A scalable solution for delivery of Diabetes Self-Management Education in Thailand

用于在泰国提供糖尿病自我管理教育的可扩展解决方案

• 批准号: MR/R020876/1
• 负责人: Sanjay Kinra
• 金额: $ 49.87万
• 依托单位: London School of Hygiene & Tropical Medicine
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2018
• 资助国家: 英国
• 起止时间: 2018 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FR020876%2F1
• 关键词: scalable; solution; delivery; Diabetes; Self

Type 2 diabetes is a leading health problem in Thailand, with over 4 million adults living with the chronic condition in 2015. If the disease is not managed properly, it can lead to severe complications (e.g. heart disease, kidney disease, loss of sight) and even death. In addition, there are steep costs to the Thai economy - treating diabetes and its complications consumes over 10% of all healthcare spending, and many people with diabetes have to stop work due to the condition. To successfully manage diabetes and prevent its negative consequences, education and lifestyle counselling are prescribed as standard in many countries, supported by research evidence. Such programs (known as Diabetes Self-Management Education, DSME) help people by giving them motivation and skills to lead a healthier lifestyle, monitor warning signs for complications, follow complex medication regimes, and manage the stress of having diabetes. In Thailand, people suffering from diabetes are not currently offered any DSME services by the national health system, which means that management of diabetes is poor and rates of complications are high. The reason for this gap in service is partly the lack of a DSME program proven to work in Thailand, but also government concerns over affordability and feasibility of offering such a program at national level.To overcome these barriers, we propose to develop a new low-cost DSME program for people living with diabetes in Thailand, test that it works in a trial, and also find out how it can be made affordable for the government to provide it to everyone. The DSME program will be delivered as monthly meetings led by community health volunteers and nurses, aided by a short films about living with diabetes, to introduce key topics. These films will be produced in Thailand featuring real patients, in collaboration with award-winning charity Medical Aid Films (www.medicalaidfilms.org). The education and skills training will be followed by an open discussion session to discuss common challenges and solutions, set lifestyle goals and seek advice. We will develop the content of the DSME program through working closely with health care workers and patient groups, testing our initial version and refining it, based on observing what works and what doesn't work. Then we will test its effectiveness in a trial, by randomly assigning 15 community hospitals to offer all newly diagnosed persons either a) DSME program delivered by community health volunteers, b) DSME program delivered by nurses, or c) usual care (no DSME program). After one year, we will compare the control of blood glucose and risk of heart disease between patients of hospitals with and without the DSME program. We predict that in hospitals receiving the DSME program, management of diabetes will be better than in those without any program, and that both nurses and community health volunteers will be able to deliver it effectively. Alongside the main trial, we will collect data from participants and health care workers (through interviews) on their responses to the program and why and how it helped to improve diabetes management. Understanding these processes is vital to be able to adapt the program for other countries, making use of lessons learnt in Thailand. We will collect data on the costs involved with each part of the DSME program, and use it to identify the most affordable way of providing DSME in the Thai health system (we suspect it will be DMSE provided by community health volunteers). We will summarize all these results into policy recommendations, to be used by our collaborators at the Ministry of Public Health to decide whether and how to deliver the DSME program to the whole country. If adopted, the program has huge potential to improve the lives of people with diabetes and contribute to Thailand's continued economic growth and development.

