From the Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD (CJWL); College of Journalism & Communications, UF Health Cancer Center, UF Health Center for Arts in Medicine, University of Florida, Gainesville, FL (CLF); Henry M. Jackson Foundation, Military Primary Care Research Network, Uniformed Services University of the Health Sciences, Department of Family Medicine, Bethesda, MD (LAC, JTJ); Department of Family Medicine, Augusta University, Augusta, GA (DAS); Department of Family Medicine, Nellis Family Medicine Residency, Mike O'Callaghan Military Medical Center, Las Vegas, NV (PFC).
J Am Board Fam Med. 2020 Mar-Apr;33(2):211-219. doi: 10.3122/jabfm.2020.02.190136.
Understanding patients' perspectives about their diabetes and what causes those perspectives to shift is critical to building a treatment strategy with the patient and facilitating patient self-management behavior. Key "turning points" can provide crucial opportunities to enact a change in perspective. The goal of this study is to identify "turning points" that have significance to diabetes-related health.
Research coordinators interviewed 33 patients aged 25 to 65 diagnosed with type 2 diabetes mellitus or prediabetes at medical centers in Augusta, Georgia, and Las Vegas, Nevada. Retrospective interview technique and turning point analysis was employed to plot health or diabetes management changes from diagnosis up to the present day. The constant comparative method was used to conduct a thematic analysis. Axial coding identified properties characterizing each turning point.
Patients reported 5 interrelated turning points occurring at various times after diagnosis: 1) either through patients own research and/or a health care class; 2) including exercising and healthier eating; 3) including events that derailed healthy behavior, motivated health behavior, and removed barriers to enacting healthy behavior; 4) either through holding patients accountable or encouraging them to enact healthy behavior; and 5) such as medication changes or behavior changes critical to disease management.
These turning points provide specific moments throughout diabetes care in which family physicians can effectively partner with patients. By prompting, facilitating, or attending to these turning points, family physicians can partner with patients throughout diabetes care.
了解患者对糖尿病的看法以及导致这些看法发生变化的原因，对于与患者一起制定治疗策略并促进患者自我管理行为至关重要。关键的“转折点”可以为改变观点提供重要机会。本研究的目的是确定与糖尿病相关的健康有意义的“转折点”。
研究协调员在佐治亚州奥古斯塔和内华达州拉斯维加斯的医疗中心采访了 33 名年龄在 25 至 65 岁之间被诊断患有 2 型糖尿病或前期糖尿病的患者。采用回顾性访谈技术和转折点分析来绘制从诊断到现在的健康或糖尿病管理变化。使用恒定比较法进行主题分析。轴向编码确定了每个转折点的特征属性。
患者报告了 5 个相互关联的转折点，这些转折点发生在诊断后的不同时间：1）通过患者自己的研究和/或医疗保健课程；2）包括锻炼和更健康的饮食；3）包括破坏健康行为、激发健康行为和消除实施健康行为障碍的事件；4）通过让患者负责或鼓励他们实施健康行为；5）例如对疾病管理至关重要的药物变化或行为变化。
这些转折点提供了糖尿病护理过程中的具体时刻，家庭医生可以在这些时刻与患者有效合作。通过提示、促进或关注这些转折点，家庭医生可以在整个糖尿病护理过程中与患者合作。
