Interactive Behavior Change Technology to Support Diabetes Self-Management
Interactive Behavior Change Technology to Support Diabetes Self-Management
复制标题
支持糖尿病自我管理的交互式行为改变技术
作者：
J. Piette
糖尿病患者人数继续以惊人的速度增加 (1)。此外，儿童肥胖症的流行，加上高脂肪、低纤维饮食的广泛摄入，表明这个问题在可预见的将来不会减轻 (2)。即使糖尿病患者的数量奇迹般地保持不变，对糖尿病医疗管理和自我护理支持的需求仍将继续呈上升趋势。近年来，糖尿病的治疗和结果有所改善 (3-5)，并且与总体人口一样，患者的寿命也更长。与此同时，人们对糖尿病护理的期望不断提高，自我护理支持应包括哪些内容的标准更加明确（这是一件好事 [6]），并且 A1C 和血压等生理指标的目标也越来越积极（这一直以来备受争议 [7,8]）。医疗服务付款人越来越难以为糖尿病护理提供资金。专家们一致认为，当前的医疗保险计划将在不到 20 年的时间内资不抵债 (9)，而私人保险公司不断增加的成本导致他们增加成本分摊、限制资格和福利，甚至完全关门。保险公司将这些财务压力转嫁给服务提供者（通过较低的付款）和受益人（通过较高的共付额和较少的福利），使自付费用成为有效糖尿病管理的主要障碍之一（10,11）。简而言之，我们现在面临着一种难以为继的局面：对糖尿病服务的需求不断增长，而支付这些服务的资源却越来越少。
应对这一挑战需要解决医疗保健中一些最复杂的问题，包括如何协调各提供者之间的糖尿病服务以及如何为门诊患者的自我管理提供有效的支持。慢性病护理模式现已被全世界接受，作为转变后的护理系统的蓝图……
The number of people living with diabetes continues to rise at an astounding rate (1). Moreover, the epidemic of childhood obesity, coupled with widespread intake of high-fat, low-fiber diets, suggests that this problem will not abate in the foreseeable future (2). Even if the number of diabetic patients miraculously held constant, the need for diabetes medical management and self-care support would continue to trend upward. Diabetes treatment and outcomes have improved over recent years (3–5), and, like the population overall, patients are living longer. Meanwhile, expectations for diabetes care are increasing, with clearer standards for what self-care support should include (which is a good thing [6]), as well as increasingly aggressive goals for physiologic targets such as A1C and blood pressure (which has been more controversial [7,8]). Payers for health services are having an increasingly difficult time funding diabetes care. Experts agree that the current Medicare program will be insolvent in less than 20 years (9), and mounting costs on private insurers have led them to increase cost sharing, limit eligibility and benefits, and even close their doors completely. Insurers pass these financial pressures onto both service providers (through lower payments) and beneficiaries (through higher co-pays and fewer benefits), making out-of-pocket cost one of the major barriers to effective diabetes management (10,11). In short, we now face the untenable situation of a growing demand for diabetes services, coupled with fewer and fewer resources to pay for it.
Meeting this challenge requires addressing some of the most complex problems in health care, including how to coordinate diabetes services across providers and how to provide effective support for self-management between outpatient visits. The Chronic Care Model is now accepted worldwide as a blueprint for how a transformed system of care should look …
影响因子：
16.2
作者：
Krein, SL;Heisler, M;Kerr, EA
通讯作者：
Kerr, EA
影响因子：
9.7
作者：
Druss, BG;Marcus, SC;Pincus, HA
通讯作者：
Pincus, HA
影响因子：
5.1
作者：
Glasgow, RE;Boles, SM;Barrere, M
通讯作者：
Barrere, M