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Keywords:

  • behavior change;
  • motivational interviewing;
  • nurse case management
  • 行为改变,动机性会谈,护士病例管理

Abstract

Background

The aim of the present study was to determine whether the addition of nurse case managers (NCMs) trained in motivational interviewing (MI) to usual care would result in improved outcomes in high-risk type 2 diabetes patients.

Methods

A 2-year randomized controlled pragmatic trial randomized 545 patients to usual care control (n = 313) or those who received the intervention (n = 232) with additional practice-embedded NCM care, including MI-guided behavior change counseling. The NCMs received intensive MI training with ongoing fidelity assessment.

Results

Systolic blood pressure (SBP) was better in the intervention than usual care group (131 ± 15 vs. 135 ± 18 mmHg, respectively; P < 0.05). Improvements were seen in both the control and intervention groups in terms of HbA1c (from 9.1% to 8.0% and from 8.8% to 7.8%, respectively), low-density lipoprotein (LDL; from 127 to 100 mg/dL and from 128 to 102 mg/dL, respectively), and diastolic blood pressure (from 78 to 74 mmHg and from 80 to 74 mmHg, respectively). Depression symptom scores were better in the intervention group. The reduction in diabetes-related distress approached statistical significance.

Conclusions

The NCMs and MI improved SBP and complications screening. The large decrease in HbA1C and LDL in the control group may have obscured any further intervention effect. Although nurses prompted providers for medication titration, strategies to reduce provider clinical inertia may also be needed.

摘要

背景

本研究的目的是评估在常规护理中加入接受过动机性会谈(MI)训练的护士病例管理经理(nurse case managers NCMs)后是否能够改善高风险2型糖尿病患者的预后。

方法

这是一项为期2年的实用随机对照试验,545名患者被随机分入常规护理对照组(n=313)或者接受加入额外的NCM护理的干预组(n=232),后一组包括MI引导的行为改变咨询。NCMs要接受强化的MI训练以及持续进行的尽职性评估。

结果

干预组的收缩压(SBP)控制比常规护理组好(131±15 vs 135±18mmHg;P < 0.05)。在对照组与干预组中都可以看到HbA1C(分别从9.1%降至8.0%以及从8.8%降至7.8%)、低密度脂蛋白(分别从127降至100 mg/dL以及从128降至102mg/dL)以及舒张压(分别从78降至74mmHg以及从80降至74mmHg)有所改善。干预组的抑郁症状评分更好。糖尿病相关痛苦的减少接近达到统计学意义。

结论

NCMs与MI可以改善SBP以及并发症的筛查。对照组的HbA1C以及低密度脂蛋白也有大幅度的下降可能掩盖了进一步的干预效果。虽然护士推动了医生进行药物剂量的滴定,但是仍然需要有效的策略以减少医生的临床惰性。