Professor, School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada.
Can J Diabetes. 2013 Feb;37(1):45-50. doi: 10.1016/j.jcjd.2013.01.004. Epub 2013 Mar 14.
Best practice diabetes mellitus clinical treatment and education takes place in the medical clinic, however, patient outcomes are largely mediated through their own behaviour and lifestyle that occurs after they leave the clinical setting. Once they return home, people usually continue to engage in the social, cultural and lifestyle behaviours that had contributed to having diabetes in the first place. Although a host of factors (e.g. economic, health care team and system, condition and client-related) can impact a client's capacity to self-manage, there are client, organizational and community level strategies that may partially mitigate these difficulties. To address client behaviour, clinicians are increasingly becoming skilled to incorporate self-management support including behavioural counselling interventions into routine practice. At the organizational level, the operation and structure of the clinical setting may create difficulty for staff to provide self-management support. Sustaining benefits on a day-to-day basis presents an additional challenge. This article will review several common implementation barriers to self-management support and describe strategies and techniques used elsewhere to successfully integrate self-management support as a core care component for persons with diabetes.
糖尿病的最佳临床治疗和教育实践发生在医疗诊所，但患者的治疗效果在很大程度上取决于他们离开临床环境后的自身行为和生活方式。一旦他们回到家，人们通常会继续参与导致他们患上糖尿病的社会、文化和生活方式行为。尽管许多因素（如经济、医疗保健团队和系统、病情和客户相关因素）可能会影响客户自我管理的能力，但客户、组织和社区层面的策略可能会部分缓解这些困难。为了解决客户的行为问题，临床医生越来越熟练地将自我管理支持（包括行为咨询干预）纳入常规实践。在组织层面，临床环境的运作和结构可能会给员工提供自我管理支持带来困难。维持日常的益处是另一个挑战。本文将回顾自我管理支持实施的几个常见障碍，并描述其他地方使用的策略和技术，以成功地将自我管理支持整合为糖尿病患者的核心护理组成部分。
