多学科协作护理对基层医疗机构糖尿病患者心血管风险因素的影响：系统回顾与荟萃分析。

IF 2.6 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes Pub Date : 2024-08-01 DOI:10.1016/j.pcd.2024.05.003

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引用次数: 0

摘要

背景：多学科协作护理已被广泛推荐为管理糖尿病的有效策略；然而，在初级医疗机构中，糖尿病患者的心血管风险因素往往得不到充分管理。本研究旨在评估多学科协作对初级医疗机构糖尿病患者心血管风险因素的影响：系统检索了五个数据库（即 Medline、Embase、CINAHL、SCOPUS 和 CENTRAL），以检索随机对照试验。如果干预措施包括一个多学科团队，其中至少有来自三个健康学科的专业人员，并且以初级医疗机构中的糖尿病患者为研究对象，则符合纳入条件。采用随机效应模型计算汇总效应：荟萃分析共纳入了 19 项研究，涉及 6538 名患者。结果显示，与常规护理相比，多学科协作护理能显著降低心血管风险因素，包括平均收缩压（-3.27 mm Hg，95 % 置信区间 [CI]：-4.72 至 -1.82, p < 0.01）、舒张压（-1.4 mm Hg，95 % 置信区间：-2.32 至 -0.47，p <0.01）、糖化血红蛋白（-0.42 %，95 % 置信区间：-0.59 至 -0.25，p <0.01）、低密度脂蛋白（-0.16 mmol/L，95 % 置信区间：-0.26 至 -0.06，p <0.01）和高密度脂蛋白（0.06 mmol/L，95 % 置信区间：0.00 至 0.12，p <0.05）。亚组分析表明，当多学科协作由来自不同学科的团队成员组成、结合药物和非药物成分、包括面对面和远程互动以及在高收入国家实施时，能更有效地降低心血管风险因素：结论：多学科协作护理与初级医疗中糖尿病患者心血管风险因素的降低有关。需要开展进一步研究，以确定最佳团队组成。

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The effects of multidisciplinary collaborative care on cardiovascular risk factors among patients with diabetes in primary care settings: A systematic review and meta-analysis

Background

Multidisciplinary collaborative care has been widely recommended as an effective strategy for managing diabetes; however, the cardiovascular risk factors of patients with diabetes are often inadequately managed in primary care settings. This study aimed to assess the effect of multidisciplinary collaboration on cardiovascular risk factors among patients with diabetes in primary care settings.

Methods

Five databases (i.e., Medline, Embase, CINAHL, SCOPUS and CENTRAL) were systematically searched to retrieve randomised controlled trials. Studies were eligible for inclusion if the interventions included a multidisciplinary team with professionals from at least three health disciplines and focused on patients with diabetes in primary care settings. A random-effects model was used to calculate the pooled effects.

Results

In total, 19 studies comprising 6538 patients were included in the meta-analysis. The results showed that compared with usual care, multidisciplinary collaborative care significantly reduced cardiovascular risk factors, including mean systolic blood pressure (–3.27 mm Hg, 95 % confidence interval [CI]: –4.72 to –1.82, p < 0.01), diastolic blood pressure (–1.4 mm Hg, 95 % CI: –2.32 to –0.47, p < 0.01), glycated haemoglobin (–0.42 %, 95 % CI: –0.59 to –0.25, p < 0.01), low-density lipoprotein (–0.16 mmol/L, 95 % CI: –0.26 to –0.06, p < 0.01) and high-density lipoprotein (0.06 mmol/L, 95 % CI: 0.00–0.12, p < 0.05). The subgroup analysis showed multidisciplinary collaboration was more effective in reducing cardiovascular risk factors when it comprised team members from a number of different disciplines, combined pharmacological and non-pharmacological components, included both face-to-face and remote interactions and was implemented in high-income countries.

Conclusion

Multidisciplinary collaborative care is associated with reduced cardiovascular risk factors among patients with diabetes in primary care. Further studies need to be conducted to determine the optimal team composition.

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来源期刊

Primary Care Diabetes ENDOCRINOLOGY & METABOLISM-PRIMARY HEALTH CARE

CiteScore

5.00

自引率

3.40%

发文量

134

审稿时长

47 days

期刊介绍： The journal publishes original research articles and high quality reviews in the fields of clinical care, diabetes education, nutrition, health services, psychosocial research and epidemiology and other areas as far as is relevant for diabetology in a primary-care setting. The purpose of the journal is to encourage interdisciplinary research and discussion between all those who are involved in primary diabetes care on an international level. The Journal also publishes news and articles concerning the policies and activities of Primary Care Diabetes Europe and reflects the society''s aim of improving the care for people with diabetes mellitus within the primary-care setting.