为2型糖尿病患者制定成功的出院计划:挑战与解决方案
Instituting a Successful Discharge Plan for Patients With Type 2 Diabetes: Challenges and Solutions.
作者信息
Demidowich Andrew P, Batty Kristine, Zilbermint Mihail
机构信息
Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD.
Johns Hopkins Community Physicians at Howard County General Hospital, Division of Hospital Medicine, Johns Hopkins Medicine, Columbia, MD.
出版信息
Diabetes Spectr. 2022 Fall;35(4):440-451. doi: 10.2337/dsi22-0013. Epub 2022 Nov 15.
Achieving target inpatient glycemic management outcomes has been shown to influence important clinical outcomes such as hospital length of stay and readmission rates. However, arguably the most profound, lasting impact of inpatient diabetes management is achieved at the time of discharge-namely reconciling and prescribing the right medications and making referrals for follow-up. Discharge planning offers a unique opportunity to break through therapeutic inertia, offer diabetes self-management education, and institute an individualized treatment plan that prepares the patient for discharge and promotes self-care and engagement. However, the path to a successful discharge plan can be fraught with potential pitfalls for clinicians, including lack of knowledge and experience with newer diabetes medications, costs, concerns over insurance coverage, and lack of time and resources. This article presents an algorithm to assist clinicians in selecting discharge regimens that maximize benefits and reduce barriers to self-care for patients and a framework for creating an interdisciplinary hospital diabetes discharge program.
实现住院患者血糖管理目标已被证明会影响重要的临床结果,如住院时间和再入院率。然而,可以说住院糖尿病管理最深远、持久的影响是在出院时实现的,即协调并开出正确的药物处方以及安排后续随访。出院计划提供了一个独特的机会,以打破治疗惰性,提供糖尿病自我管理教育,并制定个性化的治疗计划,使患者为出院做好准备并促进自我护理和参与。然而,对于临床医生而言,成功的出院计划之路可能充满潜在陷阱,包括对新型糖尿病药物缺乏了解和经验、成本问题、对保险覆盖范围的担忧以及时间和资源不足。本文介绍了一种算法,以协助临床医生选择能使患者受益最大化并减少自我护理障碍的出院方案,以及一个创建跨学科医院糖尿病出院计划的框架。