AIM: To assess the effectiveness of the Chronic Disease Self-Management Program(CDSMP) on glycated hemoglobin A1c(HbA1c) and selected self-reported measures.METHODS: We compared patients who received a diabetes self-c...AIM: To assess the effectiveness of the Chronic Disease Self-Management Program(CDSMP) on glycated hemoglobin A1c(HbA1c) and selected self-reported measures.METHODS: We compared patients who received a diabetes self-care behavioral intervention, the CDSMP developed at the Stanford University, with controls whoreceived usual care on their HbA1c and selected self-reported measures, including diabetes self-care activities, health-related quality of life(HRQOL), pain and fatigue. The subjects were a subset of participants enrolled in a randomized controlled trial that took place at seven regional clinics of a university-affiliated integrated healthcare system of a multi-specialty group practice between January 2009 and June 2011. The primary outcome was change in HbA1c from randomization to 12 mo. Data were analyzed using multilevel statistical models and linear mixed models to provide unbiased estimates of intervention effects.RESULTS: Demographic and baseline clinical characteristics were generally comparable between the two groups. The average baseline HbA1c values in the CDSMP and control groups were 9.4% and 9.2%, respectively. Significant reductions in HbA1c were seen at 12 mo for the two groups, with adjusted changes around 0.6%(P < 0.0001), but the reductions did not differ significantly between the two groups(P = 0.885). Few significant differences were observed in participants' diabetes self-care activities. No significant differences were observed in the participants' HRQOL, pain, or fatigue measures.CONCLUSION: The CDSMP intervention may not lower HbA1c any better than good routine care in an integrated healthcare system. More research is needed to understand the benefits of self-management programs in primary care in different settings and populations.展开更多
Aim: Although numerous studies of disease management and case management of chronic heart failure (CHF) have been carried out, length of effectiveness after program commencement has not been examined, so we examined a...Aim: Although numerous studies of disease management and case management of chronic heart failure (CHF) have been carried out, length of effectiveness after program commencement has not been examined, so we examined a follow-up study at 36 months after program commencement. Methods: Participants went for follow-up visits to one Japanese clinic which specializes in internal cardiovascular medicine and they were given diagnoses of CHF. 104 outpatients participated in this study and randomized control trial was implemented. An educational program was implemented for 6 months. The data were collected at baseline, 3, 6, 9, 12 months from both intervention and control groups and at 24 and 36 months from the intervention group. Results: There was significant improvement in New York Heart Association (NYHA) in the intervention group between baseline and 36 months. Improvement in weight monitoring and activities or exercise in the intervention group continued up to 36 months. Meanwhile, sodium restricted diets and quitting smoking and/or drinking depended on individual preference and it was difficult to make improvements in these areas. Conclusions: The educational program showed promise in preventing CHF outpatients from deteriorating significantly on a long-term basis as self-monitoring of activity and weight continued significantly and there were no participants with CHF who deteriorated in the intervention group at 36 months after program commencement, although the program aimed only to provide illness and self-management knowledge. On the other hand, future work will need to compare participants in this program to a control group over an extended period of time with consideration for relieving the burden of the control group.展开更多
目的:探讨对脑梗死恢复期患者实施慢性病自我管理方案(chronic di sease sel f-management program,CDSMP)干预的效果。方法:选取2018年8月至2019年8月在闵行区吴泾社区卫生服务中心就诊的150例脑梗死患者,按入组先后顺序分为两组。对...目的:探讨对脑梗死恢复期患者实施慢性病自我管理方案(chronic di sease sel f-management program,CDSMP)干预的效果。方法:选取2018年8月至2019年8月在闵行区吴泾社区卫生服务中心就诊的150例脑梗死患者,按入组先后顺序分为两组。对照组按照常规管理模式进行管理,观察组按照慢性病自我管理方案进行干预。分别在干预前和干预后6个月,采用社区脑卒中患者功能锻炼依从性量表、简式Fugl-Meyer运动功能评分法(Fugl-Meyer Assessment,FMA)、改良Barthel指数(Modified Barthel Index,MBI)、脑卒中恢复期患者自我管理行为评定量表、脑卒中生活质量量表(stroke-specific quality of life scale,SS-QOL)、自我效能量表(General Self-Efficacy Scale,GSES)评定两组康复锻炼依从性、运动功能、日常生活活动能力、自我管理行为、生活质量及自我效能。结果:干预前,两组社区脑卒中患者功能锻炼依从性量表各维度评分及总分、上下肢FMA评分、MBI评分、SS-QOL各维度评分及总分、脑卒中恢复期患者自我管理行为评定量表各维度评分及总分和GSES量表评分比较差异无统计学意义(P>0.05);干预6个月后,观察组社区脑卒中患者功能锻炼依从性量表各维度评分及总分、上下肢FMA评分、MBI评分、SS-QOL各维度评分及总分、脑卒中恢复期患者自我管理行为评定量表各维度评分及总分和GSES量表评分均显著高于对照组,差异有统计学意义(P<0.05)。结论:对脑梗死恢复期患者实施CDSMP干预可提高其康复锻炼的依从性、自我管理行为及自我效能,促进肢体功能恢复,提高生活质量。展开更多
