WONCA研究论文摘要汇编——全科医学中的护士问诊与糖尿病控制:一项回顾性观察研究

发布时间：2018-11-07 21:27

【摘要】：背景英国有360万人患有糖尿病。既往研究表明,全科医生在更多护士的帮助下可以提供更优质的糖尿病治疗,但是关于患者特点或问诊的研究数据并不多见。目的探讨全科护士对糖尿病患者进行问诊的比例是否与以糖化血红蛋白(Hb A1c)水平为标准的糖尿病控制相关。设计与地点收集2002—2011年英国471家全科诊所的319 649例患者的问诊记录,进行回顾性观察研究。方法采用分级多层模型研究全科护士问诊比例与Hb A1c目标水平实现情况的关系,控制因素为病例组合和实践层面因素。结果 2002年以后,护士问诊比例提高了20%,但是2011年糖尿病患者年问诊量较2002年降低(11.6和16.0)。与2002年相比,2011年的血糖水平控制有所改善,控制目标实现情况更好。护士问诊比例高的诊所与护士问诊比例低的诊所的表现无差异{Hb A1c≤53 mmol/mol(7%),2002年OR=1.04〔95%CI(0.87,1.25)〕,2011年OR=0.95〔95%CI(0.87,1.03)〕;Hb A1c≤86 mmol/mol(10%),2002年OR=0.97〔95%CI(0.73,1.29)〕,2011年OR=0.95〔95%CI(0.86,1.04)〕}。结论以全科医生作为糖尿病治疗主力的诊所可以让护士接手更多相关治疗,如此可以释放更多重要资源且没有负面影响。
[Abstract]:Background 3.6 million people in the UK have diabetes. Previous studies have shown that general practitioners, with the help of more nurses, can provide better treatment for diabetes, but research data on patient characteristics or consultation are rare. Objective to investigate whether the proportion of general nurses asking for diabetes is related to the control of diabetes mellitus based on the level of glycosylated hemoglobin (Hb A1c). The design and location of 319,649 patients from 471 general clinics in England from 2002 to 2011 were collected for retrospective observation. Methods the multilevel hierarchical model was used to study the relationship between the proportion of general practice nurses and the achievement of Hb A1c target level. The control factors were case mix and practice level. Results after 2002, the proportion of nurses asked for consultation increased by 20 percent, but the annual number of patients with diabetes mellitus in 2011 was lower than that in 2002 (11.6 and 16.0). Compared with 2002, the control of blood glucose level in 2011 was improved and the control goal was achieved better. There was no difference between the clinic with high nurse consultation rate and the clinic with low nurse consultation ratio {Hb A1c 鈮，

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