The effectiveness of a primary care nursing-led dietary intervention for prediabetes: a mixed methods pilot study
The effectiveness of a primary care nursing-led dietary intervention for prediabetes: a mixed methods pilot study
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DOI：
10.1186/s12875-017-0671-8
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发表时间：
2017-12-21
影响因子：
2.9
通讯作者：
Whitehead, Lisa C.
中科院分区：
文献类型：
--
作者：
Coppell, Kirsten J.;Abel, Sally L.;Whitehead, Lisa C.
背景：初级保健护士领导的糖尿病前期干预很少报道。我们研究了6个月的多层次初级保健护士领导的糖尿病前期生活方式干预的实施和可行性，并与糖尿病前期患者的现行做法进行了比较，以体重和糖化血红蛋白（HbA 1c）作为结果。方法：本研究采用收敛混合方法设计，包括为期6个月的务实非随机试点研究和定性过程评估，在新西兰两个邻近的省级城市进行，土著毛利人分别占18.2%和23.0%。受试者为年龄≥ 25 kg/m2的非妊娠成年人，未开具二甲双胍处方。在四个干预实践中实施了由初级保健护士在基线、2-3周、3个月和6个月进行访问的结构化饮食干预工具。四个对照实践继续提供常规护理。主要定量结局指标是体重和HbA 1c。使用线性和分位数回归模型比较两组随访时的每个结果。定性数据包括：观察护士培训课程和指导小组会议;文件审查;半结构化访谈的关键知情人（n = 17）和干预患者（n = 20）的有目的的样本。结果：157例糖尿病前期患者入组（85例干预，72例对照），47.8%为女性，31.2%为毛利人。合并症常见，尤其是高血压（49.7%）、血脂异常（40.1%）和痛风（15.9%）。91%的对照组和79%的干预组参与者可获得基线和6个月的测量结果。调整后，干预组比对照组平均多减掉1.3 kg（p < 0.001）。干预组平均HbA 1c、BMI和腰围降低，对照组升高，但差异无统计学意义。实施保真度高，在忙碌的全科医疗环境中实施干预是可行的。干预是高度可接受的患者和主要利益相关者，特别是初级保健nurs.Conclusions：研究结果证实了初级保健护士提供结构化的饮食建议，糖尿病前期患者在忙碌一般的做法设置的可行性和可接受性。干预组中较小但潜在有益的平均体重减轻支持进一步研究。
Background: Primary care nurse-led prediabetes interventions are seldom reported. We examined the implementation and feasibility of a 6-month multilevel primary care nurse-led prediabetes lifestyle intervention compared with current practice in patients with prediabetes, with weight and glycated haemoglobin (HbA1c) as outcomes.Methods: This study used a convergent mixed methods design involving a 6-month pragmatic non-randomised pilot study with a qualitative process evaluation, and was conducted in two neighbouring provincial cities in New Zealand, with indigenous Maori populations comprising 18.2% and 23.0%, respectively. Participants were non-pregnant adults aged = 25 kg/m(2) and not prescribed Metformin. A structured dietary intervention tool delivered by primary care nurses with visits at baseline, 2-3 weeks, 3 months and 6 months was implemented in four intervention practices. Four control practices continued to provide usual care. Primary quantitative outcome measures were weight and HbA1c. Linear and quantile regression models were used to compare each outcome between the two groups at follow-up. Qualitative data included: observations of nurse training sessions and steering group meetings; document review; semi-structured interviews with a purposive sample of key informants (n = 17) and intervention patients (n = 20). Thematic analysis was used.Results: One hundred fifty-seven patients with prediabetes enrolled (85 intervention, 72 control), 47.8% female and 31.2% Maori. Co-morbidities were common, particularly hypertension (49.7%), dyslipidaemia (40.1%) and gout (15.9%). Baseline and 6 month measures were available for 91% control and 79% intervention participants. After adjustment, the intervention group lost a mean 1.3 kg more than the control group (p < 0.001). Mean HbA1c, BMI and waist circumference decreased in the intervention group and increased in the control group, but differences were not statistically significant. Implementation fidelity was high, and it was feasible to implement the intervention in busy general practice settings. The intervention was highly acceptable to both patients and key stakeholders, especially primary care nurses.Conclusions: Study findings confirm the feasibility and acceptability of primary care nurses providing structured dietary advice to patients with prediabetes in busy general practice settings. The small but potentially beneficial mean weight loss among the intervention group supports further investigation.