2型糖尿病是泰国的主要健康问题，2015年有超过400万成年人患有这种慢性疾病。如果疾病管理不当，可能导致严重的并发症（如心脏病、肾病、失明），甚至死亡。此外，泰国经济的成本也很高——治疗糖尿病及其并发症消耗了超过10%的医疗保健支出，许多糖尿病患者因此不得不停止工作。为了成功管理糖尿病并预防其负面后果，在许多国家，教育和生活方式咨询被规定为标准，并得到研究证据的支持。这些项目（被称为糖尿病自我管理教育，DSME）通过给人们动力和技能来帮助他们过上更健康的生活方式，监测并发症的警告信号，遵循复杂的药物治疗方案，并管理患有糖尿病的压力。在泰国，国家卫生系统目前没有向糖尿病患者提供任何DSME服务，这意味着糖尿病管理很差，并发症发生率很高。造成这种服务差距的部分原因是缺乏在泰国行之有效的DSME项目，但也有政府对在全国范围内提供此类项目的可负担性和可行性的担忧。为了克服这些障碍，我们建议为泰国的糖尿病患者开发一个新的低成本的DSME项目，在试验中测试它的有效性，并找出如何使政府能够负担得起并向每个人提供它。DSME计划将以每月一次的会议形式进行，由社区卫生志愿者和护士主持，并辅以关于糖尿病患者生活的短片，介绍关键话题。这些影片将与屡获殊荣的慈善机构Medical Aid films （www.medicalaidfilms.org）合作，在泰国拍摄真实的病人。在教育和技能培训之后，将有一个公开的讨论环节，讨论共同的挑战和解决方案，设定生活方式目标，并寻求建议。我们将通过与卫生保健工作者和患者团体密切合作，测试我们的初始版本，并根据观察哪些有效，哪些无效，对其进行改进，从而开发DSME计划的内容。然后，我们将在一项试验中测试其有效性，随机分配15家社区医院，为所有新诊断的患者提供a)社区卫生志愿者提供的DSME项目，b)护士提供的DSME项目，或c)常规护理（没有DSME项目）。一年后，我们将比较有DSME项目和没有DSME项目的医院患者的血糖控制和心脏病风险。我们预测，在接受DSME项目的医院，糖尿病的管理将比那些没有任何项目的医院更好，护士和社区卫生志愿者将能够有效地提供糖尿病。除了主要试验外，我们还将收集参与者和卫生保健工作者（通过访谈）对该计划的反应以及该计划为何以及如何帮助改善糖尿病管理的数据。了解这些过程对于能够利用在泰国吸取的经验教训，使该方案适用于其他国家至关重要。我们将收集DSME项目每个部分的费用数据，并使用它来确定在泰国卫生系统中提供DSME的最实惠的方式（我们怀疑这将是由社区卫生志愿者提供的DMSE）。我们将把所有这些结果总结为政策建议，供我们在公共卫生部的合作者决定是否以及如何将DSME项目推广到全国。如果被采纳，该项目将有巨大的潜力改善糖尿病患者的生活，并为泰国的持续经济增长和发展做出贡献。

项目成果

The Integration of Clinical Decision Support Systems Into Telemedicine for Patients With Multimorbidity in Primary Care Settings: Scoping Review.

• DOI: 10.2196/45944
• 发表时间: 2023-06-28
• 期刊: Journal of medical Internet research
• 影响因子: 7.4

Development of a tool to estimate sugar and caloric contents in alcoholic beverages for a diabetes self-management program in Thailand.

• DOI: 10.1016/j.heliyon.2023.e21162
• 发表时间: 2023-11
• 期刊: HELIYON
• 影响因子: 4
• 作者: Thin Nyein Nyein Aung;Kanittha Thaikla;Nutchar Wiwatkunupakarn;Chanchanok Aramrat;Kanokporn Pinyopornpanish;Wichuda Jiraporncharoen;Orawan Quansri;Iliatha Papachristou Nadal;Sanjay Kinra;Chaisiri Angkurawaranon
• 通讯作者: Chaisiri Angkurawaranon

Process evaluation protocol of a cluster randomised trial for a scalable solution for delivery of Diabetes Self-Management Education in Thailand (DSME-T).

• DOI: 10.1136/bmjopen-2021-056141
• 发表时间: 2021-12-09
• 期刊: BMJ open
• 影响因子: 2.9
• 作者: Papachristou Nadal I;Aramrat C;Jiraporncharoen W;Pinyopornpanish K;Wiwatkunupakarn N;Quansri O;Rerkasem K;Srivanichakorn S;Techakehakij W;Wichit N;Pateekhum C;Birk N;Ngetich E;Khunti K;Hanson K;Kinra S;Angkurawaranon C
• 通讯作者: Angkurawaranon C

Advancing multimorbidity management in primary care: a narrative review.

• DOI: 10.1017/s1463423622000238
• 发表时间: 2022-07-01
• 期刊: PRIMARY HEALTH CARE RESEARCH AND DEVELOPMENT
• 影响因子: 1.6
• 作者: Aramrat, Chanchanok;Choksomngam, Yanee;Jiraporncharoen, Wichuda;Wiwatkunupakarn, Nutchar;Pinyopornpanish, Kanokporn;Mallinson, Poppy Alice Carson;Kinra, Sanjay;Angkurawaranon, Chaisiri
• 通讯作者: Angkurawaranon, Chaisiri

Exploring perceptions, attitudes and beliefs of Thai patients with type 2 diabetes mellitus as they relate to medication adherence at an out-patient primary care clinic in Chiang Mai, Thailand

• DOI: 10.1186/s12875-020-01233-7
• 发表时间: 2020-08-21
• 期刊: BMC FAMILY PRACTICE
• 影响因子: 2.9
• 作者: Jiraporncharoen, Wichuda;Pinyopornpanish, Kanokporn;Angkurawaranon, Chaisiri
• 通讯作者: Angkurawaranon, Chaisiri