Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
J Gen Intern Med. 2024 Nov;39(15):2970-2979. doi: 10.1007/s11606-024-08868-7. Epub 2024 Jun 28.
Diabetes self-management education and support can be effectively and efficiently delivered in primary care in the form of shared medical appointments (SMAs). Comparative effectiveness of SMA delivery features such as topic choice, multi-disciplinary care teams, and peer mentor involvement is not known.
To compare effects of standardized and patient-driven models of diabetes SMAs on patient-level diabetes outcomes.
Pragmatic cluster randomized trial.
A total of 1060 adults with type 2 diabetes in 22 primary care practices.
Practice personnel delivered the 6-session Targeted Training in Illness Management (TTIM) curriculum using either standardized (set content delivered by a health educator) or patient-driven SMAs (patient-selected topic order delivered by health educators, behavioral health providers [BHPs], and peer mentors).
Outcomes included self-reported diabetes distress and diabetes self-care behaviors from baseline and follow-up surveys (assessed at 1st and final SMA session), and HbA1c, BMI, and blood pressure from electronic health records. Analyses used descriptive statistics, linear regression, and linear mixed models.
Both standardized and patient-driven SMAs effectively improved diabetes distress, self-care behaviors, BMI (- 0.29 on average), and HbA1c (- 0.45% (mmol/mol) on average, 8.3 to 7.8%). Controlling for covariates, there was a small, significant effect of condition on overall diabetes distress in favor of standardized SMAs (F(1,841) = 4.3, p = .04), attributable to significant effects of condition on emotion and regimen distress subscales. There was a small, significant effect of condition on diastolic blood pressure in favor of standardized SMAs (F(1,5199) = 4.50, p = .03). There were no other differences between conditions.
Both SMA models using the TTIM curriculum yielded significant improvement in diabetes distress, self-care, and HbA1c. Patient-driven diabetes SMAs involving BHPs and peer mentors and topic selection did not lead to better clinical or patient-reported outcomes than standardized diabetes SMAs facilitated by a health educator following a set topic order.
NCT03590041.
糖尿病自我管理教育和支持可以在初级保健中以共同医疗预约（SMAs）的形式有效地进行。关于 SMA 交付功能（如主题选择、多学科护理团队和同伴导师参与）的比较效果尚不清楚。
比较标准化和患者驱动的糖尿病 SMA 模型对患者水平糖尿病结局的影响。
实用的聚类随机试验。
22 个初级保健实践中的 1060 名 2 型糖尿病成年患者。
实践人员使用靶向培训在疾病管理（TTIM）课程进行 6 次课程，使用标准化（由健康教育者提供的设定内容）或患者驱动的 SMA（由健康教育者、行为健康提供者[BHPs]和同伴导师提供的患者选择主题顺序）。
结果包括基线和随访调查中的自我报告的糖尿病困扰和糖尿病自我护理行为（在第 1 次和最后 1 次 SMA 会议时评估），以及电子健康记录中的糖化血红蛋白（HbA1c）、体重指数（BMI）和血压。分析使用描述性统计、线性回归和线性混合模型。
标准化和患者驱动的 SMA 均有效地改善了糖尿病困扰、自我护理行为、BMI（平均降低 0.29）和 HbA1c（平均降低 0.45%（mmol/mol），8.3 至 7.8%）。控制协变量后，条件对总体糖尿病困扰有小而显著的影响，有利于标准化 SMA（F（1,841）=4.3，p=0.04），这归因于条件对情绪和方案困扰子量表的显著影响。条件对舒张压有小而显著的影响，有利于标准化 SMA（F（1,5199）=4.50，p=0.03）。两种条件之间没有其他差异。
使用 TTIM 课程的两种 SMA 模型都显著改善了糖尿病困扰、自我护理和 HbA1c。涉及 BHPs 和同伴导师以及主题选择的患者驱动型糖尿病 SMA 并没有导致比由健康教育者按照既定主题顺序促进的标准化糖尿病 SMA 更好的临床或患者报告结果。
NIH 试验注册号：NCT03590041。
