Glucose control, self-care behaviors, and the presence of the chronic care model in primary care clinics
Glucose control, self-care behaviors, and the presence of the chronic care model in primary care clinics
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DOI：
10.2337/dc06-2516
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发表时间：
2007-11-01
期刊：
影响因子：
16.2
通讯作者：
Romero, Raquel L.
中科院分区：
文献类型：
--
作者：
Parchman, Michael L.;Pugh, Jacqueline A.;Romero, Raquel L.
目的-本研究的目的是检查AlC之间的关系，在控制自我护理行为后，在初级保健诊所向2型糖尿病患者提供的护理与慢性护理模式（CCM）一致的程度。南德克萨斯州的自治初级保健诊所。受试者完成了退出调查。提取病历中的AlC值。临床医生完成了评估慢性病护理（ACIC）调查，在何种程度上提供护理的验证措施是一致的CCM.RESULTS -有一个显着的关系ACIC评分和AlC之间，但这种关系根据自我保健行为的运动和最强的那些谁不坚持锻炼的建议：ACIC评分每增加1分，AlC降低0.144%（P < 0.001）。ACIC评分和AlC的那些谁坚持自己的饮食之间的关系是相似的，对于那些谁没有，调整运动后，但整体水平的控制是更好的那些谁坚持自己的diet.Conclusions -初级保健诊所的特点，其中一个接受护理是一个重要的预测血糖控制。如果实施CCM的资源有限，则可能需要关注ACIC评分较低的诊所，这些诊所服务于久坐患者人群，因为这一人群可能从改善血糖控制中获益最多。
OBJECTIVE - The purpose of this study was to examine the relationship between AlC and the extent to which care delivered to patients with type 2 diabetes in primary care clinics is consistent with the chronic care model (CCM), after controlling for self-care behaviors.RESEARCH DESIGN AND METHODS - This was a cross-sectional, observational study of care provided to 618 patients with type 2 diabetes across 20 small, autonomous primary care clinics in South Texas. Subjects completed an exit survey. The medical record was abstracted for AlC values. Clinicians completed the Assessment of Chronic Illness Care (ACIC) survey, a validated measure of the extent to which care delivered is consistent with the CCM.RESULTS - There was a significant relationship between ACIC score and AlC, but this relationship varied according to self-care behavior for exercise and was strongest for those who did not adhere to exercise recommendations: for every 1-point increase in ACIC score, AlC was 0.144% lower (P < 0.001). The relationship between ACIC score and AlC for those who adhered to their diet was similar to that for those who did not, after adjusting for exercise, but the overall level of control was better for those who adhered to their diet.CONCLUSIONS - Characteristics of the primary care clinic where one receives care are an important predictor of glucose control. If resources for implementing the CCM are limited, one might want to focus on clinics with low ACIC scores that serve a population of patients who are sedentary because this population may be likely to realize the most benefit from improved glucose control.