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The Valuation of the Case Management for Type 2 Diabetes in a Nurse-led Clinic Applied by Nurse Specialist

Author: ZhouPeiRu
Tutor: LiYaJie
School: Southern Medical University,
Course: Nursing
Keywords: Diabetes specialist nurses Nurses in outpatient Personalized management of diabetes Diabetes Education Complications screening Case Management
CLC: R473.5
Type: Master's thesis
Year: 2008
Downloads: 442
Quote: 3
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Abstract

Objective: Diabetes (Diabetes mellitus, DM) is a threat to people's health in the world's third-largest killer in our country, the sharp increase in the incidence of diabetes, a heavy economic burden to patients, their families and society, patients with complications low treatment compliance; compared with developed countries, China's diabetes care, education and management, there is a great gap, more lack of effect of diabetes education and management of long-term follow-up. But diabetes is a common life-long, systemic disease, and how to get patients to master the knowledge of the prevention and treatment of diabetes and its complications; make it right to treat diabetes and treatment of diabetes related issues; improve treatment compliance monitoring and care ; reduce hospitalization rates and medical costs, is the most pressing problem in the management of diabetes care. Diabetes specialist nurses (Diabetes specialisy nurse, DSN) plays an important role in diabetes education and management of patients with lifelong. Content and method in order to explore the work of the diabetes specialist care, and diabetes the outpatient specialist nurses (Diabetesspecialist nurse-led clinic, DSNLC) to open DSNLC, to take care of the case management work, individualized assessment of patients with diabetes, and design specialist nurses in outpatient newly diagnosed process, the referral process, implementation of personalized guidance; regularly complications of diabetes screening patients, standardize the management of diabetes, improve diabetes self-care ability and behavior compliance to treatment and care, to achieve good control of diabetes and glucose metabolism in the purpose of . The the innovative discussed topics on the way of working and the case management model in DSNLC propose a suitable to in work mode of DSNLC, provide a theoretical basis for the future Guangdong Province Hospital DSNLC's work to promote and DSN certification and assessment. Subjects and methods: Method: This subject using case-control study, convenience sampling, January 2007-June outpatient visits in the First Affiliated Hospital of Jinan University, 109 diabetic patients were divided into experimental and control groups. The experimental group and 49 patients in the control group of 60 patients. Experimental group were independent or referral by a specialist nurse outpatient. Inclusion criteria: according to the World Health Organization in 1997 (World health organization, WHO) diagnostic criteria for diabetes diagnosis of type 2 diabetes, aged 30-70 years old. Exclusion criteria: impaired glucose tolerance (Impaired glucose tolerance, IGT) and diabetes, there are other circumstances that may affect the effectiveness of education, with severe diabetic complications, not by and / or impossible to understand and comply with the program. Control group: randomly selected from the same period in the First Affiliated Hospital of Jinan University, endocrine general medical clinic, rather than DSNLC treatment, aged 30-70 years old, at the same time a large class of diabetes education in patients with type 2 diabetes. Period 2006, the First Affiliated Hospital of Jinan University Medical Services, Department of Endocrinology, Department of Nursing approved the creation of DSNLC, pre-design and research and the nurse outpatient work content, including diabetes specialist nursing assessment sheet, specialist nurses outpatient treatment process . Experimental group of 49 patients by specialist nurses to carry out detailed diabetes specialist nursing assessment, analysis of the patient's personality problems, conduct one-on-one diabetes education, management of patients 3 months of follow-up care case management, evaluation of education and management effectiveness. Control group of 60 patients for the first time to assess patients medical outpatient waiting by the Department of Endocrinology, nurses hand (assessment table with DSNLC, specialist nursing assessment sheet), control group patients involved in organization of Endocrinology, The First Affiliated Hospital of Jinan University large class of diabetes education. Respectively to intervene in the three months before and after the intervention, the two groups of patients with FBG (Fasting blood glucose, FBG), PBG (Postprandial blood glucose PBG), treatment compliance monitoring behavior and self-management, etc. indicators to compare. Intervention control group, FBG, PBG data type 2 diabetes, the Second Hospital of Zhongshan, Guangzhou Collaborative Group conducted Guangzhou metabolic control survey, carried out simultaneously, on the same day of blood collection. Statistics using SPSS13.0 software package for