Application of contract-based follow-up management of special diseases in patients with diabetes nephropathy
10.3760/cma.j.cn115682-20220614-02863
- VernacularTitle:专病签约式随访管理在糖尿病肾病患者中的应用
- Author:
Yangcui DONG
1
;
Suhua LI
;
Qin MA
Author Information
1. 新疆医科大学第一附属医院肾脏疾病中心肾病一科，乌鲁木齐 830000
- Keywords:
Diabetic nephropathy;
Contract-based follow-up management of special diseases;
Self-perceived burden;
Self-management;
Disease control
- From:
Chinese Journal of Modern Nursing
2023;29(25):3476-3481
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the effects of contract-based follow-up management of special diseases on self-perceived burden, self-management behaviors and disease control in patients with diabetic nephropathy (DN) .Methods:Taking the establishment of DN contract-based follow-up management model by the First Affiliated Hospital of Xinjiang Medical University and the community in January 2020 as the dividing line, 50 DN patients who were included in the study and implemented routine follow-up management from the First Affiliated Hospital of Xinjiang Medical University and the community from July 2018 to September 2019 were selected as the control group, and 50 DN patients who were included in the study and implemented contract-based follow-up management of specific diseases from January 2020 to March 2021 were selected as the observation group. All patients were followed up for 3 months. Self-perceived burden [Self-Perceived Burden Scale (SPBS) ] , self-management behaviors [Self-made Self-management Behavior Scale of Patients with DN] , disease status indicators [fasting blood glucose (FBG) , 2 h postprandial blood glucose (PBG) , urine albumin creatine ratio (UACR) ] and nursing satisfaction were compared between the two groups before and after intervention.Results:After 3 months of intervention, the physical burden, economic burden and emotional burden scores on the SPBS scale of patients of the two groups decreased compared to those before intervention, and the physical burden, economic burden and emotional burden scores on the SPBS scale of the observation group were lower than those of the control group after intervention, and the differences were statistically significant ( P<0.05) . After 3 months of intervention, the scores of dietary management, exercise management, blood glucose monitoring, hemodialysis care, and medication compliance in Self-management Behavior Scale of Patients with DN of patients in the two groups increased compared to those before intervention. Moreover, the scores of dietary management, exercise management, blood glucose monitoring, hemodialysis care and medication compliance in Self-management Behavior Scale of Patients with DN of the observation group were higher than those in the control group after intervention, and the differences were statistically significant ( P<0.05) . After 3 months of intervention, the levels of FBG, PBG, and UACR in both groups of patients decreased compared to before intervention. The levels of FBG, PBG, and UACR in the observation group after intervention were lower than those in the control group, and the differences were statistically significant ( P<0.05) . The overall nursing satisfaction of the observation group patients was higher than that of the control group, and the difference was statistically significant ( P<0.05) . Conclusions:The contract-based follow-up management of special diseases can reduce the self-perceived burden of DN patients, improve their self-management behavior and contribute to better disease control.
