Diabetes doctor and nurse co-diagnosis integration management path

Abstract

The invention relates to a diabetes doctor and nurse co-diagnosis integration management path. A doctor-seeing mode of doctor and nurse co-diagnosis is established: doctor seeing is carried out in a 1+1 mode, namely, an endocrinologist and a nurse perform diagnosis, the nurse is required to accept diabetes educator training and get a nutritionist qualification, and family members or friends of a patient are suggested to accompany the patient to see a doctor; and the endocrinologist performs detailed diabetes complication screening on the patient, the nurse performs nutrition and motion assessment and problem discovery and makes a management goal and executable nutrition and motion schemes under the participation of the patient, and the endocrinologist makes drug, monitoring and follow-up visit schemes in combination with the nutrition and motion schemes. The path has the advantages that the patient compliance and management effects are improved, the blood sugar control is stable, and the rate of reaching the standard is controlled; by strengthening daily self management of the patient, acute and chronic complications are reduced or delayed, and personal medical expense of the patient is reduced; and diabetes self-management consciousness improvement and knowledge popularization are promoted.

Description

technical field [0001] The invention relates to the field of integrated management of diabetes in medical and nursing co-diagnosis, in particular to an integrated management path for co-diagnosis of diabetes by medical and nursing staff. Background technique [0002] Since diabetes is closely related to lifestyle, the comprehensive goal of diabetes control is not only blood sugar, but also blood lipids, blood pressure, weight, smoking cessation... Therefore, diabetes treatment should actually support diabetes self-management, and patients' misunderstandings about diabetes and The lack of management skills or even mistakes, and the misleading of patients by some unfavorable factors in the society... are not conducive to the control of diabetes patients. [0003] 1. The program is incomplete: the current situation is that the patient goes to the doctor for consultation, and the doctor conducts relevant tests according to the patient's condition, and gives a diagnosis and drug ...

AI Technical Summary

Problems solved by technology

[0002] Since diabetes is closely related to lifestyle, the comprehensive goal of diabetes control is not only blood sugar, but also blood lipids, blood pressure, weight, smoking cessation... Therefore, diabetes treatment should actually support diabetes self-management, and patients' misunderstandings about diabetes and The lack of management skills or even mistakes, and the misleading of patients by some unfavorable factors in the society... are not conducive to the control of diabetes patients

[0003] 1. The plan is incomplete: the current situation is that the patient goes to the doctor for consultation, the doctor conducts relevant tests according to the patient's condition, and gives a diagnosis and drug prescription after the test, lack of nutrition and exercise plan

[0004] 2. Lack of connection between various links: some hospitals have set up nutrition clinics, and patients in need can consult a nutritionist in the nutrition department after seeing a doctor. In Taiwan, doctors recommend patients to go to health teachers for diabetes education according to the patient's condition. They all happen one after another. Nutritionists or health teachers may not be able to fully understand the patient's condition, because they are not doctors, and their control over the condition is not as experienced as doctors; nor can they fully understand the doctor's intentions and precautions in formulating the plan, so they cannot Fully cooperate with the doctor to achieve the purpose of treatment and management of the disease, but because the doctor does not understand the patient's work, living and eating habits, the choice of medication is more based on subjective consciousness, cannot optimize the medication, and the effect of the drug is not obvious. Formulated, the patient does not have the awareness of taking the initiative to take responsibility, and the doctor's order is poorly followed, resulting in half the effect

[0005] 3. Poor patient compliance: patients have limited time to see a doctor, and most of the time depends on the self-management of the patient at home rather than in the hospital. Among the diabetic patients currently being treated, the treatment compliance rate is less than 1 / 3. It is also related to the poor compliance of the treatment plan (medical compliance behavior), lack of long-term guidance and self-management, how to truly achieve the patient's knowledge, belief and action, and transform theoretical knowledge into the patient's long-term behavior, so as to achieve metabolic control , improve the quality of life, reduce the disability rate and fatality rate, and reduce the burden on the family, society and the country

[0007] The existing diabetes management methods usually formulate the management plan by the doctor, and the nurses / nutritionists / educators implement it separately. There are the following problems: 1. The nurse does not participate in the plan formulation, cannot fully understand the patient's condition, and cannot fully understand the reasons for the plan formulated by the doctor. Intent; 2. The patient's drug therapy, medical nutrition therapy, exercise intervention and follow-up plan are not integrated, which is not conducive to maximizing the effect of diabetes management

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