目的:对糖尿病足治疗中的时间延迟进行系统评价,并探讨这些时间延迟的影响因素和潜在结局。
方法:研究人员搜索了几个电子数据库(Pubmed,WebofScience,科克伦图书馆,EMBase,CNKI,万方,CBM和VIP)用于中英文研究,研究了糖尿病足管理途径中的时间延迟。两位作者独立筛选和提取数据,并使用纽卡斯尔-渥太华量表和卫生研究和质量检查表评估纳入研究的质量。由于研究之间的异质性,进行描述性分析.
结果:评论包括28篇文章,包括20项队列研究和8项横断面研究,符合纳入标准。其中,14个被认为是高质量的。从症状发作到初级保健或专科护理的中位时间从3天到46.69天不等。初级保健专家的转诊延迟中位数为7至31天,最终治疗的中位时间为6.2~56天.发现多种复杂因素导致了这些延误,包括患者人口统计数据(年龄较大,较低的教育水平和收入水平)和不良的患者寻求健康的行为(不准确的自我治疗,对症状的不正确识别和解释),卫生初级专业人员的不准确评估或初步治疗,糖尿病足的复杂转诊途径和临床特征(足部溃疡数量,瓦格纳等级量表,和血红蛋白A1c指数)。与这些延迟相关的负面结果包括严重截肢和死亡的风险增加,伤口愈合率下降,住院时间延长,医院费用增加。
结论:糖尿病足管理途径的时间延迟既常见又严重,导致糖尿病足患者的负面健康结果。许多复杂的因素与患者的不良患者寻求健康的行为有关,卫生系统,糖尿病足的临床特征是这些延误的原因。因此,有必要制定标准转诊实践的新策略,并加强患者寻求护理的意识。
OBJECTIVE: A systematic review was conducted to evaluate the time delays in the management of diabetic foot and explore influencing factors of these delays and potential outcomes.
METHODS: The researchers searched several electronic databases (Pubmed, Web of Science, Cochrane Library, EMbase, CNKI, WanFang, CBM and VIP) for English and Chinese studies that examined time delays in the management pathway of diabetic foot. Two authors independently screened and extracted data, and assessed the quality of the included studies using the Newcastle-Ottawa Scale and the Agency for Health Research and Quality checklist. Due to heterogeneity among the studies, descriptive analysis was performed.
RESULTS: The review included 28 articles, comprising 20 cohort studies and 8 cross-sectional studies, that met the inclusion criteria. Among these, 14 were deemed of high quality. The median times from symptom onset to primary health care or specialist care varied from 3 to 46.69 days. The median delay in referral by primary care specialists ranged from 7 to 31 days, and subsequent median times to definitive treatment ranged from 6.2 to 56 days. Multiple complex factors were found to contribute to these delays, including patient demographics (older age, lower education level and income level) and poor patient health-seeking behaviors (inaccurate self-treatment, incorrect recognition and interpretation of symptoms), inaccurate assessment or initial treatment by health primary professionals, complex referral pathways and clinical characteristics of diabetic foot (number of foot ulcers, Wagner grade scale, and hemoglobin A1c index). Negative outcomes associated with these delays included increased risk of major amputation and mortality, decreased wound healing rate, prolonged hospital stay, and increased hospital costs.
CONCLUSIONS: Time delays in the diabetic foot management pathway were both common and serious, contributing to negative health outcomes for patients with diabetic foot. Many complex factors related to patient\'s poor patient health-seeking behaviors, health system, and clinical characteristics of diabetic foot are responsible for these delays. Therefore, it is necessary to develop new strategies for standard referral practices and strengthen patient awareness of seeking care.