Molayaghobi Nasrin Soltani, Abazari Parvaneh, Taleghani Fariba, Iraj Bijan, Etesampour Ali, Zarei Asghar, Hashemi Hajar, Abasi Feridoon
Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
Endocrinologist, Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Int J Prev Med. 2019 Jan 15;10:13. doi: 10.4103/ijpvm.IJPVM_485_18. eCollection 2019.
Reforming the health care system to improve suitable health care model for diabetic patients is essential. This study aimed to implement, identify, and overcome the challenges of implementing the Chronic Care Model in diabetes management in a clinic.
This study is a qualitative technical action research with the Kemmis and McTaggart model including planning, action, reflection, observation, and revision plan which was conducted in the specialized polyclinic from 2015 to 2017 in Isfahan city - Iran. Data were gathered through qualitative and quantitative methods. Diabetes team and 17 patients with type 2 diabetes participated in semi-structured interviews that were purposively chosen. Qualitative data were analyzed using content analysis and then quantitative data collected.
The qualitative findings of this research are in five main categories: System design upgrade, self-management upgrade, decision support, health care organization, and clinical information system upgrade. Results of quantitative data showed that most metabolic indicators like HbA1c have statistical meaningful changes ( value < 0.05).
Implementing the Chronic Care Model became feasible despite serious challenges and two groups of ready and active team and active patients were developed. The study showed that one important lost link of diabetes management is underestimating the nurses' capabilities in the management of this disease. Inevitably, serious investment on maximum use of nurses' knowledge and skills in improving diabetes management will help diabetes care upgrade significantly.
改革医疗保健系统以改善适合糖尿病患者的医疗模式至关重要。本研究旨在实施、识别并克服在一家诊所的糖尿病管理中实施慢性病护理模式所面临的挑战。
本研究是一项采用凯米斯和麦克塔格特模型的定性技术行动研究，包括规划、行动、反思、观察和修订计划，于2015年至2017年在伊朗伊斯法罕市的专科门诊进行。数据通过定性和定量方法收集。糖尿病团队和17名2型糖尿病患者参与了有目的选择的半结构化访谈。定性数据采用内容分析法进行分析，然后收集定量数据。
本研究的定性结果主要分为五大类：系统设计升级、自我管理升级、决策支持、医疗保健组织和临床信息系统升级。定量数据结果显示，大多数代谢指标如糖化血红蛋白（HbA1c）有统计学意义的变化（值<0.05）。
尽管面临严峻挑战，但实施慢性病护理模式变得可行，并且形成了两组准备充分且积极主动的团队和活跃的患者群体。研究表明，糖尿病管理中一个重要的缺失环节是低估了护士在该疾病管理中的能力。不可避免的是，在最大限度利用护士知识和技能以改善糖尿病管理方面进行大量投入将有助于显著提升糖尿病护理水平。
