决策辅助工具在老年2型糖尿病患者用药决策中的应用进展

doi:10.12114/j.issn.1007-9572.2023.0861

中国全科医学 ›› 2024, Vol. 27 ›› Issue (24): 3061-3066.DOI: 10.12114/j.issn.1007-9572.2023.0861

决策辅助工具在老年2型糖尿病患者用药决策中的应用进展

戴香桂¹, 李珍², 李萱¹, 张斯齐³, 刘东玲⁴, 秦月兰⁵^,^*()

1．410005　湖南省长沙市，湖南师范大学附属第一医院　湖南省人民医院护理部
2．410005　湖南省长沙市，湖南省人民医院　湖南师范大学附属第一医院老年科一病区
3．410005　湖南省长沙市，湖南省人民医院　湖南师范大学附属第一医院骨科二病区
4．410005　湖南省长沙市，湖南省人民医院　湖南师范大学附属第一医院消毒供应中心
5．410005　湖南省长沙市，湖南省人民医院　湖南师范大学附属第一医院院办

收稿日期:2023-11-10 修回日期:2024-01-10 出版日期:2024-08-20 发布日期:2024-01-16
通讯作者: 秦月兰
作者贡献：
戴香桂、李珍、秦月兰提出论文写作思路，负责撰写论文和论文修订；戴香桂、李珍、李萱负责制订检索策略、收集与整理文献；李珍、张斯齐、刘东玲负责论文的修订、文章的质量控制及审校；秦月兰对文章整体负责、监督管理。
基金资助:
湖南省卫生健康委科研计划项目(202114052157)

Research Progress on Application of Patient Decision Aid in the Medication of Elderly Patients with Type 2 Diabetes

DAI Xianggui¹, LI Zhen², LI Xuan¹, ZHANG Siqi³, LIU Dongling⁴, QIN Yuelan⁵^,^*()

1. Nursing Department, the First Affiliated Hospital of Hunan Normal University/Hunan Provincial People's Hospital, Changsha 410005, China
2. Geriatric Ward 1, Hunan Provincial People's Hospital/the First Affiliated Hospital of Hunan Normal University, Changsha 410005, China
3. Orthopedic Ward 2, Hunan Provincial People's Hospital/the First Affiliated Hospital of Hunan Normal University, Changsha 410005, China
4. Disinfection Supply Center, Hunan Provincial People's Hospital/the First Affiliated Hospital of Hunan Normal University, Changsha 410005, China
5. Hospital Office, Hunan Provincial People's Hospital/the First Affiliated Hospital of Hunan Normal University, Changsha 410005, China

Received:2023-11-10 Revised:2024-01-10 Published:2024-08-20 Online:2024-01-16
Contact: QIN Yuelan

分享到

摘要/Abstract

摘要： 老年2型糖尿病患者常面临多病共存和多重用药的问题，这些情况常导致用药不合理或不适当，显著影响了患者的治疗效果和生活质量，因此早期进行有效的药物治疗决策尤为重要。而决策辅助工具作为用药支持信息的重要补充，包括基于电子健康记录的系统、移动应用程序、在线健康平台等，通过提供个性化、基于证据的医疗信息，以帮助患者了解用药治疗方案，辅助患者和医疗专业人员做出更合理的药物治疗决策，提升药物治疗的适宜性和安全性，降低药物相互作用的风险，从而改善患者的整体治疗效果和生活质量，已在老年2型糖尿病患者用药管理中的应用取得了显著进展。本文综述了老年2型糖尿病患者用药的现状，决策辅助工具的影响因素、类型、应用方法及其作用，旨在为国内开发针对这一人群的用药决策辅助工具提供参考。

关键词: 糖尿病，2型, 老年人, 用药审查, 用药决策, 决策辅助工具

Abstract:

Elderly patients with type 2 diabetes mellitus often face the problems of multimorbidity and multiple medications, and these conditions often lead to irrational or inappropriate medication use, significantly affecting patient outcomes and quality of life, making early and effective medication decisions particularly important. As an important supplement to medication support information, decision support tools, including electronic health record-based systems, mobile applications, online health platforms, etc., provide personalized, evidence-based medical information to help patients understand medication regimens, assist patients and healthcare professionals in making more rational medication decisions, enhance the appropriateness and safety of medication, and reduce the risk of drug interactions, thereby improving the overall treatment of patients and reducing the risk of drug interactions. The application of medication management in elderly patients with type 2 diabetes mellitus has made significant progress, thus improving the overall outcome and quality of life of patients. This article summarizes the current situation of medication use in elderly patients with type 2 diabetes mellitus, the influencing factors, types, application methods and their roles of decision aids, aiming to provide reference for the development of medication decision aids for this population in China.

