Shared Medical Appointments May Be Effective for Improving Clinical and Behavioral Outcomes in Type 2 Diabetes: A Narrative Review.
Shared Medical Appointments May Be Effective for Improving Clinical and Behavioral Outcomes in Type 2 Diabetes: A Narrative Review.
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DOI：
10.3389/fendo.2017.00263
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发表时间：
2017
影响因子：
5.2
通讯作者：
de Courten B
中科院分区：
文献类型：
--
作者：
Menon K;Mousa A;de Courten MP;Soldatos G;Egger G;de Courten B
2型糖尿病(T2 DM)是一种复杂的慢性疾病，全世界有超过4亿人受到影响。由于时间和资源有限，而且无法接触到多学科团队，在个别患者会诊中管理T2 DM及其相关并发症对医生构成了巨大挑战。共享医疗预约(SMA)是由医生在小组环境中提供的连续医疗会诊，其中综合医疗保健和患者教育在单一会话中提供。SMAS允许医生同时向多个患者提供相同级别的护理，从而最大限度地利用可用资源。然而，SMA在T2 DM管理中的有效性和实用性仍不清楚。这篇叙述性综述总结了当前和新出现的证据，表明SMA在改善T2 DM患者的临床结果方面的有效性，以及SMA是否与降低成本和改善糖尿病相关的行为和生活方式改变有关。在包括PubMed和Google Scholar的主要电子数据库上进行广泛的文献搜索，使用包括SMAS、小组访问和T2 DM的关键词来确定T2 DM患者中SMA的所有研究。1型糖尿病或混合或未指明人群的研究被排除在外，以及SMA不涉及医生的研究，因为这些研究不符合SMA的经典定义。确定了19项研究，并纳入本综述。总体而言，目前的证据表明，随着时间的推移，定期服用SMA可能在改善血糖结果、糖尿病知识和一些糖尿病相关行为方面有效。然而，现有研究的主要局限性是缺乏与标准护理的比较，这限制了就SMA在T2 DM管理中是否优于标准护理得出结论的能力。此外，较少的研究和研究设计、人群和干预措施的实质上的异质性造成了在临床护理环境中建立SMA的实用性和有效性的困难。我们的结论是，仍然需要进行更大规模的研究，以确定哪些人群可能受益于或可能不受益于SMA护理模式，并澄清将SMA应用于常规糖尿病护理的潜在好处和障碍。
Type 2 diabetes mellitus (T2DM) is a complex chronic disease affecting over 400 million people worldwide. Managing T2DM and its associated complications in individual patient consultations poses substantial challenges to physicians due to limited time and resources and lack of access to multidisciplinary teams. Shared medical appointments (SMAs) are consecutive medical consultations provided by a physician in a group setting, where integrated medical care and patient education are delivered in a single session. SMAs allow physicians to deliver the same level of care to multiple patients at the same time, thereby maximizing available resources. However, the effectiveness and practicality of SMAs in the management of T2DM remains unknown. This narrative review summarizes current and emerging evidence regarding the effectiveness of SMAs in improving clinical outcomes in patients with T2DM, as well as whether SMAs are associated with reduced costs and improved diabetes-related behavioral and lifestyle changes. An extensive literature search was conducted on major electronic databases including PubMed and Google Scholar using keywords, including SMAs, group visits, and T2DM to identify all studies of SMAs in patients with T2DM. Studies in type 1 diabetes or mixed or unspecified populations were excluded, as well as studies where SMAs did not involve a physician since these do not meet the classical definition of a SMA. Nineteen studies were identified and are included in this review. Overall, current evidence suggests that SMAs delivered regularly over time may be effective in improving glycemic outcomes, diabetes knowledge, and some diabetes-related behaviors. However, the main limitation of existing studies was the paucity of comparisons with standard care which limits the ability to draw conclusions regarding whether SMAs are superior to standard care in T2DM management. Moreover, the small number of studies and substantial heterogeneity in study designs, populations, and interventions creates difficulties in establishing the practicality and efficiency of SMAs in the clinical care setting. We conclude that there remains a need for larger studies to identify populations who may or may not benefit from the SMA model of care and to clarify the potential benefits and barriers to implementing SMAs into routine diabetes care.
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