du Pon Esther, van Dooren Ad, Kleefstra Nanne, van Dulmen Sandra
Research Group Process Innovations in Pharmaceutical Care, Utrecht University of Applied Sciences, Utrecht, the Netherlands.
Diabetes Centre, Isala, Zwolle, the Netherlands.
J Clin Med Res. 2020 Feb;12(2):79-89. doi: 10.14740/jocmr3965. Epub 2020 Feb 1.
Nowadays, patients with chronic conditions such as type 2 diabetes mellitus (T2DM) need and want to be more active participants in their health care. This study aimed to investigate the effects of the Proactive Interdisciplinary Self-Management (PRISMA) training program on participation during consultations with practice nurses and self-efficacy of patients with T2DM in general practice.
Within a randomized controlled trial, patients were followed for 6 months. They received either PRISMA in addition to usual care or usual care only. Self-efficacy was assessed using the 5-item Perceived Efficacy in Patient-Physician Interactions (PEPPI-5) scale. Consultations were video-recorded and analyzed using the Roter interaction analysis system. Multilevel analysis was carried out.
No differences in the PEPPI-5 were found between the intervention (n = 101) and control groups (n = 102) (U = 1,737.5, z = -0.2, P = 0.8). In addition, the groups did not differ in patient participation. However, patients who attended the PRISMA program expressed more counselling utterances (B = 0.22; standard error (SE) = 0.09).
PRISMA did not result in higher self-efficacy or patient participation during the consultation with practice nurses at 6 months. Possibly, two training sessions are insufficient and a more powerful intervention might be needed. However, the study showed indications that patients counselled themselves more frequently during the consultation. Practice nurses could stimulate patients who are already engaged in self-counselling by further specifying their goals of behavior change.
如今，患有2型糖尿病（T2DM）等慢性病的患者需要且希望在其医疗保健中更积极地参与。本研究旨在调查主动跨学科自我管理（PRISMA）培训计划对与执业护士会诊期间的参与度以及全科医疗中T2DM患者自我效能感的影响。
在一项随机对照试验中，对患者进行了6个月的随访。他们要么在常规护理基础上接受PRISMA，要么仅接受常规护理。使用5项患者 - 医生互动中的感知效能（PEPPI - 5）量表评估自我效能感。会诊过程进行视频录制，并使用罗特尔互动分析系统进行分析。进行了多层次分析。
干预组（n = 101）和对照组（n = 102）在PEPPI - 5上未发现差异（U = 1,737.5，z = -0.2，P = 0.8）。此外，两组在患者参与度方面也没有差异。然而，参加PRISMA计划的患者表达了更多的咨询话语（B = 0.22；标准误（SE）= 0.09）。
在与执业护士会诊的6个月期间，PRISMA并未导致更高的自我效能感或患者参与度。可能，两次培训课程是不够的，可能需要更有力的干预措施。然而，该研究表明有迹象表明患者在会诊期间更频繁地自我咨询。执业护士可以通过进一步明确其行为改变目标来激励已经参与自我咨询的患者。