Key words: Diabetes mellitus, type 2, Aged, Medication review, Medication decision-making, Decision support tools

中图分类号:

R 587.1

戴香桂,李珍,李萱,等. 决策辅助工具在老年2型糖尿病患者用药决策中的应用进展[J]. 中国全科医学, 2024, 27(24): 3061-3066. DOI: 10.12114/j.issn.1007-9572.2023.0861.
DAI Xianggui,LI Zhen,LI Xuan, et al. Research Progress on Application of Patient Decision Aid in the Medication of Elderly Patients with Type 2 Diabetes[J]. Chinese General Practice, 2024, 27(24): 3061-3066. DOI: 10.12114/j.issn.1007-9572.2023.0861.

参考文献 42

[1]	GBD Diabetes Collaborators. Global，regional，and national burden of diabetes from 1990 to 2021，with projections of prevalence to 2050：a systematic analysis for the Global Burden of Disease Study 2021[J]. Lancet，2023，402（10397）：203-234. DOI：10.1016/S0140-6736(23)01301-6.
[2]	MARTINEZ R，LLOYD-SHERLOCK P，SOLIZ P，et al. Trends in premature avertable mortality from non-communicable diseases for 195 countries and territories，1990-2017：a population-based study[J]. Lancet Glob Health，2020，8（4）：e511-523. DOI：10.1016/S2214-109X(20)30035-8.
[3]	国家统计局，国务院第七次全国人口普查领导小组办公室. 第七次全国人口普查公报（第一号）——第七次全国人口普查工作基本情况[J]. 中国统计，2021（5）：6-7.
[4]	LI Y Z，TENG D，SHI X G，et al. Prevalence of diabetes recorded in mainland China using 2018 diagnostic criteria from the American Diabetes Association：national cross sectional study[J]. BMJ，2020，369：m997. DOI：10.1136/bmj.m997.
[5]	《中国老年型糖尿病防治临床指南》编写组. 中国老年2型糖尿病防治临床指南（2022年版）[J]. 中国糖尿病杂志，2022，30（1）：2-51. DOI：10.3969/j.issn.1006-6187.2022.01.002.
[6]	WILLIAMS D M，JONES H，STEPHENS J W. Personalized type 2 diabetes management：an update on recent advances and recommendations[J]. Diabetes Metab Syndr Obes，2022，15：281-295. DOI：10.2147/DMSO.S331654.
[7]	BAILEY R A，PFEIFER M，SHILLINGTON A C，et al. Effect of a patient decision aid （PDA） for type 2 diabetes on knowledge，decisional self-efficacy，and decisional conflict[J]. BMC Health Serv Res，2016，16：10. DOI：10.1186/s12913-016-1262-4.
[8]	冯小萌，邹郁松. 糖尿病患者对医患共同决策辅助工具态度的研究[J]. 医学与哲学，2021，42（10）：62-66. DOI：10.12014/j.issn.1002-0772.2021.10.14.
[9]	DANNER M，DEBROUWERE M，RUMMER A，et al. A scattered landscape：assessment of the evidence base for 71 patient decision aids developed in a hospital setting[J]. BMC Med Inform Decis Mak，2022，22（1）：44. DOI：10.1186/s12911-022-01777-x.
[10]	YU C H，MCCANN M，SALE J. "In my age，we didn't have the computers" ：using a complexity lens to understand uptake of diabetes eHealth innovations into primary care-a qualitative study[J]. PLoS One，2021，16（7）：e0254157. DOI：10.1371/journal.pone.0254157.
[11]	YEN R W，SMITH J，ENGEL J，et al. A systematic review and meta-analysis of patient decision aids for socially disadvantaged populations：update from the international patient decision aid standards （IDPAS）[J]. Med Decis Making，2021，41（7）：870-896. DOI：10.1177/0272989X211020317.
[12]	American Diabetes Association Professional Practice Committee. 13. older adults：standards of medical care in diabetes-2022[J]. Diabetes Care，2022，45（Suppl 1）：S195-207. DOI：10.2337/dc22-S013.
[13]	ARAUNA D，CERDA A，GARCÍA-GARCÍA J F，et al. Polypharmacy is associated with frailty，nutritional risk and chronic disease in Chilean older adults：remarks from PIEI-ES study[J]. Clin Interv Aging，2020，15：1013-1022. DOI：10.2147/CIA.S247444.
[14]	陈晓敏，张丽娜，李友佳. 高龄老年2型糖尿病患者多重用药特点分析[J]. 中国全科医学，2023，26（10）：1271-1277. DOI：10.12114/j.issn.1007-9572.2022.0536.
