ผลของโปรแกรมการจัดการผู้ป่วยรายกรณีผู้สูงอายุโรคเบาหวานที่ควบคุมไม่ได้

Abstract

Complications related to diabetes are more severe in the older adult than in other populations, which are at high risk for disability and reduced quality of life. The purpose of this quasi-experimental research with one-group pretest-posttest design was to test the effects of a case management program for older adults with uncontrolled diabetes mellitus. The study population was older adults with diabetes mellitus who had HbA1C > 7% over the last 6 months and attended the Outpatient Unit of the Family Medicine Department, Ramathibodi Hospital between December 2011 and June 2012. A total of 30 patients who met the inclusion criteria received the 12-week case management program for older adults with uncontrolled diabetes mellitus, consisting of comprehensive health assessment, a clinical care plan developed by a multidisplinary team, health education and consultation, demonstration and self-care practice, a home visit, follow-up telephone calls, and group learningsharing activities. The data were collected by interview before and after the intervention. According to the paired t-tests, after the experiment the sample had significantly higher self-care behavior, and better service satisfaction compared with before the experiment (p < .05). Quality of life of the subjects increased significantly compared with before the experiment (p < .05). Clinical outcome, HbA1C level, and diastolic blood pressure decreased significantly compared with before the experiment (p < .05), whereas systolic blood pressure remained unchanged (p > .05). These findings suggest that the case management program can improve self-care behavior, clinical outcome, quality of life, and service satisfaction of older adults with uncontrolled diabetes mellitus. Public health nurses should apply case management for older adults with other chronic diseases to prevent complications, reduce complexity of care, and improve quality of life among older adults