Yeh Mei Chang
Department of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan.
Hu Li Za Zhi. 2009 Apr;56(2):22-7.
Diabetes case management and self-care education can effectively improve patient clinical outcomes and quality of life. Diabetes case management should be provided by an interdisciplinary team. Diabetes education has evolved from its previous focus on "teaching proper content" to "achieving successful patient outcomes" in line with the current emphasis in health education on patient-centered goals. Behavioral changes are facilitated based on these goals. Behavioral change directed at successful diabetes self-care was adopted as one of the desired outcomes of diabetes case management. The American Association of Diabetes Educators developed seven diabetes self-care behaviors as behavior objectives and evaluation indicators of diabetes education. These indicators include healthy eating, being active, monitoring, taking medication, problem solving, healthy coping, and reducing risks. The process of diabetes case management includes assessment, expected outcome identification, planning, implementation, evaluation, and documentation. In Taiwan, the Diabetes Share Care Network has promoted the advantages and techniques of diabetes case management. Based on network recommendations, the improvement program of National Health Insurance payment for diabetes medical treatment under the Bureau of National Health Insurance now provides package payment and requires quality interdisciplinary care and case management.
糖尿病病例管理和自我护理教育可以有效改善患者的临床结局和生活质量。糖尿病病例管理应由一个跨学科团队提供。糖尿病教育已从以往侧重于“传授适当内容”转变为“实现成功的患者结局”,这与当前健康教育中以患者为中心的目标相一致。基于这些目标促进行为改变。针对成功的糖尿病自我护理的行为改变被采纳为糖尿病病例管理的预期结果之一。美国糖尿病教育者协会制定了七种糖尿病自我护理行为,作为糖尿病教育的行为目标和评估指标。这些指标包括健康饮食、积极运动、自我监测、按时服药、解决问题、健康应对和降低风险。糖尿病病例管理的过程包括评估、确定预期结果、规划、实施、评估和记录。在台湾,糖尿病共享照护网络推广了糖尿病病例管理的优势和技术。根据网络建议,国民健康保险局下属的糖尿病医疗费用全民健康保险支付改善计划现在提供打包支付,并要求提供高质量的跨学科护理和病例管理。