[15]	TANG J，WANG K，YANG K，et al. A combination of Beers and STOPP criteria better detects potentially inappropriate medications use among older hospitalized patients with chronic diseases and polypharmacy：a multicenter cross-sectional study[J]. BMC Geriatr，2023，23（1）：44. DOI：10.1186/s12877-023-03743-2.
[16]	LEE S，JIANG L H，DOWDY D，et al. Effects of the Chronic Disease Self-Management Program on medication adherence among older adults[J]. Transl Behav Med，2019，9（2）：380-388. DOI：10.1093/tbm/iby057.
[17]	LIM L M，MCSTEA M，CHUNG W W，et al. Prevalence，risk factors and health outcomes associated with polypharmacy among urban community-dwelling older adults in multi-ethnic Malaysia[J]. PLoS One，2017，12（3）：e0173466. DOI：10.1371/journal.pone.0173466.
[18]	ELLIOTT R，PHARMACIST C，HEALTH A. Problems with medication use in the elderly：an Australian perspective[J].Journal of Pharmacy Practice and Research，2006，36（1）：58-66. DOI：10.1002/j.2055-2335.2006.tb00889.x.
[19]	刘国珍，薛承斌，丁玉峰，等. 湖北某高校社区居民安全用药现状调查以及用药风险因素分析[J]. 中国医院药学杂志，2021，41（17）：1795-1800. DOI：10.13286/j.1001-5213.2021.17.18.
[20]	STACEY D，LÉGARÉ F，COLNF K，et al. Decision aids for people facing health treatment or screening decisions[J]. Cochrane Database Syst Rev，2017，4（4）：CD001431.
[21]	LARSEN K，AKINDELE B，HEAD H，et al. Developing a user-centered digital clinical decision support app for evidence-based medication recommendations for type 2 diabetes mellitus：prototype user testing and validation study[J]. JMIR Hum Factors，2022，9（1）：e33470. DOI：10.2196/33470.
[22]	ERTUĞRUL D Ç，AKCAN N，BITIRIM Y，et al. A knowledge-based decision support system for inferring supportive treatment recommendations for diabetes mellitus[J]. Technol Health Care，2023，31（6）：2279-2302. DOI：10.3233/THC-230237.
[23]	CHARPENTIER P A，MECCA M C，BRANDT C，et al. Development of REDCap-based architecture for a clinical decision support tool linked to the electronic health record for assessment of medication appropriateness[J]. JAMIA Open，2023，6（2）：ooad041. DOI：10.1093/jamiaopen/ooad041.
[24]	MAIERHÖFER S，WALTERING I，JACOBS M，et al. Decision support software-guided medication reviews in elderly patients with polypharmacy：a prospective analysis of routine data from community pharmacies （OPtiMed study protocol）[J]. J Pharm Policy Pract，2022，15（1）：100. DOI：10.1186/s40545-022-00495-z.
[25]	MACALALAD-JOSUE A A，PALILEO-VILLANUEVA L A，SANDOVAL M A，et al. Development of a patient decision aid on the choice of diabetes medication for Filipino patients with type 2 diabetes mellitus[J]. J ASEAN Fed Endocr Soc，2019，34（1）：44-55. DOI：10.15605/jafes.034.01.08.
[26]	王天琳，宗航帆，曹丰，等. 老年慢病患者用药风险的影响因素分析[J]. 中国慢性病预防与控制，2023，31（7）：489-493. DOI：10.16386/j.cjpccd.issn.1004-6194.2023.07.003.
[27]	SCHMIDT N E，STEFFEN A，MEUSER T M. Impairment for medication management in older adults：validity of a family report measure[J]. Clin Gerontol，2020，43（3）：350-362.
[28]	GENCH M，SAWAN M J，LANGFORD A，et al. Tools to evaluate medication management for caregivers of people living with dementia：a systematic review[J]. Health Expect，2021，24（5）：1570-1581. DOI：10.1111/hex.13318.
[29]	VANDYKE M M，STEFFEN A M. Medication saving behaviors of older adults：scale developed to assess family caregiver perspectives[J]. Clin Gerontol，2017，40（4）：258-267.
