Fisher Edwin B, Brownson Carol A, O'Toole Mary L, Anwuri Victoria V, Shetty Gowri
The School of Public Health, University of North Carolina at Chapel Hill (Dr Fisher)
The National Program Office of the Robert Wood Johnson Foundation Diabetes Initiative, Division of Health Behavior Research, Departments of Internal Medicine and Pediatrics, Washington University School of Medicine, St Louis, Missouri (Ms Brownson, Dr O’Toole, Ms Anwuri, Ms Shetty)
Diabetes Educ. 2007 Jun;33 Suppl 6:216S-224S. doi: 10.1177/0145721707304124.
Review and highlight findings from the projects of the Diabetes Initiative of the Robert Wood Johnson Foundation described in this special supplemental issue.
The broad framework for self-management around which these programs were developed, "Resources and Supports for Self Management," includes individualized assessment, collaborative goal setting, building skills for self-management, ongoing follow-up and support, community resources, and continuity of quality clinical care. Lessons learned include the central role of community health workers in self-management, the importance of ongoing follow-up and support to sustain self-management, varied program approaches to depression and negative emotion, the importance of organizational infrastructure to support self-management programs, and the contributions of clinic-community partnerships. Several emergent themes include the value of providing choices among "good practices" as opposed to one best practice, the role of the physician as part of the self-management team, and the importance of broad efforts in promoting dissemination of self-management programs. Finally, self-management will benefit from replacing categorical distinctions, like good and bad control, proven and unproven treatment, with thinking in terms of key dimensions, like level of control and continued quality improvement.
Diabetes Initiative projects have shown that diabetes self-management can be promoted in the "real worlds" of community agencies and primary care settings serving diverse and disadvantaged populations.
回顾并强调本期特刊中所描述的罗伯特·伍德·约翰逊基金会糖尿病倡议项目的研究结果。
这些项目所围绕的自我管理的广泛框架“自我管理的资源与支持”包括个性化评估、协作式目标设定、培养自我管理技能、持续随访与支持、社区资源以及优质临床护理的连续性。经验教训包括社区卫生工作者在自我管理中的核心作用、持续随访与支持对维持自我管理的重要性、针对抑郁和负面情绪的多种项目方法、支持自我管理项目的组织基础设施的重要性以及诊所 - 社区伙伴关系的贡献。几个新出现的主题包括在“良好实践”中提供选择而非单一最佳实践的价值、医生作为自我管理团队一员的角色以及广泛努力促进自我管理项目传播的重要性。最后，自我管理将受益于用关键维度（如控制水平和持续质量改进）的思维取代诸如良好与不良控制、已证实与未证实治疗等分类区分。
糖尿病倡议项目表明，在服务于不同和弱势人群的社区机构和初级保健环境的“现实世界”中，可以促进糖尿病自我管理。
