健康素养和运动干预对上海市2型糖尿病患者医患沟通满意度的影响

Effects of Health Literacy and Exercise-focused Interventions on Doctor-patient Communications among Type 2 Diabetes Patients in Shanghai

目的评估健康素养和运动干预对2型糖尿病患者(T2DM)医患沟通满意度的影响。方法基于2015年2月-2016年3月开展的一项整群随机对照试验,该试验采用多阶段抽样方法,从上海市长宁区和闵行区8个社区卫生服务中心招募800名T2DM患者。以社区为“群”,将患者整群随机分为健康素养干预组、运动干预组、综合干预组(健康素养+运动)和对照组。在基线、干预第3、第6、第12个月(干预结束)和干预结束后1年收集患者基本特征、医患沟通质量和糖化血红蛋白(HbA 1c)等信息。采用汉化版人际照护过程量表(c-IPC)评估医患沟通质量。用广义估计方程评估干预提高患者医患沟通满意度的效果。结果c-IPC在该人群中具有良好的效度和信度,中位得分74分(IQR:66~80),沟通满意度(>72分)为56.9%。与基线相比,随访期间3个干预组及对照组的医患沟通满意度均显著增加,但未发现干预组的满意度显著高于对照组。结论相对于常规护理,健康素养和运动干预未改善患者医患沟通满意度。提示两种干预方式可能并非通过改善患者医患沟通满意度而降低患者HbA 1c水平。

Objective To evaluate the effect of health literacy intervention and exercise intervention on the doctor-patient communications in patients with type 2 diabetesmellitus(T2DM).Methods This study based on a cluster randomized-controlled trial conducted in Shanghai,China,during February 2015 to March 2016.A total of 800 patients were recruited from eight community health care centers(CHCs)in Changning and Minhang districts using a multi-stage sampling method.A cluster randomization based on CHCs was conducted to classify all subjects into a control arm(usual care)and three intervention arms receiving the usual care and 1-year intervention focused on health literacy,exercise or both.Information was collected for each subject at baseline,3,6,12 and 24 months follo-wup.The Chinese version Interpersonal Processes of Care(c-IPC)was used to assess the doctor-patient communication in view of patients.Generalized estimated equation was applied to evaluate the effect of the interventions on doctor-patient communications at each time point.Results The c-IPC was a valid and reliable scale to measure patient-reported doctor-patient communications in our subjects.The median and interquartile of score of c-IPC was 74(66 to 80)at baseline,with a satisfaction rate for communications(score>72)of 56.9%.The communication satisfaction was found significantly improved at follow-up surveys in four arms.Compared with the control arm,however,no significant increase in communication satisfaction was observed in three intervention groups.Conclusion Both health lite-racy and exercise interventions may not be superior to usual care of diabetes in improving patients'satisfaction on doctor-patient communication.Our findings suggest that improved HbA 1c level by interventions in our subjects may not be achieved by improving doctor-patient communications.