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首页> 外文期刊>Diabetes, metabolic syndrome and obesity: targets and therapy >An exploratory retrospective assessment of a quantitative measure of diabetes risk: medical management and patient impact in a primary care setting
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An exploratory retrospective assessment of a quantitative measure of diabetes risk: medical management and patient impact in a primary care setting

机译：对糖尿病风险定量测量的探索性回顾性评估：基层医疗机构中的医疗管理和患者影响

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Background: Primary care providers with limited time and resources bear a heavy responsibility for chronic disease prevention or progression. Reliable clinical tools are needed to risk stratify patients for more targeted care. This exploratory study examined the care of patients who had been risk stratified regarding their likelihood of clinically progressing to type 2 diabetes. Methods: This was a retrospective chart review pilot study conducted to assess a primary care provider's use of a risk screening test. In this quality improvement project, the result of the risk screening was examined in relation to its influence on medical management and clinical impact on patients at risk for diabetes. All providers were board certified in family medicine and had more than 10 years clinical experience in managing diabetes and prediabetes. No specific clinical practice guidelines were mandated for patient care in this pilot study. Physicians in the practice group received an orientation to the diabetes risk measure and its availability for use in a pilot study to be conducted over a 6-month period. We identified the 696 nondiabetic adults in family practices who received a risk screening test (PreDx?, a multi-marker blood test that estimates the 5-year likelihood of conversion to type 2 diabetes) between June and November 2011 for a 6-month sample. A comparison group of 2,002 patients from a total database of 3.2 million patients who did not receive the risk test was randomly selected from the same clinical database after matching for age, sex, selected diagnoses, and metabolic risk factors. Patient groups were compared for intensity of care provided and clinical impact. Results: Compared to patients with a similar demographic and diagnostic profile, patients who had the risk test received more intensive primary care and had better clinical outcome than comparison patients. Risk-tested patients were more likely to return for follow-up visits, be monitored for relevant cardio-metabolic risk factors, and receive prescription medications with P<0.001. Further, intensity of care was associated with the level of risk test result: patients with moderate or high scores were more likely to return for follow-up visits and receive prescription medications than patients with low scores. All P-values for comparison patients between the low and moderate groups, low and high groups, and moderate and high groups resulted in P<0.001. Risk-tested patients were more likely than their comparison group counterparts to achieve weight reduction, lowered blood pressure, and improved blood glucose and cholesterol as demonstrated by P-values of <0.001. Conclusion: Use of a risk stratification test in primary care may help providers to more effectively identify high risk patients, manage diabetes risk, increase patient involvement in diabetes risk management, and improve clinical outcomes. A randomized controlled study is the next step to investigate the impact of diabetes risk stratification in primary care.
机译：背景：时间和资源有限的初级保健提供者对慢性病的预防或进展负有重大责任。需要可靠的临床工具来对患者进行分层，以进行更有针对性的护理。这项探索性研究检查了在临床上可能发展为2型糖尿病的风险分层患者的护理。方法：这是一项回顾性图表审查试验研究，旨在评估初级保健提供者对风险筛查测试的使用。在这个质量改进项目中，检查了风险筛查的结果，了解其对医疗管理的影响以及对有糖尿病风险的患者的临床影响。所有提供者都通过了家庭医学的董事会认证，并且在糖尿病和前驱糖尿病的管理方面拥有10多年的临床经验。在该初步研究中，没有为患者护理制定任何具体的临床实践指南。练习组的医师接受了有关糖尿病风险度量及其可用于为期6个月的试点研究的信息。我们确定了在2011年6月至2011年11月之间接受家庭筛查的696名非糖尿病成年人，他们接受了风险筛查测试（PreDx ?，这是一种多标志物血液测试，可以估计5年内转变为2型糖尿病的可能性）。 。在对年龄，性别，选定的诊断和代谢风险因素进行匹配后，从同一临床数据库中随机选择了320万未接受风险测试的总数据库中的2,002名患者作为比较组。比较患者组的护理强度和临床影响。结果：与具有相似人口统计学特征和诊断特征的患者相比，进行风险测试的患者比对照患者接受了更深入的初级保健，并且临床结局更好。经过风险测试的患者更有可能返回随访，监测相关的心血管代谢危险因素，并接受P <0.001的处方药。此外，护理的强度与风险测试结果的水平有关：分数中等或较高的患者比分数较低的患者更有可能返回随访并接受处方药。在低和中等组，低和高组以及中和高组之间比较患者的所有P值均导致P <0.001。经风险测试的患者比对照组的患者更有可能实现体重减轻，血压降低，血糖和胆固醇改善，如P值<0.001所示。结论：在初级保健中使用风险分层测试可以帮助提供者更有效地识别高风险患者，控制糖尿病风险，增加患者对糖尿病风险管理的参与度并改善临床结果。下一步，将进行一项随机对照研究，以调查糖尿病风险分层对基层医疗的影响。

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