Encounter frequency and serum glucose level, blood pressure, and cholesterol level control in patients with diabetes mellitus.
Encounter frequency and serum glucose level, blood pressure, and cholesterol level control in patients with diabetes mellitus.
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DOI：
10.1001/archinternmed.2011.400
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发表时间：
2011-09-26
影响因子：
--
通讯作者：
Turchin, Alexander
中科院分区：
文献类型：
--
作者：
Morrison, Fritha;Shubina, Maria;Turchin, Alexander
更频繁的患者-提供者接触可能会导致更快的A1 c，血压和LDL控制并改善结果，但对于糖尿病患者应该多久看一次没有指导方针。这项回顾性队列研究分析了2000年1月1日至2009年1月1日期间两家教学医院初级保健医生治疗的26，496名糖尿病和A1 c、血压和/或LDL胆固醇升高的患者。评估了提供者接触（定义为医疗记录中的注释）频率与A1 c、血压和LDL控制时间之间的关系。比较在1-2周与3-6个月之间与医生接触的患者，A1 c < 7.0%的中位时间为4.4个月与24.9个月（未使用胰岛素）和10.1 vs. 52.8个月（胰岛素）;血压< 130/85 mm Hg的中位时间为1.3个月对13.9个月; LDL < 100 mg/dL的中位时间分别为5.1个月和36.9个月（所有患者p < 0.0001）。在多变量分析中，医生就诊间隔时间加倍导致A1 c（停用和使用胰岛素）、血压和LDL目标的中位时间分别增加35%、17%、87%和27%（所有p < 0.0001）。对于大多数靶点，随着治疗频率增加至每两周一次，控制时间逐渐缩短，与相应药物类别的药效学一致。每两周一次的初级保健提供者接触与糖尿病患者最快实现A1 c，血压和LDL目标相关。
More frequent patient-provider encounters may lead to faster A1c, blood pressure and LDL control and improve outcomes but there are no guidelines for how frequently patients with diabetes should be seen. This retrospective cohort study analyzed 26,496 patients with diabetes and elevated A1c, blood pressure, and/or LDL cholesterol treated by primary care physicians at two teaching hospitals between 1/1/2000 and 1/1/2009. Relationship between provider encounter (defined as a note in medical record) frequency and time to A1c, blood pressure and LDL control was assessed. Comparing patients who had encounters with their physicians between 1-2 weeks vs. 3-6 months, median time to A1c < 7.0% was 4.4 vs. 24.9 months (not on insulin) and 10.1 vs. 52.8 months (on insulin); median time to blood pressure < 130/85 mm Hg was 1.3 vs. 13.9 months; and median time to LDL < 100 mg/dL was 5.1 vs. 36.9 months, respectively (p < 0.0001 for all). In multivariable analysis, doubling the time between physician encounters led to a 35%, 17%, 87%, and 27% increase in median time to A1c (off and on insulin), blood pressure, and LDL targets, respectively (p < 0.0001 for all). Time to control decreased progressively as encounter frequency increased up to once every two weeks for most targets, consistent with pharmacodynamics of respective medication classes. Biweekly primary care provider encounters are associated with fastest achievement of A1c, blood pressure, and LDL targets for patients with diabetes.
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影响因子：
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影响因子：
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