多学科主动电子会诊改善糖尿病和慢性肾病患者的指南指导医疗疗法:一项实施研究

IF 3.7 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM BMJ Open Diabetes Research & Care Pub Date : 2024-05-01 DOI:10.1136/bmjdrc-2024-004155
Sharon Rikin, Laurie Bauman, Ivelina Arnaoudova, Katherine DiPalo, Nisha Suda, Sonali Gupta, Yuting Deng, Ladan Golestaneh
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MPE included (1) a dashboard to identify patients without a prescription for sodium-glucose cotransporter-2 inhibitors (SGLT2i) and without a maximum dose prescription for renin–angiotensin–aldosterone system inhibitors (RAASi), (2) a multidisciplinary team of specialists to provide recommendations using e-consult templates, and (3) a workflow to deliver timely e-consult recommendations to PCPs. In-depth interviews were conducted with PCPs and specialists to assess feasibility, acceptability, and appropriateness of MPE and were analyzed using an iterative qualitative analysis approach to identify major themes. Prescription data were extracted from the electronic health record to assess preliminary effectiveness to increase GDMT. Results 20 PCPs agreed to participate, 18 PCPs received MPEs for one of their patients with T2D and CKD, and 16 PCPs and 2 specialists were interviewed. 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引用次数: 0

摘要

引言 我们假设,多学科、主动式电子会诊(MPE)可以克服 2 型糖尿病(T2D)和慢性肾脏病(CKD)患者在开具指南指导的医学疗法(GDMT)处方时遇到的障碍。研究设计与方法 我们在一个学术医疗系统开展了一项针对 T2D 和 CKD 的 MPE 的试点研究,研究对象是初级保健提供者(PCP)- 患者二人组。MPE 包括:(1)一个仪表板,用于识别未开具钠-葡萄糖共转运体-2 抑制剂(SGLT2i)处方和未开具肾素-血管紧张素-醛固酮系统抑制剂(RAASi)最大剂量处方的患者;(2)一个多学科专家团队,使用电子会诊模板提供建议;(3)一个向初级保健医生及时提供电子会诊建议的工作流程。对初级保健医生和专家进行了深入访谈,以评估 MPE 的可行性、可接受性和适当性,并采用迭代定性分析方法进行分析,以确定主要主题。从电子健康记录中提取处方数据,以评估增加 GDMT 的初步效果。结果 20 名初级保健医生同意参与,18 名初级保健医生为其一名患有 T2D 和 CKD 的患者接受了 MPE,16 名初级保健医生和 2 名专家接受了访谈。主要议题如下:T2D 和 CKD GDMT 优先级的适当性、建议内容的可接受性、PCP 特征对 MPE 经验的影响、多学科合作的可接受性和适当性、MPE 克服患者特定 GDMT 障碍的可行性以及工作流程的适当性。在基线后 6 个月,7/18(39%)名患者新处方了 SGLT2i,7/18(39%)名患者新处方或增加了 RAASi 的剂量。结论 MPE 是一种可接受的、适当的医疗系统策略,可用于识别和解决 T2D 和 CKD 患者的 GDMT 差距。采用 MPE 可加强 GDMT,但初级保健医生也提出了可行性问题,这些问题可通过改进计划加以解决,包括加强后续电子咨询,以及为克服系统层面的障碍提供行政支持。可根据合理要求提供数据。可向通讯作者索取去身份化的参与者数据。
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Multidisciplinary proactive e-consults to improve guideline-directed medical therapies for patients with diabetes and chronic kidney disease: an implementation study
Introduction We hypothesized that multidisciplinary, proactive electronic consultation (MPE) could overcome barriers to prescribing guideline-directed medical therapies (GDMTs) for patients with type 2 diabetes (T2D) and chronic kidney disease (CKD). Research design and methods We conducted an efficacy-implementation pilot study of MPE for T2D and CKD for primary care provider (PCP)–patient dyads at an academic health system. MPE included (1) a dashboard to identify patients without a prescription for sodium-glucose cotransporter-2 inhibitors (SGLT2i) and without a maximum dose prescription for renin–angiotensin–aldosterone system inhibitors (RAASi), (2) a multidisciplinary team of specialists to provide recommendations using e-consult templates, and (3) a workflow to deliver timely e-consult recommendations to PCPs. In-depth interviews were conducted with PCPs and specialists to assess feasibility, acceptability, and appropriateness of MPE and were analyzed using an iterative qualitative analysis approach to identify major themes. Prescription data were extracted from the electronic health record to assess preliminary effectiveness to increase GDMT. Results 20 PCPs agreed to participate, 18 PCPs received MPEs for one of their patients with T2D and CKD, and 16 PCPs and 2 specialists were interviewed. Major themes were as follows: appropriateness of prioritization of GDMT for T2D and CKD, acceptability of the content of the recommendations, PCP characteristics impact experience with MPE, acceptability and appropriateness of multidisciplinary collaboration, feasibility of MPE to overcome patient-specific barriers to GDMT, and appropriateness of workflow. At 6 months postbaseline, 7/18 (39%) patients were newly prescribed an SGLT2i, and 7/18 (39%) patients were either newly prescribed or had increased dose of RAASi. Conclusions MPE was an acceptable and appropriate health system strategy to identify and address gaps in GDMT among patients with T2D and CKD. Adopting MPE could enhance GDMT, though PCPs raised feasibility concerns which could be improved with program enhancements, including follow-up e-consults for reinforcement, and administrative support for navigating system-level barriers. Data are available upon reasonable request. Deidentified participant data are available upon request from the corresponding author.
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来源期刊
BMJ Open Diabetes Research & Care
BMJ Open Diabetes Research & Care Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
9.30
自引率
2.40%
发文量
123
审稿时长
18 weeks
期刊介绍: BMJ Open Diabetes Research & Care is an open access journal committed to publishing high-quality, basic and clinical research articles regarding type 1 and type 2 diabetes, and associated complications. Only original content will be accepted, and submissions are subject to rigorous peer review to ensure the publication of high-quality — and evidence-based — original research articles.
期刊最新文献
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