护理授权门诊改善社区糖前期患者临床转归的效果验证及工作优化研究

Empowerment-based Nursing Outpatient Clinics to Improve the Clinical Outcome of Pre-diabetic Patients in the Community Effectiveness Verification and Work Optimization Research

目的验证糖尿病前期患者接受护理授权门诊的健康管理效果,分析授权门诊显效的内在机制,检验目前所用工具的有效性,为医护人员找到最高效的慢病管理方式提供依据。方法选取上海市松江区车墩镇社区卫生服务中心2018年200例糖尿病前期患者作为研究对象,干预组为车墩村居患者,接受授权教育干预,对照组为一般管理模式下的华阳村居患者。回顾性收集其2018年、2019年及2020年生理指标如空腹血糖、餐后2h血糖和糖化血红蛋白等,并收集2018年、2020年糖尿病授权评分量表、糖尿病管理自我效能量表、糖尿病自我管理量表、社会支持评估量表的测量结果,进行组间和组内分析;基于临床指标改善的有效性,进一步采用结构方程模型建立各个变量之间的内在关系。数据统计在SPSS 24.0和AMOS 24.0中进行,以P<0.05为具有统计学意义。结果两组糖化血红蛋白和餐后2h血糖测量值有显著差异,且干预组平均值低于对照组;而空腹静脉血糖无显著性差异。干预组糖前期患者2年内糖尿病发病率为17.86%,对照组糖前期患者2年糖尿病发病率为12%。患者的授权能力是通过直接介导患者自我管理行为的改变来实现临床生化指标的改变。此外,干预组与对照组在授权能力和自我管理行为上在2年内均有显著提升,且干预组提升效果显著优于对照组。干预组与对照组的自我效能变化值有显著差异,且干预组的自我效能提升更显著。社会支持的变化无统计学意义。结论车墩社区采用的基于授权理论的护理门诊相较于仅进行常规健康教育的干预方案更有效果。患者的授权能力是通过直接介导患者自我管理行为的改变来实现临床生化指标的改变。社会支持作为健康信念层面诱发行为改变的因素,其实是难以改变的惰性因素。授权能力为糖尿病前期患者管理过程中的重中之重。

Objective This study is to verify the health management effect of pre-diabetes patients receiving care authorized outpatient clinics,and analyze the internal mechanism of authorized outpatient clinics to be effective,test the effectiveness of the current tools,and provide the basis for medical staff to find the most efficient chronic disease management methods.Methods 200 prediabetes patients from the Chedun Town Community Health Service Center in Songjiang District,Shanghai were selected as the research objects in 2018.The intervention group was Chedun village patients who received authorized education intervention,and the control group was Huayang village patients under general management model.Retrospectively collect their physiological indicators in 2018,2019 and 2020,such as fasting blood glucose,2h postprandial blood glucose and glycosylated hemoglobin,etc.,and collect the 2018 and 2020 diabetes authorization score scale,diabetes management self-efficacy energy scale,diabetes self-management scales,social support assessment scales,and analyzed the results between groups and within groups.Based on the effectiveness of clinical index improvement,the structural equation model is further used to establish the internal relationship between each variable relationship.Data statistics were performed in SPSS 24.0 and AMOS 24.0,and P<0.05 was considered statistically significant.Results There was a significant difference in HbA1c measurement and postprandial 2-hour blood glucose,and the average value of intervention group was lower than that of control group.However,there was no significant difference in fasting venous blood glucose.The 2-year incidence rate of diabetes in the intervention group was 17.86%,while that in the control group was 12%in 2 years.Patients’empowerment is directly mediated by the change of patients’self-management behavior to achieve the change of clinical biochemical indicators.In addition,the empowerment and self-management behavior of the intervention group and the control group were significantly improved within 2 years,and the improvement effect of the intervention group was significantly better than that of the control group.The change value of self-efficacy between the intervention group and the control group was significantly different,and the improvement of self-efficacy in the intervention group was more significant.Finally,there was no significant difference in social support.Conclusion The empowerment-based nursing outpatient in Chedun community is more effective than routine health education.Patients’empowerment ability directly mediates the change of patients’self-management behavior to achieve the change of clinical biochemical indicators.Social support,as the factors inducing behavior change at the level of health belief,is actually inert factor that is difficult to change.Empowerment is the top priority in the prediabetes management.