胰岛素注射患者量表评估与体验式互动及个体化随访指导管理模式的探讨

Management of scale evaluation,experience interaction and individualized follow-up patients with insulin injections

目的通过对糖尿病患者量表评估与体验式互动教育及个体化随访指导前后各项指标的对比和研究,探索更高效更理想的糖尿病教育模式。方法采用《BGAT糖尿病教育评价量表》对患者体验式教育前及教育后第1、3、6个月认知及行为水平各25项进行问卷调查并评分,评估患者认知及行为改变情况,用《糖尿病患者随访评估与指导记录表》随访并记录教育前及教育后第1、3、6个月患者空腹、餐后血糖、糖化血红蛋白、微量白蛋白/肌酐以及血糖检测频次、胰岛素漏注射频次、注射剂量错误频次、注射针头使用次数、低血糖发生频次、并发症缓解情况(糖尿病肾病测微量白蛋白/肌酐变化,其他并发症对比症状缓解情况)、体重指数、胰岛素用量、医疗费的变化,并予以个体化指导。结果糖尿病患者认知得分、行为得分、空腹与餐后血糖、糖化血红蛋白以及并发症症状减轻率、胰岛素漏注射频次、注射剂量错误频次在教育后第1、3、6个月和入组时比较(P<0.001),差异有统计学意义;血糖检测频次教育后第3、6个月和入组时比较(P<0.001),差异有统计学意义,注射针头重复使用教育后第1个月和入组时比较(P=0.050),第3、6个月和入组时比较(P<0.001),差异有统计学意义;低血糖发生频次在教育后第6个月和入组时对比,差异均有统计学意义(P=0.001)。结论量表评估与体验式互动教育及个体化随访指导的教育模式是目前糖尿病教育的理想模式。此模式更注重个体化和系统化,患者亲自体验,既直观又有趣,易于熟悉和掌握,加之全程定期随访和个体化指导以及对患者心理的关注,大大增加了患者安全感、归属感及治疗的信心和依从性。

Objective To investigate the more efficient model of diabetic education,through the changes of index by management of scale evaluation,experience interactive education and individualized follow-up. Methods Systemic evaluation was carried out for patients that accepted the experience interactive education with BGAT diabetic education evaluation scale. Furthermore,individualized follow-up and instruction were recorded by the follow-up evaluation and instruction form for patient with diabetes. Results Compared to the baseline,significant difference（ P 0.001） was found in the score of diabetes acknowledge and action,blood glucose,Hb A1 c,frequencies of glucose monitoring,missing injection of insulin,incorrect dosage,repeated needle use and complication remission after education in 3rd and 6th months.The level of urine ratio ALB/Cr and frequency of hypoglycemia were significantly decreased（ P = 0.001） in 6th month. Conclusion Scale evaluation,experience interactive education and individualized follow-up were ideal model in diabetes education. These models pay more attentions to the individualization and systemization. Patients may understand well the related knowledge by personally experience with intuition and interest. Psychological attention,Individualized follow-up and instruction were performed throughout,which strengthen the sense of security,belonging,confidence and compliance.