Wright & Associates Family Healthcare, Amherst, New Hampshire.
Wright & Associates Family Healthcare, Concord, New Hampshire.
J Am Assoc Nurse Pract. 2024 Jul 1;36(7):399-408. doi: 10.1097/JXX.0000000000001026.
The COVID-19 pandemic created barriers in the management of type 2 diabetes mellitus (T2DM) and worsened social determinants of health (SDOH). A New Hampshire primary care office worked to adhere to T2DM standards of care and began screening for SDOH. This project assessed adherence to quality metrics, hemoglobin A1C, and SDOH screening as telehealth utilization decreased.
A1C values have increased at the practice, especially since COVID-19. The practice also began screening for SDOH at every visit, but there was need to assess how needs were being documented and if/how they were addressed.
A retrospective chart review of patients with T2DM was performed. Demographic data and T2DM metrics were collected and compared with previous years and compared new versus established patients. Charts were reviewed to evaluate documentation of SDOH and appropriate referral.
The practice transitioned from an increased utliization of telehealth back to prioritizing in-office visits. The practice also began routinely screening for SDOH in 2020; however, this process had not been standardized or evaluated.
Adherence to nearly all quality metrics improved. Glycemic control improved after a year of nurse practitioner (NP) care, especially in new patients. All patients were screened for SDOH, but documentation varied, and affected patients had higher A1Cs, despite receiving comparable care.
Nurse practitioners at this practice are adhering to American Diabetes Association guidelines, and A1C values improve under their care. Social determinants of health continue to act as unique barriers that keep patients from improving glycemic control, highlighting the need for individualized treatment of SDOH in T2DM care.
COVID-19 大流行给 2 型糖尿病（T2DM）的管理带来了障碍，并恶化了健康的社会决定因素（SDOH）。新罕布什尔州的一家初级保健办公室努力遵守 T2DM 护理标准，并开始对 SDOH 进行筛查。该项目评估了随着远程医疗利用率的降低，对质量指标、糖化血红蛋白（A1C）和 SDOH 筛查的遵守情况。
该诊所的 A1C 值有所上升，尤其是自 COVID-19 以来。该诊所还开始在每次就诊时筛查 SDOH，但需要评估需求的记录方式以及是否/如何解决这些需求。
对 T2DM 患者进行了回顾性图表审查。收集了人口统计学数据和 T2DM 指标，并与前几年进行了比较，并比较了新患者和已建立患者的情况。对图表进行了审查，以评估 SDOH 的记录和适当的转介情况。
该诊所从增加远程医疗的使用转回优先考虑门诊就诊。该诊所还于 2020 年开始常规筛查 SDOH；然而，该过程尚未标准化或评估。
几乎所有质量指标的依从性都有所提高。在接受了一年的执业护士（NP）护理后，血糖控制得到了改善，尤其是新患者。所有患者都接受了 SDOH 的筛查，但记录方式各不相同，受影响的患者 A1C 更高，尽管接受了类似的护理。
该诊所的执业护士遵守美国糖尿病协会的指南，在他们的护理下，A1C 值有所改善。社会决定因素继续成为患者改善血糖控制的独特障碍，这突显了在 T2DM 护理中对 SDOH 进行个体化治疗的必要性。
