{"title":"支持2型糖尿病患者的跨专业项目(Siscare)的有效性","authors":"Noura Bawab, Marie-Paule Schneider, Pierluigi Ballabeni, Isabella Locatelli, Olivier Bugnon, Clémence Perraudin","doi":"10.2337/ds21-0084","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To assess the effectiveness of an interprofessional support program (Siscare) that includes motivational interviews (patient-pharmacist), electronic monitoring (EM) of medications, patient-reported and clinical outcomes monitoring, and interactions with physicians for patients with type 2 diabetes in French-speaking Switzerland.</p><p><strong>Methods: </strong>This was a prospective, multicenter, observational cohort study using a hybrid implementation-effectiveness design. Individual daily adherence to at least one oral antidiabetic medication was measured by EM. A global adherence score was estimated by the product of a model-estimated implementation and a nonparametric estimate of persistence over time. Clinical outcomes (A1C, blood glucose, BMI, blood pressure, heart rate, and cholesterol levels) and quality of life (QoL) were analyzed over time using linear mixed-effect models.</p><p><strong>Results: </strong>A total of 212 patients were included from 27 pharmacies; 120 patients (57%) were followed up for at least 15 months. In total, 140 patients (66%) were male, the mean age was 64 ± 11 years, and the mean number of chronic medications per patient at baseline was 5 ± 3. Of 178 patients who used EM, 95% (95% CI 92-99%) remained persistent at the end of the follow-up period. The percentage of persistent patients taking their medications appropriately (implementation) was stable during follow-up and was estimated to be 90% (95% CI 87-92%) at baseline and 88% (95% CI 84-91%) at month 15. At baseline, the mean A1C and BMI were 7.5% and 31 kg/m<sup>2</sup>, respectively, which decreased by 0.5% (<i>P</i> = 0.012) and 0.6 kg/m<sup>2</sup> (<i>P</i> = 0.017), respectively, after 15 months. QoL remained stable during follow-up.</p><p><strong>Conclusion: </strong>The program supports medication adherence and improves clinical outcomes, illustrating the overall preventive effect of coordinated care.</p>","PeriodicalId":39737,"journal":{"name":"Diabetes Spectrum","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9935292/pdf/","citationCount":"0","resultStr":"{\"title\":\"Effectiveness of an Interprofessional Program (Siscare) for Supporting Patients With Type 2 Diabetes.\",\"authors\":\"Noura Bawab, Marie-Paule Schneider, Pierluigi Ballabeni, Isabella Locatelli, Olivier Bugnon, Clémence Perraudin\",\"doi\":\"10.2337/ds21-0084\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To assess the effectiveness of an interprofessional support program (Siscare) that includes motivational interviews (patient-pharmacist), electronic monitoring (EM) of medications, patient-reported and clinical outcomes monitoring, and interactions with physicians for patients with type 2 diabetes in French-speaking Switzerland.</p><p><strong>Methods: </strong>This was a prospective, multicenter, observational cohort study using a hybrid implementation-effectiveness design. Individual daily adherence to at least one oral antidiabetic medication was measured by EM. A global adherence score was estimated by the product of a model-estimated implementation and a nonparametric estimate of persistence over time. Clinical outcomes (A1C, blood glucose, BMI, blood pressure, heart rate, and cholesterol levels) and quality of life (QoL) were analyzed over time using linear mixed-effect models.