201
1 2 1 1,3
1 2
3
2003 2004
( Diabetes mellitus ) ( Diabetes education )
1995 1 3 5 2000
1 7 1
1-2
2030
3 6 6
22000
3
2
6% 12%
3-51
1 9 7 8
6.5 1995 33.97
2 0 0 3 4 4 . 3 8 1 9 8 3
6
( lifestyle modification ) ( pharmacological intervention ) ( patient education )
Brown 1988
1 9 9 0
7 - 8
9 - 1 0
Padgett
111988
( physical ) ( psychological ) ( knowledge ) ( compliance )
1 9 9 2
1998
12-14
2004
2003 2004
( European Association for the Study o f D i a b e t e s , E A S D )
( Diabetes Education Study Group, DESG )
1 5
1 3
5 5
1 ( )
( )
2003 10-11 2004 10-11
1 0
( )
1 2
3 4 6 7 8 9 5
10 ,
11
12
13
2003 2004
15
Cronbach's alpha 0.72 Crobanch's alpha 0.90
SPSS ( SPSS 12.0.1 for windows )
t-test ANOVA
2003 2004
(
) 2003
2004
7 2 7 2
100% 19 ( 26% )
22 ( 31% ) 24 ( 33% )
7 ( 10% ) a
7 2 5 6
88% 12 ( 21% ) 20
( 36% ) 18 ( 32% ) 5 ( 9% )
1 ( 2% ) b
1
2 0 0 3
( 4.06 0.99 )
1.07 ) 2004 ( 3.82 1.03 )
( 3.75 0.97 )
( 3.55 1.14 ) ( 3.55 1.03 ) ( )
1 3
2003 2004
( 2003 45.68 7.57
2004 45.13 10.43 ) ANOVA
2003 p 0.004
2004 p 0.697 ( )
a 2003 b 2004
2003
( p=0.609 ) 2004 ( p=0.002 ) ( )
( ) 2003
( 3.48 0.80 ) ( 3 . 1 4 0 . 7 2 )
( 2.93 0.77 ) 2004 (
3 . 5 6 0 . 8 8 3 . 4 1
0.84 2.92 0.90 ) 2003
ANOVA
2003
( p=0.010 p=0.003 ) 2004
2003 2004
1 4.06 ± 0.99 3.82 ± 1.03
2 3.60 ± 1.16 3.75 ± 0.97
3 3.51 ± 1.07 3.55 ± 1.14
4 3.42 ± 1.02 3.55 ± 1.03
5 3.26 ± 1.16 3.53 ± 1.05
6 3.22 ± 0.91 3.34 ± 1.10
7 3.19 ± 0.96 3.34 ± 1.03
8 3.14 ± 1.10 3.30 ± 0.95
9 3.14 ± 0.92 3.25 ± 0.90
10 3.00 ± 0.87 3.24 ± 1.20
11 2.83 ± 1.01 2.75 ± 1.10
12 2.75 ± 1.20 2.63 ± 1.21
13 2.32 ± 1.07 2.61 ± 1.29
*
2003 2004
2004 Mean ± SD
*2003 Mean ± SD
*t
+ P value+41.08 ± 5.20 41.84 ± 5.13 -0.505 0.624
45.13 ± 10.43 45.68 ± 7.57 -0.234 0.817
41.52 ± 11.91 38.25 ± 8.28 1.166 0.260
40.40 ± 9.21 38.00 ± 5.32 0.583 0.591
*
13
+
t test 2003 2004 13
2004
Number Mean
*SD
*32 45.99 9.93
24 37.98 7.80
*
13
2003 2004
2003 2004
2004
( 42.55 9.85 ) 2003 ( 41.44 7.65 )
2 0 0 4
( )
2003 2004
2004 (
)
p 0.021 2003 2004
p 0.179
2003 2004
2 0 0 3
2004
3.14 ± 0.67 2.96 ± 0.74 0.895 0.390
3.62 ± 0.86 3.35 ± 0.79 1.394 0.179
3.33 ± 0.90 3.12 ± 0.65 0.982 0.340
3.47 ± 0.87 3.00 ± 0.61 1.200 0.296
Total 3.41 ± 0.84 3.14 ± 0.72 2.371 0.021
2.60 ± 0.62 2.89 ± 0.78 -1.644 0.128
3.19 ± 0.97 3.36 ± 0.77 -0.797 0.435
2.86 ± 0.98 2.54 ± 0.64 1.363 0.191
2.84 ± 0.75 2.97 ± 0.50 -0.390 0.717
Total 2.92 ± 0.90 2.93 ± 0.77 -0.064 0.949
3.73 ± 0.73 3.69 ± 0.66 0.183 0.858
3.67 ± 0.85 3.76 ± 0.68 -0.508 0.617
3.45 ± 1.04 3.23 ± 0.89 0.875 0.394
3.16 ± 0.77 2.83 ± 0.72 0.996 0.389
Total 3.56 ± 0.88 3.48 ± 0.80 0.725 0.471
*
+
t test 2003 2004 13
2003 2004
2 0 0 4
2 0 0 4 2 0 0 3
2 0 0 3 2 0 0 4
2004
15
1980
( )
1 6 - 1 7
16
( barriers affecting basic needs and rights )
( medical barriers )
( educational bar- riers )
( emotional barriers )
( lack of political will )
Ramachandran
17
2003 2004
2003 2004
1.King H, Aubert RE, Herman WH. Global Burden of Diabetes, 1995–2025. Diabetes Care 1998; 21: 1414-31.
