Addressing Unmet Basic Resource Needs as Part of Chronic Cardiometabolic Disease Management.
Addressing Unmet Basic Resource Needs as Part of Chronic Cardiometabolic Disease Management.
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作为慢性心脏代谢疾病管理的一部分，解决未满足的基本资源需求。
DOI：
10.1001/jamainternmed.2016.7691
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发表时间：
2017-02-01
影响因子：
39
通讯作者：
Atlas SJ
中科院分区：
文献类型：
--
作者：
Berkowitz SA;Hulberg AC;Standish S;Reznor G;Atlas SJ
目前还不清楚帮助患者满足资源需求，如难以负担食物，住房或药物，是否会改善临床结果。确定健康引导（HL）计划对改善收缩压和舒张压（SBP、DBP;单位：mmHg）、低密度脂蛋白胆固醇（LDL-C;单位：mg/dL）和血红蛋白A1 c（HbA 1c）的有效性。2012年10月1日至2015年9月30日HL的差异中差异评价。HL包括在诊所就诊时筛查未满足的需求，并为那些筛查阳性的人提供与“倡导者”会面的机会，以帮助获得资源或获得简要信息。三个学术初级保健实践5125人筛选，使用标准化表格，未满足的基本资源需求SBP，DBP，LDL-C和HbA 1c的变化。我们使用意向治疗比较了未满足基本需求筛查阳性的患者（HL组）与筛查阴性的患者，其次，使用线性混合模型比较了参加和未参加HL的患者，检查了筛查前后的时间。在接受筛查的5125人中，1774人（35%）报告至少有一项未满足的需求，58%的人参加了HL。筛查阳性和阴性的患者的中位随访时间分别为34和32个月。在对1998例高血压受试者进行的未校正意向治疗分析中，HL组SBP（差异变化-1.2 95%置信区间[CI]-2.1至-0.4）和DBP（差异变化-1.0 95% CI-1.5至-0.5）的降幅更大。对于2281例有LDL-C降低指征的个体，结果也有利于HL组（差异变化-3.7，95%CI-6.7至-0.6）。对于774例糖尿病患者，HL组未显示HbA 1c改善（差异变化为-0.04%95%CI-0.17%至0.10%）。校正基线人口统计学和临床差异的结果没有质的差异。在入组HL项目的患者中，BP和LDL-C的改善幅度大于下降的患者（SBP差异变化−2.6 95%CI −3.5至−1.7; SBP差异变化−1.4 95%CI −1.9至−0.9; LDL-C差异变化−6.3 95%CI −9.7至−2.8）。筛查并试图解决初级保健中未满足的基本资源需求与血压和血脂水平的适度改善有关，但与血糖水平无关。
It is unclear if helping patients meet resource needs, such as difficulty affording food, housing, or medications, improves clinical outcomes. To determine the effectiveness of the Health Leads (HL) program on improvement in systolic and diastolic blood pressure (SBP, DBP; units: mm Hg), low-density lipoprotein cholesterol (LDL-C; units: mg/dL), and hemoglobin A1c (HbA1c). Difference-in-difference evaluation of HL from October 1, 2012 through September 30, 2015. HL consists of screening for unmet needs at clinic visits, and offering those who screen positive to meet with an ‘advocate’ to help obtain resources, or receive brief information provision. Three academic primary care practices 5125 people screened, using a standardized form, for unmet basic resource needs Changes in SBP, DBP, LDL-C, and HbA1c. We compared those who screened positive for unmet basic needs (HL group) to those who screened negative, using intention-to-treat, and, secondarily, between those who did and did not enroll in HL, using linear mixed modeling, examining the period before and after screening. Of 5125 people screened, 1774 (35%) reported at least one unmet need, and 58% of those enrolled in HL. Median follow-up for those who screened positive and negative was 34 and 32 months, respectively. In unadjusted intention-to-treat analyses of 1998 participants with hypertension, the HL group experienced greater reduction in SBP (differential change −1.2 95% Confidence Interval [CI] −2.1 to −0.4) and DBP (differential change −1.0 95% CI −1.5 to −0.5). For 2281 individuals with an indication for LDL-C lowering, results also favored the HL group (differential change −3.7, 95%CI −6.7 to −0.6). For 774 individuals with diabetes, the HL group did not show HbA1c improvement (differential change −0.04% 95%CI −0.17% to 0.10%). Results adjusted for baseline demographic and clinical differences were not qualitatively different. Among those who enrolled in HL program, there were greater BP and LDL-C improvements then for those who declined (SBP differential change −2.6 95%CI −3.5 to −1.7; SBP differential change −1.4 95%CI −1.9 to −0.9; LDL-C differential change −6.3 95%CI −9.7 to −2.8). Screening for and attempting to address unmet basic resource needs in primary care was associated with modest improvements in blood pressure and lipid, but not blood glucose, levels.
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影响因子：
39.2
作者：
Heisler M;Choi H;Palmisano G;Mase R;Richardson C;Fagerlin A;Montori VM;Spencer M;An LC
通讯作者：
An LC
影响因子：
6.2
作者：
Kreatsoulas, Catherine;Anand, Sonia S.
通讯作者：
Anand, Sonia S.
影响因子：
5.4
作者：
Berkowitz, Seth A.;Hulberg, A. Catherine;Atlas, Steven J.
通讯作者：
Atlas, Steven J.
影响因子：
5.5
作者：
Ford ES
通讯作者：
Ford ES
影响因子：
24
作者：
Choudhry, Niteesh K.;Fischer, Michael A.;Shrank, William H.
通讯作者：
Shrank, William H.