综合初级保健干预对改善拉丁裔成年糖尿病患者心理社会结局的效果：LUNA-D 研究。

Effectiveness of an integrated primary care intervention in improving psychosocial outcomes among Latino adults with diabetes: the LUNA-D study.

机构信息

South Bay Latino Research Center, Chula Vista, CA, USA.

Department of Psychology, San Diego State University, San Diego, CA, USA.

出版信息

Transl Behav Med. 2022 Aug 17;12(8):825-833. doi: 10.1093/tbm/ibac042.

DOI:10.1093/tbm/ibac042

PMID:35776001

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9385125/

Abstract

OBJECTIVE

To compare the effectiveness of usual care (UC) versus a culturally tailored integrated care model in improving mental health symptoms for Latino patients with Type 2 diabetes mellitus (T2DM).

METHODS

We conducted a two-arm randomized controlled trial from 2015 to 2019 at a federally qualified health center. Participants were 456 adults ages 23-80 years who had a previous diagnosis of T2DM and were not currently using insulin. Participants were randomly assigned to Integrated Care Intervention (ICI; including behavioral/mental healthcare, medical visits, health education and care coordination) or UC; standard of care including referrals for health education and behavioral/mental health care where appropriate. Intention-to-treat, multilevel models were used to compare group × time changes in depression and anxiety symptoms (PHQ-8; GAD-7) and perceived stress (PSS-10) across 6 months.

RESULTS

Participant mean age was 55.7 years, 36.3% were male, and 63.7% were primarily Spanish speaking. Baseline sociodemographic factors and mental health symptoms across study arms were balanced. Significant group × time interaction effects were observed for anxiety and depression symptoms (p < .05). Within the ICI and UC groups, mean depression symptom changes were -0.93 and -0.39 (p < .01); anxiety symptom changes were -0.97 (p < .01) and -0.11 (p = .35); and perceived stress changes were -1.56 and -1.27 (p < .01), respectively.

CONCLUSIONS

Although both ICI and UC showed decreases over time, the ICI group evidenced larger, statistically significant changes in both depression and anxiety. Adapted integrated models of behavioral and chronic disease management appear to be effective and could be considered for usual care practices.

CLINICALTRIALS.GOV IDENTIFIER: NCT03983499.

摘要

目的

比较常规护理（UC）与文化适应综合护理模式对改善 2 型糖尿病（T2DM）拉丁裔患者心理健康症状的效果。

方法

我们于 2015 年至 2019 年在一家合格的联邦健康中心进行了一项双臂随机对照试验。参与者为 456 名年龄在 23-80 岁之间的成年人，他们之前被诊断患有 T2DM，且目前未使用胰岛素。参与者被随机分配到综合护理干预组（ICI；包括行为/心理健康护理、医疗访视、健康教育和护理协调）或 UC；标准护理包括适当情况下提供健康教育和行为/心理健康护理的转诊。使用意向治疗、多层次模型比较了 6 个月内抑郁和焦虑症状（PHQ-8；GAD-7）和感知压力（PSS-10）的组×时间变化。

结果

参与者的平均年龄为 55.7 岁，36.3%为男性，63.7%主要讲西班牙语。研究臂之间的基线社会人口统计学因素和心理健康症状是平衡的。焦虑和抑郁症状观察到显著的组×时间交互效应（p<.05）。在 ICI 和 UC 组中，抑郁症状的平均变化分别为-0.93 和-0.39（p<.01）；焦虑症状的变化分别为-0.97（p<.01）和-0.11（p=.35）；感知压力的变化分别为-1.56 和-1.27（p<.01）。