'만성질환관리의 질에 대한 환자평가'가 노인 당뇨병환자의 자가관리행위에 미치는 영향

Abstract

This study was conducted on elderly patients with diabetes to evaluate their assessment of chronic illness care (PACIC), knowledge of diabetes, self-efficacy of diabetes care, and diabetes self-care activities. The aim of this descriptive study was to confirm the impacts of the PACIC on patients' diabetes self-care activities, and to provide the base data with data regarding the quality improvement of chronic illness care in these patients. The PACIC was the primary end-point of this study in assessing the significance for self-care perceived by patients, and was measured by the Korea-Patient Assessment of Chronic Illness Care (K-PACIC). The patients' knowledge of diabetes was evaluated using the primary questionnaire of the two same-type diabetes knowledge questionnaires previously developed by Wan-Seop Sim et al. (2006). The self-efficacy of diabetes care was evaluated by the Diabetes Management Self-efficacy Scale for Older Adults (DMSES-O) previously developed by Mi-Sun Song et al. (2014). Diabetes self-care activities were evaluated by the Summary of Diabetes Self-Care Activities Questionnaire (SDSCA), which was translated and validated by Seon-Ju Jang and Mi-Sun Song (2009). The data were collected by conducting a person-to-person survey on 190 elderly patients with type 2 diabetes mellitus who were aged ≥65 years at senior citizen centers and social welfare centers in district J, from February 7 to March 7, 2017. The hierarchical regression analysis was conducted on the collected data to identify the impacts of frequency, percentages, averages, standard deviations, t-test, ANOVA, Scheffe's test, Pearson's correlation coefficient, and the PACIC on diabetic patients' self-care activities. In the analysis, models 1 and 2 included individual characteristics of the patients, their knowledge of diabetes, and self-efficacy of diabetes care, and the quality of chronic illness care was newly added. This study was conducted after the approval by the institutional review board of Jeju National University (approval no. JJNU-IRB-2015-026-001). The results of the study are as follows: 1. The average age of the study participants was 75.5 years; the average diabetes duration was 11.5 years. Of the total subjects, 86.8% had concomitant diseases and 86.3% received education on diabetes. 2. The average score of the PACIC for the quality of chronic illness care was 2.39. The subcategories of "Goal Setting and Tailoring" and "Patient Activation" showed the lowest scores of 2.22 and 2.34, respectively. 3. The average score for the knowledge of diabetes was 11.05. The average score for the self-efficacy of diabetes care was 2.86 ± .63 at the level of "Little confident (3)" on the scale of 1–4. The average score for diabetes self-care activities was 4.26; the subcategory "Administration Site" showed the highest score of 6.92, while the subcategory "Blood Glucose Test" showed the lowest score of 1.67. 4. The characteristics identified from the patients who showed significant difference in terms of their diabetes self-care activities were: sex (t=3.81, p<.001), age (t=3.74, p<.001), level of education (t=19.21, p<.001), profession (t=5.82, p<.001), monthly income per household (56.48, p<.001), family members living together (t=6.93, p<.001), family members supporting diabetes management (t=6.71, p<.001), complications (t=2.12, p=.035), duration of illness (t=7.23, p<.001), concomitant diseases (t=8.89, p<.001), and education on diabetes (t=3.78, p<.001). 5. The result of the correlation analysis showed that the PACIC has a positive correlation with the knowledge of diabetes (r=.65, p<.001), self-efficacy of diabetes care (r=.75, p<.001), and diabetes self-care activities (r=.80, p<.001). 6. The result of the hierarchical regression analysis showed that, in model 1 such as the characteristics, knowledge of diabetes, and self-efficacy of subjects who showed significant difference in diabetes self-care activities, the explanatory power was 68.4% (F=32.23, p=<.001). In model 2 in which the PACIC was newly added, the explanatory power was 74.3% (F=39.74, p=<.001), indicating a statistically significant increase by 6% (R2 Change=.06, p=<.001). Based on the above result, it was confirmed that the PACIC had an impact on the self-care activities of patients even under the condition of full control over the characteristics of the participants, knowledge of diabetes and self-efficacy of diabetes care. Therefore, efforts to improve the quality of chronic illness care to promote self-care activities by elderly patients with diabetes must be implemented.As the subjects of this study were randomly selected among elderly patients with diabetes at senior citizen centers and social welfare centers in district J, the result therefore cannot be generalized to the entire elderly population with diabetes. However, the study is still significant because unlike any other previous studies, this study presents a new approach in identifying the impact of the PACIC on self-care activities to investigate patients with diabetes. Therefore, future studies should be performed to develop and evaluate programs to improve the quality of chronic illness care for elderly patients with diabetes.