Wright Wendy L, White Patricia A, Welsh Meredith, Cutting Kelly
Wright & Associates Family Healthcare, Amherst, New Hampshire.
Wright & Associates Family Healthcare, Concord, New Hampshire.
J Am Assoc Nurse Pract. 2022 Sep 1;34(9):1090-1097. doi: 10.1097/JXX.0000000000000768.
The COVID-19 pandemic necessitated lockdowns resulting in the disruption of access to primary care. A family nurse practitioner (NP)-owned practice shifted many visits to telehealth to provide care to all their patients including those with chronic illness . The purpose of this project was to evaluate the impact of the pandemic on selected diabetes quality measures and adherence to national diabetes guidelines in two previously well-performing NP-owned primary care clinics.
Previous quality improvement studies demonstrated high performing metrics for their patients with type 2 diabetes mellitus (DM). The evaluation of the patients with type 2 DM was necessary to assess the care being delivered in the practice.
A retrospective record review and analysis of 179 patients older than 18 years was implemented during the early days of the pandemic. Demographic data, process, and outcome measures for diabetes care were collected and compared with previous data from 2013 to 2017 to identify gaps in care.
Telehealth was implemented to deliver care to patients because of the lockdown. The evaluation of these metrics during the period where telehealth was being used to provide care was warranted to evaluate the status of patients with type 2 DM.
Patients with type 2 DM receiving care with telehealth demonstrated worsening A1cs and other quality care measures, including fewer ophthalmology evaluations.
While access to telehealth was important for these patients with type 2 DM, the findings demonstrated that the COVID-19 pandemic had a negative impact on diabetes quality measures. While these may have also reflected the challenges of adhering to lifestyle interventions during this stressful time, telehealth alone may not be an adequate delivery mechanism for primary care for those with type 2 DM.
2019年冠状病毒病（COVID-19）大流行导致封锁措施实施，从而扰乱了初级保健服务的获取。一家由家庭执业护士（NP）开办的诊所将许多就诊转移到远程医疗，以便为所有患者，包括慢性病患者提供护理。本项目的目的是评估大流行对两家之前表现良好的由NP开办的初级保健诊所中选定的糖尿病质量指标以及对国家糖尿病指南遵循情况的影响。
先前的质量改进研究表明，其2型糖尿病（DM）患者的指标表现良好。对2型糖尿病患者进行评估对于评估该诊所提供的护理是必要的。
在大流行初期，对179名18岁以上的患者进行了回顾性记录审查和分析。收集了糖尿病护理的人口统计学数据、过程和结果指标，并与2013年至2017年的先前数据进行比较，以确定护理中的差距。
由于封锁，实施了远程医疗以向患者提供护理。在使用远程医疗提供护理期间对这些指标进行评估，以评估2型糖尿病患者的状况。
接受远程医疗护理的2型糖尿病患者的糖化血红蛋白（A1c）及其他质量护理指标恶化，包括眼科评估减少。
虽然远程医疗对这些2型糖尿病患者很重要，但研究结果表明，COVID-19大流行对糖尿病质量指标产生了负面影响。虽然这些可能也反映了在这段压力时期坚持生活方式干预的挑战，但仅靠远程医疗可能不是2型糖尿病患者初级保健的充分提供机制。
