【摘要】：背景英國有360萬人患有糖尿病。既往研究表明,全科醫(yī)生在更多護(hù)士的幫助下可以提供更優(yōu)質(zhì)的糖尿病治療,但是關(guān)于患者特點(diǎn)或問診的研究數(shù)據(jù)并不多見。目的探討全科護(hù)士對(duì)糖尿病患者進(jìn)行問診的比例是否與以糖化血紅蛋白(Hb A1c)水平為標(biāo)準(zhǔn)的糖尿病控制相關(guān)。設(shè)計(jì)與地點(diǎn)收集2002—2011年英國471家全科診所的319 649例患者的問診記錄,進(jìn)行回顧性觀察研究。方法采用分級(jí)多層模型研究全科護(hù)士問診比例與Hb A1c目標(biāo)水平實(shí)現(xiàn)情況的關(guān)系,控制因素為病例組合和實(shí)踐層面因素。結(jié)果 2002年以后,護(hù)士問診比例提高了20%,但是2011年糖尿病患者年問診量較2002年降低(11.6和16.0)。與2002年相比,2011年的血糖水平控制有所改善,控制目標(biāo)實(shí)現(xiàn)情況更好。護(hù)士問診比例高的診所與護(hù)士問診比例低的診所的表現(xiàn)無差異{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)〕}。結(jié)論以全科醫(yī)生作為糖尿病治療主力的診所可以讓護(hù)士接手更多相關(guān)治療,如此可以釋放更多重要資源且沒有負(fù)面影響。
[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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