Construction Of A Community-Based Integrated Health Management Program For Elderly People With Type 2 Diabetes Mellitus Combined With Mild Cognitive Impairment

Objectives:This study was designed to construct a systematic and scientific integrated health management program for elderly people with type 2 diabetes mellitus combined with mild cognitive impairment in the community based on evidence-based method,which provided a theoretical basis for primary health care providers to systematically manage those people,improve their disease management,and delay their cognitive decline.Methods:1.A qualitative integrative approach was used to summarize the experiences and needs of elderly people with diabetes mellitus combined with cognitive impairment.A thematic integration approach was used to explore patients’ experiences and needs in coping with illness.2.A descriptive qualitative research method was used to explore the challenges and needs of primary care providers in managing elderly people with type 2 diabetes mellitus combined with cognitive impairment.Semi-structured interviews were conducted with primary care providers and interview data was analyzed using content analysis.3.The literature related to the management of elderly people with type 2 diabetes mellitus combined with mild cognitive impairment was systematically searched,and relevant evidence was extracted and graded for quality after evaluation of the included literature.High-quality evidence was synthesized to form a summary of the best evidence for the management of elderly people with type 2 diabetes mellitus combined with mild cognitive impairment.4.Based on the evidence summary,a preliminary draft of the protocol was constructed by combining the results of qualitative integration and qualitative studies.The preliminary draft was revised and improved by Delphi expert consultation to establish a comprehensive health management program for elderly people with type 2 diabetes mellitus combined with mild cognitive impairment in the community.Results:1.Eight qualitative studies were finally included in this study for qualitative integration,and a total of 7 descriptive themes were summarized and synthesized into 3 analytical themes:self-perception of cognitive decline(lack of knowledge,symptom distress,impaired diabetes self-management),self-response to cognitive decline(coping in multiple methods),and positive about cognitive interventions(perceived benefits of cognitive interventions,attitudes toward cognitive interventions,requirements for cognitive interventions).2.From content analysis of the interview data of 25 primary care providers,14 sub-themes were extracted and summarized into 3 themes:lack of knowledge and management of the elderly with type 2 diabetes combined with cognitive impairment(lack of knowledge,lack of cognitive impairment management services),multiple barriers to the management of the elderly with type 2 diabetes combined with cognitive impairment(insufficient equipment and facilities,shortage of human resources,poor integration of vertical medical resources,patient mistrust,patient communication difficulties,low patient compliance,etc.),and multifaceted requirements for the management of the elderly with type 2 diabetes combined with cognitive impairment(systematic education,comprehensive support,reasonable incentives and evaluation mechanisms,clinical practice guidelines,etc.).3.A total of 21 literatures were included in this study for evidence summary,including 15 guidelines and 6 expert consensuses,and a total of 108 evidence elements in 4 areas were extracted:team formation,patient assessment,patient management,and health education.4.Two rounds of expert correspondence were completed,and a total of 15 experts participated in this study.The recall rate of the questionnaire for both rounds of expert correspondence was 100%,the authority coefficient of the experts was 0.861,and the Kendall’s harmony coefficient of the program content was 0.187 and 0.226.A community-based integrated care health management program for the elderly with type 2 diabetes combined with mild cognitive impairment was finally formed,which includes 4 primary indicators,2 secondary indicators and 74 tertiary indicators.Conclusions:This study constructed a community-based integrated health management program for the elderly with type 2 diabetes mellitus combined with mild cognitive impairment on the basis of four components:qualitative integration,qualitative research,evidence summary,and expert correspondence.The program is scientific,comprehensive,and practical,which is useful for giving guidance to manage the elderly with type 2 diabetes mellitus combined with mild cognitive impairment in the community,enhancing the disease knowledge of patients and their caregivers,improving glycemic management and cognitive function of patients,and increasing patients’ life quality.