Kruse Robin L, Olsberg Joshua E, Oliver Debra Parker, Shigaki Cheryl L, Vetter-Smith Molly J, LeMaster Joseph W
Department of Family and Community Medicine, University of Missouri, Columbia, MO 65212, USA.
Fam Med. 2013 May;45(5):319-22.
Controlling diabetes requires sustained self-management on the part of patients. Health care providers can support patients' self-care efforts through communication and problem solving. We conducted this study to determine the frequency with which self-care activities were discussed during office visits for follow-up care of diabetes and how much time was spent on these discussions.
Audio recordings of 28 patient encounters in five primary care clinics were analyzed. We determined the frequency of self-care discussions and the amount of time devoted to these discussions.
Self-care was discussed in all 28 encounters. Median encounter times for each clinic ranged from 19.8 to 37.6 minutes, with self-care discussions taking from 0.1 to 17.2 minutes. Median discussion time devoted to all self-care activities was 5.2 minutes, representing 23.5% of a visit of median length. Blood sugar testing was discussed longer than the other activities. The least time was devoted to eye and foot examinations. Discussions were usually initiated by providers and did not differ in length according to who initiated the discussion.
Patients with diabetes regularly discussed self-care activities during follow-up visits at family medicine clinics. Providers varied in their capacity to incorporate self-care planning into routine medical care for patients with diabetes. Interventions are needed that help improve goal-setting and documentation. Documentation of self-care discussions will be important for meeting Meaningful Use criteria.
控制糖尿病需要患者持续进行自我管理。医疗保健提供者可以通过沟通和解决问题来支持患者的自我护理工作。我们开展这项研究以确定在糖尿病随访门诊中讨论自我护理活动的频率以及用于这些讨论的时间。
分析了五个基层医疗诊所28次患者诊疗的音频记录。我们确定了自我护理讨论的频率以及用于这些讨论的时间。
在所有28次诊疗中均讨论了自我护理。每个诊所每次诊疗的中位时间为19.8至37.6分钟，自我护理讨论时间为0.1至17.2分钟。用于所有自我护理活动的中位讨论时间为5.2分钟，占中位时长诊疗的23.5%。血糖检测的讨论时间比其他活动更长。用于眼部和足部检查的时间最少。讨论通常由提供者发起，且根据发起讨论的人不同，讨论时长无差异。
糖尿病患者在家庭医学诊所的随访就诊中经常讨论自我护理活动。提供者将自我护理计划纳入糖尿病患者常规医疗护理的能力各不相同。需要采取干预措施来帮助改善目标设定和记录。自我护理讨论的记录对于满足有意义使用标准很重要。
