Section for Health Services Research, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Copenhagen k, Denmark.
BMC Health Serv Res. 2012 Jun 14;12:160. doi: 10.1186/1472-6963-12-160.
Self-management support is considered to be an essential part of diabetes care. However, the implementation of self-management support within healthcare settings has appeared to be challenging and there is increased interest in "real world" best practice examples to guide policy efforts. In order to explore how different approaches to diabetes care and differences in management structure influence the provision of SMS we selected two healthcare systems that have shown to be comparable in terms of budget, benefits and entitlements. We compared the extent of SMS provided and the self-management behaviors of people living with diabetes in Kaiser Permanente (KP) and the Danish Healthcare System (DHS).
Self-administered questionnaires were used to collect data from a random sample of 2,536 individuals with DM from KP and the DHS in 2006-2007 to compare the level of SMS provided in the two systems and identify disparities associated with educational attainment. The response rates were 75 % in the DHS and 56 % in KP. After adjusting for gender, age, educational level, and HbA1c level, multiple linear regression analyses determined the level of SMS provided and identified disparities associated with educational attainment.
Receipt of SMS varied substantially between the two systems. More people with diabetes in KP reported receiving all types of SMS and use of SMS tools compared to the DHS (p < .0001). Less than half of all respondents reported taking diabetes medication as prescribed and following national guidelines for exercise.
Despite better SMS support in KP compared to the DHS, self-management remains an under-supported area of care for people receiving care for diabetes in the two health systems. Our study thereby suggests opportunity for improvements especially within the Danish healthcare system and systems adopting similar SMS support strategies.
自我管理支持被认为是糖尿病护理的重要组成部分。然而，在医疗保健环境中实施自我管理支持似乎具有挑战性，并且人们越来越关注“真实世界”的最佳实践范例，以指导政策努力。为了探索不同的糖尿病护理方法和管理结构差异如何影响 SMS 的提供，我们选择了两个在预算、福利和权益方面表现出可比性的医疗保健系统。我们比较了 Kaiser Permanente（KP）和丹麦医疗保健系统（DHS）中提供的 SMS 程度以及患有糖尿病的人的自我管理行为。
我们使用自我管理问卷从 2006-2007 年 KP 和 DHS 的随机样本中收集了 2536 名 DM 患者的数据，以比较两个系统中提供的 SMS 水平，并确定与教育程度相关的差异。DHS 的回复率为 75%，KP 的回复率为 56%。在调整了性别、年龄、教育程度和 HbA1c 水平后，多元线性回归分析确定了提供的 SMS 水平，并确定了与教育程度相关的差异。
两个系统之间的 SMS 接收情况差异很大。与 DHS 相比，KP 中有更多的糖尿病患者报告接受了所有类型的 SMS 和 SMS 工具的使用（p<.0001）。不到一半的受访者报告按照规定服用糖尿病药物并遵循国家锻炼指南。
尽管与 DHS 相比，KP 提供了更好的 SMS 支持，但在这两个医疗系统中，自我管理仍然是接受糖尿病护理的患者支持不足的护理领域。因此，我们的研究表明，特别是在丹麦医疗保健系统和采用类似 SMS 支持策略的系统中，有改进的机会。
