Medical School, Fremantle Hospital, University of Western Australia, Fremantle, Western Australia, Australia.
Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Western Australia, Australia.
Intern Med J. 2021 Jan;51(1):62-68. doi: 10.1111/imj.14669.
Overburdened hospital clinics can have adverse outcomes.
To evaluate the effectiveness and patient acceptability of an integrated model of complex type 2 diabetes care delivered in a community-based general practice by upskilled general practitioners (GP) co-located with an endocrinologist and diabetes nurse educator.
Patients transferred from hospital clinic lists or referred by local GP were assessed in two southern Perth practices. An upskilled GP and endocrinologist developed a management plan which was communicated to the participant's usual GP. Up to two follow-up visits over 6 months ensured that management was acceptable and effective.
A total of 464 people with type 2 diabetes (mean ± standard deviation age = 59.3 ± 13.7 years, 52.2% males) was enrolled. Their mean glycated haemoglobin (HbA ) was 9.3% (78 mmol/mol) and their mean body mass index 33.7 kg/m . Use of injectable blood glucose-lowering therapies increased between the initial and final visit in association with a median HbA reduction of 1.2% (13 mmol/mol) which was sustained to 12 months in assessable participants. There were also reductions in blood pressure, and serum low-density lipoprotein cholesterol and triglyceride concentrations. Patient satisfaction with current treatment, time for self-management, time spent in diabetes-related appointments and diabetes knowledge increased significantly. Non-attendance for scheduled appointments was <10%. Local hospital referrals and waiting lists reduced over the study period.
This study confirms the value of integrated community-based care of complex type 2 diabetes which could represent a sustainable solution to overburdened hospital diabetes outpatient clinics.
医院门诊负担过重可能会产生不良后果。
评估由经过提升技能的全科医生（与内分泌学家和糖尿病护士教育者同地办公）在社区基层医疗机构中为复杂 2 型糖尿病患者提供综合管理模式的效果和患者接受度，该模式整合了 2 型糖尿病的管理。
在珀斯南部的两家诊所中，对从医院门诊转来的患者或当地全科医生转介的患者进行评估。经过提升技能的全科医生和内分泌学家为每位患者制定了一份管理计划，并将其传达给患者的常规全科医生。在 6 个月内最多进行两次随访，以确保管理方案是可接受且有效的。
共纳入 464 例 2 型糖尿病患者（平均年龄±标准差为 59.3±13.7 岁，52.2%为男性）。他们的平均糖化血红蛋白（HbA ）为 9.3%（78mmol/mol），平均体重指数为 33.7kg/m 。在初始就诊和最终就诊之间，使用注射用血糖降低疗法的比例增加，与 HbA 中位数降低 1.2%（13mmol/mol）相关，该降低在可评估患者中持续至 12 个月。血压、血清低密度脂蛋白胆固醇和甘油三酯浓度也有所降低。患者对当前治疗方案的满意度、自我管理时间、与糖尿病相关的就诊时间以及糖尿病知识均显著增加。按时预约就诊的患者不到 10%。在研究期间，当地医院的转介和候诊人数有所减少。
本研究证实了复杂 2 型糖尿病的综合社区管理模式具有价值，该模式可能为医院糖尿病门诊负担过重提供可持续的解决方案。
