健康教育可提高可能患有糖尿病视网膜病变者的转诊依从性：一项随机对照试验。
Health education improves referral compliance of persons with probable Diabetic Retinopathy: A randomized controlled trial.
机构信息
Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh.
出版信息
PLoS One. 2020 Nov 12;15(11):e0242047. doi: 10.1371/journal.pone.0242047. eCollection 2020.
OBJECTIVE
Lack of awareness about Diabetic Retinopathy (DR) is the most commonly cited reason why many persons with type 2 diabetes are non-compliant with referral instruction to undergo retinal screening. The purpose of this study was to evaluate the efficacy of a culturally, geographically and socially appropriate, locally adapted five-month-long health education on referral compliance of participants.
METHOD
A prospective randomized, open-label parallel group study was conducted on persons with type 2 diabetes who underwent basic eye screening at a diabetes hospital between September 2017 and August 2018. Participants who were noncompliant with referral instruction to visit a hospital for advanced DR management were randomly divided into health education intervention group (n = 143) and control group (n = 156). Both groups received information regarding DR and referral instruction at the diabetes hospital. The intervention group was provided personalized education followed by telephonic reminders. The primary endpoint was 'increase in referral compliance' and the secondary endpoint was 'increase in knowledge of DR'. Multivariate logistic regression model was used to identify significant predictors of compliance to referral.
RESULTS
A total of nine participants dropped and 290 completed the post intervention survey. The compliance rate in intervention group was found to be significantly higher than the control group (64.3% vs 28.2%; OR 4.73; 95% CI 2.87-7.79; p<0.001). Participants in the intervention group acquired better knowledge on DR (p<0.05). Apart from intervention, referral compliance rate was also found to be significantly associated with participants' self-perception of vision problem (OR 2.02; 95% CI 1.02-4.01; p = 0.045) and participants' income (OR 1.24; 95% CI 1.06-1.44; p = 0.008).
DISCUSSION
Our results suggest that intensive health education on DR should be integrated with diabetes education as it may result in significantly improved referral compliance. Outcomes may be sustainable if interventions are institutionalized at referral point.
TRIAL REGISTRATION
Clinical Trials.gov (Registration # NCT03658980); https://clinicaltrials.gov/ct2/show/NCT03658980.
目的
缺乏对糖尿病视网膜病变（DR）的认识是导致许多 2 型糖尿病患者不遵守转诊指示进行视网膜筛查的最常见原因。本研究的目的是评估一项文化上、地理上和社会上适宜、本土化的为期五个月的健康教育对参与者转诊依从性的效果。
方法
2017 年 9 月至 2018 年 8 月期间，在一家糖尿病医院对接受基本眼部筛查的 2 型糖尿病患者进行了一项前瞻性随机、开放标签平行组研究。不符合转诊指示前往医院进行晚期 DR 管理的参与者被随机分为健康教育干预组（n=143）和对照组（n=156）。两组均在糖尿病医院接受 DR 相关信息和转诊指示。干预组接受个性化教育并辅以电话提醒。主要终点是“转诊依从性提高”，次要终点是“DR 知识增加”。采用多变量逻辑回归模型确定对转诊的依从性的显著预测因素。
结果
共有 9 名参与者退出，290 名完成了干预后调查。干预组的依从率明显高于对照组（64.3%比 28.2%；OR 4.73；95%CI 2.87-7.79；p<0.001）。干预组的参与者在 DR 知识方面的获得有显著提高（p<0.05）。除了干预措施外，转诊依从率还与参与者对视力问题的自我感知（OR 2.02；95%CI 1.02-4.01；p=0.045）和参与者的收入（OR 1.24；95%CI 1.06-1.44；p=0.008）显著相关。
讨论
我们的研究结果表明，DR 的强化健康教育应与糖尿病教育相结合，因为这可能会显著提高转诊的依从性。如果在转诊点将干预措施制度化，结果可能是可持续的。
试验注册
ClinicalTrials.gov（注册号：NCT03658980）；https://clinicaltrials.gov/ct2/show/NCT03658980。
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