セルフマネジメントスキルの獲得を目的とした2型糖尿病疾病管理プログラムの開発過程と試行の効果

Developmental Process of Disease Management Program of Type 2Diabetes with a View to Acquiring Self-Management Skills: Effects of the Trial Implementation

要旨

　【目的】疾病管理手法に則り，2型糖尿病患者のセルフマネジメントスキルの獲得を目的とした6カ月間教育プログラムを作成し，効果と運用性を検討した．

　【方法】2施設に通院する36名を対象に，無作為化対照試験を行った．介入群には開発した構造化プログラムを適用し，対照群は従来どおりとした．看護師と管理栄養士がプログラムに基づき，月1回30分の面接と電話モニタリングを行った．

　【結果】時間的理由で4名が中断したが，32名は最後まで継続した(完了率：81.0％)．自己効力感が介入群において上昇し，食事や運動の目標達成度も有意に上昇したが，生理学的データの改善はなかった．最終アウトカムであるHbA1c，QOL得点は改善したが両群に有意差は得られなかった．プログラムの評価はおおむね良好であった．

　【考察】対象の選定，目標設定と指導，実施期間，対照群からのデータ収集方法について改善すべき点が考察された．有効な運用にあたっては，電子媒体等の活用と病診連携の重要性が示唆された．

Abstract

　Purpose：In accordance with the method of disease management, a 6-month educational program was developed with a view to acquiring self-management skills for patients with type 2diabetes. The effects and operational potential of the program were examined.

　Method：The subjects were 36outpatients at two institutions.A randomized clinical trial was conducted. The newly developed structured program was applied to the intervention group, while the current treatment was given to the control group. A nurse and a registered dietitian conducted a 30-minute interview once a month and also telephone monitoring in accordance with the program.

　Results：Four subjects dropped out of the program due to time constraints,while the remaining 32 continued the program through to the end (completion rate：81.0％). The sense of self-efficacy improved in the intervention group. The achievement rate for the dietary and exercise therapies increased significantly；however, there was no statistically significant improvement in the physiological data. The HbA1c and QOL scores, which were the final outcomes, improved；however, there was no significant difference between the two groups. The overall evaluation of the program was favorable.

　Discussion：It was suggested that there is room for improvement in terms of criteria for choosing a target population, goal-setting and guidance, the period of implementation, and data collection methods for the control group. In terms of effective operation, utilization of electronic media and the importance of hospital-clinics collaboration were suggested.