Evaluating adherence to American Diabetes Association standards of care in diabetes and impacts of social determinants of health on patients at two nurse practitioner-owned clinics.

IF 1.2 4区 医学
Christine A Tuohy, Kathryn E Liziewski, Patricia A White, Wendy L Wright
{"title":"Evaluating adherence to American Diabetes Association standards of care in diabetes and impacts of social determinants of health on patients at two nurse practitioner-owned clinics.","authors":"Christine A Tuohy, Kathryn E Liziewski, Patricia A White, Wendy L Wright","doi":"10.1097/JXX.0000000000001026","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic created barriers in the management of type 2 diabetes mellitus (T2DM) and worsened social determinants of health (SDOH). A New Hampshire primary care office worked to adhere to T2DM standards of care and began screening for SDOH. This project assessed adherence to quality metrics, hemoglobin A1C, and SDOH screening as telehealth utilization decreased.</p><p><strong>Local problem: </strong>A1C values have increased at the practice, especially since COVID-19. The practice also began screening for SDOH at every visit, but there was need to assess how needs were being documented and if/how they were addressed.</p><p><strong>Methods: </strong>A retrospective chart review of patients with T2DM was performed. Demographic data and T2DM metrics were collected and compared with previous years and compared new versus established patients. Charts were reviewed to evaluate documentation of SDOH and appropriate referral.</p><p><strong>Interventions: </strong>The practice transitioned from an increased utliization of telehealth back to prioritizing in-office visits. The practice also began routinely screening for SDOH in 2020; however, this process had not been standardized or evaluated.</p><p><strong>Results: </strong>Adherence to nearly all quality metrics improved. Glycemic control improved after a year of nurse practitioner (NP) care, especially in new patients. All patients were screened for SDOH, but documentation varied, and affected patients had higher A1Cs, despite receiving comparable care.</p><p><strong>Conclusion: </strong>Nurse practitioners at this practice are adhering to American Diabetes Association guidelines, and A1C values improve under their care. Social determinants of health continue to act as unique barriers that keep patients from improving glycemic control, highlighting the need for individualized treatment of SDOH in T2DM care.</p>","PeriodicalId":17179,"journal":{"name":"Journal of the American Association of Nurse Practitioners","volume":null,"pages":null},"PeriodicalIF":1.2000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American Association of Nurse Practitioners","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/JXX.0000000000001026","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

Abstract

Background: The COVID-19 pandemic created barriers in the management of type 2 diabetes mellitus (T2DM) and worsened social determinants of health (SDOH). A New Hampshire primary care office worked to adhere to T2DM standards of care and began screening for SDOH. This project assessed adherence to quality metrics, hemoglobin A1C, and SDOH screening as telehealth utilization decreased.

Local problem: A1C values have increased at the practice, especially since COVID-19. The practice also began screening for SDOH at every visit, but there was need to assess how needs were being documented and if/how they were addressed.

Methods: A retrospective chart review of patients with T2DM was performed. Demographic data and T2DM metrics were collected and compared with previous years and compared new versus established patients. Charts were reviewed to evaluate documentation of SDOH and appropriate referral.

Interventions: The practice transitioned from an increased utliization of telehealth back to prioritizing in-office visits. The practice also began routinely screening for SDOH in 2020; however, this process had not been standardized or evaluated.

Results: Adherence to nearly all quality metrics improved. Glycemic control improved after a year of nurse practitioner (NP) care, especially in new patients. All patients were screened for SDOH, but documentation varied, and affected patients had higher A1Cs, despite receiving comparable care.

Conclusion: Nurse practitioners at this practice are adhering to American Diabetes Association guidelines, and A1C values improve under their care. Social determinants of health continue to act as unique barriers that keep patients from improving glycemic control, highlighting the need for individualized treatment of SDOH in T2DM care.

评估两家执业护士诊所对美国糖尿病协会糖尿病护理标准的遵守情况以及健康的社会决定因素对患者的影响。
背景:COVID-19 大流行给 2 型糖尿病 (T2DM) 的管理造成了障碍,并使健康的社会决定因素 (SDOH) 恶化。新罕布什尔州的一家初级保健诊所努力遵守 T2DM 护理标准,并开始筛查 SDOH。该项目对质量指标、血红蛋白 A1C 和 SDOH 筛查的遵守情况进行了评估,因为远程医疗的使用率有所下降。当地问题:该诊所的 A1C 值有所上升,尤其是自 COVID-19 以来。该诊所还开始在每次就诊时筛查 SDOH,但需要评估如何记录需求以及是否/如何满足这些需求:方法:对 T2DM 患者进行回顾性病历审查。方法:对 T2DM 患者的病历进行了回顾性审查,收集了他们的人口统计学数据和 T2DM 指标,并与前几年的数据进行了比较,还对新患者和老患者进行了比较。回顾病历以评估 SDOH 和适当转诊的记录:干预措施:该诊所从增加远程医疗的使用过渡到优先考虑诊室内就诊。2020 年,该诊所还开始对 SDOH 进行常规筛查;但这一流程尚未标准化或进行评估:结果:几乎所有质量指标的遵守情况都有所改善。在接受执业护士(NP)护理一年后,血糖控制情况有所改善,尤其是新患者。所有患者都接受了 SDOH 筛查,但记录情况各不相同,受影响患者的 A1C 值更高,尽管他们接受的护理相当:结论:该诊所的执业护士遵守美国糖尿病协会的指导方针,在他们的护理下,A1C 值有所改善。健康的社会决定因素仍然是阻碍患者改善血糖控制的独特障碍,这凸显了在 T2DM 护理中对 SDOH 进行个体化治疗的必要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
自引率
16.70%
发文量
172
期刊介绍: The Journal of the American Association of Nurse Practitioners (JAANP) is a monthly peer-reviewed professional journal that serves as the official publication of the American Association of Nurse Practitioners. Published since 1989, the JAANP provides a strong clinical focus with articles related to primary, secondary, and tertiary care, nurse practitioner education, health policy, ethics and ethical issues, and health care delivery. The journal publishes original research, integrative/comprehensive reviews, case studies, a variety of topics in clinical practice, and theory-based articles related to patient and professional education. Although the majority of nurse practitioners function in primary care, there is an increasing focus on the provision of care across all types of systems from acute to long-term care settings.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信