An updated meta-analysis to assess the effectiveness of psychological interventions delivered by psychological specialists and generalist clinicians on glycaemic control and on psychological status

被引:65
作者
Alam, Rahul [1 ]
Sturt, Jackie [1 ]
Lall, Ranjit [2 ]
Winkley, Kirsty
机构
[1] Univ Warwick, Warwick Med Sch, Hlth Sci Res Inst, Coventry CV4 7AL, W Midlands, England
[2] Warwick Med Sch, Clin Trials Unit, Warwick, England
基金
英国医学研究理事会;
关键词
Diabetes; Psychological interventions; Glycaemic control; HbA(1c); Psychological specialist; Generalist clinicians; Health care delivery; TYPE-2; DIABETES-MELLITUS; PHYSICAL-ACTIVITY; BEHAVIOR-MODIFICATION; SELF-MANAGEMENT; WEIGHT-LOSS; RELAXATION; DEPRESSION; EDUCATION; THERAPY; NIDDM;
D O I
10.1016/j.pec.2008.08.026
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Objective: To update a meta-analysis and determine the effectiveness of psychological interventions on glycaemic control measured by HbA(1c) and psychological status in type 2 diabetes and to compare effects when interventions are delivered by generalist clinicians compared to psychological specialists. Methods: We used the original review protocol and searched the Cochrane central register of controlled trials, Medline, Embase, PsychLIT, and Google Scholar from February 2003 (end of previous review) to March 2007. We extracted data on the participants, interventions, delivery methods, comparison groups and outcome measures. Results: 35 trials were reviewed and meta-analysis of 19 trials (n = 1431), reporting HbA(1c) found a reduction in HbA(1c) by 0.54% (-0.32; 95% Cl: -0.47 to -0.16). In nine trials (n = 832) interventions were delivered by diabetes or general clinicians reducing HbA(1c) by 0.51%(-0.27; 95% Cl: -0.50 to 0.04). In nine trials, interventions (n = 561) were delivered by psychological specialists reducing HbA(1c) by 0.57% (-0.36; 95% Cl: -0.61 to 0.12). Meta-analysis of 13 trials reporting psychological status found psychological status to be lower in the intervention groups -0.56 (95% Cl: 1.00 to -0.13).Trial quality for the majority of studies remained poor. Conclusion: Our findings suggest that psychological and general clinicians are similarly effective in delivering psychological interventions, however, effect sizes for all clinicians have reduced since the earlier review. Practice implications: Psychological training opportunities for generalist clinicians could lead to wider availability of effective psychological care. (C) 2008 Elsevier Ireland Ltd. All rights reserved.
引用
收藏
页码:25 / 36
页数:12
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