个案管理师主导的MMC随访平台在2型糖尿病患者院内外护理中的应用  

Case manager-led metabolic management center review platform in full-course nursing care of Type Ⅱ diabetic inpatient and outpatient

作　　者：陈飞 张琼丹[1] 周红丽[1] 叶凤基 蒋雯[1] 周苏梅 何琳[1] Chen Fei;Zhang Qiongdan;Zhou Hongli;Ye Fengji;Jiang Wen;Zhou Sumei;He Lin(Department of Endocrinology and Geriatrics,Deyang People's Hospital,Deyang,618000,China)

机构地区：[1]四川省德阳市人民医院内分泌代谢及老年病科,四川德阳618000

出　　处：《现代临床护理》2021年第3期51-57,共7页Modern Clinical Nursing

基　　金：四川省护理学会科研项目,项目编号为H19034。

摘　　要：目的探讨个案管理师主导的MMC随访平台在2型糖尿病患者院内外护理中的应用效果。方法选择本院内分泌科2018年10月—2019年3月收治的105例2型糖尿病患者作为研究对象,采用随机数字表法将其分为试验组(n=52)和对照组(n=53),对照组患者实施常规的健康教育和随访工作,试验组患者实施由个案管理师主导的MMC平台护理,比较两组患者干预后的糖化血红蛋白、空腹和餐后血糖值,随访12个月后自我管理行为得分及护理服务满意度。结果重复测量方差分析显示,两组患者在随访3个月、6个月、12个月的糖化血红蛋白、空腹血糖、餐后2h血糖的时间主效应、时间×处理交互效应、处理主效应差异具有统计学意义(P<0.01)。试验组患者在随访6个月、12个月的糖化血红蛋白、空腹血糖、餐后2h血糖均低于对照组,随访12个月后自我管理行为的各维度分及总分高于对照组,护理服务满意度高于对照组,两组比较,差异均具有统计学意义(均P<0.05)。结论由个案管理师主导MMC平台的院内外护理可改善2型糖尿病患者的自我管理行为及血糖水平,从而提高护理满意度。Objective To explore the effect of the Metabolic Management Center(MMC)review platform led by case managers in the full-course care of Type Ⅱ diabetic inpatients and outpatients.Methods A total of 105 patients with Type II diabetes in our hospital were selected as the subjects in this study from October 2018 to March 2019.According to the random number table,the patients were divided into an trial group(n=52)and a control group(n=53).The control group was managed by routine care,and the trial group was offered with a whole course nursing based on MMC platform led by the case manager,in and out of the hospital.The two groups were compared with glycosylated haemoglobin,blood glucose,self-management behaviour and satisfaction to the nursing service after intervention.Results Repeated measurement analysis of variance showed that there were differences in the main effect of time,the effect of time×treatment interaction and main effect of treatment in glycosylated haemoglobin,fasting blood glucose and 2-hour postprandial blood glucose between the two groups in the reviews at 1,6 and 12 months(P<0.01).The levels of glycosylated haemoglobin,fasting blood glucose and 2-hour postprandial blood glucose in the trial group were lower than those of the control group in the reviews at 6 and 12 months.The scores of all dimensions and total scores of patient self-management were significantly higher than those in the control group,as well as the satisfaction to the nursing services was significantly higher(all P<0.05).Conclusion The MMC platform-based in and out of hospital full-course nursing care led by a case manager can improve the blood glucose and the selfmanagement in Type Ⅱ diabetic patients,hence enhances nursing satisfaction.

关 键 词：个案管理师 国家标准化代谢性疾病管理中心平台 2型糖尿病 院内外护理 

分 类 号：R473.5[医药卫生—护理学]