Pérez-Cuevas Ricardo, Reyes Morales Hortensia, Doubova Svetlana Vladislavovna, Zepeda Arias Maribel, Díaz Rodríguez Gustavo, Peña Valdovinos Abel, Muñoz Hernández Onofre
Unidad de Investigación Epidemiológica y en Servicios de Salud, Centro Médico Nacional, Instituto Mexicano del Seguro Social, México.
Rev Panam Salud Publica. 2009 Dec;26(6):511-7. doi: 10.1590/s1020-49892009001200006.
To evaluate the effectiveness of involving primary care nurses in comprehensive care of patients with hypertension and diabetes mellitus type II (DM2).
A quasi-experimental, before-and-after study was conducted, without a control group, in eight family-practice clinics. Trained nurses offered comprehensive care in conjunction with a team made up of a family doctor, a nutritionist, a social worker, and a dentist. The intervention lasted seven months and its outcome variables were changes in body mass index, fasting blood glucose, blood pressure, self-perceived health status, treatment compliance, and emergency services requests. Any change was determined by comparing the baseline to the final measurement through interviews and recording the variables of interest in a spreadsheet.
In all, 1 131 patients completed the follow-up, of which 44.9% were diagnosed with hypertension, 27% with DM2, and 28.1% with both conditions. The proportion of patients seen by the coordinated health teams increased; there was a rise in cases of normal weight and overweight; a decrease in the proportion of obese (P < 0.05); and an increase in hypertensives with high blood pressure (< 130/ 80mmHg) (P < 0.05). There was no change in the proportion of diabetics with high blood glucose (< 140 mg/dl); 18.2% reported improved self-perceived health status (P < 0.05); there was improved treatment compliance (P < 0.05); and a decrease in requests for emergency services at the clinics (-4.5%) and at the hospitals (-6.8%) (P < 0.05).
Comprehensive care for chronically ill patients through the involvement of nurses contributes to improved health outcomes in primary care.
评估基层护理护士参与高血压和2型糖尿病（DM2）患者综合护理的效果。
在八家家庭医疗诊所进行了一项非对照组的前后对照准实验研究。经过培训的护士与由家庭医生、营养师、社会工作者和牙医组成的团队共同提供综合护理。干预持续了七个月，其结果变量包括体重指数、空腹血糖、血压、自我感知健康状况、治疗依从性和急诊服务需求的变化。通过访谈将基线与最终测量结果进行比较，并将感兴趣的变量记录在电子表格中，以确定任何变化。
共有1131名患者完成了随访，其中44.9%被诊断为高血压，27%为DM2，28.1%同时患有这两种疾病。接受协调医疗团队诊治的患者比例有所增加；体重正常和超重的病例有所上升；肥胖患者比例下降（P<0.05）；高血压患者血压降至<130/80mmHg的比例增加（P<0.05）。血糖<140mg/dl的糖尿病患者比例没有变化；18.2%的患者报告自我感知健康状况有所改善（P<0.05）；治疗依从性有所提高（P<0.05）；诊所（-4.5%）和医院（-6.8%）的急诊服务需求有所下降（P<0.05）。
通过护士参与为慢性病患者提供综合护理有助于改善基层医疗的健康结局。
