Masyuko Sarah, Ngongo Carrie J, Smith Carole, Nugent Rachel
RTI International, Seattle, Washington, United States of America.
Department of Global Health, University of Washington, Seattle, Washington, United States of America.
PLoS One. 2021 Jan 15;16(1):e0245269. doi: 10.1371/journal.pone.0245269. eCollection 2021.
Patient-reported outcome measures (PROMs) assess patients' perspectives on their health status, providing opportunities to improve the quality of care. While PROMs are increasingly used in high-income settings, limited data are available on PROMs use for diabetes and hypertension in low-and middle-income countries (LMICs). This scoping review aimed to determine how PROMs are employed for diabetes and hypertension care in LMICs.
We searched PubMed, EMBASE, and ClinicalTrials.gov for English-language studies published between August 2009 and August 2019 that measured at least one PROM related to diabetes or hypertension in LMICs. Full texts of included studies were examined to assess study characteristics, target population, outcome focus, PROMs used, and methods for data collection and reporting.
Sixty-eight studies met the inclusion criteria and reported on PROMs for people diagnosed with hypertension and/or diabetes and receiving care in health facilities. Thirty-nine (57%) reported on upper-middle-income countries, 19 (28%) reported on lower-middle-income countries, 4 (6%) reported on low-income countries, and 6 (9%) were multi-country. Most focused on diabetes (60/68, 88%), while 4 studies focused on hypertension and 4 focused on diabetes/hypertension comorbidity. Outcomes of interest varied; most common were glycemic or blood pressure control (38), health literacy and treatment adherence (27), and acute complications (22). Collectively the studies deployed 55 unique tools to measure patient outcomes. Most common were the Morisky Medication Adherence Scale (7) and EuroQoL-5D-3L (7).
PROMs are deployed in LMICs around the world, with greatest reported use in LMICs with an upper-middle-income classification. Diabetes PROMs were more widely deployed in LMICs than hypertension PROMs, suggesting an opportunity to adapt PROMs for hypertension. Future research focusing on standardization and simplification could improve future comparability and adaptability across LMIC contexts. Incorporation into national health information systems would best establish PROMs as a means to reveal the effectiveness of person-centered diabetes and hypertension care.
患者报告结局测量（PROMs）评估患者对自身健康状况的看法，为改善医疗质量提供了机会。虽然PROMs在高收入环境中越来越多地被使用，但关于中低收入国家（LMICs）将PROMs用于糖尿病和高血压的数据有限。本范围综述旨在确定在中低收入国家中，PROMs如何用于糖尿病和高血压护理。
我们在PubMed、EMBASE和ClinicalTrials.gov上搜索了2009年8月至2019年8月发表的英文研究，这些研究测量了中低收入国家中至少一种与糖尿病或高血压相关的PROM。对纳入研究的全文进行审查，以评估研究特征、目标人群、结局重点、使用的PROMs以及数据收集和报告方法。
68项研究符合纳入标准，并报告了在医疗机构中接受护理的被诊断患有高血压和/或糖尿病的人群的PROMs情况。39项（57%）报告了中高收入国家的情况，19项（28%）报告了中低收入国家的情况，4项（6%）报告了低收入国家的情况，6项（9%）为多国研究。大多数研究聚焦于糖尿病（60/68，88%），而4项研究聚焦于高血压，4项研究聚焦于糖尿病/高血压合并症。感兴趣的结局各不相同；最常见的是血糖或血压控制（38项）、健康素养和治疗依从性（27项）以及急性并发症（22项）。这些研究总共使用了55种独特的工具来测量患者结局。最常见的是莫氏药物依从性量表（7项）和欧洲五维度健康量表-3L（7项）。
PROMs在世界各地的中低收入国家都有应用，报告显示在中高收入类别的中低收入国家使用最多。与高血压PROMs相比，糖尿病PROMs在中低收入国家的应用更为广泛，这表明有机会调整PROMs以用于高血压。未来专注于标准化和简化的研究可以提高未来在中低收入国家背景下的可比性和适应性。纳入国家卫生信息系统将最有助于将PROMs确立为揭示以患者为中心的糖尿病和高血压护理有效性的一种手段。