processing and analysis, statistical methods, including independent samples T-test (Independent Samples Test), chi-square test, Mann-Whitney U rank sum test, Shapiro-Wilk normality test, Wilcoxon signed rank sum test. The results: 1. Experimental group (49 cases), the average age of (53.306 ± 9.607) years in the control group of 60 patients, average age (55.617 ± 7.975), P = 0.173. Experimental group, the average body mass index (Body mass index, BMI) (24.096 ± 2.960) kg / m to the control group average BMI (23.731 ± 4.385) kg / m ~ 2 independent samples T-test, P = 0.621. A history of the history of the experimental group and the control group by the χ ~~ 2 test, χ to 2 = 3.261, P = 0.353. Experimental group and the control group, the patient's age, medical history, BMI value differences, to ensure the comparability of the two groups. FBG, PBG of the two groups of patients before the intervention rank sum test stratified comparison, P> 0.05, were not statistically different, indicating no significant difference in the sample source. 2 after the intervention of the two groups of patients with glycosylated hemoglobin (the Glycosylated haemoglobin, HbA1c) check, microalbuminuria checks, blood lipid examination, foot screening, self-monitoring of blood glucose, blood pressure monitors, exercise behavior, diet control, fundus examination compliance analysis showed that the experimental group condition monitoring indicators of compliance than the control group, the two groups have a significant difference (P <0.05). Specialist nurses in outpatient management of patients, self-monitoring and management of complications re-screening effect is better than the control group of patients. Complications of diabetes through regular screening, early detection of diabetes complications in high-risk factors, and to give timely guidance on specific issues for patients to be effectively addressed. 3 after the intervention of the two groups of patients FBG, PBG layered comparison PBG comparison between the two groups was no significant difference (P> 0.05). The two sets of the FBG compliance rate stratified There were significant differences (P <0.05). Experimental group and the control group, the experimental group patients the FBG reached the ideal control target rate improved significantly. Experimental group and the control group of patients before and after the intervention of FBG, compare the difference between the PBG evaluation guidelines. The results showed that the experimental group FBG, PBG intervention lower than before the intervention, before and after comparison shows that there is a statistically significant difference (P <0.05). Accept DSNLC personalized education and case management of patients, average FBG (6.582 ± 2.144) mmol / L was significantly lower than the average before the intervention the FBG (8.549 ± 3.090) mmol / L, P <0.05. Experimental group and the control group compared with the control group patients after the intervention of the average FBG (8.842 ± 3.380) mmol / L, P = 0.000, the FBG of the experimental group was significantly lower than the control group FBG. After the intervention of the experimental group patients PBG (8.560 ± 2.333) mmol / L significantly higher than before the intervention the PBG (12.222 ± 5.350) mmol / L, low (P = 0.000). PBG difference compares the experimental and control groups after the intervention (P = 0.011), statistically significant, PBG PBG than the control group, the experimental group after the intervention. 5.DSNLC work, reported by the media, to attend an academic conference papers, receiving visits and studies, to declare a national continuing education classes in the form of promotion. Conclusion: 1. Established the outpatient diabetes specialist nurse modes: the lead in establishing and perfecting the mode of implementation of the case management of patients with diabetes specialist nurse outpatient system; patients with newly diagnosed, referral process, specialist nurses outpatient work content personalized guidance and regular follow-up guidelines. 2. Effect of patient education: reduce blindness in diabetes treatment, standardized diabetes complications screening methods, improve diabetes therapy monitoring compliance, improve patient self-management skills to control glucose metabolism, solve every diabetes individual issues; reach the secondary prevention of diabetes; reduce the incidence of diabetic complications, in theory, reduce the long-term health care costs due to complications arising from medical cost accounting to be next. Role of specialist nurses in outpatient: You can play the advantages of the diabetes specialist nurse is more targeted to solve the problems of patients personalized approach to education; able to make up the doctors do not have time to explain in detail the deficiencies of the various questions raised by the patients; specialist nurses in outpatient and case management model has practicality and maneuverability, and promote the use of a number of hospitals in Guangdong province, a broad social benefits, welcomed by patients and praise; can be used as a reference for future diabetes management methods.

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