基于个人健康记录的全程管理模式干预对老年糖尿病患者的效果评价

Intervention effect of personal health record-based whole-process management model in elderly patients with diabetes mellitus

目的 分析基于个人健康记录(PHR)的全程管理模式干预对老年糖尿病患者认知水平、心理痛苦、自我管理行为、生活质量及血糖、血脂的影响。方法 将100例老年糖尿病患者按照随机数字表法分成常规组和干预组,各50例。常规组患者采用常规管理措施进行干预,干预组患者采用基于PHR的糖尿病全程管理模式进行干预。两组患者均干预6个月,各失访1例,最后分别纳入49例患者。干预前后采用自制糖尿病认知问卷、糖尿病痛苦量表(DDS)、糖尿病患者自我管理行为量表(SDSCA)、生存质量特异性量表(DSQL)评定两组患者认知水平、心理痛苦、自我管理行为、生存质量,比较干预前后两组患者血糖、血脂水平。结果 干预后,两组患者糖尿病认知水平均优于干预前,且干预组优于常规组(P<0.01)。干预后,两组患者DDS、DSQL各维度评分均低于干预前,且干预组低于常规组(P<0.05或0.01);两组患者SDSCA各维度评分均高于干预前,且干预组高于常规组(P<0.05或0.01)。干预后,两组患者空腹血糖、糖化血红蛋白、餐后2 h血糖、总胆固醇、低密度脂蛋白、三酰甘油水平均低于干预前,且干预组低于常规组(P<0.01);高密度脂蛋白水平高于干预前,且干预组高于常规组(P<0.01)。结论 基于PHR的糖尿病全程管理模式不仅有助于提升老年糖尿病患者的认知水平,缓解其心理痛苦,增强患者自我管理行为,提升患者生存质量,还能够改善老年糖尿病患者的糖脂控制情况。

Objective To analyze the effect of whole-course management model based on personal health record(PHR)on cognitive level,psychological distress,self-management behavior,quality of life and blood glucose and lipid in elderly patients with diabetes mellitus.Methods A total of 100 elderly patients with diabetes mellitus were divided into intervention and routine group according to random number table method,with 50 cases in each.Routine group was treated with routine management measure and the intervention with PHR-based whole-process diabetes mellitus management model.Both groups were intervened for 6 months,one case of both groups was lost to follow up,and 49 cases were respectively included.Before and after intervention cognitive levels,psychological distress,selfmanagement behaviors,quality of life were assessed for both groups using self-made diabetes cognition questionnaire,Diabetes Distress Scale(DDS),Summa ry of Diabetes Self-care Activities(SDSCA),and Diabetes Specific Quality of Life(DSQL)respectively,pre-and post-intervention blood glucose and lipid levels compared between two groups.Results After intervention cognitive levels of both groups were better compared with pre-intervention and so was that in intervention than routine group(P<0.01).After intervention all dimensions scores of both DDS and DSQL in both groups were lower compared with pre-intervention and so were those in intervention than routine group(P<0.05 or 0.01),all dimensions scores of the SDSCA in both groups were higher compared with preintervention and so were those in intervention than routine group(P<0.05 or 0.01).After intervention FBG,HbA1c,2h PG,TC,LDL-C,and TG levels of both groups were lower compared with pre-intervention and so were those in intervention than routine group(P<0.01),HDL-C levels of both groups were higher compared with pre-intervention and so was that in intervention than routine group(P<0.01).Conclusion PHR-based whole-process diabetes mellitus management model not only help to improve the cognition level,alleviate the psychological distress,enhance the self-management behavior,and improve the quality of life,but also can improve the glucolipid control in elderly patients with diabetes mellitus.