</p><p><strong>Results: </strong>A total of 212 patients were included from 27 pharmacies; 120 patients (57%) were followed up for at least 15 months. In total, 140 patients (66%) were male, the mean age was 64 ± 11 years, and the mean number of chronic medications per patient at baseline was 5 ± 3. Of 178 patients who used EM, 95% (95% CI 92-99%) remained persistent at the end of the follow-up period. The percentage of persistent patients taking their medications appropriately (implementation) was stable during follow-up and was estimated to be 90% (95% CI 87-92%) at baseline and 88% (95% CI 84-91%) at month 15. At baseline, the mean A1C and BMI were 7.5% and 31 kg/m<sup>2</sup>, respectively, which decreased by 0.5% (<i>P</i> = 0.012) and 0.6 kg/m<sup>2</sup> (<i>P</i> = 0.017), respectively, after 15 months. 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引用次数: 0
摘要
目的:评估跨专业支持项目(Siscare)的有效性，该项目包括动机访谈(患者-药剂师)、药物电子监测(EM)、患者报告和临床结果监测，以及瑞士法语区2型糖尿病患者与医生的互动。方法:这是一项前瞻性、多中心、观察性队列研究，采用实施-有效性混合设计。通过EM测量个体每天对至少一种口服抗糖尿病药物的依从性。通过模型估计的实施和随时间持续的非参数估计的产物来估计全球依从性评分。临床结果(A1C、血糖、BMI、血压、心率和胆固醇水平)和生活质量(QoL)使用线性混合效应模型随时间分析。结果:共纳入患者212例，来自27家药店;120例患者(57%)随访至少15个月。140例患者(66%)为男性，平均年龄64±11岁，基线时平均服用慢性药物5±3次。在178例使用EM的患者中，95% (95% CI 92-99%)在随访结束时仍持续使用。在随访期间，持续适当服用药物的患者比例稳定，基线时估计为90% (95% CI 87-92%)，第15个月时估计为88% (95% CI 84-91%)。基线时，平均A1C和BMI分别为7.5%和31 kg/m2, 15个月后分别下降0.5% (P = 0.012)和0.6 kg/m2 (P = 0.017)。随访期间生活质量保持稳定。结论:该项目支持药物依从性并改善临床结果，说明协调护理的整体预防效果。
Effectiveness of an Interprofessional Program (Siscare) for Supporting Patients With Type 2 Diabetes.
Objective: To assess the effectiveness of an interprofessional support program (Siscare) that includes motivational interviews (patient-pharmacist), electronic monitoring (EM) of medications, patient-reported and clinical outcomes monitoring, and interactions with physicians for patients with type 2 diabetes in French-speaking Switzerland.
Methods: This was a prospective, multicenter, observational cohort study using a hybrid implementation-effectiveness design. Individual daily adherence to at least one oral antidiabetic medication was measured by EM. A global adherence score was estimated by the product of a model-estimated implementation and a nonparametric estimate of persistence over time. Clinical outcomes (A1C, blood glucose, BMI, blood pressure, heart rate, and cholesterol levels) and quality of life (QoL) were analyzed over time using linear mixed-effect models.
Results: A total of 212 patients were included from 27 pharmacies; 120 patients (57%) were followed up for at least 15 months. In total, 140 patients (66%) were male, the mean age was 64 ± 11 years, and the mean number of chronic medications per patient at baseline was 5 ± 3. Of 178 patients who used EM, 95% (95% CI 92-99%) remained persistent at the end of the follow-up period. The percentage of persistent patients taking their medications appropriately (implementation) was stable during follow-up and was estimated to be 90% (95% CI 87-92%) at baseline and 88% (95% CI 84-91%) at month 15. At baseline, the mean A1C and BMI were 7.5% and 31 kg/m2, respectively, which decreased by 0.5% (P = 0.012) and 0.6 kg/m2 (P = 0.017), respectively, after 15 months. QoL remained stable during follow-up.
Conclusion: The program supports medication adherence and improves clinical outcomes, illustrating the overall preventive effect of coordinated care.
期刊介绍：
The mission of Diabetes Spectrum: From Research to Practice is to assist health care professionals in the development of strategies to individualize treatment and diabetes self-management education for improved quality of life and diabetes control. These goals are achieved by presenting review as well as original, peer-reviewed articles on topics in clinical diabetes management, professional and patient education, nutrition, behavioral science and counseling, educational program development, and advocacy. In each issue, the FROM RESEARCH TO PRACTICE section explores, in depth, a diabetes care topic and provides practical application of current research findings.
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