Piette John D, Lange Ilta, Issel Michelle, Campos Solange, Bustamante Claudia, Sapag Jaime, Poblete Fernando, Tugwell Peter, O'Connor Annette M
VA Ann Arbor Healthcare System and University of Michigan Diabetes Research and Training Center, P.O. Box 130170, Ann Arbor, MI 48113-0170, USA.
Chronic Illn. 2006 Jun;2(2):87-96. doi: 10.1177/17423953060020020401.
In 2004, the Chilean National Ministry of Health instituted a cardiovascular disease (CVD) management programme aimed at improving diabetes care among patients treated in the public healthcare system. We sought to identify the characteristics of patients participating in the CVD programme and the feasibility of extending its reach through structured nurse telephone contacts between outpatient encounters.
We surveyed 569 low-income adults with type 2 diabetes treated in public clinics of Santiago, to assess patients' participation in the CVD programme and willingness to use telephone care services. Surveys were linked to information from medical records.
One-third of patients met the target of two visits to the CVD programme in the previous 6 months, and an additional 32% made more than three visits. Use of the CVD programme was associated with greater patient satisfaction, even after controlling for potential confounders. However, 27% of patients had inadequate programme contact, and many of these patients were in poor health. Many CVD programme participants reported difficulties with lifestyle changes, and greater contact with the CVD programme was not associated with healthier behaviours. Most patients (95%) reported telephone access and 37% had used the telephone to contact their clinic. The majority of patients would be willing to use telephone care for additional behaviour change and emotional support. Patients with fewer CVD programme visits were particularly likely to report willingness to use telephone care.
Clinic-based CVD disease management services reach a large number of socio-economically vulnerable Chileans with diabetes. However, barriers to access remain, and planned telephone care services may increase the reach of self-management support.
2004年，智利国家卫生部设立了一项心血管疾病（CVD）管理计划，旨在改善公共医疗系统中接受治疗的患者的糖尿病护理。我们试图确定参与CVD计划的患者的特征，以及通过门诊就诊之间结构化的护士电话联系扩大该计划覆盖范围的可行性。
我们对在圣地亚哥公共诊所接受治疗的569名低收入2型糖尿病成年人进行了调查，以评估患者对CVD计划的参与情况以及使用电话护理服务的意愿。调查与病历信息相关联。
三分之一的患者在前6个月达到了参加CVD计划两次就诊的目标，另有32%的患者就诊次数超过三次。即使在控制了潜在的混杂因素后，使用CVD计划也与更高的患者满意度相关。然而，27%的患者与该计划的联系不足，其中许多患者健康状况不佳。许多CVD计划参与者报告在改变生活方式方面存在困难，与CVD计划的更多联系与更健康的行为无关。大多数患者（95%）表示可以使用电话，37%的患者曾使用电话联系他们的诊所。大多数患者愿意使用电话护理来促进更多的行为改变和获得情感支持。参加CVD计划就诊次数较少的患者尤其可能表示愿意使用电话护理。
基于诊所的CVD疾病管理服务覆盖了大量患有糖尿病的社会经济弱势群体智利人。然而，获取服务的障碍仍然存在，计划中的电话护理服务可能会扩大自我管理支持的覆盖范围。
