Research On The Reason Of Loss Of Follow-up Diabetes Patients And The Application Of Empowerment-based Education

Objectives1To discover the reason of why diabetes patients got loss of follow-ups from a nurse-led clinics, and to analyze the potential factors.2To determine if an empowerment-based education is effective to the patients who ever dropped out in improving blood glucose, behaviors and self-efficacy.Methods1Firstly we discovered the reason of loss of follow-up by a case control study. Patients who discharged from February2011to May2012were allocated into2groups by whether dropped out..In each group,180patients were chosen randomly. Open questions were asked by telephone on their attitude towards follow-ups and the reason why they did not attend. The patients’files were also collected including gender, age, course, family history, education, work, insurance, the treatment and medication as well as the complications.2It was an extra experiment of the first part of this research. Another240patients who were discharged from November2011were randomized into3groups. Different frequency was determined by nurses as they visit every week, two weeks and every month. They were monitored before the follow-up and then6months and1year later.3Patients who were once became loss of follow-ups were telephoned,80of them with attempt to come back were intervened with the empowerment education. They were tested before and6months and1year after the intervention.Results1Patients’despise (OR=1.60), the impaired activities (OR=2.53) onset of work (OR=1.90),and non-existence of complication (OR=2.17) are the risk factors of loss of follow up. However, gender, age, course, family history, education, work, insurance, the treatment and social support has not been proved to be related factors(p>0.05). 2Thus, different frequency was not the reason for loss of follow up, neither(p=0.375). According to the empowerment education visits, the patients HbAlc(F=37.63), FBS(F=21.68) and2hPG(F=199.44) decreased as the time past. While there was no difference between groups(p>0.05),which means the frequency was not a risk factor.3With the application of the empowerment education, the drop-out rate(21.5) was similar to normal patients while compared with the patients who ever lost to follow up. The patients self-care behaviors score, including food (F=38.22), exercise (F=89.39), monitoring (F=50.7), foot care (F=20.63) and smoking (F=9.43) were all increased (p<0.05). Patients’ self-efficiency score(F=122.16) and the CM-DES score (F=127.53) were also increased before intervention.Conclusion1The reasons of loss of follow up would be complicated.Patient’s serious attention to follow-up visits, their mobility and working state were very important factors.2Different visit frequency would be decided by discussion with patient for it would not cause loss of follow up. Nurses should pay more attention to the loss of follow-ups.3The empowerment education was an effective way to activate the patients, and enhance the self-management, by which they changed their behaviors. The intervention to the patients who ever became loss of follow-ups was effective in helping patients come back to routine visits, as well as enhance their ability of self-management, self-efficiency, so their blood glucose level were better controlled, which indicates an optimal outcome.