Marsh Zyrene, Nguyen Yen, Teegala Yamini, Cotter Valerie T
Johns Hopkins School of Nursing (JHSON), Baltimore, Maryland.
Rocking Horse Community Health Center (RHCHC), Springfield, Ohio.
J Am Assoc Nurse Pract. 2021 Apr 7;34(1):26-31. doi: 10.1097/JXX.0000000000000595.
Diabetes mellitus (DM) disproportionately affects older adults from marginalized communities. In the United States, the prevalence of DM in ages ≥65 years is twofold higher than the national average for adult populations. Telemedicine and community health workers (CHWs) are emerging diabetes care models but their impact on older adults with limited resources are relatively neglected within the medical literature.
The purpose of this systematic review was to explore the impact of telemedicine and CHW interventions for improving A1C levels and self-management behaviors among underserved older adults with DM.
A systematic literature search was performed in PubMed, CINAHL, Embase, and Cochrane databases using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses as a reporting guideline.
Diabetes self-management education (DSME) administered through telemedicine and CHW interventions were effective for improving A1C levels, self-care adherence, and patient and provider satisfaction among adults aged ≥50 years. Common barriers to diabetes care include inadequate resources, lack of transportation, inconsistent means of communications, social isolation, and low motivation. Community health workers and telemedicine were effective in improving disease management and optimizing care coordination within the vulnerable adult populations.
Well-coordinated, evidence-based, and population-centered interventions can overcome the unique disparities experienced by underserved older adults with diabetes. Incorporating DSME-guided telemedicine and CHW interventions into primary care can mitigate diabetes-related complications in older populations. The lack of evidence specific to adults aged ≥65 years calls for a universally accepted age range when referring to older adults in future research.
糖尿病（DM）对边缘化社区的老年人影响尤为严重。在美国，65岁及以上人群中糖尿病的患病率比成年人口的全国平均水平高出两倍。远程医疗和社区卫生工作者（CHW）是新兴的糖尿病护理模式，但医学文献中相对忽视了它们对资源有限的老年人的影响。
本系统评价的目的是探讨远程医疗和社区卫生工作者干预措施对改善服务不足的老年糖尿病患者糖化血红蛋白（A1C）水平和自我管理行为的影响。
按照系统评价和Meta分析的首选报告项目作为报告指南，在PubMed、CINAHL、Embase和Cochrane数据库中进行了系统的文献检索。
通过远程医疗和社区卫生工作者干预实施的糖尿病自我管理教育（DSME）对于改善50岁及以上成年人的A1C水平、自我护理依从性以及患者和提供者满意度是有效的。糖尿病护理的常见障碍包括资源不足、交通不便、沟通方式不一致、社会孤立和积极性低。社区卫生工作者和远程医疗在改善弱势成年人群体的疾病管理和优化护理协调方面是有效的。
协调良好、基于证据且以人群为中心的干预措施可以克服服务不足的老年糖尿病患者所经历的独特差异。将DSME指导的远程医疗和社区卫生工作者干预措施纳入初级保健可以减轻老年人群中与糖尿病相关的并发症。缺乏针对65岁及以上成年人的具体证据，这就要求在未来研究中提及老年人时采用普遍接受的年龄范围。
