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加强初级保健中糖尿病自我管理教育的可及性。

Enhancing Access to Diabetes Self-management Education in Primary Care.

作者信息

Chomko Maureen E, Odegard Peggy S, Evert Alison B

机构信息

University of Washington Neighborhood Clinics, Seattle, Washington, USA (Ms Chomko)

Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington, USA (Dr Odegard)

出版信息

Diabetes Educ. 2016 Oct;42(5):635-45. doi: 10.1177/0145721716659147. Epub 2016 Jul 31.

Abstract

PURPOSE

The purpose of this continuous quality improvement project was to improve access to diabetes self-management education (DSME) and to evaluate the impact on glycemic and weight control by translating an academic medical center's DSME program, accredited per the Education Recognition Program (ERP) of the American Diabetes Association, into a program offered at primary care clinics (PCCs).

METHODS

Certified diabetes educators from the medical center trained PCC registered dietitian nutritionists, registered nurses, and social workers to provide DSME in their community-based clinic. Main outcomes of this retrospective, pretest/posttest, observational project were to evaluate enrollment in DSME classes and change in A1C and weight as patients underwent a combined intervention of diabetes education classes with or without consultation and support from a PCC registered dietitian nutritionist or registered nurse.

RESULTS

PCC DSME was associated with increased enrollment in DSME classes and a significant reduction of A1C and weight at 3 and 6 months post-DSME. Greatest A1C and weight reductions were observed in patients with newly diagnosed diabetes. Reductions were also seen in patients with diabetes duration ≥10 years, participants taking insulin, and those with depression.

CONCLUSIONS

PCC DSME availability increased access to group diabetes education and resulted in reduced A1C and weight for participants. This model was successful in translating an established academic accredited DSME-ERP into a PCC. Results have implications for increasing access to diabetes education programs and improving diabetes control for patients not located near major hospital-based DSME programs.

摘要

目的

这个持续质量改进项目的目的是改善糖尿病自我管理教育(DSME)的可及性,并通过将一个根据美国糖尿病协会教育认可计划(ERP)认证的学术医疗中心的DSME项目转化为基层医疗诊所(PCC)提供的项目,来评估其对血糖和体重控制的影响。

方法

医疗中心的认证糖尿病教育者培训PCC的注册营养师、注册护士和社会工作者,以便在其社区诊所提供DSME。这个回顾性、干预前/干预后观察项目的主要结果是评估DSME课程的注册情况,以及患者在接受糖尿病教育课程联合干预(有或没有PCC注册营养师或注册护士的咨询和支持)时糖化血红蛋白(A1C)和体重的变化。

结果

PCC的DSME与DSME课程注册人数增加以及DSME后3个月和6个月时A1C和体重显著降低相关。新诊断糖尿病患者的A1C和体重降低最为明显。糖尿病病程≥10年的患者、使用胰岛素的参与者以及患有抑郁症的患者的A1C和体重也有所降低。

结论

PCC提供DSME增加了团体糖尿病教育的可及性,并使参与者的A1C和体重降低。该模式成功地将一个既定的学术认可的DSME-ERP转化为PCC项目。研究结果对于增加糖尿病教育项目的可及性以及改善不在大型医院DSME项目附近的患者的糖尿病控制具有重要意义。

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