糖尿病衛教整合效益評價－某區域教學醫院經驗

張富勝; 吳南緯; 洪禎澤; 陳國寶; 張倩淇; 孫嘉成

doi:10.3966/168232812016092603002

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P135 - 146

医药卫生 > 社会医学

DOI： 10.7023/TJFM

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糖尿病卫教整合效益评价－某区域教学医院经验

The Clinical Effectiveness of Combined Educational and Self-Care Interventions in Diabetes Health Care: Experiences of a Regional Teaching Hospital in Central Taiwan

张富胜(Fu-Sheng Chang) ；吴南纬(Nan-Wei Wu) ；洪祯泽(Chen-Tse Hung) ；陈国宝(Kuo-Pao Chen) ；张倩淇(Cian-Ci Jhang) ；孙嘉成(Chia-Cheng Sun)

台湾家庭医学杂志； 26 卷 3 期 (2016 / 09 / 01) ， P135 - 146

繁体中文 DOI： 10.3966/168232812016092603002

慢性疾病；糖尿病；健康教育为基础的医疗照护； chronic illness ； diabetes mellitus ； health education-based medical care ； hyperglycemia

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摘要 │ 参考文献 (24) │ 被引用文献 (3) │ 国际计量

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Background: Cardiovascular diseases as one of top three leading causes of death in Taiwan find a major risk factor in diabetes mellitus. However, poor compliance and self-care often interferes with the blood sugar control of type 2 DM patients and results in unsatisfactory outcomes. In this study, by providing quality health care education through team works from clinical physicians, nurses, nutritionists and pharmacists, we aimed to analyze the clinical effectiveness of combined educational and self-care interventions for DM patients with poorly controlled blood sugar with the hope to obtain insights applicable to chronic disease care in general. Methods: Totally, 132 type 2 DM outpatients with poor recorded blood sugar (HbA1c＞8%), either with insulin injection or at least two kinds of oral antidiabetic (OAD) combination therapy, from a regional hospital in Changhua were enrolled. Analyses on indexes including blood sugar control (HbA1c and fasting blood sugar), the self-assessment of diabetes management scale (SADMS), the insulin treatment appraisal scale (ITAS), combinations of OAD agents, and dose adjustments of insulin preparations were performed six months after the interventions. Results: Study results showed improvement in blood sugar control (HbA1c and fasting blood sugar) after the interventions. With the only exception of psychological self-adjustment, statistically significant improvement was also observed in the remaining SADMS subscales on healthy diet, medication use, blood sugar monitoring, exercising, risk mitigation, and problem solving. Similar improvement further appeared in all ITAS subscales on benefits of insulin, selfblaming and health, daily life interference, social problems, and injection related problems and side effects. The insulin injection therapy rate increased from 60.8 to 72.5%. Conclusion: Through teamwork-based quality combined educational and self-care interventions, affirmative benefits were observed in nearly all clinical aspects of major indexes for assessing type 2 DM patients with poorly controlled blood sugar. Development of positive perceptions about insulin use through health education is crucial for early insulin treatment of patients with poorly controlled DM. Lack of improvement in psychological self-adjustment indicates the need to pay attention to the mental states of patients in addition to the provision of medical care. psychological evaluation and support are crucial in caring DM patients, as well as patients with chronic conditions, comprehensive health care.

参考文献 ( 24 ) 〈TOP〉

糖尿病对话网。2015年8月，取自http://www.dawnstudy.tw/index.asp.
Abu Hassan, H,Tohid H,Mohd Amin, R,Long Bidin, MB,Muthupalaniappen, L,Omar, K(2013).Factors influencing insulin acceptance among type 2 diabetes mellitus patients in a primary care clinic: a qualitative exploration.BMC Fam Pract,14,164.
American Diabetes Association(2010).Standards of medical care in diabetes.Diabetes Care,33(Suppl 1),S4-10.
Boren, SA(2007).AADE7TM Self-care Behaviors: systematic reviews.Diabetes Educ,33,866-71.
Brown, SA(1988).Effects of educational interventions in diabetes care: a meta-analysis of findings.Nurs Res,37,223-30.

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