The Diabetes Mellitus Medication Choice Decision Aid A Randomized Trial
The Diabetes Mellitus Medication Choice Decision Aid A Randomized Trial
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DOI：
10.1001/archinternmed.2009.293
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发表时间：
2009-09-28
影响因子：
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通讯作者：
Smith, Steven A.
中科院分区：
文献类型：
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作者：
Mullan, Rebecca J.;Montori, Victor M.;Smith, Steven A.
背景：患者参与选择降糖药物可以改善2型糖尿病患者的依从性，优化血糖控制。方法：我们进行了一项糖尿病药物选择的试验性、整群随机试验，该试验描述了5种降糖药物的治疗负担(不良反应、给药和自我监测需求)以及对血红蛋白A(1c)(HbA(1c))的影响。21名临床医生在临床会诊期间随机使用决策辅助工具，19名医生分发常规护理和一本教育小册子。结果：与常规护理患者(n=37)相比，接受决策辅助的患者(n=48)发现该工具更有帮助(7分量表中的集群调整平均差[AMD]为0.38；95%可信区间[CI]，0.04-0.72)；提高了知识水平(AMD，10个问题中的1.10；95%可信区间，0.11-2.09)；更多地参与糖尿病药物的决策(AMD，21.8/100；95%CI，13.0-30.5)。在6个月的随访中，两组患者的用药近乎完美(中位数，覆盖天数为100%)，依从性(AMD，覆盖天数增加9%；95%CI，4%-14%)和持久性(AMD，覆盖12天以上；95%CI，3-21d)，对HBA(1c)水平没有显著影响(AMD，0.01；95%CI，-0.49至0.50)。结论：一种创新的决策辅助工具有效地让2型糖尿病患者参与他们的药物决定，但并未提高依从性或HbA(1c)水平。
Background: Patient involvement in the choice of antihyperglycemic agents could improve adherence and optimize glycemic control in patients with type 2 diabetes mellitus.Methods: We conducted a pilot, cluster randomized trial of Diabetes Medication Choice, a decision aid that describes 5 antihyperglycemic drugs, their treatment burden (adverse effects, administration, and self-monitoring demands), and impact on hemoglobin A(1c) (HbA(1c)) levels. Twenty-one clinicians were randomized to use the decision aid during the clinical encounter and 19 to dispense usual care and an educational pamphlet. We used surveys and video analysis to assess postvisit decisional outcomes, and medical and pharmacy records to assess 6-month medication adherence and HbA(1c) levels.Results: Compared with usual care patients (n = 37), patients receiving the decision aid (n = 48) found the tool more helpful (clustered-adjusted mean difference [AMD] in a 7-point scale, 0.38; 95% confidence interval [CI], 0.04-0.72); had improved knowledge (AMD, 1.10 of 10 questions; 95% CI, 0.11-2.09); and had more involvement in making decisions about diabetes medications (AMD, 21.8 of 100; 95% CI, 13.0-30.5). At 6-month follow-up, both groups had nearly perfect medication use (median, 100% of days covered), with better adherence (AMD, 9% more days covered; 95% CI, 4%-14%) and persistence (AMD, 12 more days covered; 95% CI, 3-21 days) in the usual care group, and no significant impact on HbA(1c) levels (AMD, 0.01; 95% CI, -0.49 to 0.50).Conclusion: An innovative decision aid effectively involved patients with type 2 diabetes mellitus in decisions about their medications but did not improve adherence or HbA(1c) levels.