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首页> 外文期刊>Journal of the American Academy of Nurse Practitioners. >Evaluation of a diabetes specialist-guided primary care diabetes treatment program.
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Evaluation of a diabetes specialist-guided primary care diabetes treatment program.

机译：对糖尿病专家指导的初级保健糖尿病治疗计划的评估。

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PURPOSE: An initial pilot program demonstrated promising results in improvements in glycosylated hemoglobin (HbA(1c)), low-density lipoprotein cholesterol (LDL-C), and systolic blood pressure (SBP) and prompted us to test these findings in a controlled trial. The purpose of the Diabetes-focused, Algorithm-directed care, Midlevel practitioner-administered, Electronically coached, Treatment (DAMET-2) program clinical trial was to investigate the benefits of a novel program for disseminating guidance in the treatment of diabetes from a central specialist clinic to primary care centers with access to midlevel provider services. DATA SOURCES: DAMET-2 included standardized treatment algorithms and education disseminated through computer-assisted and traditional methods associated with distance medicine. Two primary care practices were selected and subjects with diagnosed type 2 diabetes > or =6 months, > or =18 years of age with one or more cardiovascular risk factors (identified by chart review) were eligible for inclusion. Midlevel practitioners for subjects in the experimental group (N = 34) received training in American Diabetes Association treatment algorithms, had telephone consultations at 2- to 4-week intervals and bimonthly visits with diabetes specialists, and received treatment guidance within 24 h from remote diabetes specialists. Weekly diabetes clinics were made available to subjects in the experimental group. After 12 months, the last available subject data were extracted from the subjects' charts and compared to 12-month chart data from a control group (N = 101) that did not receive additional study services. CONCLUSIONS: Mean HbA(1c) values decreased from baseline by 0.46% in the active treatment group versus 0.06% in the control group; however, reductions in HbA(1c) did not achieve statistical significance potentially because of the small sample size of the experimental group. Mean SBP values were significantly reduced in both groups; however, LDL-C was only significantly reduced in the control group, where more aggressive use of statins may have had an effect. IMPLICATIONS FOR PRACTICE: Despite the inconsistencies in risk factor reduction from the pilot program, the DAMET-2 program provided insights regarding the importance of electronic records and provider notifications, patient adherence, prioritization of provider resources by risk factor level among patients, and access to self-management education.
机译：目的：初步的试验计划显示了改善糖基化血红蛋白（HbA（1c）），低密度脂蛋白胆固醇（LDL-C）和收缩压（SBP）的有希望的结果，并促使我们在对照试验中测试这些发现。以糖尿病为重心，以算法为导向的护理，由中级从业者管理，电子指导治疗（DAMET-2）计划的临床试验的目的是研究一种新计划的益处，该计划可从中枢传播糖尿病治疗指南初级保健中心的专科诊所，可以使用中级提供者服务。数据来源：DAMET-2包括标准化的治疗算法和通过与远程医学相关的计算机辅助和传统方法传播的教育。选择了两种初级保健实践，被诊断为2型糖尿病>或= 6个月，>或= 18岁且具有一种或多种心血管危险因素（通过图表审查确定）的受试者符合入选条件。实验组中的中级从业者（N = 34）接受了美国糖尿病协会治疗算法的培训，每隔2至4周进行电话咨询，每两个月与糖尿病专家进行一次拜访，并在偏远糖尿病发生后24小时内接受治疗指导专家。实验组的受试者每周都可以接受糖尿病门诊。 12个月后，从受试者图表中提取最后的可用受试者数据，并将其与未接受额外研究服务的对照组（N = 101）的12个月图表数据进行比较。结论：活动治疗组的平均HbA（1c）值较基线下降0.46％，而对照组为0.06％;然而，由于实验组的样本量较小，HbA（1c）的降低未达到统计学意义。两组的平均SBP值均显着降低;但是，LDL-C仅在对照组中显着降低，在对照组中更积极地使用他汀类药物可能会产生作用。实践的意义：尽管该试点计划在降低风险因素方面存在不一致之处，但DAMET-2计划提供了有关电子记录和提供者通知的重要性，患者依从性，按患者中的风险因素水平对提供者资源进行优先级排序以及获得医疗服务的机会的见解。自我管理教育。

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