实施临床实践指南能否提高医生的临床能力以及2型糖尿病患者的肾功能？

Can the implementation of clinical practice guidelines improve clinical competence of physicians and kidney function of patients with type 2 diabetes mellitus?

作者信息

Martínez-Martínez Petra, Cueto-Manzano Alfonso M, Cortés-Sanabria Laura, Martínez-Ramírez Héctor R, Rojas-Campos Enrique, Hernández-Herrera Aurora

机构信息

Departamento de Nefrología, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco, Mexico.

Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco, Mexico.

出版信息

Front Med (Lausanne). 2022 Dec 15;9:977937. doi: 10.3389/fmed.2022.977937. eCollection 2022.

DOI:10.3389/fmed.2022.977937

PMID:36590934

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9797849/

Abstract

BACKGROUND

There are many clinical practice guidelines (CPGs) in Nephrology; however, there is no evidence that their availability has improved the clinical competence of physicians or the outcome of patients with chronic kidney disease (CKD). This study was aimed to evaluate the effect of implementation of CPGs for early CKD on family physicians (FP) clinical competence and subsequently on kidney function preservation of type 2 diabetes mellitus (DM2) patients at a primary healthcare setting.

METHODS

A prospective educative intervention (40-h) based on was applied to FP; a questionnaire to evaluate clinical competence was applied at the beginning and end of the educative intervention (0 and 2 months), and 12 months afterwards. DM2 patients with CKD were evaluated during 1-year of follow-up with estimated glomerular filtration rate (eGFR) and albuminuria.

RESULTS

After educative intervention, there was a significant increase in FP clinical competence compared to baseline; although it was reduced after 1 year, it remained higher compared to baseline. One-hundred thirteen patients with early nephropathy (58 stage 1, 55 stage 2) and 28 with overt nephropathy (23 stage 3, 5 stage 4) were studied. At final evaluation, both groups maintained eGFR [(mean change) early 0.20 ± 19 pNS; overt 0.51 ± 13 mL/min pNS], whereas albuminuria/creatinuria (early -67 ± 155 < 0.0001; overt -301 ± 596 mg/g < 0.0001), systolic blood pressure (early -10 ± 18 < 0.05; overt -8 ± 20 mmHg < 0.05), and total cholesterol (early -11 ± 31 < 0.05; overt -17 ± 38 mg/dL < 0.05) decreased. Diastolic blood pressure, waist circumference and LDL-cholesterol were also controlled in early nephropathy patients.

CONCLUSIONS

CPGs for Prevention, Diagnosis and Treatment of CKD, by means of an educative intervention increases FP clinical competence and improves renal function in DM2 patients with CKD.

摘要

背景

肾脏病领域有许多临床实践指南（CPG）；然而，尚无证据表明这些指南的可获取性提高了医生的临床能力或改善了慢性肾脏病（CKD）患者的预后。本研究旨在评估早期CKD的CPG实施对家庭医生（FP）临床能力的影响，以及随后对初级医疗环境中2型糖尿病（DM2）患者肾功能保留的影响。

方法

对FP实施基于[具体内容未给出]的40小时前瞻性教育干预；在教育干预开始和结束时（0个月和2个月）以及之后12个月应用一份评估临床能力的问卷。对患有CKD的DM2患者进行为期1年的随访，评估其估算肾小球滤过率（eGFR）和蛋白尿情况。

结果

教育干预后，与基线相比，FP的临床能力显著提高；尽管1年后有所下降，但仍高于基线水平。研究了113例早期肾病患者（58例1期，55例2期）和28例显性肾病患者（23例3期，5例4期）。在最终评估时，两组的eGFR均保持稳定[（平均变化）早期0.20±19，无统计学意义；显性0.51±13 mL/分钟，无统计学意义]，而尿白蛋白/肌酐比值（早期-67±155，<0.0001；显性-301±596 mg/g，<0.0001）、收缩压（早期-10±18，<0.05；显性-8±20 mmHg，<0.05）和总胆固醇（早期-11±31，<0.05；显性-17±38 mg/dL，<0.05）均下降。早期肾病患者的舒张压、腰围和低密度脂蛋白胆固醇也得到了控制。