以糖尿病對話卡進行團體衛教在基層診所的成效

The Efficacy of Group-based Education Using Diabetes Dialogue Card in a Primary Care Clinic

目的：相較於醫學中心，健康教育資源在基層診所是相對較少的。如何有效的教育第2型糖尿病患者的自我照護在基層診所是一種挑戰，更是需要進一步研究的領域。本研究的目的是比較不同教育計劃在控制不良的非胰島素治療的第2型糖尿病建立於基層醫療診所在自我照顧行為及血糖控制上的成效。
方法：這是一項隨機對照臨床試驗。將研究對象(n=69)隨機分為兩組分別：第一組是使用互動式對話衛教工具(Diabetes Dialogue Card (DCCTM) from)；第二組是常規衛教組(usual care, UC)，則接受一般門診衛教方式進行衛教。比較兩組介入前、後（3, 6, 12個月）之糖化血色素、空腹及餐後血糖值等生理及行為指標。
結果：介入到6個月時兩個組皆有顯著降低糖化血色素，在介入組糖化血色素下降幅度更多：在DDCTM8.51%±0.95%至7.69%±1.01%和在UC組8.56%±0.96%至8.28%±1.14% (p<0.05)。此外，DDCTM組，整體幸福感，糖尿病困擾，身體活動和食物攝入的質量皆有改善。
結論：這項研究顯示，團體模式的衛教可在基層診所設置執行，它可以改善第2型糖尿病患的生活型態及其血糖控制。由基層診所的護理人員來建構這種以互動並且賦能的團體衛教策略可以作為基層診所衛教基礎的教育方案。

Background: Compared to tertiary care hospitals, there are relatively few educational resources in primary care clinics. Effectively educating patients with type 2 diatetes mellitus (T2D) in primary care clinics is a challenge and is a field that warrants further research. The aim of this study was to assess the feasibility of implementing group-based education in a primary care clinic and to evaluate its efficacy compared with that of routine usual care.
Methods: This was a randomized clinical trial. The study participants (n = 69) were randomly divided into two groups: group 1, education group which used the Diabetes Dialogue Card (DDCTM), and group 2, the routine usual care group (UC). The glycemic and lifestyle behavioral outcomes were evaluated from baseline to 3, 6, and 12 months.
Results: Both groups had a significant reduction of HbA1c from baseline to 12 months, with a greater reduction in intervention group as compared with the UC group: 8.51% ± 0.95% to 7.69% ± 1.01% in DDCTM vs. 8.56% ± 0.96% to 8.28% ± 1.14% in UC group, respectively (p<0.05). In addition, general well-being, diabetes distress, physical activity, and the quality of food intake generally improved in the intervention group.
Conclusion: This study demonstrated that group-based education can be implemented in a primary care setting and that it can improve glycemic control as well as lifestyle variables in patients with T2D. This supports the notion that an interactive and empowerment strategy can be used as the basis of a group-based education program delivered by a primary care nurse.