Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
Chronical Care, Hadoks, The Hague, The Netherlands.
BMJ Open. 2020 Apr 27;10(4):e033085. doi: 10.1136/bmjopen-2019-033085.
Whether care group participation by general practitioners improves delivery of diabetes care is unknown. Using 'monitoring of biomedical and lifestyle target indicators as recommended by professional guidelines' as an operationalisation for quality of care, we explored whether (1) in new practices monitoring as recommended improved a year after initial care group participation (aim 1); (2) new practices and experienced practices differed regarding monitoring (aim 2).
Observational, real-life cohort study.
Primary care registry data from Eerstelijns Zorggroep Haaglanden (ELZHA) care group.
From six new practices (n=538 people with diabetes) that joined care group ELZHA in January 2014, two practices (n=211 people) were excluded because of missing baseline data; four practices (n=182 people) were included. From all six new practices (n=538 people), 295 individuals were included. From 145 experienced practices (n=21 465 people), 13 744 individuals were included.
Care group participation includes support by staff nurses on protocolised diabetes care implementation and availability of a system providing individual monitoring information. 'Monitoring as recommended' represented minimally one annual registration of each biomedical (HbA1c, systolic blood pressure, low-density lipoprotein) and lifestyle-related target indicator (body mass index, smoking behaviour, physical exercise).
In new practices, odds of people being monitored as recommended in 2014 were compared with baseline (2013). Odds of monitoring as recommended in new and experienced practices in 2014 were compared.
After 1-year care group participation, odds of being monitored as recommended increased threefold (OR 3.00, 95% CI 1.84 to 4.88, p<0.001). Compared with new practices, no significant differences in the odds of monitoring as recommended were found in experienced practices (OR 1.21, 95% CI 0.18 to 8.37, p=0.844).
We observed a sharp increase concerning biomedical and lifestyle monitoring as recommended after 1-year care group participation, and subsequently no significant difference between new and experienced practices-indicating that providing diabetes care within a collective approach rapidly improves registration of care.
全科医生参与护理小组是否能改善糖尿病护理尚不清楚。我们将“根据专业指南推荐监测生物医学和生活方式目标指标”作为护理质量的操作化定义，以此来探讨（1）新实践中，推荐的监测是否在初始护理小组参与一年后有所改善（目标 1）；（2）新实践和有经验的实践在监测方面是否存在差异（目标 2）。
观察性、真实队列研究。
ELZHA 护理小组的 Eerstelijns Zorggroep Haaglanden（ELZHA）初级保健登记处数据。
2014 年 1 月加入 ELZHA 护理小组的 6 个新实践（n=538 名糖尿病患者）中，有 2 个实践（n=211 名患者）因缺乏基线数据而被排除；4 个实践（n=182 名患者）被纳入研究。在所有 6 个新实践（n=538 名患者）中，有 295 名患者被纳入研究。在 145 个有经验的实践中（n=21465 名患者），有 13744 名患者被纳入研究。
护理小组参与包括工作人员护士对协议化糖尿病护理实施的支持，以及提供个人监测信息的系统。“推荐的监测”代表至少每年对每个生物医学（糖化血红蛋白、收缩压、低密度脂蛋白）和与生活方式相关的目标指标（体重指数、吸烟行为、体育锻炼）进行一次登记。
在新实践中，2014 年与基线（2013 年）相比，被推荐进行监测的患者的可能性。在 2014 年，新实践和有经验实践中推荐监测的可能性进行比较。
经过 1 年的护理小组参与，被推荐进行监测的可能性增加了两倍（OR 3.00，95%CI 1.84 至 4.88，p<0.001）。与新实践相比，在有经验的实践中，推荐监测的可能性没有显著差异（OR 1.21，95%CI 0.18 至 8.37，p=0.844）。
我们观察到，在参与护理小组 1 年后，生物医学和生活方式监测的推荐显著增加，随后，新实践和有经验实践之间没有显著差异，这表明在集体方法下提供糖尿病护理可以迅速提高护理的登记率。
