American Diabetes Association, Arlington, Virginia.
Sutter Health Systems, Elk Grove, California.
Ann Fam Med. 2024 Nov-Dec;22(6):550-556. doi: 10.1370/afm.3175.
Despite medical advances, diabetes management remains a considerable challenge in the United States, with little to no improvement in patient outcomes and stark disparities in underserved communities. One acute challenge is that, as the US population with diabetes grows steadily-numbering 38.4 million people today-there are too few endocrinologists available to treat the disease and the burdens on primary care professionals, who treat more than 90% of cases currently, are staggering. This disconnect between need and care capacity presents what may be the greatest of many threats to the care of diabetic Americans. To understand what is required to solve this need-to-capacity mismatch, we examine the critical role of primary care professionals and propose national policy approaches to empower and improve the nation's primary care architecture for the nearly 12% of Americans who have diabetes. Policy recommendations encompass the integration of the chronic care model and the patient-centered medical home approach, expansion of workforce development initiatives, and payment reform to incentivize team-based care with the aim of ensuring equitable access to essential diabetes management tools. We urge policy makers to prioritize primary care workforce development, enhance reimbursement models, and implement strategies to mitigate disparities in diabetes care. Evidence reviewed here highlights the critical need for a comprehensive, multidimensional approach to diabetes management in primary care, emphasizing the importance of decisive action by policy makers to equip primary care professionals with the necessary resources and support to effectively address the nation's diabetes epidemic.
尽管医学取得了进步，但糖尿病管理在美国仍然是一个巨大的挑战，患者的治疗效果几乎没有改善，服务不足的社区之间存在明显的差异。一个紧迫的挑战是，随着美国糖尿病患者人数的稳步增长——目前已达 3840 万人——治疗这种疾病的内分泌科医生数量太少，而目前治疗超过 90%病例的初级保健专业人员的负担令人震惊。这种需求与护理能力之间的脱节，可能是对美国糖尿病患者护理的众多威胁中最大的威胁之一。为了了解解决这种供需不匹配需要什么，我们考察了初级保健专业人员的关键作用，并提出了国家政策方法，以增强和改善全国近 12%的糖尿病患者的初级保健架构。政策建议包括整合慢性病管理模式和以患者为中心的医疗之家方法、扩大劳动力发展计划以及支付改革，以激励以团队为基础的护理，目的是确保平等获得基本的糖尿病管理工具。我们敦促政策制定者优先考虑初级保健劳动力的发展，增强报销模式，并实施策略，以减轻糖尿病护理方面的差异。这里审查的证据强调了在初级保健中采用全面、多维度的糖尿病管理方法的迫切需要，强调政策制定者采取果断行动的重要性，为初级保健专业人员配备必要的资源和支持，以有效应对国家的糖尿病流行。
