| Objective Through the introduction of the concept of health management,this study carried out the practice of health management program for elderly type 2 diabetic patients over 60 in the community hospital of Nanjing.The medium-term and long-term effect of health management were evaluated and the influencing factors of health management were analyzed.Effective community health management model was explored base on this study.This study will help us to explore the elderly patients with type 2 diabetes health management program to improve the health of patients and improve the relevant policy recommendations.Methods A randomized controlled trial was taken to investigate the 380 elderly patients with type 2 diabetes in a community hospital in Nanjing from March 2013 to December 2016.Elderly participants were randomly divided into either management or control group and each group contains 190 patients.After grouping,the management group received the intervention,while the control group was not interfered with.Health management includes health education,health manuals and self-management cards,telephone follow-up,health records,and personalized health management.All participants were required to complete questionnaires at baseline and in 24-months later.The questionnaires include social demographic characteristics(age,sex,education,living conditions,marital status),lifestyle(diet,smoking,drinking,exercise,meditation),diabetes course,complications,family history,diabetes health knowledge,fasting blood glucose,blood pressure,BMI,quality of life,and so on.Data were entered via EpiData3.1 and analyzed by SPSS21.0.Method of statistical analysis like descriptive analysis,t-test,Chi-square test,Difference-in-Difference,and multivariable linear regression model were applied in this study.Markov model were performed using EXCEL to assess the long-term effects of elderly type 2 diabetes health management.Results(1)In this study,190 participants in management group and 190 participants in control group completed baseline survey.171 participants in management group and 164 participants in control group completed 24-month survey.The number of lost in the management and control groups was 19 and 26,respectively and the loss ratio were 10.00%and 13.68%,respectively.(2)The mean age of the management group was 72.29 ± 6.27 years old and the control group was 72.52 ± 6.12 years old.The number of patients with complications and hypertension in the baseline management group was higher than that in the control group(P<0.05).Age,sex,education,physical condition,marital status,duration,diet,smoking,drinking,exercise,meditation time,family history,diabetes health knowledge,fasting blood gllucose,whether the regular detection of blood glucose,BMI were not statistically significant(P>0.05).(3)The heath-related measures were compared between the management group and the control group.Results showed that among various indexes including diet score,meditation time,diabetes health knowledge,fasting blood glucose,physical function score,psychological function score,diabetes specific score and total quality of life score,there is significant improvement in management group(P<0.05).There was no significant difference in the other indexes.Compare the difference between the baseline of the management group and the baseline of the control group,we found that meditation time was reduced more,health knowledge score increased more,psychological function and diabetes specific module score also increased more.However,in the control group,the social function score increased more than the management group.The difference was statistically significant(P<0.05).The differences between the management group and the control group were compared with the baseline,we found that the difference between meditation time,health knowledge score,psychological function,social function and diabetes specific module was significantly higher in the management group and the control group than in the baseline.The difference was statistically significant(P<0.05).(4)The Markov model was applied to simulate the status of 100000 diabetes after 16 years of the management of diabetics’ health.The results provided that in the next 16 years,36.35%of diabetics in the management group converted into diabetes complication patients,0.08%of diabetics died,where as 69.33%of diabetics suffered from diabetes complications,and 0.11%of diabetics died in control group.There are about 32975 patients avoid complications and 33 patients avoid death who received health management the next 16 years.(5)Multivariable linear regression model was employed to conduct influencing factors of health management effectiveness.The results revealed:Diabetic patients with long course and lower baseline scores had higher dietary scores;That the younger female with a shorter baseline had a higher change in dietary scores;That the female with higher education background,without family history of diabetes,and worse baseline health knowledge had a higher change in health knowledge scores;That the younger aged with the lower baseline body function had a higher change in body function;That the male with the lower baseline psychological function had a higher change in psychological function;That the female with the lower baseline social function had a higher.change in social function;That the older without hypertension and the lower baseline diabetes-specific function had a higher change in diabetes-specific function;In the aspect of diabetes overall quality of life,the younger female aged with lower baseline quality of life had better management effectiveness significantly than the older male aged with higher baseline quality of life.Conclusion This study shows that after 24 months of health management the management group has better indicators than the control group.The health intervention programs demonstrated significant effects in "Co-participatory" communities.Based on the schools,hospitals,community to actively carry out diabetes health management projects would play an essential role in rational utilization of health resources and improvement of the health of elderly diabetic patients.This health management model worthy of further research and promotion. |
