延续护理模式对Ⅱ型糖尿病患者治疗依从性和血糖控制的影响

Impact of transitional care program on treatment compliance and glycemic control in patients with type 2 diabetes

目的 设计以高级实践护士（APN）为主导的延续护理方案,并评价该方案对Ⅱ型糖尿病患者治疗依从性和血糖控制的影响.方法 选择2011年1月至2012年12月在广州市某医院住院、符合研究标准的Ⅱ型糖尿病患者96例,将其随机分配到干预组及对照组,各48例.两组患者均接受住院及出院常规护理服务,试验组同时还接受以APN为主导的延续护理干预.分别在患者接受干预前、干预4周及12周后收集患者的治疗依从性和血糖资料,采用重复测量方差分析、t检验、卡方检验等统计方法分析结果.结果 干预后4周,干预组治疗依从性总得分以及血糖监测、运动和饮食控制依从性3个维度的得分均高于对照组,且差异有统计学意义（P＜0.05）;干预后12周,干预组治疗依从性总得分及用药、血糖监测和饮食控制依从性3个维度得分均高于对照组,且差异有统计学意义（P＜0.05）;干预后12周,干预组糖化血红蛋白测量值与对照组相比,差异无统计学意义（P＞0.05）,干预组糖化血红蛋白达标率高于对照组,且差异有统计学意义（P＜0.05）.结论 以高级实践护士主导的延续护理模式可以有效提高Ⅱ型糖尿病患者治疗依从性、糖化血糖蛋白达标率.

Objective To develop a transitional care program led by advanced practice nurse（APN） for patients with type 2 diabetes and to evaluate its impact on the patients＇ treatment compliance and glycemic control.Methods A random sampling method was used.96 patients with type 2 diabetes from an inpatient department were divided into an intervention group and a control group randomly.Both groups received regular nursing service,and the intervention group also received transitional care led by APN.The treatment compliance and glycosylated hemoglobin Alc（HbAlc） of the patients were collected before and 4 and 12 weeks after the intervention.Results 4 weeks after the intervention,the total average score of treatment compliance and the scores of ＂self-monitoring＂,＂exercise＂,and ＂diet-control＂ were statistically higher in the intervention group than in the control group（P ＜ 0.05）.12 weeks after intervention,the total average score of treatment compliance and the scores of ＂self-monitoring＂,＂medication＂,and ＂diet-control＂ were statistically higher in the intervention group than in the control group（P ＜ 0.05）.The t-test showed that there was no statistical difference in HbAlc between the two groups 12 weeks after the intervention.But more patients were qualified in HbAlc in the intervention group than in the control group （P ＜ 0.05）.Conclusions Transitional care program led by APN is an effective approach in improving treatment compliance and making more patients qualified in HbAlc.