Hopper Wade, Ruane Patrick, DiMucci-Ward JuliSu, Ables Adrienne Z
Surgery, Edward Via College of Osteopathic Medicine, Spartanburg, USA.
Nutrition, Edward Via College of Osteopathic Medicine, Spartanburg, USA.
Cureus. 2023 Mar 27;15(3):e36745. doi: 10.7759/cureus.36745. eCollection 2023 Mar.
To evaluate the effectiveness of an intensive, multidisciplinary patient-centered approach involving a pharmacist and a dietician in a population of uninsured free clinic patients with diabetes and hypertension.
A single-center retrospective chart review of a quality improvement project. All patients had diagnoses of diabetes and hypertension and a most recent hemoglobin A1c ≥ 9.0%. Patients met individually with a pharmacist and a dietician during 6 encounters over 12 months. The pharmacist made medication changes, encouraged lifestyle reflections, and helped patients create and track self-management goals. The dietician helped patients plan strategies for diet and exercise. The primary outcome was a change in mean hemoglobin A1c.
Of 30 enrolled patients, 17 completed three months of treatment, and seven completed 12 months. The 17 patients who completed three months of treatment had the following characteristics: mean age 55.5 years; mean hemoglobin A1c 11.5%; 82% were taking two or more antidiabetic medications; 59% were taking two or more antihypertensive medications. Significant reductions in mean hemoglobin A1c values were observed at three months (-3.4%, P<0.0001) and twelve months (-4.0%, P=0.0156). Reductions in systolic blood pressure were also observed at three months (-6 mmHg, P=0.1060) and twelve months (-17 mmHg, P=0.2188).
Large and significant hemoglobin A1c reductions were observed in free clinic patients with diabetes refractory to traditional medical management. Goal-oriented patient empowerment effectively improves a wide range of patient outcomes in the free clinic setting. Other free clinics can implement this collaborative, multidisciplinary model with access to similar personnel.
评估一种以患者为中心的强化多学科方法的有效性，该方法涉及药剂师和营养师，应用于未参保的糖尿病和高血压免费诊所患者群体。
对一项质量改进项目进行单中心回顾性病历审查。所有患者均诊断为糖尿病和高血压，且最近糖化血红蛋白（A1c）≥9.0%。患者在12个月内分6次分别与药剂师和营养师会面。药剂师进行药物调整，鼓励生活方式反思，并帮助患者制定和跟踪自我管理目标。营养师帮助患者制定饮食和运动策略。主要结局是平均糖化血红蛋白的变化。
30名入组患者中，17名完成了3个月的治疗，7名完成了12个月的治疗。完成3个月治疗的17名患者具有以下特征：平均年龄55.5岁；平均糖化血红蛋白11.5%；82%服用两种或更多种抗糖尿病药物；59%服用两种或更多种抗高血压药物。在3个月时（-3.4%，P<0.0001）和12个月时（-4.0%，P=0.0156）观察到平均糖化血红蛋白值显著降低。在3个月时（-6 mmHg，P=0.1060）和12个月时（-17 mmHg，P=0.2188）收缩压也有所降低。
在传统医疗管理难治的糖尿病免费诊所患者中观察到糖化血红蛋白大幅显著降低。以目标为导向的患者赋权有效地改善了免费诊所环境中广泛的患者结局。其他免费诊所可以采用这种协作式多学科模式并配备类似人员。
