Variation in treatment preferences and care goals among older patients with diabetes and their physicians
Variation in treatment preferences and care goals among older patients with diabetes and their physicians
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DOI：
10.1097/mlr.0b013e318158af40
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发表时间：
2008-03-01
期刊：
影响因子：
3
通讯作者：
Meltzer, David O.
中科院分区：
文献类型：
--
作者：
Chin, Marshall H.;Drum, Melinda L.;Meltzer, David O.
背景：老年糖尿病患者的预期寿命和虚弱程度是不同的，新的指南建议个体化护理。目的：(1)描述老年糖尿病患者在积极控制血糖和避免糖尿病并发症方面的偏好变化。(2)确定患者偏好与医生治疗目标的相关性。(3)评估医生的目标是否与患者的偏好一致。研究设计：城市学术诊所的横断面调查和图表回顾。对象：473例65岁及以上糖尿病患者和内科医生。测量：患者对糖尿病并发症和治疗强度的偏好(公用事业从0到1，0死亡，1=完全健康)，以及医生的目标治疗目标和治疗方法的侵略性评级。结果：80%的患者是非洲裔美国人，63%是女性，平均年龄73.7+/-5.9岁，26%的人预计生存5年或更短。患者的喜好/效用有显著差异：失明0.39(SD，0.32)，小腿截肢0.45(0.34)，常规治疗0.76(0.27)，强化胰岛素治疗0.64(0.32)。医生的血红蛋白摄取目标是
Background: Older persons with diabetes are heterogeneous with respect to life expectancy and frailty, and new guidelines recommend individualizing care.Objectives: (1) To describe variation in the preferences of older patients with diabetes regarding aggressiveness of glycemic control and avoiding diabetic complications. (2) To determine correlates of patient preferences and physician treatment goals. (3) To assess whether physicians' goals were consistent with their patients' preferences.Research Design: Cross-sectional surveys and chart reviews in urban academic clinics. Subjects: Four hundred seventy-three patients with diabetes age 65 or older and 64 physicians. Measures: Patient preferences (utilities on a scale from 0 to 1, 0 death, 1 = perfect health) for diabetic complications and intensity of treatment, and physician target treatment goals and ratings of aggressiveness of approach.Results: Eighty percent of the patients were African American, 63% were women, average age was 73.7 +/- 5.9 years and 26% expected to live 5 years or less. Patient preferences/utilities showed significant variation: blindness 0.39 (SD, 0.32), lower leg amputation 0.45 (0.34), conventional treatment 0.76 (0.27), and intensive insulin treatment 0.64 (0.32). Physicians' hemoglobin Ate goal was