Improvements in patient-reported outcomes associated with an intervention to enhance qualify of care for rural patients with type 2 diabetes - Results of a controlled trial

被引:42
作者
Maddigan, SL
Majumdar, SR
Guirguis, LM
Lewanczuk, RZ
Lee, TK
Toth, EL
Johnson, JA
机构
[1] Inst Hlth Econ, Edmonton, AB T5J 3N4, Canada
[2] Grey Nuns Hosp, Dept Med, Edmonton, AB, Canada
[3] Univ Alberta, Div Pulm Med, Edmonton, AB, Canada
[4] Univ Alberta, Div Endocrinol & Metab, Edmonton, AB, Canada
[5] Univ Alberta, Dept Med, Div Gen Internal Med, Edmonton, AB, Canada
关键词
D O I
10.2337/diacare.27.6.1306
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVE - The aim of this study was to examine patient-reported outcomes in a controlled trial of a multifaceted provider-level intervention to improve duality of care for rural patients with type 2 diabetes. RESEARCH DESIGN AND METHODS - We conducted a before/after intervention study with concurrent controls in two rural regions in Alberta, Canada. The intervention consisted of six monthly visits by a multidisciplinary health care team and was primarily directed at primary care providers. Clinical and patient-reported outcomes were assessed after 6 months. Patient-reported Outcomes included changes in health-related quality of life (Health Utilities Index Mark 3 [HUI3]), satisfaction with care, lifestyle (Diabetes Lifestyle Form), and adherence to self-care activities. Analysis of covariance was used to assess differences over time between the control and intervention regions. RESULTS - A total of 200 intervention and 172 control subjects were included in this analysis. After adjusting for important clinical and demographic differences, a statistically significant and clinically important improvement in the overall HUI3 score was seen at the 6-month follow-up in the intervention region (0.06 [95% CI 0.02-0.10]) compared with the control region (0.01 [-0.04 to 0.04]) (P = 0.03 for the difference between groups). Satisfaction with general medical care (P < 0.001 between groups) and diabetes care (P < 0.001 between groups) increased among patients in the intervention region compared with the control region. Self-efficacy, attitudes, and beliefs about diabetes control all increased in the intervention region when compared with the control region, but adherence to self-care activities did not. CONCLUSIONS - A provider-level intervention directed at improving quality of clinical care for patients with type 2 diabetes also had a favorable impact on overall health-related quality of life, satisfaction with care, and other humanistic outcomes.
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收藏
页码:1306 / 1312
页数:7
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