2.Wild S, Roglic G, Green A, Sicree R, King H. Global Prevalence of Diabetes. Diabetes Care 2004; 27: 1047–53.
3. 1996-2000
2002; 21: 173-80
4.Chou P, Li CL, Tsai ST. Epidemiology of type 2 diabetes in Taiwan. Diabetes Research and Clinical Practice 2001; 54 (S1):
S29-35.
5.
2002; 21: 83- 96
6. 2003
7.Brown SA. Effects of educational interventions in diabetes care:
a meta-analysis of findings. Nursing Research. 1988; 37: 223- 30.
8.Brown SA. Studies of educational interventions and outcomes in diabetic adults: a meta-analysis revisited. Patient Education and Counseling 2000; 16: 189-215.
9.
2000; 13: 1-17
10. 2
1999; 12:
39-50
nagement of diabetes mellitus. Journal of Clinical Epidemiology 1988; 41: 1007-30.
12.
1998; 12: 11-7
13.Chuang LM, Tsai ST, Huang BY, Tai TY, the DIABCARE (Taiwan) Study Group. The current state of diabetes manage- ment in Taiwan. Diab Res Clin Pract 2001; 54(S1): S55-65.
14.Lin JD, Tsai ST, Lin HD. Comparison of glycemic control in the year 2004 and 1998 among diabetic patients of Taipei Veterans General Hospital. Proceedings of Annual Meeting, the Endocrine Society and the Diabetes Association, ROC, March 19-20, 2005.
15.Assal J-Ph, Lion S. Difficulties encountered with patient edu- cation in European Diabetic Centers. In: Assal J-Ph, Berger M, Gay N, Canivet J, eds. Diabetes education. How to improve pa- tient education. Proceedings of the 2nd European Symposium of the Diabetes Education Study Group ( Geneva, 3-6 June 1982 ) and selected topics held at workshops of the DESG. Amsterdam:
Excerpta Medica; 1983; 78-89.
16.Chan JCN, Cockram CS. Organization of Care: Western Pacific Region, China and Hong Kong as examples. In: DeFronzo RA, Ferrannini E, Keen H, Zimmet P eds. International Textbook of Diabetes Mellitus. 3rd ed. Chichester, West Sussex, England.
John Wiley & Sons, Ltd; 2004; 1793-800.
17.Ramachandran A, Shera S. Indian Subcontinent, The economics of diabetes and diabetes care. A report of the Diabetes Health Economics Study Group. IDF-WHO, 1997; 75-81.
in Taipei Veterans General Hospital
Li-Ying Juan
1, Shir-Ling Lin
2, Pin-Fan Chen
1, and Hong-Da Lin
1,3Patient education is an essential component in the treatment of diabetes mellitus. Understanding the diffi- culties encountered during patient education helps health providers to offer better education programs and there- fore to achieve better disease outcomes. We performed two questionnaire-studies in the year of 2003 and 2004 to evaluate the difficulties encountered in diabetes education. In addition, we try to find out the impacts of "Global Budget Payment System" and"Diabetic Case Management" on diabetes education. Our results found institute and administrative factors, especially short of education manpower, were the major problem resulting in educa- tion difficulties. "Global Budget Payment System" and "Diabetic Case Management" add some difficulties on dia- betes education. Our study found the administrative institutes must provide more support to solve the difficulties encountered in diabetes education. ( J Intern Med Taiwan 2005; 16: 216-224 )
1
Division of Endocrinology and Metabolism, Department of Medicine,
2
Department of Nursing, Taipei Veterans General Hospital, and
3
