电话回访对农村地区糖尿病患者的延续性护理及医疗状况调查研究  

Application of the continuous nursing based on telephone follow-up for diabetic patients in rural areas and the investigation research on medical service status

作　　者：杨秋[1] 赵莉[2] 崔素芬[1] 李莉[2] YANG Qiu;ZHAO Li;CUI Sufen;LI Li(Department of Endocrinology,Affiliated Hospital of North Sichuan Medical College;Nanchong,Sichuan,63700;2.School of Nursing North Sichuan Medical College,Nanchong,Sichuan,637000)

机构地区：[1]川北医学院附属医院内分泌科,四川南充637000 [2]川北医学院护理学院,四川南充637000

出　　处：《中西医结合护理（中英文）》2018年第9期7-10,共4页Journal of Clinical Nursing in Practice

基　　金：四川省基层卫生事业发展研究中心2017年项目(SWFZ16-C-72);四川省南充市社科研究"十三五"规划2016年度项目(NC16B035);四川省南充市科学技术和知识产权局2017年市校合作科研项目(NSMC20170476)

摘　　要：目的通过定期电话回访的方式对南充市周边农村地区糖尿病患者进行延续性服务,了解患者医疗状况,对患者进行健康指导。方法通过电话回访的方式,对523例农村地区糖尿病患者进行回访,回访3个月。观察回访前后患者血糖的变化、并发症的发生率及自我护理能力。结果在进行电话回访后,糖尿病患者空腹血糖(FPG)、餐后2 h血糖(P2hPG)和糖化血红蛋白(Hb A1c)均较电话回访前明显降低,差异有统计学意义(P <0. 05)。在进行电话回访后,糖尿病患者的低血糖、酮症酸中毒、足部病变和眼部病变并发症的发生率均下降,电话回访后并发症总发生率为4. 59%(24/523)低于电话回访前的15. 30%(80/523),差异有统计学意义(χ~2=33. 480,P <0. 05)。在进行电话回访后,糖尿病患者的血糖监测、血糖异常处理、遵医用药、合理饮食和适当锻炼评分均较回访前明显升高,差异有统计学意义(P <0. 05)。结论通过3个月定期的电话回访方式对农村地区糖尿病患者进行延续性服务,了解患者的医疗状况,有利于帮助糖尿病患者更好地控制血糖水平,降低并发症的发生率,提高患者自我护理能力。Objective To provide continuous nursing based on telephone follow-up for diabetic patients in rural areas of Nanchong, in order to understand the medical service status and carry out health education. Methods A three-month follow-up by telephone was conducted to 523 di- abetic patients in rural areas of Nanchong. The change of blood glucose level, incidence of complications and self-care ability of patients were observed after follow-up. Results After three- month follow-up by telephone, there was a decreased level of fasting blood glucose, 2 h postpran- dial blood glucose and hemoglobin A1 c among patients （P 〈 0.05 ）. There was a decreased inci- dence of hypoglycemia, ketoacidosis, foot lesions and diabetic oculopathy after follow-up, the overall complication rate dropped from 15.30% （80/523）before implementation of telephone follow-up to 4.59 % （24/523） after implementation of telephone follow-up （χ2= 33. 480, P 〈 0.05 ）. Patients achieved higher scores in assessment of blood sugar monitoring, treatment on glucose ab-normalities, medication adherence, reasonable diet and suitable exercise after follow-up compared with those of patients before follow-up （P 〈 0.05）. Conclusion Based on a three-month follow-up by telephone, continuous services were conducted on diabetic patients in rural areas and patients＇medical status were continuously monitored. The continuous nursing based on telephone follow-up is effective for diabetic patients to control blood glucose level and reduce the risk of dia- betic complications.

关 键 词：电话回访 糖尿病 延续性护理 低血糖 农村地区 自我护理 

分 类 号：R473.2[医药卫生—护理学]