[30]	RUISSEN M M，SONT J K，VAN VUGT H A，et al. Key factors relevant for healthcare decisions of patients with type 1 and type 2 diabetes in secondary care according to healthcare professionals[J]. Patient Prefer Adherence，2022，16：809-819. DOI：10.2147/PPA.S354686.
[31]	BRESLIN M，MULLAN R J，MONTORI V M. The design of a decision aid about diabetes medications for use during the consultation with patients with type 2 diabetes[J]. Patient Educ Couns，2008，73（3）：465-472. DOI：10.1016/j.pec.2008.07.024.
[32]	WALKER R J，GEBREGZIABHER M，MARTIN-HARRIS B，et al. Understanding the influence of psychological and socioeconomic factors on diabetes self-care using structured equation modeling[J]. Patient Educ Couns，2015，98（1）：34-40.
[33]	YU C，CHOI D，BRUNO B A，et al. Impact of MyDiabetesPlan，a web-based patient decision aid on decisional conflict，diabetes distress，quality of life，and chronic illness care in patients with diabetes：cluster randomized controlled trial[J]. J Med Internet Res，2020，22（9）：e16984. DOI：10.2196/16984.
[34]	KANAZAWA A，FUJIBAYASHI K，WATANABE Y，et al. Evaluation of a medical interview-assistance system using artificial intelligence for resident physicians interviewing simulated patients：a crossover，randomized，controlled trial[J]. Int J Environ Res Public Health，2023，20（12）：6176. DOI：10.3390/ijerph20126176.
[35]	SUTTON R T，PINCOCK D，BAUMGART D C，et al. An overview of clinical decision support systems：benefits，risks，and strategies for success[J]. NPJ Digit Med，2024. DOI：10.1038/s41746-020-0221-y.
[36]	CROWLEY E K，SALLEVELT B T G M，HUIBERS C J A，et al. Intervention protocol：OPtimising thERapy to prevent avoidable hospital Admission in the Multi-morbid elderly （OPERAM）：a structured medication review with support of a computerised decision support system[J]. BMC Health Serv Res，2020，20（1）：220. DOI：10.1186/s12913-020-5056-3.
[37]	JUSTINIA T，QATTAN W，ALMENHALI A，et al. Medication errors and patient safety：evaluation of physicians' responses to medication-related alert overrides in clinical decision support systems[J]. Acta Inform Med，2021，29（4）：248-252. DOI：10.5455/aim.2021.29.248-252.
[38]	TAMURA Y，OMURA T，TOYOSHIMA K，et al.Nutrition management in older adults with diabetes：a revie w on the importance of shifting prevention strategies from metabolic syndrome to frailty[J]. Nutrients，2020，12（11）：E3367. DOI：0.3390/nu12113367.
[39]	TAN N C，KOONG YING LENG A，PHOON KWONG YUN I，et al. Cultural adaptation of a patient decision-aid for insulin therapy[J]. BMJ Open，2020，10（3）：e033791.
[40]	HOEFEL L，O'CONNOR A M，LEWIS K B，et al. 20th anniversary update of the Ottawa decision support framework part 1：a systematic review of the decisional needs of people making health or social decisions[J]. Med Decis Making，2020，40（5）：555-581. DOI：10.1177/0272989X20936209.
[41]	KANAZAWA A，FUJIBAYASHI K，WATANABE Y，et al. Evaluation of a medical interview-assistance system using artificial intelligence for resident physicians interviewing simulated patients：a crossover，randomized，controlled trial[J]. Int J Environ Res Public Health，2023，20（12）：6176. DOI：10.3390/ijerph20126176.
[42]	NASSAR C M，DUNLEA R，MONTERO A，et al. Feasibility and preliminary behavioral and clinical efficacy of a diabetes education chatbot pilot among adults with type 2 diabetes[J]. J Diabetes Sci Technol，2023：19322968231178020. DOI：10.1177/19322968231178020.

