Confronting disparities in diabetes care: The clinical effectiveness of redesigning care management for minority patients in rural primary care practices
Confronting disparities in diabetes care: The clinical effectiveness of redesigning care management for minority patients in rural primary care practices
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DOI：
10.1111/j.1748-0361.2005.tb00101.x
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发表时间：
2005-09-01
影响因子：
4.9
通讯作者：
Whetstone, L
中科院分区：
文献类型：
--
作者：
Bray, P;Thompson, D;Whetstone, L
背景：糖尿病及其并发症对农村社区的少数族裔公民的影响不成比例，他们中的许多人获得全面的糖尿病管理服务的机会有限。目的：探讨护理管理与跨学科小组访视相结合对农村非裔美国人糖尿病患者的治疗效果。方法：在干预实习中，一名高级实习护士每周访问实习一次，为期12个月，并促进糖尿病教育、病人流动和管理。患者参加了由一名护士、一名内科医生、一名药剂师和一名营养师领导的4节小组访问教育/支持计划。对照组患者在单独的诊所接受常规护理。结果：干预组和对照组的中位血红蛋白A1c(Hb(A1c))在基线时没有显著差异，但在12个月随访期结束时有显著差异(P<；0.05)。在干预组，基线时的中位Hb(A1c)为8.2+/-2.6%，平均随访11.3个月时的中位Hb(A1c)为7.1+/-2.3%，(P<；.0001)。在对照组，中位数Hb(A1c)在同一时间段从8.3+/-2.0%上升到8.6+/-2.4%(P<；0.05)。在干预组中，61%的患者Hb(A1c)降低，Hb(A1c)<7%的患者的百分比从32%提高到45%(P<；0.05)。结论：这些发现表明，重新设计的护理管理模式结合了护士主导的病例管理和结构化的团体教育访问，可以成功地纳入农村初级保健实践，并可以显著改善血糖控制。
Context: Diabetes mellitus and its complications disproportionately affect minority citizens in rural communities, many of whom have limited access to comprehensive diabetes management services. Purpose: To explore the efficacy of combining care management and interdisciplinary group visits for rural African American patients with diabetes mellitus. Methods: In the intervention practice, an advanced practice nurse visited the practice weekly for 12 months and facilitated diabetes education, patient flow, and management. Patients participated in a 4-session group visit education/support program led by a nurse, a physician, a pharmacist, and a nutritionist. The control patients in a separate practice received usual care. Findings: Median hemoglobin A1c (Hb(A1c)) was not significantly different at baseline in the intervention and control groups but was significantly different at the end of the 12-month follow-up period (P < .05). In the intervention group, median Hb(A1c) at baseline was 8.2 +/- 2.6%, and median Hb(A1c) at an average follow-up of 11.3 months was 7.1 +/- 2.3%, (P < .0001). In the control group, median Hb(A1c) increased from 8.3 +/- 2.0% to 8.6 +/- 2.4% (P < .05) over the same time period. In the intervention group, 61% of patients had a reduction in Hb(A1c), and the percentage of patients with a Hb(A1c) Of less than 7% improved from 32% to 45% (P < .05). Conclusions: These findings suggest that a redesigned care management model that combines nurse-led case management with structured group education visits can be successfully incorporated into rural primary care practices and can significantly improve glycemic control.