Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.
Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.
Can J Diabetes. 2020 Jul;44(5):387-393. doi: 10.1016/j.jcjd.2019.11.004. Epub 2019 Dec 10.
The factors associated with allied health-care professional (HCP) time spent face-to-face with patients in clinic have not been well described in type 1 diabetes (T1D) given the introduction of resource-intensive technologies and gaps in socioeconomic circumstances. The objective of this study was to evaluate clinical and social factors associated with nonphysician HCP time in a pediatric T1D practice.
Nonphysician HCP workload data, including time spent in direct clinical care over a 1-year period and nonclinic contacts, were linked to data from 723 pediatric subjects with T1D and evaluated in relation to key demographic, social and diabetes treatment factors.
HCPs spent 145.7 min per patient on a median of 3 clinic visits, with certified diabetes educators (CDEs) being responsible for most clinic interactions compared with psychosocial staff. CDE time varied considerably according to T1D duration, with new-onset patients (≤1 year) taking a median of 392.0 min compared with 114.5 min for their established counterparts (p<0.0001). Among the established group (n=629), CDE time was strongly associated with continuous subcutaneous insulin infusion therapy initiation, psychosocial service use, glycated hemoglobin (A1C) and degree of marginalization (p<0.0001). Overall, CDE time increased by 8.6 min for each 1.0% increase in A1C (p=0.022) and by 16.3 min for each 1-U increase in marginalization (p=0.01).
We observed HCP time was associated with multiple clinical factors in addition to overall marginalization. Although initial investments in education and continuous subcutaneous insulin infusion training were considerable, our results suggest that these lead to a decrease in time spent in clinic over time, and is largely driven by lower A1C.
由于引入了资源密集型技术和社会经济状况存在差距，1 型糖尿病（T1D）中尚未很好地描述与医疗保健专业人员（HCP）在诊所面对面花费的时间相关的因素。本研究的目的是评估儿科 T1D 实践中与非医师 HCP 时间相关的临床和社会因素。
将非医师 HCP 工作量数据（包括在 1 年期间花费在直接临床护理上的时间和非诊所接触）与 723 名 T1D 儿科患者的数据相关联，并根据关键的人口统计学，社会和糖尿病治疗因素进行评估。
HCP 平均每个患者在 3 次就诊中花费 145.7 分钟，与心理社会工作人员相比，认证糖尿病教育者（CDE）负责大多数诊所互动。CDE 时间差异很大，新发病患者（≤1 年）中位数为 392.0 分钟，而新发病患者（≤1 年）中位数为 392.0 分钟。相比之下，对于已经建立的患者（n=629），CDE 时间与持续皮下胰岛素输注疗法的启动，心理社会服务的使用，糖化血红蛋白（A1C）和边缘化程度密切相关（p<0.0001）。总体而言，CDE 时间随 A1C 每增加 1.0％而增加 8.6 分钟（p=0.022），随边缘化程度每增加 1.0 个单位而增加 16.3 分钟（p=0.01）。
我们观察到，HCP 的时间除了总体边缘化之外，还与多种临床因素相关。尽管在教育和持续皮下胰岛素输注培训方面的初始投资相当可观，但我们的研究结果表明，这些投资随着时间的推移会导致在诊所花费的时间减少，而这主要是由于 A1C 降低所致。
