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目的病友健康辅导这种潜在的医疗模式可能会增强初级保健中糖尿病患者的自我管理能力。此随机对照试验将对临床病友健康辅导与常规照顾组进行对照研究,以验证病友健康辅导是否能改善低收入血糖控制不良患者的血糖控制。方法本研究为随机对照试验,入选患者源于旧金山6家诊所。选取23例糖化血红蛋白(HbA1c)水平<8.5%的患者参加36 h病友健康辅导培训,并成为病友健康辅导员。将同诊所HbA1c水平>8.0%的299例患者纳入研究,并随机分为病友健康辅导组(n=148)和常规照顾组(n=151)。主要结果为6个月时HbA1c水平改变值;次要结果为6个月时HbA1c水平下降≥1.0%的患者比例,及HbA1c水平<7.5%的患者比例。使用基线差值校正或非校正的混合线性模式进行数据分析。结果 6个月时,辅导组HbA1c水平下降1.07%,常规照顾组下降0.3%,两者差值为0.77%(校正后P=0.01)。HbA1c水平下降≥1.0%的患者比例:辅导组为49.6%,常规照顾组为31.5%(校正后P=0.001);6个月时,HbA1c水平<7.5%的患者比例:辅导组为22.0%,常规照顾组为14.9%(校正后P=0.04)。结论病友健康辅导项目使低收入初级保健患者的血糖控制得到了明显改善。
Aims This potential medical model of health counseling for patients may enhance the self-management skills of people with diabetes in primary care. This randomized, controlled trial will conduct a controlled study of clinical patient health counseling and general care to verify whether patient health counseling can improve glycemic control in low-income people with poor glycemic control. Methods This study was a randomized controlled trial of patients enrolled in six clinics in San Francisco. Twenty-three patients with HbA1c level <8.5% were enrolled in health counseling training for 36-h patients and became the health counselors of patients. A total of 299 patients with a HbA1c level of> 8.0% at the same clinic were included in the study and randomly assigned to receive either a patient’s health counseling group (n = 148) or a regular care group (n = 151). The primary outcome was a change in HbA1c level at 6 months; the secondary outcome was a proportion of patients with a HbA1c level decrease of> 1.0% at 6 months and a HbA1c level <7.5%. Data analysis was performed using baseline-corrected or non-corrected mixed linear models. Results At 6 months, HbA1c level decreased 1.07% in the counseling group and 0.3% in the routine care group, with a difference of 0.77% (adjusted P = 0.01). At 6 months, the proportion of patients with HbA1c levels <7.5% was 22.0% in the cohort, and the percentage of patients with HbA1c levels> 1.0% was 49.6% in the cohort and 31.5% in the routine care group (P = 0.001 after adjustment) The conventional care group was 14.9% (adjusted P = 0.04). Conclusion The patient counseling program has significantly improved glycemic control in low-income primary care patients.