当前位置: X-MOL 学术Diabetes Res. Clin. Pract. › 论文详情
Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)
Closing the indigenous health gap in Canada: Results from the TransFORmation of IndiGEnous PrimAry HEAlthcare delivery (FORGE AHEAD) program.
Diabetes Research and Clinical Practice ( IF 6.1 ) Pub Date : 2020-02-08 , DOI: 10.1016/j.diabres.2020.108066
Mariam Naqshbandi Hayward 1 , Romina Pace 2 , Harsh Zaran 3 , Roland Dyck 4 , Anthony J Hanley 5 , Michael E Green 6 , Onil Bhattacharyya 7 , Merrick Zwarenstein 3 , Joelle Emond 8 , Cynthia Benoit 9 , Marie L Jebb 10 , Stewart B Harris 3 ,
Affiliation  

AIMS TransFORmation of IndiGEnous PrimAry HEAlthcare Delivery (FORGE AHEAD) partnered with local clinical and community teams in 11 First Nations (FN) communities across Canada to develop quality improvement (QI) initiatives aimed at improving T2DM. METHODS Pre-post mixed-methods case study design was used. The 18-month intervention included community and clinical readiness, development of a community diabetes registry and clinical system, and QI activities. Participants consisted of community members, 18 yrs and older, with diabetes. Changes in clinical outcomes and clinical practice guideline (CPG) recommendations were assessed pre and post intervention using multilevel regression (patients nested within communities) adjusted forindividual andcommunity baseline characteristics. RESULTS No significant change in HbA1c orsBP, but a small reduction indBP(-0.75 mmHg, p < 0.05) and LDL (-0.09 mmol/L, p < 0.05) was observed in 2008 adults with T2DM (mean age: 60·5 (SD:14·6) years; female: 57·2%). Individuals not at CPG targets at baseline had significant reductions in: %HbA1c (N = 616): -0.40 (95%CI:-0·55,-0·24),sBP (N = 561): -7·67 mmHg (95%CI:-9·23, -5·72),dBP (N = 291): -7·46 mmHg (95%CI:-8·69, -6·26), LDL (N = 450): -0·37mmo/l (95%CI:-0·44, -0·29).Annual HbA1c (OR: 1·95; 95%CI:1·66, 2·29), BP (OR: 1·78; 95%CI:1·52, 2·09), LDL (OR: 1·27; 95%CI:1·10, 1·47) and CKD screening (OR: 6·37; 95%CI:5·16, 7·92)increased but retinopathy screening decreased (OR: 0·68; 95%CI:0·57, 0·82). No significant change in foot exams (OR: 0·97; 95%CI:0·76, 1·23) or BMI recordings (OR: 0·96; 95%CI:0·82, 1·12) was seen. Overall, individualsweremorelikely to receive ≥75% of CPG recommended services compared to baseline (OR: 1·51; 95%CI:1·27, 1·80). CONCLUSIONS FORGE AHEAD is the first Canadian study to demonstrate that a FN community-led QI intervention can lead to diabetes improvements.

中文翻译:

缩小加拿大的本地卫生差距:土著初级保健医疗服务转型计划(FORGE AHEAD)的成果。

AIMS改造原始初级保健交付服务(FORGE AHEAD)与加拿大11个原住民(FN)社区的当地临床和社区团队合作,制定旨在改善T2DM的质量改进(QI)计划。方法采用事后混合方法案例研究设计。为期18个月的干预包括社区和临床准备情况,社区糖尿病登记和临床系统的开发以及QI活动。参与者包括年龄在18岁以上且患有糖尿病的社区成员。使用针对个体和社区基线特征进行调整的多层回归(患者嵌套在社区中)对干预前后的临床结局和临床实践指南(CPG)建议的变化进行评估。结果HbA1c orsBP没有明显变化,但是在2008年患有T2DM的成年人(平均年龄:60·5(SD:14·6)岁)中,indBP(-0.75 mmHg,p <0.05)和LDL(-0.09 mmol / L,p <0.05)有少量降低;女性:57·2%)。基线时未达到CPG指标的个体显着降低:%HbA1c(N = 616):-0.40(95%CI:-0·55,-0·24),sBP(N = 561):-7·67 mmHg (95%CI:-9·23,-5·72),dBP(N = 291):-7·46 mmHg(95%CI:-8·69,-6·26),LDL(N = 450) :-0·37mmo / l(95%CI:-0·44,-0·29)。年度HbA1c(OR:1·95; 95%CI:1·66,2·29),BP(OR:1 ·78; 95%CI:1·52,2·09),LDL(OR:1·27; 95%CI:1·10,1·47)和CKD筛查(OR:6·37; 95%CI: 5·16、7·92)升高,但视网膜病变筛查减少(OR:0·68; 95%CI:0·57,0·82)。脚部检查(OR:0·97; 95%CI:0·76,1·23)或BMI记录(OR:0·96; 95%CI:0·82,1·12)未见明显变化。总体,与基线相比,个人更有可能获得≥75%的CPG推荐服务(OR:1·51; 95%CI:1·27、1·80)。结论FORge AHEAD是加拿大第一项证明FN社区主导的QI干预可改善糖尿病的研究。
更新日期:2020-02-10
down
wechat
bug