Piette J D, Weinberger M, McPhee S J, Mah C A, Kraemer F B, Crapo L M
Center for Health Care Evaluation/HSR&D Field Program, VA Palo Alto Health Care System, California, USA.
Am J Med. 2000 Jan;108(1):20-7. doi: 10.1016/s0002-9343(99)00298-3.
We sought to evaluate the effect of automated telephone assessment and self-care education calls with nurse follow-up on the management of diabetes.
We enrolled 280 English- or Spanish-speaking adults with diabetes who were using hypoglycemic medications and who were treated in a county health care system. Patients were randomly assigned to usual care or to receive an intervention that consisted of usual care plus bi-weekly automated assessment and self-care education calls with telephone follow-up by a nurse educator. Outcomes measured at 12 months included survey-reported self-care, perceived glycemic control, and symptoms, as well as glycosylated hemoglobin (Hb A1c) and serum glucose levels.
We collected follow-up data for 89% of enrollees (248 patients). Compared with usual care patients, intervention patients reported more frequent glucose monitoring, foot inspection, and weight monitoring, and fewer problems with medication adherence (all P -0.03). Follow-up Hb A,, levels were 0.3% lower in the intervention group (P = 0.1), and about twice as many intervention patients had Hb A1c levels within the normal range (P = 0.04). Serum glucose levels were 41 mg/dL lower among intervention patients than usual care patients (P = 0.002). Intervention patients also reported better glycemic control (P = 0.005) and fewer diabetic symptoms (P <0.0001 ), including fewer symptoms of hyperglycemia and hypoglycemia.
Automated calls with telephone nurse follow-up may be an effective strategy for improving self-care behavior and glycemic control, and for decreasing symptoms among vulnerable patients with diabetes.
我们试图评估自动电话评估和自我护理教育电话并由护士进行随访对糖尿病管理的效果。
我们招募了280名使用降糖药物且在县医疗保健系统接受治疗的讲英语或西班牙语的成年糖尿病患者。患者被随机分配至常规护理组或接受一项干预措施，该干预措施包括常规护理加上每两周一次的自动评估和自我护理教育电话，并由一名护士教育工作者进行电话随访。在12个月时测量的结果包括调查所报告的自我护理、感知血糖控制和症状，以及糖化血红蛋白（Hb A1c）和血糖水平。
我们收集了89%（248名患者）入组者的随访数据。与常规护理患者相比，干预组患者报告更频繁地进行血糖监测、足部检查和体重监测，且药物依从性问题更少（所有P<0.03）。干预组的随访Hb A1c水平低0.3%（P = 0.1），并且干预组中Hb A1c水平在正常范围内的患者数量约为常规护理组的两倍（P = 0.04）。干预组患者的血糖水平比常规护理患者低41mg/dL（P = 0.002）。干预组患者还报告血糖控制更好（P = 0.005）且糖尿病症状更少（P<0.0001），包括高血糖和低血糖症状更少。
自动电话并由电话护士进行随访可能是一种有效的策略，可改善自我护理行为和血糖控制，并减少弱势糖尿病患者的症状。
