澳大利亚悉尼基于患者为中心的医疗之家模式对 2 型糖尿病患者的糖尿病和其他临床相关结局的影响。

Effectiveness of a Patient-Centre Medical Home model on diabetes and other clinically relevant outcomes among primary care patients diagnosed with type-2 diabetes in Sydney, Australia.

机构信息

Translational Health Research Institute, Western Sydney University, New South Wales 2560, Australia; Rozetta Institute, Level 4, 55 Harrington Street, Sydney, New South Wales 2000, Australia.

School of Business, Western Sydney University, Parramatta, New South Wales 2150, Australia.

出版信息

Prim Care Diabetes. 2021 Jun;15(3):464-471. doi: 10.1016/j.pcd.2021.01.007. Epub 2021 Feb 3.

DOI:10.1016/j.pcd.2021.01.007

PMID:33547009

Abstract

AIM

We aim to evaluate the effectiveness of patient-centred medical home (PCMH) model in improving diabetes and clinical outcomes among primary care patients diagnosed with T2D.

METHODS

The WellNet study used cohort design with a concurrent comparison group to evaluate changes in clinical outcomes across six general practices in Sydney, Australia. The treatment group comprised of 279 patients who received PCMH care whereas the matched comparison group included 3671 patients who received standard care. t-tests with analysis of covariance were conducted to evaluate significant mean differences and multivariate logistic regression was performed to determine predictors of glycaemic control at follow-up.

RESULTS

WellNet patients observed slightly larger within-group mean differences compared to comparison group patients (-0.2% vs -0.04%). Additionally, WellNet patients saw a larger increase in the percentage of patients achieving glycaemic control (7.9% vs 2.3%). A statistically significant mean difference was seen in waist circumference after adjusting for covariates (-2.41 cm, 95% CI -4.72 to -0.11; p < 0.05). Findings of multivariate logistic regression analysis showed that withdrawn patients and elevated HbA1c measures at baseline were associated with poor glycaemic control at follow-up.

CONCLUSION

The study findings may be beneficial to patients in terms of improved clinical outcomes and self-management support.

摘要

目的

评估以患者为中心的医疗之家（PCMH）模式在改善接受 2 型糖尿病（T2D）诊断的初级保健患者的糖尿病和临床结局方面的有效性。

方法

WellNet 研究采用队列设计和同期对照组，评估澳大利亚悉尼六家全科诊所的临床结局变化。治疗组由 279 名接受 PCMH 护理的患者组成，而匹配的对照组包括 3671 名接受标准护理的患者。采用协方差分析的 t 检验评估显著的均数差异，采用多变量逻辑回归确定随访时血糖控制的预测因素。

结果

与对照组患者相比，WellNet 患者的组内平均差异略大（-0.2%比-0.04%）。此外，WellNet 患者实现血糖控制的患者比例增加幅度更大（7.9%比 2.3%）。调整协变量后，腰围出现统计学意义上的均数差异（-2.41cm，95%CI-4.72 至-0.11；p<0.05）。多变量逻辑回归分析的结果表明，撤药患者和基线时 HbA1c 升高与随访时血糖控制不良相关。