Authors (including presenting author) :
LAM SM(1), LAW CS(1), Mok PH(2), Yeung CK(1), Cheung SY(1)
Affiliation :
1)Diabetes Centre, Ambulatory Stream, Tseung Kwan O Hospital
2)NSD, United Christian Hospital
Introduction :
Diabetes Mellitus was the tenth leading cause of death in HK in 2017. Diabetes education is a crucial element to improve patients’ glycemic control and reduce potential long term complications. Studies showed Diabetes nurses are in a key position to empower patients about disease management. This nurse-led patient empower program is an individualized structured program to educate patients in patient centered approach carried out in a secondary referral centre.
Objectives :
1)Empower diabetic patients on knowledge and skills of self-management
2)Set-up patients’ personal goals for achieving their optimal glycemic targets
Methodology :
All diabetic patients referred from GOPC-RAMP to Diabetes Centre in TKOH between 1st December 2018 – 30th June 2019 were enrolled. This program was implemented before 1st diabetologist consultation including 1-4 nurse clinic visits, phone follow-up, using standardized checklist, direct face-to-face nurse assessment, in order to identify patients’ individual needs and barriers. Self care plan with mutual goals was set in the first visit and reviewed in subsequent visits. Self-assessment questionnaire was adopted to assess their knowledge and management adherence in the first and last visit of nurse clinic. Baseline and post intervention HbA1c without doctors’ medication adjustment were collected.
Result & Outcome :
Results:
Totally 31 diabetic patients were recruited. Mean age was 62.8+/-8.5 years. 51.6% was male. Mean duration of diabetes was 16.6+/-9.0 years and insulin treatment was 43.8+/-30 months. Education level included Primary (45.2%), Secondary (51.6%) and Tertiary (3.3%).
The results were compared before and after nurse clinic. There was a significant drop of mean from 9.7% (pre-HbA1c) to 8.6% (post-HbA1c) (p< 0.05, 95% CI -1.60 to -0.53), where 77% patients without anti-diabetic drug alteration, even with 6% patients had drug reduction, a significant improvement of knowledge from 75% (pre-questionnaire) to 87.5% (post-questionnaire) (p< 0.05, 95% CI -18.98 to -17.64), where the most improvement in drug adherence (Question 6) from 39 % to 78% and insulin adherence (Question 7) from 42% to 71%, a significant improvement of SMBG adherence from 51.6% to 80.6% after nurse intervention. At 1st diabetologist consultation, 29% patients kept the same regimen, which included 55% patients were discharged back to GOPC.
Outcome:
This nurse-led patient empowerment program is useful to enhance patients’ DM knowledge, SMBG adherence, and hence achieve significant improvement in glycemic control.