决策辅助工具在老年2型糖尿病患者用药决策中的应用进展

Research Progress on Application of Patient Decision Aid in the Medication of Elderly Patients with Type 2 Diabetes

RichHTML

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献 42

相关文章 15

编辑推荐

Metrics

留言

[1]	陈领, 孔晓明, 孙艳, 洪虹, 张丽. 合并亚临床甲状腺功能减退老年抑郁症住院患者的临床特征分析[J]. 中国全科医学, 2024, 27(24): 2982-2986.
[2]	姜荣生, 张龙, 管其凡, 张静, 吴元丰, 刘明军. 短链脂肪酸在2型糖尿病中的作用研究进展[J]. 中国全科医学, 2024, 27(24): 3031-3037.
[3]	李航, 侯朝铭, 高静, 傅涵, 杨青, 刘欢乐. 基于COSMIN指南对老年人社会衰弱评估工具的系统评价[J]. 中国全科医学, 2024, 27(24): 3067-3068.
[4]	刘晓罡, 杨世诚, 付乃宽, 邵独婧, 张鹏. 达格列净对2型糖尿病患者经皮冠状动脉介入治疗术后对比剂肾病发病的影响[J]. 中国全科医学, 2024, 27(24): 2994-2999.
[5]	李明哲, 田一川, 王成龙, 王晶晶. 身体活动和睡眠对中老年人腰背痛的独立和联合影响研究[J]. 中国全科医学, 2024, 27(23): 2869-2874.
[6]	王华萍, 朱华杰, 祝春满, 潘丹红. 中国老年护理机构安宁疗护服务模式构建研究[J]. 中国全科医学, 2024, 27(22): 2739-2744.
[7]	周瑾, 王雁, 王卉, 张宜南, 智晓旭, 张致远, 徐德静, 周欣, 张柳柳. 老年结直肠癌术后患者全方位健康管理方案的构建[J]. 中国全科医学, 2024, 27(21): 2600-2606.
[8]	周潇, 周云婷, 孔小岑, 刘晓梅, 袁璐, 荆亭, 王蔚萍, 李惠琴. 基于动态血糖监测结果评价门诊教育对2型糖尿病患者血糖谱的影响研究[J]. 中国全科医学, 2024, 27(21): 2572-2577.
[9]	王萧冉, 关新月, 张丹. 老年共病患者就医延迟行为及其影响因素研究[J]. 中国全科医学, 2024, 27(20): 2505-2511.
[10]	谢可欣, 杜芳, 张丹. 社区老年慢性病共病患者家庭医生签约服务成效影响因素研究[J]. 中国全科医学, 2024, 27(20): 2512-2519.
[11]	关新月, 王萧冉, 张丹. 老年共病患者服药依从性及其影响因素研究[J]. 中国全科医学, 2024, 27(20): 2520-2526.
[12]	赵子寅, 张佳军, 孙文俊, 李慧宁, 邢星, 祝贺. 中国老年人躯体慢性病共病的复杂模式及其对卫生服务利用影响研究[J]. 中国全科医学, 2024, 27(20): 2498-2504.
[13]	聂作婷, 陈龙, 曾凯, 陶璐, 杨如美. 老年人跌倒风险感知研究现状及其对老年人主动跌倒预防的启示[J]. 中国全科医学, 2024, 27(19): 2395-2400.
[14]	廖艳萍, 李云意, 周志衡, 王皓翔. 65岁及以上老年人群中基于脂肪组织过多引起的慢性疾病患病情况及影响因素分析[J]. 中国全科医学, 2024, 27(19): 2357-2363.
[15]	黄书玮, 周志衡, 冯天元, 刘莉, 邓光璞, 李尧天, 朱宏. 不同胰岛素抵抗替代指数对中老年2型糖尿病患者发生高尿酸血症的预测价值研究[J]. 中国全科医学, 2024, 27(19): 2364-2374.