No moment wasted: the primary-care visit for adults with diabetes and low socio-economic status.
No moment wasted: the primary-care visit for adults with diabetes and low socio-economic status.
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DOI：
10.1017/s1463423615000134
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发表时间：
2016-01
影响因子：
1.6
通讯作者：
Stange KC
中科院分区：
文献类型：
--
作者：
Bolen SD;Sage P;Perzynski AT;Stange KC
为了更好地了解患者和提供者在为患有糖尿病和低社会经济地位(SES)的成年人提供“高质量”初级保健时提出的健康问题的类型和范围。尽管护理质量指南是直截了当的，但初级保健中的糖尿病就诊往往比遵守指南更复杂，特别是在SES低的成年人，他们在良好护理方面遇到了许多经济和环境障碍。我们在2009-2010年间进行了一项定性研究，使用直接观察初级保健糖尿病就诊的示范安全网实践。在主要是非裔美国人(93%)的低收入人群中，心血管控制良好(平均糖化血红蛋白7.5%，血压134/81毫米汞柱，低密度脂蛋白胆固醇100毫克/分升)，就诊涉及各种生物-心理社会健康问题[中位数：25个问题/就诊(范围13-32)]。医生最常发起关于慢性病、预防和健康行为的讨论。患者最常发起关于社会环境和急性症状的讨论，其次是预防和健康行为。SES低的糖尿病患者的初级保健就诊解决了数量惊人和多样性的问题。新出现的初级保健提供和质量衡量模式应允许有足够的时间和资源来处理一系列必要的任务，将生物医学和心理社会关切结合起来，以改善社会经济上处于不利地位的患者的健康。
To better understand the type and range of health issues initiated by patients and providers in ‘high-quality’ primary-care for adults with diabetes and low socio-economic status (SES). Although quality of care guidelines are straightforward, diabetes visits in primary care are often more complex than adhering to guidelines, especially in adults with low SES who experience many financial and environmental barriers to good care. We conducted a qualitative study using direct observation of primary-care diabetes visits at an exemplar safety net practice in 2009–2010. In a mainly African American (93%) low-income population with fair cardiovascular control (mean A1c 7.5%, BP 134/81 mmHg, and low-density lipoprotein cholesterol 100 mg/dL), visits addressed a variety of bio-psychosocial health issues [median: 25 problems/visit (range 13–32)]. Physicians most frequently initiated discussions about chronic diseases, prevention, and health behavior. Patients most frequently initiated discussions about social environment and acute symptoms followed by prevention and health behavior. Primary-care visits by diabetes patients with low SES address a surprising number and diversity of problems. Emerging new models of primary-care delivery and quality measurement should allow adequate time and resources to address the range of tasks necessary for integrating biomedical and psychosocial concerns to improve the health of socio-economically disadvantaged patients.