糖尿病腎症患者への療養指導状況と糖尿病透析予防指導管理料の算定がそれに及ぼす影響—糖尿病看護認定看護師・慢性疾患看護専門看護師の横断的調査から

The effects of the receipt of the medical fee “charge for medical instruction to prevent dialysis in diabetes” on the nurses' performance of self-management consultation for outpatients with diabetic nephropathy by nurse specialists : a cross-sectional study

　わが国の糖尿病腎症２期以降の外来患者への看護師による療養指導の実施内容とその程度，および診療報酬「糖尿病透析予防指導管理料（以下，透防管）」の算定が療養指導の実施程度の向上に寄与するかを明らかにするため，全国472施設に勤務する糖尿病看護認定看護師と慢性疾患看護専門看護師を対象に，自記式質問紙の郵送法による横断調査を行った．

　回収した224件では，療養指導の実施割合が非常に高く，73.2％が透防管を算定していた．多重ロジスティック回帰分析の結果，透防管の算定の有無は「自身の腎症の理解を促す指導」と「腎症の状態に応じた療養指導」の実施に対して統計的に有意な要因であった（それぞれへのオッズ比［95％ CI］; 3.19［1.18-8.60］および2.82［1.05-7.56］）．

　以上のことから，わが国の糖尿病腎症患者への外来での療養指導は，糖尿病看護の専門性の高い看護師の間では広く行われつつあり，透防管の算定は療養指導の充実につながる可能性が示唆された．

We conducted a cross-sectional study to investigate the current conditions of self-management consultation for outpatients with diabetic nephropathy by nurses. The effect of the receipt of the medical fee “Tounyoubyou touseki yobou shidou kanri ryou (charge for medical instruction to prevent dialysis in diabetes, MIPDD)” on the nurses' performance was also studied.

We sent self-administered questionnaires by mail to 472 nurses who were the certified nurses in diabetes nursing and the certified nurse specialists in chronic care nursing and took in 224 returns. Many nurses provided self-management consultation for the patients and 73.2％ of them charged MIPDD fee. Multiple logistic regression analysis revealed that the nurses who charged MIPDD tended to consult for patients to improve the knowledge of their own kidney disease (odds ratio (OR)＝3.19, 95％ confidence interval (CI)＝1.18-8.60) and to give them the consultation corresponding to the stage of diabetic nephropathy (OR＝2.82, 95％ CI＝1.05-7.56). These findings suggest that the self-management consultation for outpatients with diabetic nephropathy by nurses has become popular among nurse specialists in Japan and that the charge of MIPDD could enhance consultation quality.