个案管理平台在2型糖尿病患者中的应用研究

Effects of mobile health application based on case management on self-care behavior and empowerment ability of patients with Type 2 diabetes mellitus

目的探讨个案管理平台在2型糖尿病患者延续性护理中应用的可行性,并分析其对患者自我管理行为和授权能力的影响.方法2017年4月—2018年3月,选取江苏省某三级甲等医院内分泌科住院的2型糖尿病患者300例,随机分为试验组(n=150)与对照组(n=150).两组住院期间均接受个案管理,出院后试验组采用个案管理平台进行管理,对照组接受常规个案管理.分别比较两组干预前和干预12个月后的各项生化指标、糖尿病自我管理行为量表得分和糖尿病授权简化量表得分.结果干预前两组各指标的比较,差异无统计学意义(P>0.05).试验组干预12个月后,糖化血红蛋白、胰岛素抵抗指数、总胆固醇较干预前降低(P<0.01),糖尿病自我管理行为量表中饮食控制、规律锻炼、血糖监测、遵医嘱用药和足部护理5个维度得分、总分及糖尿病授权简化量表得分较干预前提高(P<0.01).干预12个月后,两组生化指标及糖尿病自我管理行为得分的比较,差异无统计学意义(P>0.05);糖尿病授权简化量表总分及量表条目4和条目8的得分均高于对照组,差异有统计学意义(P<0.05).两组护理门诊时间和护理干预总时间的比较,差异有统计学意义(P<0.001).结论个案管理平台的运用可激发患者糖尿病自我照护的内在潜力,有效改善各项代谢指标和提高自我管理能力,且减少了患者专科护理门诊时间和护理干预总时间.

Objective To explore the feasibility of case management combining mobile medical application(mHealth APP)for patients with type 2 diabetes(T2DM)and its impact on self-management behavior and empowerment abilities.Methods A total of 300 inpatients with type 2 diabetes in a tertiary hospital in Jiangsu were enrolled from April 2017 to March 2018,and they were randomly divided into 2 groups:case management control group(n=150)and case management combining mHealth APP intervention group(n=150).Both groups received case management during hospitalization.After discharge,the patients in the control group continued to receive case management,while the intervention group was managed by mHealth APP on the basis of the control group.The biochemical indexes were monitored and the SDSCA scale and DES-SF scale were completed before the intervention and 12 months after the intervention.Results Before the intervention,there was no statistically significant difference between the 2 groups.The total scores and the score of each dimension(Diet,Exercise,Blood Glucose Monitoring,Medication and Foot Care)in SDSCA,and the DES-SF score were higher than those before the intervention(P<0.01).12 months after the intervention,there were no significant difference in the total score and each dimension score of self-management behavior between the 2 groups(P>0.05).But we found that the total time of nursing management and specialist nursing outpatient service in one year was significantly less than that of the control group(P<0.01),and the improvement of the total score and items 4,8 of the DES-SF scale in the intervention group was significant than that in the control group(P<0.05)after one-year intervention.In the intervention group,HbA1c,HOMA-IR and TC were significantly reduced after 12 months of intervention(P<0.01),and self-management behaviors and empowerment ability were significantly improved after 12 months of intervention(P<0.01).Conclusion The case management combining mHealth APP can stimulate the inherent potential of self-care of patients with type 2 diabetes.It can improve various metabolic indicators and self-management capabilities while saving time and human resources effectively.