Quality of diabetes mellitus care by rural primary care physicians.
Quality of diabetes mellitus care by rural primary care physicians.
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DOI：
10.1111/j.1748-0361.2012.00410.x
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发表时间：
2012
期刊：
影响因子：
--
通讯作者：
Estrada CA
中科院分区：
文献类型：
--
作者：
Tonks SA;Makwana S;Salanitro AH;Safford MM;Houston TK;Allison JJ;Curry W;Estrada CA
探讨糖尿病患者农村化程度与血糖（血红蛋白A1c）、血压（BP）、血脂（LDL）控制的关系。描述性研究;在美国的205个乡村诊所里有1649个病人。患者居住地邮政编码定义农村化程度（城乡通勤区编码）。结果为可接受控制（A1c <= 9%, BP < 140/90 mmHg, LDL < 130 mg/dL）和最佳控制（A1c < 7%, BP < 130/80 mmHg, LDL < 100 mg/dL）。差异有统计学意义P < 0.008 （Bonferroni校正）。虽然A1c控制合理的患者比例随着农村化程度的增加而恶化，但差异无统计学意义（城市90%，大农村88%，小农村85%，孤立农村83%，P = 0.10）；平均A1c值也随农村化程度的增加而增加，但没有统计学意义（城市7.2 [sd1.6]，农村大地区7.3 [sd1.7]，农村小地区7.5 [SD1.8]，偏远地区7.5 [SD1.9]; P = 0.16）。我们观察到农村与合理血压或LDL控制程度（P = 0.42, P = 0.23）或最佳A1c或血压控制程度（P = 0.52, P = 0.65）之间无差异。最佳LDL值和平均LDL值随着乡村性的增加而恶化（P = 0.08, P = 0.029）。在美国南部农村寻求治疗的糖尿病患者中，我们观察到患者居住的农村程度与传统的护理质量衡量标准之间没有关系。有必要进一步研究农村化程度增加导致代谢控制相对恶化的趋势和解释因素。
To explore the relationship between degree of rurality and glucose (hemoglobin A1c), blood pressure (BP), and lipid (LDL) control among patients with diabetes. Descriptive study; 1,649 patients in 205 rural practices in the United States. Patients’ residence ZIP codes defined degree of rurality (Rural-Urban Commuting Areas codes). Outcomes were measures of acceptable control (A1c <= 9%, BP < 140/90 mmHg, LDL < 130 mg/dL) and optimal control (A1c < 7%, BP < 130/80 mmHg, LDL < 100 mg/dL). Statistical significance was set at P < .008 (Bonferroni’s correction). Although the proportion of patients with reasonable A1c control worsened by increasing degree of rurality, the differences were not statistically significant (urban 90%, large rural 88%, small rural 85%, isolated rural 83%; P = .10); mean A1c values also increased by degree of rurality, although not statistically significant (urban 7.2 [SD 1.6], large rural 7.3 [SD 1.7], small rural 7.5 [SD1.8], isolated rural 7.5 [SD1.9]; P = .16). We observed no differences between degree of rural and reasonable BP or LDL control (P = .42, P = .23, respectively) or optimal A1c or BP control (P = .52, P = .65, respectively). Optimal and mean LDL values worsened as rurality increased (P = .08, P = .029, respectively). In patients with diabetes who seek care in the rural Southern US, we observed no relationship between degree of rurality of patients’ residence and traditional measures of quality of care. Further examination of the trends and explanatory factors for relative worsening of metabolic control by increasing degree of rurality is warranted.
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