共病与糖尿病医生网络——游牧干预：针对糖尿病和共病患者的多学科团队会议可行性试验方案

Network of doctors for multimorbidity and diabetes - the NOMAD intervention: protocol for feasibility trial of multidisciplinary team conferences for people with diabetes and multimorbidity.

作者信息

Bugge Stine Jorstad, Henriksen Daniel Pilsgaard, Damkier Per, Rahbek Martin Torp, Schousboe Karoline, Rothmann Mette Juel, Poulsen Marianne Kjær, Hansen Camilla, Nagarajah Subagini, Jensen Per Bruno, Johansson Sofie Lock, Panou Vasiliki, Schneider Ida Ransby, Pedersen Charlotte Gjørup, Andersen Jonas Dahl, Hangaard Jørgen, Zwisler Ann-Dorthe Olsen

机构信息

Steno Diabetes Centre Odense, Odense University Hospital, 5000, Odense, Denmark.

Department of Pharmacology, Odense University Hospital, Odense, Denmark.

出版信息

Pilot Feasibility Stud. 2024 Jun 15;10(1):91. doi: 10.1186/s40814-024-01517-0.

DOI:10.1186/s40814-024-01517-0

PMID:38879561

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11179232/

Abstract

BACKGROUND

The prevalence of diabetes and coexisting multimorbidity rises worldwide. Treatment of this patient group can be complex. Providing an evidence-based, coherent, and patient-centred treatment of patients with multimorbidity poses a challenge in healthcare systems, which are typically designed to deliver disease-specific care. We propose an intervention comprising multidisciplinary team conferences (MDTs) to address this issue. The MDT consists of medical specialists in five different specialities meeting to discuss multimorbid diabetes patients. This protocol describes a feasibility test of MDTs designed to coordinate care and improve quality of life for people with diabetes and multimorbidity.

METHODS

A mixed-methods one-arm feasibility test of the MDT. Feasibility will be assessed through prospectively collected data. We will explore patient perspectives through patient-reported outcomes (PROs) and assess the feasibility of electronic questionnaires. Feasibility outcomes are recruitment, PRO completion, technical difficulties, impact of MDT, and doctor preparation time. During 17 months, up to 112 participants will be recruited. We will report results narratively and by the use of descriptive statistics. The collected data will form the basis for a future large-scale randomised trial.

DISCUSSION

A multidisciplinary approach focusing on better management of diabetic patients suffering from multimorbidity may improve functional status, quality of life, and health outcomes. Multimorbidity and diabetes are highly prevalent in our healthcare system, but we lack a solid evidence-based approach to patient-centred care for these patients. This study represents the initial steps towards building such evidence. The concept can be efficiency tested in a randomised setting, if found feasible to intervention providers and receivers. If not, we will have gained experience on how to manage diabetes and multimorbidity as well as organisational aspects, which together may generate hypotheses for research on how to handle multimorbidity in the future.

ADMINISTRATIVE INFORMATION

Protocol version: 01 TRIAL REGISTRATION: NCT05913726 - registration date: 21 June 2023.

摘要

背景

糖尿病及并存的多种疾病在全球范围内的患病率呈上升趋势。对这一患者群体的治疗可能较为复杂。在通常旨在提供针对特定疾病护理的医疗系统中，为患有多种疾病的患者提供基于证据、连贯且以患者为中心的治疗构成了一项挑战。我们提出了一项包含多学科团队会议（MDTs）的干预措施来解决这一问题。多学科团队由五个不同专业的医学专家组成，他们聚在一起讨论患有多种疾病的糖尿病患者。本方案描述了多学科团队会议的可行性测试，旨在为患有糖尿病和多种疾病的患者协调护理并改善生活质量。

方法

对多学科团队会议进行混合方法的单组可行性测试。可行性将通过前瞻性收集的数据进行评估。我们将通过患者报告结局（PROs）探索患者的观点，并评估电子问卷的可行性。可行性结果包括招募情况、PROs完成情况、技术困难、多学科团队会议的影响以及医生准备时间。在17个月内，将招募多达112名参与者。我们将以叙述方式并使用描述性统计报告结果。所收集的数据将为未来的大规模随机试验奠定基础。

讨论

一种专注于更好地管理患有多种疾病的糖尿病患者的多学科方法可能会改善功能状态、生活质量和健康结局。在我们的医疗系统中，多种疾病和糖尿病非常普遍，但我们缺乏一种坚实的基于证据的以患者为中心的护理方法来治疗这些患者。本研究代表了建立此类证据的初步步骤。如果发现对干预提供者和接受者可行，该概念可在随机环境中进行效率测试。如果不可行，我们将获得有关如何管理糖尿病和多种疾病以及组织方面的经验，这些经验共同可能会为未来如何处理多种疾病的研究产生假设。