School of Health and Society, Building 15, Room 146, University of Wollongong, NSW 2522, Australia; and Corresponding author. Email:
School of Health and Society, Building 15, Room 146, University of Wollongong, NSW 2522, Australia.
Aust J Prim Health. 2020 Dec;26(6):431-442. doi: 10.1071/PY19204.
Patient activation has been recognised as a reliable driver of self-management decision-making. This systematic review and meta-analysis examines existing evidence on whether embedding patient activation within Type 2 diabetes mellitus (T2DM) self-management programs can improve patient outcomes. This review has included 10 randomised controlled trials (RCTs) conducted between 2004 and 2019 retrieved from well-known databases such as MEDLINE, PubMed, CINAHL Plus, Scopus, ProQuest and ScienceDirect. The eligible RCTs were excluded if they scored low according to Cochrane Collaboration's 'risk of bias' criteria. Random-effects meta-analyses showed that there were no significance changes in haemoglobin A1C (HbA1c), body mass index (BMI) and patient activation measure (PAM) between intervention and control groups after the intervention; however, the systematic review findings indicated that an improved patient activation level led to significant improvements in T2DM self-management and clinical outcomes including HbA1c level. Studies with a longer follow-up period conducted in community settings and delivered by peer coaches were more likely to lead to significant improvement in both patient activation levels and T2DM self-management and clinical outcomes. This review concludes that patient activation can be used as a reliable tool for improving T2DM self-management and clinical outcomes.
患者激活已被认为是自我管理决策的可靠驱动因素。本系统评价和荟萃分析考察了将患者激活嵌入 2 型糖尿病（T2DM）自我管理计划中是否可以改善患者结局的现有证据。本综述包括了 2004 年至 2019 年间从知名数据库（如 MEDLINE、PubMed、CINAHL Plus、Scopus、ProQuest 和 ScienceDirect）中检索到的 10 项随机对照试验（RCT）。如果根据 Cochrane 协作组的“偏倚风险”标准评分较低，则排除合格的 RCT。随机效应荟萃分析显示，干预后干预组和对照组之间的血红蛋白 A1C（HbA1c）、体重指数（BMI）和患者激活测量（PAM）没有显著变化；然而，系统评价结果表明，患者激活水平的提高导致 T2DM 自我管理和临床结局（包括 HbA1c 水平）的显著改善。在社区环境中进行且由同伴教练提供的随访时间较长的研究更有可能导致患者激活水平以及 T2DM 自我管理和临床结局的显著改善。本综述得出结论，患者激活可作为改善 T2DM 自我管理和临床结局的可靠工具。
