检查农村社区高危患者的糖尿病自我管理教育和支持远程医疗模式。
Examining a Diabetes Self-Management Education and Support Telemedicine Model With High-Risk Patients in a Rural Community.
机构信息
Division of Endocrinology and Metabolism, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
出版信息
J Diabetes Sci Technol. 2023 Sep;17(5):1190-1197. doi: 10.1177/19322968231180884. Epub 2023 Jun 20.
BACKGROUND
Ongoing support is critical to diabetes self-management education and support (DSMES) effectiveness, but difficult to realize, particularly in areas with limited resources. The objective of this feasibility study was to assess the impact of a virtual support model on diabetes outcomes and acceptability with high-risk patients with type 2 diabetes in a rural community.
METHODS
In a 12-month nonrandomized trial in federally qualified health centers (FQHCs), patients with hemoglobin A1c (HbA1c) >9% were referred to the Telemedicine for Reach, Education, Access, Treatment, and Ongoing Support (TREAT-ON) program where a Diabetes Care and Education Specialist provided DSMES through videoconferencing. HbA1c change was compared in 30 patients in the intervention group (IG) to a propensity score-matched retrospective control group (CG) of patients who received in-person DSMES delivered by a DCES. Changes in HbA1c, diabetes distress, empowerment, self-care and acceptability were assessed within the intervention group (IG) between those who did and did not meet self-management goals.
RESULTS
The IG experienced similar significant reductions in HbA1c as the CG. Most (64%) IG participants achieved their self-management goal. Goal attainers had a significant HbA1c decrease of 0.21% every 3 months as well as significant reduction in diabetes distress and improvement in general dietary intake. Regardless of goal attainment, IG participants reported high levels of acceptability with TREAT-ON.
CONCLUSIONS
This feasibility study suggests that TREAT-ON was well-received and as effective as traditional in-person DSMES. While findings augment ample evidence regarding DSMES benefits, the TREAT-ON model offers additional advantages and provides validation for telehealth to inform future practice in reaching and supporting self-management for high-risk patients in underserved areas.
TRIAL REGISTRATION
Clinicaltrials.gov, # NCT04107935.
背景
持续支持对于糖尿病自我管理教育和支持（DSMES）的效果至关重要，但在资源有限的地区，这很难实现。本可行性研究的目的是评估虚拟支持模式对农村地区 2 型糖尿病高危患者的糖尿病结局和可接受性的影响。
方法
在联邦合格健康中心（FQHCs）的 12 个月非随机试验中，糖化血红蛋白（HbA1c）>9%的患者被转介到远程医疗获取、教育、获取、治疗和持续支持（TREAT-ON）项目，该项目由糖尿病护理和教育专家通过视频会议提供 DSMES。在干预组（IG）的 30 名患者与接受由糖尿病护理专家（DCES）提供的面对面 DSMES 的回顾性匹配倾向评分对照组（CG）中比较 HbA1c 的变化。在干预组（IG）内，评估了达到和未达到自我管理目标的患者之间 HbA1c 的变化、糖尿病困扰、赋权、自我护理和可接受性。
结果
IG 与 CG 一样，HbA1c 显著降低。大多数（64%）IG 参与者实现了他们的自我管理目标。达到目标的患者每 3 个月 HbA1c 降低 0.21%，糖尿病困扰显著降低，一般饮食摄入显著改善。无论是否达到目标，IG 参与者均报告对 TREAT-ON 的高度可接受性。
结论
这项可行性研究表明，TREAT-ON 受到欢迎，与传统的面对面 DSMES 一样有效。虽然研究结果增加了大量关于 DSMES 益处的证据，但 TREAT-ON 模式提供了额外的优势，并为远程医疗提供了验证，以指导未来在服务不足地区为高风险患者提供自我管理支持。
试验注册
Clinicaltrials.gov，# NCT04107935。
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