基金Supported by The National Institutes of Health’s National Institute on Minority Health and Health Disparities,No.#1P20MD002295
文摘AIM: To assess the effectiveness of the Chronic Disease Self-Management Program(CDSMP) on glycated hemoglobin A1c(HbA1c) and selected self-reported measures.METHODS: We compared patients who received a diabetes self-care behavioral intervention, the CDSMP developed at the Stanford University, with controls whoreceived usual care on their HbA1c and selected self-reported measures, including diabetes self-care activities, health-related quality of life(HRQOL), pain and fatigue. The subjects were a subset of participants enrolled in a randomized controlled trial that took place at seven regional clinics of a university-affiliated integrated healthcare system of a multi-specialty group practice between January 2009 and June 2011. The primary outcome was change in HbA1c from randomization to 12 mo. Data were analyzed using multilevel statistical models and linear mixed models to provide unbiased estimates of intervention effects.RESULTS: Demographic and baseline clinical characteristics were generally comparable between the two groups. The average baseline HbA1c values in the CDSMP and control groups were 9.4% and 9.2%, respectively. Significant reductions in HbA1c were seen at 12 mo for the two groups, with adjusted changes around 0.6%(P < 0.0001), but the reductions did not differ significantly between the two groups(P = 0.885). Few significant differences were observed in participants' diabetes self-care activities. No significant differences were observed in the participants' HRQOL, pain, or fatigue measures.CONCLUSION: The CDSMP intervention may not lower HbA1c any better than good routine care in an integrated healthcare system. More research is needed to understand the benefits of self-management programs in primary care in different settings and populations.
文摘Aim: Although numerous studies of disease management and case management of chronic heart failure (CHF) have been carried out, length of effectiveness after program commencement has not been examined, so we examined a follow-up study at 36 months after program commencement. Methods: Participants went for follow-up visits to one Japanese clinic which specializes in internal cardiovascular medicine and they were given diagnoses of CHF. 104 outpatients participated in this study and randomized control trial was implemented. An educational program was implemented for 6 months. The data were collected at baseline, 3, 6, 9, 12 months from both intervention and control groups and at 24 and 36 months from the intervention group. Results: There was significant improvement in New York Heart Association (NYHA) in the intervention group between baseline and 36 months. Improvement in weight monitoring and activities or exercise in the intervention group continued up to 36 months. Meanwhile, sodium restricted diets and quitting smoking and/or drinking depended on individual preference and it was difficult to make improvements in these areas. Conclusions: The educational program showed promise in preventing CHF outpatients from deteriorating significantly on a long-term basis as self-monitoring of activity and weight continued significantly and there were no participants with CHF who deteriorated in the intervention group at 36 months after program commencement, although the program aimed only to provide illness and self-management knowledge. On the other hand, future work will need to compare participants in this program to a control group over an extended period of time with consideration for relieving the burden of the control group.
文摘目的:探讨对脑梗死恢复期患者实施慢性病自我管理方案(chronic di sease sel f-management program,CDSMP)干预的效果。方法:选取2018年8月至2019年8月在闵行区吴泾社区卫生服务中心就诊的150例脑梗死患者,按入组先后顺序分为两组。对照组按照常规管理模式进行管理,观察组按照慢性病自我管理方案进行干预。分别在干预前和干预后6个月,采用社区脑卒中患者功能锻炼依从性量表、简式Fugl-Meyer运动功能评分法(Fugl-Meyer Assessment,FMA)、改良Barthel指数(Modified Barthel Index,MBI)、脑卒中恢复期患者自我管理行为评定量表、脑卒中生活质量量表(stroke-specific quality of life scale,SS-QOL)、自我效能量表(General Self-Efficacy Scale,GSES)评定两组康复锻炼依从性、运动功能、日常生活活动能力、自我管理行为、生活质量及自我效能。结果:干预前,两组社区脑卒中患者功能锻炼依从性量表各维度评分及总分、上下肢FMA评分、MBI评分、SS-QOL各维度评分及总分、脑卒中恢复期患者自我管理行为评定量表各维度评分及总分和GSES量表评分比较差异无统计学意义(P>0.05);干预6个月后,观察组社区脑卒中患者功能锻炼依从性量表各维度评分及总分、上下肢FMA评分、MBI评分、SS-QOL各维度评分及总分、脑卒中恢复期患者自我管理行为评定量表各维度评分及总分和GSES量表评分均显著高于对照组,差异有统计学意义(P<0.05)。结论:对脑梗死恢复期患者实施CDSMP干预可提高其康复锻炼的依从性、自我管理行为及自我效能,促进肢体功能恢复,提高生活质量。
