Harakeh Zeena, de Hoogh Iris, Krijger-Dijkema Anne-Margreeth, Berbée Susanne, Kalkman Gino, van Empelen Pepijn, Otten Wilma
Department of Child Health, TNO, Netherlands Organization for Applied Scientific Research, Leiden, Netherlands.
Department of Microbiology and Systems Biology, TNO, Netherlands Organization for Applied Scientific Research, Leiden, Netherlands.
JMIR Form Res. 2024 Dec 4;8:e57312. doi: 10.2196/57312.
Given the multifactorial nature of type 2 diabetes (T2D), health care for this condition would benefit from a holistic approach and multidisciplinary consultation. To address this, we developed the web-based 360-degree (360°) diagnostic tool, which assesses 4 key domains: "body" (physical health parameters), "thinking and feeling" (eg, mental health and stress), "behavior" (lifestyle factors), and "environment" (eg, work and housing conditions).
This work examines the acceptability, implementation, and potential effects of the 360° diagnostic tool and subsequent tailored treatment (360° approach) in a 6-month intervention and feasibility study conducted in standard primary health care settings in the Netherlands.
A single-group design with baseline, 3-month, and 6-month follow-ups was used. A total of 15 people with T2D and their health care providers from 2 practices participated in a 6-month intervention, which included the 360° diagnosis, tailored treatment, and both individual and group consultations. The 360° diagnosis involved clinical measurements for the "body" domain and self-reports for the "thinking and feeling," "behavior," and "environment" domains. After multidisciplinary consultations involving the general practitioner, pharmacist, nurse practitioner (NP), and dietitian, the NP and dietitian provided tailored advice, lifestyle treatment, and ongoing support. At the end of the intervention, face-to-face semistructured interviews were conducted with health care professionals (n=6) and participants (n=13) to assess the acceptability and implementation of the 360° approach in primary health care. Additionally, data from 14 participants on the "thinking and feeling" and "behavior" domains at baseline, 3 months, and 6 months were analyzed to assess changes over time.
The semistructured interviews revealed that both participants with T2D and health care professionals were generally positive about various aspects of the 360° approach, including onboarding, data collection with the 360° diagnosis, consultations and advice from the NP and dietitian, the visual representation of parameters in the profile wheel, counseling during the intervention (including professional collaboration), and the group meetings. The interviews also identified factors that promoted or hindered the implementation of the 360° approach. Promoting factors included (1) the care, attention, support, and experience of professionals; (2) the multidisciplinary team; (3) social support; and (4) the experience of positive health effects. Hindering factors included (1) too much information, (2) survey-related issues, and (3) time-consuming counseling. In terms of effects over time, improvements were observed at 3 months in mental health, diabetes-related problems, and fast-food consumption. At 6 months, there was a reduction in perceived stress and fast-food consumption. Additionally, fruit intake decreased at both 3 and 6 months.
Our findings suggest that the 360° approach is acceptable to both people with T2D and health care professionals, implementable, and potentially effective in fostering positive health changes. Overall, it appears feasible to implement the 360° approach in standard primary health care.
Netherlands Trial Register NL-7509/NL-OMON45788; https://onderzoekmetmensen.nl/nl/trial/45788.
鉴于2型糖尿病（T2D）的多因素性质，针对这种疾病的医疗保健将受益于整体方法和多学科会诊。为解决这一问题，我们开发了基于网络的360度诊断工具，该工具评估4个关键领域：“身体”（身体健康参数）、“思维与情感”（如心理健康和压力）、“行为”（生活方式因素）和“环境”（如工作和住房条件）。
本研究在荷兰的标准初级卫生保健机构中进行了一项为期6个月的干预和可行性研究，考察360度诊断工具及后续个性化治疗（360度方法）的可接受性、实施情况和潜在效果。
采用单组设计，进行基线、3个月和6个月的随访。共有来自2家医疗机构的15名2型糖尿病患者及其医疗服务提供者参与了为期6个月的干预，包括360度诊断、个性化治疗以及个体和小组会诊。360度诊断包括对“身体”领域的临床测量以及对“思维与情感”、“行为”和“环境”领域的自我报告。在全科医生、药剂师、执业护士（NP）和营养师参与的多学科会诊后，NP和营养师提供个性化建议、生活方式治疗和持续支持。在干预结束时，对医疗保健专业人员（n = 6）和参与者（n = 13）进行了面对面的半结构化访谈，以评估360度方法在初级卫生保健中的可接受性和实施情况。此外，分析了14名参与者在基线、3个月和6个月时“思维与情感”和“行为”领域的数据，以评估随时间的变化。
半结构化访谈显示，2型糖尿病患者和医疗保健专业人员对360度方法的各个方面总体上持积极态度，包括入职培训、360度诊断的数据收集、NP和营养师的会诊及建议、概况轮中参数的可视化呈现、干预期间的咨询（包括专业协作）以及小组会议。访谈还确定了促进或阻碍360度方法实施的因素。促进因素包括：（1）专业人员的关怀、关注、支持和经验；（k）多学科团队；（3）社会支持；（4）积极健康效果的体验。阻碍因素包括：（1）信息过多；（2）与调查相关的问题；（3）耗时的咨询。就随时间的效果而言，在3个月时观察到心理健康、糖尿病相关问题和快餐消费有所改善。在6个月时，感知压力和快餐消费有所减少。此外，在3个月和6个月时水果摄入量均有所下降。
我们的研究结果表明，360度方法对于2型糖尿病患者和医疗保健专业人员来说是可接受的、可实施的，并且在促进积极的健康变化方面可能有效。总体而言，在标准初级卫生保健中实施360度方法似乎是可行的。
荷兰试验注册中心NL - 7509/NL - OMON45788；https://onderzoekmetmensen.nl/nl/trial/45788 。
