Kaissi Amer A, Parchman Michael
The Department of Health Care Administration, Trinity University, San Antonio, Texas (Dr Kaissi)
The Veterans Evidence-Based Research Dissemination Implementation Center, San Antonio, Texas (Dr Parchman)
Diabetes Educ. 2009 Sep-Oct;35(5):843-50. doi: 10.1177/0145721709342901.
The purpose of this article is to examine the relationship between organizational characteristics as measured by the Chronic Care Model (CCM) and patient self-management behaviors among patients with type 2 diabetes.
The study design was cross-sectional. The study setting included 20 primary care clinics from South Texas. The sample included approximately 30 consecutive patients that were enrolled from each clinic for a sample of 617 patients. For the data collection procedures, the CCM survey was completed by caregivers in the clinic. Self-management behaviors were obtained from patient exit surveys. For measures, the CCM consisted of 6 structural dimensions: (1) organization support, (2) community linkages, (3) self-management support, (4) decision support system, (5) delivery system design, and (6) clinical information systems. Patient self-management behavior included whether the patient reported always doing all 4 of the following behaviors as they were instructed: (1) checking blood sugars, (2) following diabetes diet, (3) exercising, and (4) taking medications. For data analyses, to account for clustering of patients within clinics, hierarchical logistic regression models were used.
Self-management support was positively associated with medication adherence, while decision support system was positively associated with exercise and all 4 self-management behaviors. Surprisingly, community linkages were negatively associated with medication adherence, while clinical information system was negatively associated with diet and all 4 behaviors. A total score, including all dimensions, was positively associated with only exercise.
Health care providers and diabetes educators in primary care clinics should consider how organizational characteristics of the clinic might influence self-management behaviors of patients. The focus should be on better access to evidence-based information at the point of care and self-management needs and activities.
本文旨在探讨以慢性病照护模式（CCM）衡量的组织特征与2型糖尿病患者自我管理行为之间的关系。
本研究设计为横断面研究。研究地点包括南德克萨斯州的20家初级保健诊所。样本包括从每家诊所连续招募的约30名患者，共617名患者。在数据收集过程中，CCM调查问卷由诊所的护理人员完成。自我管理行为通过患者出院调查获得。在测量方面，CCM由6个结构维度组成：（1）组织支持，（2）社区联系，（3）自我管理支持，（4）决策支持系统，（5）服务提供系统设计，以及（6）临床信息系统。患者自我管理行为包括患者是否报告总是按照指示进行以下所有4种行为：（1）检查血糖，（2）遵循糖尿病饮食，（3）锻炼，以及（4）服药。在数据分析中，为了考虑诊所内患者的聚类情况，使用了分层逻辑回归模型。
自我管理支持与药物依从性呈正相关，而决策支持系统与锻炼及所有4种自我管理行为呈正相关。令人惊讶的是，社区联系与药物依从性呈负相关，而临床信息系统与饮食及所有4种行为呈负相关。包括所有维度的总分仅与锻炼呈正相关。
初级保健诊所的医疗服务提供者和糖尿病教育工作者应考虑诊所的组织特征如何影响患者的自我管理行为。重点应放在改善在护理点获取循证信息以及自我管理需求和活动方面。
