患者激励模式对社区2型糖尿病患者血糖管理效果的研究

Effect of patient motivation model on blood glucose management in patients with type 2 diabetes mellitus in community

探讨患者激励模式对社区2型糖尿病患者血糖管理的影响。方法从上海市嘉定区外冈社区卫生服务中心已建立健康档案的2型糖尿病患者中招募符合入选标准的患者共258名,采用随机数字表法将入组患者随机分成两组,分为患者激励组(n=123)和对照组(n=135)。建立全-专联合诊治团队,培训社区医护人员,配备必要临床药品,应用移动信息系统开展远程会诊。社区家庭医生通过规范入组患者日常行为,设定血糖等控制目标,对患者进行疾病管理。干预组接受达标激励奖励(100元的血糖管理设备奖励),对照组不接受任何达标激励。结果与基线相比,12个月后,两组患者的HbA1C、空腹血糖及HbA1C达标率均有显著性差异(P<0.05),其中患者激励组的HbA1C的达标率由基线的38.2%提升至58.8%(P<0.01)。在生活质量问卷得分中,12个月后,患者激励组与对照组组间比较,在总体生活质量、满意度和影响程度的得分上存在统计学差异(P<0.05)。结论以目标激励为导向,对2型糖尿病患者建立良好的自我管理行为、更好地进行血糖管理,具有积极的作用。

Objective To investigate the effect of patient motivation model on blood glucose and quality of life in community type 2 diabetes mellitus (T2DM) patients. Methods The study recruited 258 eligible adult patients who were residents with health records from Waigang community health centers of Shanghai Jiading District. The subjects were randomly divided into incentive group (n=123) and control group(n=135). We established a cooperative pathway between community health care centers and general hospital, trained community health workers, equipped with the necessary clinical drugs, and finally, the Advance System for Diabetes Management was used to carry out the tele-medicine. The type 2 diabetic patients, who were set goals in blood glucose, managed by the general practitioners, the daily health behaviors of the patients were regulated. The study group received the incentives if they can obtain or/and maintain the ideal level of HbA1C during the 1-year study period. The control group would not receive any incentives but would be provided with diabetes education booklet and to follow group educational courses for diabetes mellitus control as usual. Results After 12 months, there were significant differences in HbA1C, fasting blood glucose, and the on-target rate of HbA1C in both two groups as compared with the baseline levels(P<0.05). In the investigation of quality of life(QOL), we found significant differences in the scores of total QOL, the degree of satisfaction, and the degree of influence between the incentive group and the control group one year after intervention(P<0.05). Conclusion The objective motivation model seems to exert a positive effect on blood glucose control and self-management for those with T2DM.