A medical home for children with insulin-dependent diabetes: Comanagement by primary and subspecialty physicians - Convergence and divergence of opinions
A medical home for children with insulin-dependent diabetes: Comanagement by primary and subspecialty physicians - Convergence and divergence of opinions
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DOI：
10.1542/peds.2007-3761
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发表时间：
2008-08-01
期刊：
影响因子：
8
通讯作者：
Stiles, Alan D.
中科院分区：
文献类型：
--
作者：
Wegner, Steven E.;Lathren, Christine R.;Stiles, Alan D.
OBJECTIVE.这项工作的目的是检查儿科医生和内分泌学家的意见，管理常规预防和急性护理，糖尿病的具体护理，家庭教育和护理协调与胰岛素依赖型糖尿病儿童。我们进行了一项混合模式的调查，调查对象包括1个医疗补助管理医疗网络中的所有儿科医生以及北卡罗来纳州治疗糖尿病儿童的所有儿科和成人内分泌学家。在接受调查的201名儿科医生中，有132名（65%）做出了回应。在61名治疗儿童的内分泌学家中，59%的人回答。几乎所有的受访者都同意，初级保健医生应该负责日常初级保健（例如，健康儿童检查，治疗小病或伤害，以及免疫接种）。同样，绝大多数人赞成内分泌学家作为糖尿病特定护理的领导者（例如，94%的人接受了使用胰岛素泵的培训，82%的人接受了使用血糖仪的培训）。许多全科医生和专科医生报告说，糖尿病护理的特定方面应该共同管理（例如，31%的人跟踪血红蛋白A1c）。然而，大部分的儿科医生和内分泌学家对家庭教育和护理协调以及具体的糖尿病服务的主要责任表达了不同的意见。例如，80%的内分泌学家认为亚专科医生是监测血糖水平的领导者，而52%的儿科医生倾向于合并治疗。一个有效的家庭医疗模式取决于建立明确的责任线之间的初级保健医生和专科医生。我们的研究结果表明，初级保健医生和专科医生同意谁应该领导胰岛素依赖型糖尿病患者的大部分护理方面，以及护理的某些方面应该共同管理。然而，初级保健医生和专科医生没有同意之间或学科内谁应该更负责监测血糖水平的基本方面。认识到初级保健医生和专科医生之间的适当分工，在需要时促进comanciliation，并奖励为患者提供医疗之家所需的合作的方法应作为护理模式进行调查。
OBJECTIVE. The purpose of this work was to examine pediatricians' and endocrinologists' views about management for routine preventive and acute care, diabetes-specific care, and family education and care coordination for children with insulindependent diabetes.METHODS. We conducted a mixed-mode survey of all of the pediatricians in 1 medicaid managed care network and all of the pediatric and adult endocrinologists who treat children with diabetes in North Carolina.RESULTS. Of the 201 pediatricians surveyed, 132 responded (65%). Among the 61 endocrinologists who treat children, 59% replied. Nearly all of the respondents agreed that primary care physicians should have responsibility for routine primary care (eg, well-child checkups, treating minor illnesses or injuries, and immunizations). Likewise, large majorities favored endocrinologists as leads for diabetes-specific care (eg, 94% for training in use of an insulin pump and 82% for training in use of a glucometer). Many generalists and subspecialists reported that specific aspects of diabetes care should be comanaged (eg, 31% for tracking of hemoglobin A1c). However, large proportions of pediatricians and endocrinologists expressed differing opinions about the primary responsibility for family education and care coordination and for specific diabetes services. For example, 80% of endocrinologists saw subspecialists as leads for monitoring blood sugar levels, whereas 52% of pediatricians favored comanagement.CONCLUSIONS. An effective medical home model of care depends on establishing clear lines of responsibility between the primary care physician and subspecialist. Our findings suggest that primary care physicians and subspecialists agree on who should lead most aspects of care for patients with insulin-dependent diabetes and that some aspects of care should be comanaged. However, primary care physicians and subspecialists did not agree either between or within disciplines on who should be more responsible for the basic aspect of monitoring of blood sugar levels. Approaches that recognize the appropriate division of care between primary care physicians and subspecialists, facilitate comanagement when it is needed, and reward the collaboration required to provide medical homes for patients should be investigated as models of care.