Patient and provider perceptions of care for diabetes: results of the cross-national DAWN Study
Patient and provider perceptions of care for diabetes: results of the cross-national DAWN Study
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DOI：
10.1007/s00125-005-0048-8
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发表时间：
2006-02-01
期刊：
影响因子：
8.2
通讯作者：
Landgraf, R
中科院分区：
文献类型：
--
作者：
Peyrot, M;Rubin, RR;Landgraf, R
目的/假设：我们评估了患者和提供者对糖尿病护理的认知在国家和个人水平上的模式。方法：本研究采用横断面设计，对来自亚洲、澳大利亚、欧洲和北美的13个国家的糖尿病患者和医疗保健提供者进行面对面或电话访谈。参与者是随机选择的1型或2型糖尿病患者（n= 5104），以及随机选择的糖尿病护理提供者，包括初级保健医生（n= 2070）、糖尿病专科医生（n= 635）和护士（n= 1122）。多变量分析用于检验结果与国家和被调查者特征之间的关系，以及这两个因素之间的相互作用。结果：提供者对慢性护理系统和慢性护理报酬的评价一般。患者报告说，获得护理的便利程度很高，但并非没有经济障碍。患者报告说，医疗服务提供者之间的合作程度中等，而医疗服务提供者表示，他们不容易获得一些专业学科。患者报告说，在他们自己的护理中，他们与提供者的合作程度很高。提供者对2型糖尿病初级预防策略的支持度很高。社会经济资源较少和糖尿病并发症较多的患者获得护理的机会较少（和/或障碍较高），患者-提供者合作的质量较低。各国在所有结果上都存在显著差异，受访者特征与结果之间的关系因国家而异。结论/解释：在所研究的所有国家中，在将慢性护理模式应用于糖尿病的治疗和预防方面还有很多需要改进的地方。每个国家都必须制定自己改善糖尿病护理的优先事项，与其他国家进行比较可以帮助确定优势和劣势。
Aims/hypothesis: We assessed country-level and individual-level patterns in patient and provider perceptions of diabetes care. Methods: The study used a cross-sectional design with face-to-face or telephone interviews of diabetic patients and healthcare providers in 13 countries from Asia, Australia, Europe and North America. Participants were randomly selected adults with type 1 or type 2 diabetes (n= 5,104), and randomly selected diabetes-care providers, including primary-care physicians ( n= 2,070), diabetes specialist physicians ( n= 635) and nurses ( n= 1,122). Multivariate analysis was used to examine the relationships between outcomes and both country and respondent characteristics, and the interaction between these two factors. Results: Providers rated chronic-care systems and remuneration for chronic care as mediocre. Patients reported that ease of access to care was high, but not without financial barriers. Patients reported moderate levels of collaboration among providers, and providers indicated that several specialist disciplines were not readily available to them. Patients reported high levels of collaboration with providers in their own care. Provider endorsement of primary prevention strategies for type 2 diabetes was high. Patients with fewer socio-economic resources and more diabetes complications had lower access (and/or higher barriers) to care and lower quality of patient - provider collaboration. Countries differed significantly for all outcomes, and the relationships between respondent characteristics and outcomes varied by country. Conclusions/interpretation: There is much need for improvement in applying the chronic-care model to the treatment and prevention of diabetes in all of the countries studied. Each country must develop its own priorities for improving diabetes care and comparison with other countries can help identify strengths as well as weaknesses.