一种基于文化的原住民初级保健服务和专科糖尿病诊所的综合糖尿病教育和眼部筛查模式：研究方案。

A model of culturally-informed integrated diabetes education and eye screening in indigenous primary care services and specialist diabetes clinics: Study protocol.

机构信息

Department of Medicine, University of Melbourne, Melbourne, Vic., Australia.

NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia.

出版信息

J Adv Nurs. 2021 Mar;77(3):1578-1590. doi: 10.1111/jan.14734. Epub 2021 Jan 10.

DOI:10.1111/jan.14734

PMID:33426727

Abstract

AIMS

To improve diabetes management in Indigenous Australians using an integrated nurse-led model of diabetes education and eye screening in indigenous primary care and specialist diabetes clinics.

DESIGN

A pre-post study.

METHODS

This study will be implemented in indigenous primary care and specialist diabetes clinics in Victoria, Australia. Participants recruited to the study will be existing adult patient with diagnosed diabetes attending study sites. A nurse-credentialled diabetes educator and certified retinal imager will deliver three study components: (a) retinal photography as a diabetic retinopathy screening and patient engagement tool; (b) lifestyle and behaviour surveys, administered at baseline and at the final visit, in 12 months. Findings from the surveys and participants' retinal images will be used to guide; and (c) personalized diabetes education. The primary outcomes are participant adherence to diabetic eye screening recommendations and health service diabetic retinopathy screening coverage. Secondary outcomes are baseline DR prevalence and changes in clinical and lifestyle risk factor levels, diabetes knowledge and satisfaction with diabetes care.

DISCUSSION

Compared with non-indigenous Australians, Indigenous Australians have a high prevalence of diabetic retinopathy and blindness, low adherence to eye screening recommendations and suboptimal health literacy. Nurse-credentialled diabetes educators can be trained to incorporate retinal imaging and eye screening into their clinical practice to give image-based diabetes education to facilitate diabetic retinopathy management.

IMPACT

Credentialled nurse diabetes educators who integrate eye screening and diabetes education can facilitate timelier diabetic retinopathy screening, referral pathways and treatment of sight-threatening retinopathy. We believe that this model of integrated diabetes education and eye screening will also improve adherence to eye screening recommendations, population screening coverage, health literacy, risk factor levels and diabetes self-care.

CLINICAL TRIAL REGISTRATION

ANZCTRN1261800120435.

摘要

目的

通过在澳大利亚原住民初级保健和专科糖尿病诊所中采用以护士为主导的综合糖尿病教育和眼部筛查模式，改善原住民的糖尿病管理。

设计

前后对照研究。

方法

本研究将在澳大利亚维多利亚州的原住民初级保健和专科糖尿病诊所实施。研究招募的参与者为现有成年糖尿病患者，他们正在研究地点就诊。一名经过认证的糖尿病教育护士和认证的视网膜成像师将提供三个研究组成部分：（a）视网膜摄影作为糖尿病视网膜病变筛查和患者参与工具；（b）生活方式和行为调查，在基线和 12 个月的最后一次就诊时进行。调查结果和参与者的视网膜图像将用于指导；（c）个性化糖尿病教育。主要结果是参与者对糖尿病眼部筛查建议的依从性和卫生服务糖尿病视网膜病变筛查的覆盖率。次要结果是基线 DR 患病率以及临床和生活方式危险因素水平、糖尿病知识和对糖尿病护理的满意度的变化。