2型糖尿病患者服药依从性行为阶段的评估及干预

Evaluation and intervention of medication compliance in type 2 diabetic patients

目的探讨基于跨理论模型的2型糖尿病患者服药依从性干预方案的应用效果。方法2019年1月—8月招募某街道社区建档的136例2型糖尿病患者,随机分为试验组(n=70)和对照组(n=66)。借助“健康小屋”服务平台对试验组开展基于跨理论模型的干预方案,通过自制的糖尿病患者服药依从性行为阶段评估问卷将试验组分为前意向阶段、意向阶段、准备阶段、行动阶段、维持阶段,并采取相应的干预措施;对照组开展智慧服务中心提供的糖尿病健康管理项目。比较两组干预前、干预后6个月和干预后12个月的服药依从性和服药自我效能,以及干预前和干预后6个月的糖代谢指标。结果服药依从性和服药自我效能得分存在组间和时间的交互效应(F=100.772,F=15.827,均P<0.05);单独效应分析显示,干预后6个月和12个月,试验组服药依从性和服药自我效能得分高于对照组(P<0.05)。干预后6个月,试验组各项糖代谢指标均优于对照组,差异有统计学意义(P<0.05)。结论应用基于跨理论模型的2型糖尿病患者服药依从性干预方案能够有效提高2型糖尿病患者服药自我效能、服药依从性,血糖控制效果良好。

Objective To explore the effects of a medication adherence program based on trans-theoretical model in patients with type 2 diabetes.Methods The convenience sampling method was uesed to recruit 136 patients with type 2 diabetes mellitus in a community from January to August 2019.Participants were assigned to the experimental group(n=70)and the control group(n=66)randomly.Based on the health cabin platform,the trans-theoretical model intervention was constructed and implemented in the experimental group.According to the self-designed stage of change questionnaire in medication compliance,behaviors of participants in the experimental group were divided into 5 stages:pre-contemplation,contemplation,preparation,action and maintenance.Corresponding interventions were taken for patients in each stage.Meanwhile,patients in the control group participated received routine services provided by the wisdom service center.The scores of medication adherence and medication self-efficacy in the two groups were compared before the intervention,6 months and 12 months after the intervention.The glucose metabolism indicators were evaluated before the intervention and 6 months after the intervention.Results There were intergroup and time interaction effects in medication adherence and medication self-efficacy(F=100.772,F=15.827,P<0.05).Simple effect analysis showed that medication adherence and medication self-efficacy scores in the experimental group were higher than those in the control group 6 months and 12 months after the intervention.In addition,the glucose metabolism indicators in the experimental group were significantly superior to those in the control group 6 months after the intervention(P<0.05).Conclusion The intervention program for medication compliance of patients with type 2 diabetes based on a trans-theoretical model can effectively improve the medication self-efficacy,medication adherence,and blood glucose control effect of type 2 diabetes patients.