Impact of Longitudinal Virtual Primary Care on Diabetes Quality of Care.
Impact of Longitudinal Virtual Primary Care on Diabetes Quality of Care.
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纵向虚拟初级保健对糖尿病护理质量的影响。
DOI：
10.1007/s11606-020-06547-x
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发表时间：
2021-09
影响因子：
5.7
通讯作者：
Ho PM
中科院分区：
文献类型：
--
作者：
Lu AD;Gunzburger E;Glorioso TJ;Smith WB 2nd;Kenney RR;Whooley MA;Ho PM
由于医生短缺而缺乏医疗服务是农村地区远程医疗扩张的重要驱动力。远程医疗对于治疗糖尿病等慢性病有效，但其在初级保健机构中的有效性尚不清楚。评估实施纵向虚拟初级保健计划前后糖尿病护理的差异。利用双重差异分析进行倾向评分匹配队列研究。 2018 年 1 月至 2019 年 12 月期间在 VA 初级保健诊所接受护理的糖尿病患者，其中实施了虚拟综合多站点患者协调护理团队 (V-IMPACT) 计划。患者参与至少一次 V-IMPACT 就诊，而常规护理患者未参加 V-IMPACT。主要结局是糖化血红蛋白 (HbA1C) 的变化，次要结局包括满足糖尿病质量指标的患者比例的变化：血压控制、他汀类药物的使用、血管紧张素转换酶抑制剂或血管紧张素 II 受体阻滞剂 (ACEi/ARB) 的使用以及年度微量白蛋白尿检测。我们的倾向匹配队列包括 9010 名患者，其中参与 V-IMPACT 的患者和仍接受常规面对面护理的患者各占一半。在参与 V-IMPACT 的糖尿病患者中，平均 HbA1C 的变化为 - 0.055%（95% CI - 0.088 至 - 0.022%），而接受常规护理的患者在计划实施前后的变化为 - 0.047%（95% CI - 0.080 至 - 0.014%）。我们观察到 V-IMPACT 组中他汀类药物处方比例绝对增加了 5.1%（95% CI 2.4 至 7.7%），ACE/ARB 处方比例增加了 5.3%（95% CI 2.5 至 8.2%），完成的年度微量白蛋白尿检测增加了 4.6%（95% CI 1.7 至 7.5%）。 V-IMPACT 与血压控制在 < 140/90 或 < 130/90 mmHg 阈值的比例的显着差异无关。纵向虚拟初级保健模型提供的糖尿病护理质量即使不比传统的面对面护理更好，也相似。在线版本包含可在 10.1007/s11606-020-06547-x 获取的补充材料。
Lack of healthcare access to due to physician shortages is a significant driver of telemedicine expansion in rural areas. Telemedicine is effective for management of chronic conditions such as diabetes but its effectiveness in primary care settings is unknown. To evaluate differences in diabetes care before and after implementation of a longitudinal virtual primary care program. Propensity score-matched cohort study utilizing difference-in-differences analysis. Patients with diabetes who received care at VA primary care clinics between January 2018 and December 2019 where the Virtual Integrated Multisite Patient Aligned Care Teams (V-IMPACT) program was implemented. Patient participation in at least one V-IMPACT visit while usual care patients did not participate in V-IMPACT. The primary outcome was change in hemoglobin A1C (HbA1C) and secondary outcomes included change in the proportion of patients meeting diabetes quality indicators: blood pressure control, statin use, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ACEi/ARB) use, and annual microalbuminuria testing. Our propensity-matched cohort included 9010 patients split evenly between those who participated in V-IMPACT and those who remained in usual in-person care. Among individuals with diabetes who participated in V-IMPACT, the change in mean HbA1C was − 0.055% (95% CI − 0.088 to − 0.022%) while those in usual care had a − 0.047% (95% CI − 0.080 to − 0.014%) change before and after program implementation. We observed a 5.1% (95% CI 2.4 to 7.7%) absolute increase in the proportion prescribed statins in the V-IMPACT group, a 5.3% (95% CI 2.5 to 8.2%) increase prescribed ACE/ARBs, and a 4.6% (95% 1.7 to 7.5%) increase in completed yearly microalbuminuria testing. V-IMPACT was not associated with a significant difference in the proportion with controlled blood pressure at < 140/90 or < 130/90 mmHg thresholds. Quality of diabetes care delivered by a longitudinal virtual primary care model was similar if not better than traditional in-person care. The online version contains supplementary material available at 10.1007/s11606-020-06547-x.
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16.2
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