Internet and information technology use in treatment of diabetes.
Internet and information technology use in treatment of diabetes.
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DOI：
10.1111/j.1742-1241.2009.02277.x
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发表时间：
2010-02-01
期刊：
影响因子：
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通讯作者：
Kaufman, N
中科院分区：
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作者：
Kaufman, N
本章包含临床研究和最新技术水平的评论，内容涉及信息技术如何通过加强教育和支持来帮助改善糖尿病患者的结局。随着糖尿病治疗方案和糖尿病相关设备的日益复杂，这种新的模式为临床医生和患者提供了一个显着的机会。有了在线工具，临床医生第一次能够对糖尿病结果产生重大影响，为大量希望通过增强对复杂行为的自我管理来改善糖尿病结果的患者提供强大且负担得起的及时支持。糖尿病患者通常需要一系列复杂的服务和支持，包括血糖监测、胰岛素和其他药物管理、心理治疗和社会支持，以及促进体力活动、营养咨询等。将这些支持整合到患者的治疗方案中提出了需要通过各种策略解决的挑战。由信息技术支持的糖尿病患者自我管理正在成为提供医疗保健的重要因素。利用信息技术来支持临床服务的方法正在被几种趋势的汇合所极大地改变。* 患者希望在管理自己的健康方面发挥积极作用，并与医疗保健提供者建立合作关系。* 广泛、低成本的互联网接入正在消除现有的地理、经济和人口障碍，以获得在线健康信息，并与先进的Web 2.0技术的高水平的互动可以吸引病人。* 临床医生和研究人员现在对人们如何在线学习和应对有了更深入的了解，这些知识可以被精心制作成产生有效的长期行为改变的解决方案。技术支持的方法在改善结果方面显示出巨大的希望，它们使用新的服务提供模式，其中技术支持的自我管理支持（SMS）为患者提供 * 及时交付量身定制的信息和体验，这些信息和体验根据每个人的独特特征、他们在关键行为方面的表现以及他们当时的需求与每个人交谈;* 如何轻松准确地跟踪他们的表现，并利用这些知识来计划和实施新的方法来实现他们的目标; * 如何直接与家人和朋友联系，以获得关键的支持，并与他们的许多提供者联系，以帮助将医疗护理与日常生活结合起来。在线工具可以扩展健康实践，并通过具有成本效益的计划提供这种支持，帮助临床医生指导患者更好地管理糖尿病。最好的互联网自我管理教育和支持计划具有丰富的相关内容，提供引人入胜的互动元素，并提供量身定制的个性化学习体验。它们包含自我评估工具和方法，供个人监测血糖、胰岛素剂量、体力活动、体重、血压和情绪等生物测量指标的表现和变化。患者可以访问他们的信息，输入他们的数据，并获得支持，每天24小时-在最方便的时间和地点，而不限于临床医生的办公时间。基于网络的学习和支持技术使临床医生和患者都受益;患者学会克服障碍，自我记录活动和互动，允许临床医生随时进行审查和反馈。除了使大部分教育内容自动化之外，这种时间转移元素是使过程高效和低成本的关键之一。对患者的活动和表现执行自动化审查的能力还为临床医生提供了提高有效性和效率的有价值的工具。与在线干预一样，“虚拟教练”可以根据对每位患者特征和表现的现成分析提供个性化指导和支持。此外，临床医生可以频繁有效地沟通，为每位患者提供个性化的电子邮件支持，而无需亲自会面，并监控“虚拟支持小组”，患者通过信息聊天室和博客在线与他人互动。通过将基于网络的患者自我管理和支持纳入传统的治疗方法，一名临床医生可以有效地支持许多患者-一次一名患者。
This chapter contains clinical studies and reviews of the state-of-the-art regarding how information technology can help improve outcomes for patients with diabetes through enhanced education and support. With the increasing sophistication of diabetes treatment protocols and diabetes-related devices this new modality offers a remarkable opportunity for clinicians and patients. For the first time, with online tools clinicians are in a position to have a major impact on diabetes outcomes by providing robust and affordable just-in-time support to large numbers of patients who want to improve their diabetes outcomes through enhanced self-management of the complex behaviours so essential for good outcomes. Patients with diabetes often need a complex set of services and support ranging from glucose monitoring, insulin and other medication management, psychotherapy and social support, to physical activity promotion, nutrition counselling and more. Integrating these supports into a patient's therapeutic regimen presents challenges that need to be addressed through a variety of strategies. Patient self-management of diabetes enabled by information technology is becoming an important factor in the way providers deliver healthcare. Approaches using information technology to support clinical services are being dramatically altered by the confluence of several trends. * Patients want an active role in managing their own health and a collaborative relationship with their healthcare providers. * Widespread, low-cost internet access is erasing existing geographic, economic and demographic barriers to obtaining health information online, and with advanced Web 2.0 technologies high levels of interactivity can engage the patient. * Clinicians and researchers now have a deeper understanding of how people learn and respond online, and that knowledge can be crafted into solutions that produce effective, long-term behaviour change. Technology enabled approaches that show great promise to improve outcomes use new models of service provision in which technology enabled self-management support (SMS) provides patients with * just-in-time delivery of tailored messages and experience that speak to each person based on their unique characteristics, their performance on key behaviours and their needs at that moment in time; * ways to easily and accurately keep track of their performance and use that knowledge to plan and implement new approaches to reaching their goals; * ways to link directly to family and friends for critical support, and to link to their many providers to help integrate medical care with everyday life. Online tools can extend health practices and provide this support through cost-effective programmes that help clinicians guide their patients to better manage their diabetes. The best internet self-management education and support programmes are rich in pertinent content, provide engaging interactive elements, and offer a tailored, personalised learning experience. They contain self-assessment tools and ways for the individual to monitor performance and changes in biological measurements such as blood sugar, insulin dosage, physical activity, weight, blood pressure and mood. The patient can access their information, input their data, and receive support 24 h a day - at a time and place most convenient for them, and not limited to clinicians' office hours. Web-based learning and support technology benefits both clinician and patient; patients learn to overcome barriers and to self-document activities and interactions, permitting clinician review and feedback at any time. In addition to automating much of the educational content, this time shifting element is one of the keys to making the process efficient and low cost. The ability to perform an automated review of the patient's activities and performance also provides the clinician with a valuable tool that increases both effectiveness and efficiency. As with online intervention, a 'virtual coach' can provide individualised guidance and support based on readily available analyses of each patient's characteristics and performance. In addition, the clinician can communicate frequently and efficiently, offering personalised email support to each patient without requiring in-person meetings, as well as monitor 'virtual support groups' where patients interact with others online via informational chat rooms and blogs. By incorporating web-based patient self-management and support into traditional treatment methods, one clinician can effectively support many patients - one patient at a time.