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[ADA2014]为中国糖尿病教育建言
——杰出糖尿病教育者Katie Weinger博士专访
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作者:K.Weinger 2014/6/15 14:31:00    加入收藏
内容概要:受访者简介: Weinger博士是一名行为和精神健康研究者,哈佛医学院精神病学副教授。她负责了Joslin糖尿病中心办公室的研究员事务以及Joslin诊疗中心的糖尿病教育工作。帮助糖尿病人群更长久健康地生活不仅需要知识,还需要他们掌握运动和饮食的自我管理能力。Weinger博士从两方面来考虑这一问题:①调查患者有效自我管理中的障碍,②明确适用于糖尿病教育者的方法并将心理学技巧整合到患者依从性和结局的改善中。

 

  受访者简介: Weinger博士是一名行为和精神健康研究者,哈佛医学院精神病学副教授。她负责了Joslin糖尿病中心办公室的研究员事务以及Joslin诊疗中心的糖尿病教育工作。帮助糖尿病人群更长久健康地生活不仅需要知识,还需要他们掌握运动和饮食的自我管理能力。Weinger博士从两方面来考虑这一问题:①调查患者有效自我管理中的障碍,②明确适用于糖尿病教育者的方法并将心理学技巧整合到患者依从性和结局的改善中。

 

   <International Diabetes> : Dr. Weinger, can you please share with us how significant the educational approach is to the care of diabetes patients?

  Dr. Weinger: Yes, the educational approach to diabetes is very significant because it helps people incorporate into their lives all the treatment prescriptions and all the recommendations that physicians and other health providers have for patients.  It is important that patients not only understand the information but also how to take that information and use it.  Many people struggle with that and the physician will tell them what to do and they will not know how to do it.  They need diabetes education to help them take that important information and incorporate it into their behavior, into their food choices, into their physical activity, and into taking their medications so they follow the doctors advice completely.  Doctors alone are not able to do that.  Doctors need support from other health providers such as nurses, dieticians, physical exercise people.  They all have to work together to work together to help the patient.  It takes a team.
 
  《国际糖尿病》:您认为教育对糖尿病患者管理有着怎样重要的意义?
  Weinger 教授:教育对糖尿病的管理而言是非常重要的,因为其能有助于对医生及其他医务工作者提供给患者的所有处方治疗措施及推荐进行整合。更重要的是,糖尿病教育不仅能使患者了解糖尿病管理的相关信息,还能教会患者如何获取和使用这些信息。很多人并不知道应该如何做。而医生通常只告诉患者应做些什么,但患者并不知道应如何做。因此,患者非常需要糖尿病教育来帮助他们采集重要信息,并利用教育改变自己的饮食选择、体力活动、服药等行为,从而很好地遵医嘱进行自我管理。就糖尿病教育而言,仅靠医生是无法完成这项工作的,需要医生与护士、营养师等多方人士组成糖尿病教育团队,携手合作,共同努力,才能真正实现对患者的帮助。
 
   <International Diabetes> :In the approach of self care for the patient, as an education approach, what kind of barrier are you going to face and what methods have you done to overcome that barrier to break the patient into the healthcare process.
  Dr. Weinger : There are so many barriers.  Each barrier and each person has a different barrier so there is not one approach that works for everybody.  What it takes is a good assessment of the individual patient and an understanding of what they are facing, what their family structure is, what their economic situation is, and all the things they face in the day and then looking at their treatment prescription is evaluating can they actually do it.  If they can do it, what kind of support do they need to incorporate it into their life in order to be able to do it.  It is very tricky.  We only know some of the psychosocial, emotional, family, community barriers.  We do not know all of them but we do know that within the family structure, bad marital relationships can impact diabetes.  Emergency illness, death in the family, these all impact how people behave to their diabetes.  The person’s ability to organize themselves, their ability to manage their own time, their work situation, these things all impact so there are many barriers and it is up to the individual’s healthcare provider team to figure out for that patient what the barriers are and then develop strategies.  We have been working on psychosocial strategies to deal with some of the cognitive barriers.  There is also family approaches which can be used when the family is the issue. It just depends on what the barriers are to understanding what the approach should be.
 
  《国际糖尿病》:就患者的自我管理而言,您认为糖尿病教育主要面临哪些困难?您主要采取哪些措施来克服上述困难使患者积极加入到糖尿病管理工作中来?
  Weinger 教授:糖尿病患者自我管理面临很多的问题,而每个患者会面临不同的困难,因此没有一种适合所有人的好方法。我们需要对患者进行个体化的评估,了解其面临的问题和困难、家庭结构、经济状况等情况,并确定他们对治疗处方的依从性如何。如果患者的依从性很好,则需要知道他们在糖尿病治疗过程中需要何种支持。这项工作是非常有难度的。目前我们仅知道患者自我管理存在心理、情绪、家庭及社会等各方面的困难和障碍。就家庭结构而言,婚姻关系不和谐会对糖尿病的管理有影响。急性病、家人死亡等均会对患者的糖尿病自我管理产生影响。此外,患者的自我组织能力、管理自己时间的能力及其工作情况也会影响糖尿病的管理,因此,糖尿病的自我管理实际上面临很多方面的困难和障碍。患者的医疗服务团队需要找出其存在的个体化障碍,并制定相对的应对策略。我们一直在努力制定应对糖尿病患者认知障碍的心理干预策略。此外,在存在家庭问题时,也有一些家庭策略有助于改善自我管理现状。总之,我们需要根据患者所面临的具体困难制定个体化的应对策略。
 


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