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实施糖尿病自我管理培训项目:突破初级保健中的障碍

Implementing diabetes self-management training programs: breaking through the barriers in primary care.

作者信息

Siminerio Linda M

机构信息

Diabetes Institute, Adult Clinical Services, University of Pittsburgh Medical Center, Pennsylvania, USA.

出版信息

Endocr Pract. 2006 Jan-Feb;12 Suppl 1:124-30. doi: 10.4158/EP.12.S1.124.

Abstract

OBJECTIVE

To review issues, examples, and recommendations for the delivery of diabetes self-management training (DSMT) services in the primary care setting.

METHODS

Barriers to provision of DSMT at the point of care and strategies to overcome such challenges are discussed. In addition, new avenues to support continuing diabetes education are presented.

RESULTS

Diabetes is a complex disease that requires education, monitoring, and medication adjustment to achieve treatment goals. Unfortunately, adequate support is seldom available for the increased time and effort needed for optimal management of diabetes. Health-care delivery systems are designed to provide a response to acute illnesses and are poorly configured to meet the needs of patients with complex chronic illnesses. Although team care and DSMT have proved to be effective, they have infrequently been integrated in primary care offices, where most patients with diabetes receive treatment. It is encouraging that the studies conducted to date have generally found office-based counseling and educational strategies to be effective for the vast majority of patients with diabetes. Community-based programs that extend DSMT have also been successful.

CONCLUSION

Diabetes is a chronic disease that requires providers to deliver multifaceted care and patients to be proficient in many self-care skills. Team care and DSMT approaches have been found to yield beneficial results, yet such strategies are seldom used in the primary care office. Thus, models that support the team approach to delivery of diabetes care and self-management education interventions should be explored and encouraged.

摘要

目的

回顾在初级保健环境中提供糖尿病自我管理培训(DSMT)服务的相关问题、实例及建议。

方法

讨论了在医疗点提供DSMT的障碍以及克服此类挑战的策略。此外,还介绍了支持持续糖尿病教育的新途径。

结果

糖尿病是一种复杂的疾病,需要通过教育、监测和药物调整来实现治疗目标。不幸的是,对于优化糖尿病管理所需增加的时间和精力,很少能获得足够的支持。医疗保健提供系统旨在应对急性疾病,在满足复杂慢性病患者需求方面配置不佳。尽管团队护理和DSMT已被证明是有效的,但它们很少被整合到大多数糖尿病患者接受治疗的初级保健诊所中。令人鼓舞的是,迄今为止进行的研究普遍发现,基于诊所的咨询和教育策略对绝大多数糖尿病患者有效。扩展DSMT的社区项目也取得了成功。

结论

糖尿病是一种慢性病,需要医疗服务提供者提供多方面的护理,患者也需要精通多种自我护理技能。团队护理和DSMT方法已被发现能产生有益的结果,但此类策略在初级保健诊所中很少使用。因此,应探索并鼓励支持采用团队方法提供糖尿病护理和自我管理教育干预措施的模式。

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