Integrating chronic care with primary care activities: enriching healthcare staff knowledge and skills and improving glycemic control of a cohort of people with diabetes through the First Line Diabetes Care Project in the Philippines.
Integrating chronic care with primary care activities: enriching healthcare staff knowledge and skills and improving glycemic control of a cohort of people with diabetes through the First Line Diabetes Care Project in the Philippines.
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DOI：
10.3402/gha.v7.25286
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发表时间：
2014
影响因子：
2.6
通讯作者：
Kegels G
中科院分区：
文献类型：
--
作者：
Ku GM;Kegels G
本研究调查了菲律宾两个地方政府卫生单位（LGHU）将初级慢性保健与当前卫生保健活动结合起来对LGHU工作人员的知识和技能以及糖尿病患者的临床结果的影响。整合是通过卫生服务重组、慢性病护理任务的（重新）分配和LGHU工作人员的培训来完成的。测量了员工培训前后的糖尿病知识水平以及他们对糖尿病护理相关技能的自我评估。向一组糖尿病患者提供了强调自我保健发展的初级糖尿病护理。在项目全面实施前和实施一年后收集糖化血红蛋白（HbA1c）和肥胖测量数据。培训讲习班提高了LGHU工作人员的糖尿病知识（p<0.001）和自我评估技能（p<0.001）。该队列的HbA1c （p<0.001）、腰臀比（p<0.001）和腰围（p=0.011）均显著降低。虽然那些社区护理提供者在知识和自我评估技能方面表现出改善的患者的HbA1c降低程度更大，但差异没有统计学意义。糖尿病等慢性病的初级保健可与菲律宾等中低收入国家卫生服务部门的其他卫生保健活动相结合，利用现有的卫生人力资源，并可改善临床终点。
This study investigated the effects of integrating primary chronic care with current healthcare activities in two local government health units (LGHU) of the Philippines on knowledge and skills of the LGHU staff and clinical outcomes for people with diabetes. Integration was accomplished through health service reorganization, (re)distribution of chronic care tasks, and training of LGHU staff. Levels of the staff's pre- and post-training diabetes knowledge and of their self-assessment of diabetes care-related skills were measured. Primary diabetes care with emphasis on self-care development was provided to a cohort of people with diabetes. Glycosylated hemoglobin (HbA1c) and obesity measures were collected prior to and one year after full project implementation. The training workshop improved diabetes knowledge (p<0.001) and self-assessed skills (p<0.001) of the LGHU staff. Significant reductions in HbA1c (p<0.001), waist–hip ratio (p<0.001) and waist circumference (p=0.011) of the cohort were noted. Although the reduction in HbA1c was somewhat greater among those whose community-based care providers showed improvement in knowledge and self-assessed skills, the difference was not statistically significant. Primary care for chronic conditions such as diabetes may be integrated with other healthcare activities in health services of low-to-middle-income countries such as the Philippines, utilizing pre-existing human resources for health, and may improve clinical endpoints.