Dept. of Health and Caring Sciences, Western Norway University of Applied Sciences, Stord, Norway.
Dept. of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
BMC Endocr Disord. 2021 Mar 10;21(1):46. doi: 10.1186/s12902-021-00713-w.
Home care services plays an important role in diabetes management, and to enable older adults remain home-dwellers. Adequate follow-up and systematic nursing documentation are necessary elements in high quality diabetes care. Therefore, the purpose of this study was to examine the diabetes treatment and management for older persons with diabetes receiving home care services.
A cross-sectional study was used to assess the diabetes treatment and management in a Norwegian municipality. Demographic (age, sex, living situation) and clinical data (diabetes diagnose, type of glucose lowering treatment, diabetes-related comorbidities, functional status) were collected from electronic home care records. Also, information on diabetes management; i.e. follow-up routines on glycated haemoglobin (HbA), self-monitoring of blood glucose, insulin administration and risk factors (blood pressure, body mass index and nutritional status) were registered. HbA was measured upon inclusion. Descriptive and inferential statistics were applied in the data analysis.
A total of 92 home care records from older home-dwelling persons with diabetes, aged 66-99 years were assessed. Only 52 (57 %) of the individuals had the diabetes diagnosis documented in the home care record. A routine for self-monitoring of blood glucose was documented for 27 (29 %) of the individuals. Only 2 (2 %) had individual target for HbA documented and only 3 (3 %) had a documented routine for measuring HbA as recommended in international guidelines. Among 30 insulin treated older individuals, a description of the insulin regimen lacked in 4 (13 %) of the home care records. Also, documentation on who performed self-monitoring of blood glucose was unclear or lacking for 5 (17 %) individuals.
The study demonstrates lack of documentation in home care records with respect to diagnosis, treatment goals and routines for monitoring of blood glucose, as well as insufficient documentation on responsibilities of diabetes management among older home-dwelling adults living with diabetes. This indicates that home care services may be suboptimal and a potential threat to patient safety.
家庭护理服务在糖尿病管理中起着重要作用，可以使老年人能够留在家里。充分的随访和系统的护理记录是高质量糖尿病护理的必要要素。因此，本研究的目的是检查接受家庭护理服务的老年糖尿病患者的糖尿病治疗和管理情况。
本研究采用横断面研究方法，评估挪威一个市的糖尿病治疗和管理情况。从电子家庭护理记录中收集人口统计学（年龄、性别、居住情况）和临床数据（糖尿病诊断、降低血糖治疗类型、与糖尿病相关的合并症、功能状态）。此外，还记录了有关糖尿病管理的信息，即糖化血红蛋白（HbA）随访常规、自我血糖监测、胰岛素给药和危险因素（血压、体重指数和营养状况）。在纳入时测量了 HbA。数据分析采用描述性和推断性统计。
共评估了 92 名年龄在 66-99 岁的居家老年糖尿病患者的家庭护理记录。只有 52 名（57%）患者的家庭护理记录中有糖尿病诊断。有 27 名（29%）患者记录了自我血糖监测常规。仅有 2 名（2%）患者记录了 HbA 的个体化目标，仅有 3 名（3%）患者记录了按照国际指南建议测量 HbA 的常规。在 30 名接受胰岛素治疗的老年患者中，有 4 名（13%）患者的胰岛素方案描述不完整。在 5 名（17%）患者中，自我血糖监测的执行者记录不明确或缺失。
本研究表明，家庭护理记录在诊断、治疗目标和血糖监测常规方面缺乏记录，并且在居家老年糖尿病患者的糖尿病管理责任方面记录不足。这表明家庭护理服务可能不够完善，对患者安全构成潜在威胁。
