Clinical effectiveness of a patient decision aid to improve decision quality and glycaemic control in people with diabetes making treatment choices: a cluster randomised controlled trial (PANDAs) in general practice.
Clinical effectiveness of a patient decision aid to improve decision quality and glycaemic control in people with diabetes making treatment choices: a cluster randomised controlled trial (PANDAs) in general practice.
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DOI：
10.1136/bmjopen-2012-001469
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发表时间：
2012
期刊：
影响因子：
2.9
通讯作者：
Bradley A
中科院分区：
文献类型：
--
作者：
Mathers N;Ng CJ;Campbell MJ;Colwell B;Brown I;Bradley A
通过一项整群随机对照试验（RCT），确定患者决策辅助（PDA）在糖尿病患者治疗选择中改善决策质量和血糖控制的有效性。一项群集RCT。英国49家全科诊所随机分为干预组（n=25）和对照组（n=24）。纳入标准：>4个医疗合作伙伴;列表大小>7000;和糖尿病登记与>1%的实践人口。评估了191个实践的合格性，49个实践随机化并完成了研究。患者2型糖尿病（T2 DM）患者至少服用两种最大耐受剂量的口服降糖药物，糖化血红蛋白（HbA 1c）大于7.4%（IFCC HbA 1c>57 mmol/mol）或在前6个月内建议增加或考虑改变胰岛素治疗。 排除标准：目前正在使用胰岛素治疗;阅读或理解英语困难;难以理解研究目的;视觉或认知障碍或精神疾病。共有182人接受了合格性评估，175人被随机分配到95个干预组和80个对照组，167人完成了分析。对临床医生进行简短培训，并在单次会诊中使用PDA。决策质量（决策冲突评分、知识、现实期望和自主性）和血糖控制（糖化血红蛋白、HbA 1c）。对胰岛素治疗和糖尿病并发症的风险和获益的了解和现实预期。干预组：决策冲突总分较低（17.4 vs 25.2，p<0.001）;更好的知识（51.6% vs 28.8%，p<0.001）;现实预期（“低血糖”、“体重增加”、“并发症”的发生率分别为81.0%、70.5%、26.3%和5.0%，P<0.001）;决策自主性更强（64.1% vs 42.9%，p=0.012）。两组的血糖控制率无显著差异。使用PANDAs决策辅助减少决策冲突，提高知识，促进糖尿病患者在一般实践中做出治疗选择的现实期望和自主权。14842077.
To determine the effectiveness of a patient decision aid (PDA) to improve decision quality and glycaemic control in people with diabetes making treatment choices using a cluster randomised controlled trial (RCT). A cluster RCT. 49 general practices in UK randomised into intervention (n=25) and control (n=24). General practices Inclusion criteria: >4 medical partners; list size >7000; and a diabetes register with >1% of practice population. 191 practices assessed for eligibility, and 49 practices randomised and completed the study. Patients People with type 2 diabetes mellitus (T2DM) taking at least two oral glucose-lowering drugs with maximum tolerated dose with a glycosolated haemoglobin (HbA1c) greater than 7.4% (IFCC HbA1c >57 mmol/mol) or advised in the preceeding 6 months to add or consider changing to insulin therapy. Exclusion criteria: currently using insulin therapy; difficulty reading or understanding English; difficulty in understanding the purpose of the study; visual or cognitive impairment or mentally ill. A total of 182 assessed for eligibility, 175 randomised to 95 intervention and 80 controls, and 167 completion and analysis. Brief training of clinicians and use of PDA with patients in single consultation. Decision quality (Decisional Conflict Scores, knowledge, realistic expectations and autonomy) and glycaemic control (glycosolated haemoglobin, HbA1c). Knowledge and realistic expectations of the risks and benefits of insulin therapy and diabetic complications. Intervention group: lower total Decisional Conflict Scores (17.4 vs 25.2, p<0.001); better knowledge (51.6% vs 28.8%, p<0.001); realistic expectations (risk of ‘hypo’, ‘weight gain’, ‘complications’; 81.0% vs 5.2%, 70.5% vs 5.3%, 26.3% vs 5.0% respectively, p<0.001); and were more autonomous in decision-making (64.1% vs 42.9%, p=0.012). No significant difference in the glycaemic control between the two groups. Use of the PANDAs decision aid reduces decisional conflict, improves knowledge, promotes realistic expectations and autonomy in people with diabetes making treatment choices in general practice. 14842077.
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影响因子：
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作者：
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