Barriers to control of blood glucose in diabetes mellitus
Barriers to control of blood glucose in diabetes mellitus
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DOI：
10.1177/106286060001500104
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发表时间：
2000-01-01
影响因子：
1.4
通讯作者：
Hershey, CO
中科院分区：
文献类型：
--
作者：
Dalewitz, J;Khan, N;Hershey, CO
这项研究的目的是描述严格控制糖尿病的障碍。这项研究从为城市人口服务的学术教学医院的初级保健诊所收集了多种来源的数据，包括患者图表、对患者的结构化采访、对医生对糖尿病的总体看法和信念的调查，以及医生对个别患者严格控制障碍的结构化审查。135名有预约的患者有资格参加这项研究，其中94%的患者最近出现了血红蛋白A(1)C(HbA(1)C)。88名提出预约的患者中有77名(88%)同意接受采访，50名提供者中有48名(96%)返回了可用调查，提供者完成了96名患者的个人评估(71%)。患者的平均年龄为61岁，平均诊断为7.60例，平均开出8.96张处方。他们的糖尿病控制并不理想，只有不到15%的人控制正常或接近正常，近四分之一的人控制不佳。HbA(1)C与年龄和显示率呈正相关。医生的评估表明，对糖尿病的动机和了解以及对饮食和药物的依从性与糖尿病控制相关。患者知识和医生知识似乎都不是问题，也与糖尿病控制无关。需要控制的障碍很多，超过一半的患者有五个或更多的障碍。严格控制血糖被认为是糖尿病患者高质量护理的一个重要方面。在这项研究中，有代表性的糖尿病患者样本的糖尿病控制不够理想。这些人在城市环境中接受他们的护理，并患有许多共病和许多难以控制的障碍。年龄、动机、对疾病的了解、出现率以及对饮食和药物的依从性与糖尿病控制有统计学上的相关性。为了提高糖尿病患者的护理质量，必须消除护理障碍。
The purpose of this study was to characterize the barriers to tight control of diabetes mellitus. The study collected data from multiple sources at a primary health care clinic in an academic teaching hospital serving an urban population, including patients' charts, structured interviews with patients, a survey of physicians' general perspectives and beliefs concerning diabetes mellitus, and a physician's structured review of barriers to tight control for individual patients. One hundred thirty five patients with scheduled appointments were eligible for the study, of whom 94% had had a recent hemoglobin A(1)C (HbA(1)C). Seventy seven of 88 patients (88%) who presented for their appointments consented to the interview, 48 of 50 providers (96%) returned useable surveys, and providers completed individual assessments for 96 patients (71%). Patients had a mean age of 61 years, an average of 7.60 diagnoses, and an average of 8.96 prescriptions. Their diabetes control was less than ideal, with less than 15% having normal or near normal control and almost a quarter having poor control. Correlations of HbA(1)C with age and show rate were seen. Physicians' assessments showed that motivation and understanding of diabetes and compliance with diet and medications correlated with diabetes control. Neither patient knowledge nor physician knowledge appeared to be a problem, nor did either correlate with diabetes control. The number of barriers to control were many, with over half of the patients having five or more barriers. Tight control of blood glucose is felt to be an important aspect of quality care for diabetic patients. In this study, a representative sample of diabetic patients had less than ideal diabetes control. This population was receiving their care in an urban setting and had many comorbid illnesses and many barriers to control. Age, motivation, understanding of the disease, show rate, and compliance with diet and medications had statistical correlations with diabetes control. In order to improve the quality of care for diabetic patients, barriers to care must be addressed.