Jaipakdee Jamabhorn, Jiamjarasrangsi Wiroj, Lohsoonthorn Vitool, Lertmaharit Somrat
Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Nurs Health Sci. 2015 Sep;17(3):362-9. doi: 10.1111/nhs.12198. Epub 2015 Mar 30.
Delivering diabetes self-management support is an enormous challenge for healthcare providers with limited human resources. We conducted a cluster randomized controlled trial to assess the effectiveness of a DSMS program incorporating the computer-assisted instruction. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework was applied to evaluate the DSMS program. Ten Public Health Centers in Bangkok, Thailand were randomized into either DSMS program or usual care. Forty eligible patients with type 2 diabetes in each Public Health Center were randomly selected. Totally, 403 patients (200 controls and 203 interventions) participated. About 93.8% participants completed the six-month follow-up. Over six months, adjusted mean changes of hemoglobin A1c (-0.14%, 95% confidence interval = -0.02 to -0.26, fasting plasma glucose (-6.37 mg/dL, -1.95 to -10.78), health behaviors (3.31 score, 2.27 to 4.34), and quality of life (1.41 score, 0.69 to 2.12) were significantly improved in intervention compared to control group. In conclusion, the DSMS program facilitates Public Health Centers to accomplish their support for people with diabetes.
对于人力资源有限的医疗服务提供者而言，提供糖尿病自我管理支持是一项巨大的挑战。我们开展了一项整群随机对照试验，以评估纳入计算机辅助教学的糖尿病自我管理支持（DSMS）项目的有效性。采用RE-AIM（覆盖、效果、采纳、实施和维持）框架来评估DSMS项目。泰国曼谷的10家公共卫生中心被随机分为DSMS项目组或常规护理组。每个公共卫生中心随机选取40名符合条件的2型糖尿病患者。共有403名患者（200名对照组和203名干预组）参与。约93.8%的参与者完成了为期6个月的随访。在6个月的时间里，与对照组相比，干预组的糖化血红蛋白校正后平均变化（-0.14%，95%置信区间=-0.02至-0.26）、空腹血糖（-6.37mg/dL，-1.95至-10.78）、健康行为（3.31分，2.27至4.34）和生活质量（1.41分，0.69至2.12）均有显著改善。总之，DSMS项目有助于公共卫生中心实现对糖尿病患者的支持。
