Bethany M Kwan, L Miriam Dickinson, Jennifer Dailey-Vail, Russell E Glasgow, R Mark Gritz, Dennis Gurfinkel, Christina M Hester, Jodi Summers Holtrop, Patrick Hosokawa, Angela Lanigan, Donald E Nease, Andrea Nederveld, Phoutdavone Phimphasone-Brady, Natalie D Ritchie, Martha Sajatovic, Robyn Wearner, Anowara Begum, Madelaine Carter, Thomas Carrigan, Barbara Clay, David Downey, Ramona Koren, Sharon A Trujillo, Jeanette A Waxmonsky
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Comparative effectiveness of SMA delivery features such as topic choice, multi-disciplinary care teams, and peer mentor involvement is not known.</p><p><strong>Objective: </strong>To compare effects of standardized and patient-driven models of diabetes SMAs on patient-level diabetes outcomes.</p><p><strong>Design: </strong>Pragmatic cluster randomized trial.</p><p><strong>Participants: </strong>A total of 1060 adults with type 2 diabetes in 22 primary care practices.</p><p><strong>Interventions: </strong>Practice personnel delivered the 6-session Targeted Training in Illness Management (TTIM) curriculum using either standardized (set content delivered by a health educator) or patient-driven SMAs (patient-selected topic order delivered by health educators, behavioral health providers [BHPs], and peer mentors).</p><p><strong>Main measures: </strong>Outcomes included self-reported diabetes distress and diabetes self-care behaviors from baseline and follow-up surveys (assessed at 1st and final SMA session), and HbA1c, BMI, and blood pressure from electronic health records. Analyses used descriptive statistics, linear regression, and linear mixed models.</p><p><strong>Key results: </strong>Both standardized and patient-driven SMAs effectively improved diabetes distress, self-care behaviors, BMI (- 0.29 on average), and HbA1c (- 0.45% (mmol/mol) on average, 8.3 to 7.8%). Controlling for covariates, there was a small, significant effect of condition on overall diabetes distress in favor of standardized SMAs (F(1,841) = 4.3, p = .04), attributable to significant effects of condition on emotion and regimen distress subscales. There was a small, significant effect of condition on diastolic blood pressure in favor of standardized SMAs (F(1,5199) = 4.50, p = .03). There were no other differences between conditions.</p><p><strong>Conclusions: </strong>Both SMA models using the TTIM curriculum yielded significant improvement in diabetes distress, self-care, and HbA1c. 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引用次数: 0
摘要
背景：糖尿病自我管理教育和支持可以通过共享医疗预约（SMA）的形式在初级保健中有效、高效地进行。目前尚不清楚共享医疗预约（SMA）的实施特点（如主题选择、多学科护理团队和同伴导师参与）的比较效果：比较糖尿病 SMA 的标准化模式和患者主导模式对患者糖尿病治疗效果的影响：设计：实用分组随机试验：干预措施：干预措施：业务人员采用标准化（由健康教育者提供固定内容）或患者驱动的SMA（由健康教育者、行为健康提供者[BHPs]和同伴指导者提供患者自选的主题顺序）提供为期6个疗程的疾病管理目标培训（TTIM）课程：结果包括基线调查和随访调查中自我报告的糖尿病困扰和糖尿病自我护理行为（在第一次和最后一次 SMA 课程中进行评估），以及电子健康记录中的 HbA1c、BMI 和血压。分析采用了描述性统计、线性回归和线性混合模型：主要结果：标准化和患者驱动的 SMA 均有效改善了糖尿病困扰、自我护理行为、体重指数（平均-0.29）和 HbA1c（平均-0.45%（mmol/mol），8.3%降至 7.8%）。控制协变量后，条件对总体糖尿病困扰的影响较小且显著，有利于标准化 SMAs（F(1,841) = 4.3，p = .04），这归因于条件对情绪和疗程困扰分量表的显著影响。在舒张压方面，条件对标准化 SMA 的影响较小且显著（F(1,5199) = 4.50，p = .03）。结论：结论：使用 TTIM 课程的两种 SMA 模式都能显著改善糖尿病患者的困扰、自我护理和 HbA1c。由必发365电子游戏轻人和同伴指导者参与的患者驱动型糖尿病SMA与健康教育者按照设定的主题顺序促进的标准化糖尿病SMA相比，并没有带来更好的临床或患者报告结果：NCT03590041。
Comparative Effectiveness of Patient-Driven versus Standardized Diabetes Shared Medical Appointments: A Pragmatic Cluster Randomized Trial.
Background: Diabetes self-management education and support can be effectively and efficiently delivered in primary care in the form of shared medical appointments (SMAs). Comparative effectiveness of SMA delivery features such as topic choice, multi-disciplinary care teams, and peer mentor involvement is not known.
Objective: To compare effects of standardized and patient-driven models of diabetes SMAs on patient-level diabetes outcomes.
Design: Pragmatic cluster randomized trial.
Participants: A total of 1060 adults with type 2 diabetes in 22 primary care practices.
Interventions: Practice personnel delivered the 6-session Targeted Training in Illness Management (TTIM) curriculum using either standardized (set content delivered by a health educator) or patient-driven SMAs (patient-selected topic order delivered by health educators, behavioral health providers [BHPs], and peer mentors).
Main measures: Outcomes included self-reported diabetes distress and diabetes self-care behaviors from baseline and follow-up surveys (assessed at 1st and final SMA session), and HbA1c, BMI, and blood pressure from electronic health records. Analyses used descriptive statistics, linear regression, and linear mixed models.
Key results: Both standardized and patient-driven SMAs effectively improved diabetes distress, self-care behaviors, BMI (- 0.29 on average), and HbA1c (- 0.45% (mmol/mol) on average, 8.3 to 7.8%). Controlling for covariates, there was a small, significant effect of condition on overall diabetes distress in favor of standardized SMAs (F(1,841) = 4.3, p = .04), attributable to significant effects of condition on emotion and regimen distress subscales. There was a small, significant effect of condition on diastolic blood pressure in favor of standardized SMAs (F(1,5199) = 4.50, p = .03). There were no other differences between conditions.
Conclusions: Both SMA models using the TTIM curriculum yielded significant improvement in diabetes distress, self-care, and HbA1c. Patient-driven diabetes SMAs involving BHPs and peer mentors and topic selection did not lead to better clinical or patient-reported outcomes than standardized diabetes SMAs facilitated by a health educator following a set topic order.
期刊介绍：
The Journal of General Internal Medicine is the official journal of the Society of General Internal Medicine. It promotes improved patient care, research, and education in primary care, general internal medicine, and hospital medicine. Its articles focus on topics such as clinical medicine, epidemiology, prevention, health care delivery, curriculum development, and numerous other non-traditional themes, in addition to classic clinical research on problems in internal medicine.
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