Patient-centered Diabetes Care in Children: An Integrated, Individualized, Systems-oriented, and Multidisciplinary Approach.
Patient-centered Diabetes Care in Children: An Integrated, Individualized, Systems-oriented, and Multidisciplinary Approach.
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DOI：
10.7453/gahmj.2013.005
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发表时间：
2013-03
影响因子：
--
通讯作者：
Hilgard D
中科院分区：
文献类型：
--
作者：
Kienle GS;Meusers M;Quecke B;Hilgard D
儿童1型糖尿病与各种医学、心理、情感、社会和组织障碍有关。以患者为中心的疾病管理应以个性化、系统导向和多学科的方法解决所有与患者相关的问题。一个10岁的女孩患有1型糖尿病，运动和感觉功能障碍和计算障碍的发育障碍，由她的母亲和一名助理护士全职照顾。接受标准强化胰岛素治疗后，患者血糖控制仍较差，轻、重度低血糖发作频繁。她在社交上被孤立，不能参加同伴活动，对自己的处境感到沮丧。母亲的压力很大，母子关系受到威胁。女孩和她的家人被转介到一个综合的、以患者为中心的、高度个性化的、多学科的糖尿病护理项目，该项目提供自我管理教育课程和心身护理。一个核心要素是将重点从技术管理和实验室数据转移到女孩和她的具体问题、愿望、目标、需求和条件上。孩子成为管理和决策的积极伙伴。该项目提供适合年龄的活动。因此，女孩能够连续自我控制她的疾病，导致血糖控制，生活质量，满意度和母女关系的实质性改善。糖尿病管理中日益复杂的技术倾向于将重点放在生物医学结果上。当病人及其需要、障碍、目标以及心理和社会问题成为他或她所接受的护理的中心时，就可以取得更好的医疗和社会心理结果。
Type 1 diabetes mellitus in children is associated with various medical, psychological, emotional, social, and organizational hurdles. Patient-centered disease management should address all patient-relevant issues in an individualized, systems-oriented, and multidisciplinary approach. A 10-year-old girl with type 1 diabetes mellitus, a developmental disorder with motor and sensory dysfunction and dyscalculia was cared for full-time by her mother and an assistant nurse. Receiving standard intensified insulin therapy, she still had poor glucose control with frequent mild and severe hypoglycemic episodes. She was socially isolated and not able to attend peer activities and was frustrated with her situation. The mother was substantially stressed, and the child-mother relationship was endangered. The girl and her family were referred to an integrated, patient-centered, and highly individualized, multidisciplinary diabetic care program that offered self-management education courses and psychosomatic care. A core element was to switch the main focus from technical management and laboratory data to the girl and her specific problems, wishes, goals, needs, and conditions. The child became an active partner in management and decisions. The program offered age-appropriate activities. Consequently, the girl was able to successively self-manage her disease, resulting in a substantial improvement in glucose control, quality of life, satisfaction, and the relationship between mother and daughter. Increasing technical sophistication in diabetes management tends to lay the focus on biomedical outcomes. Improved medical and psychosocial results may be achieved when the patient and his or her needs, hurdles, goals, and psychological and social issues are made central to the care he or she receives.