance. Only older age was associated with an increased likelihood of attendance.

CONCLUSION

Using the EMR to identify patients who need more intensive intervention strategies can help programs direct resources to those who need them most. Having identified these at-risk individuals, a targeted communication and outreach strategy can be developed to assist these individuals with overcoming barriers to attending DSMES.

摘要

目的

本研究旨在确定患者特定的因素,这些因素可从电子病历(EMR)中轻易获得,与 2 型糖尿病成年人群中不参加团体糖尿病自我管理教育和支持(DSMES)计划相关。

方法

本研究采用回顾性队列设计,以参加团体 DSMES 课程为主要结局。研究纳入了 2013 年 3 月 1 日至 2017 年 6 月 30 日期间安排参加团体 DSMES 课程的确诊为 2 型糖尿病的成年患者。排除了孕妇或患有其他类型糖尿病(如 1 型糖尿病、糖尿病前期、妊娠糖尿病)的患者。

结果

糖化血红蛋白(A1C)较高、DSMES 需要共付额、社会经济地位较低、开处的糖尿病药物数量增加、任何胰岛素处方的存在以及计算出的胰岛素总日剂量较高,均与参加课程的可能性降低相关。仅年龄较大与参加的可能性增加相关。

结论

使用 EMR 识别需要更强化干预策略的患者,可以帮助计划将资源导向最需要的人群。确定了这些高风险个体后,可以制定有针对性的沟通和外展策略,以帮助这些个体克服参加 DSMES 的障碍。

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