امروز : سه شنبه 3 مهر 1397 Rss | صفحه اصلی دانشکده
31 شهریور 1395

بررسی عوامل مؤثر بر تمکین (پذیرش و اجرا) انسولین درمانی دردیابتی های نوع 2 در تهران

انسولین درمانی به عنوان یک درمان موثر در کنترل قند خون شناخته می شود، به رغم این موضوع میزان استفاده از آن کمتر از حد انتظار است و بیماران مدت های طولانی در وضعیت هایپرگلایسمی می مانند که این موضوع از سه جنبه قابل بررسی است،  دلایل مرتبط با بیماران ،ارائه کنندگان خدمت سلامت و سیستم بهداشتی. روش اجرا: یک مطالعه مقطعی کیفی و کمی در 151 بیمار دیابتی نوع دو که اندیکاسیون انسولین درمانی داشتند و به مراکز درمانی سطح تهران مراجعه می کردند و 30 پزشک عمومی که در درمانگاه های عمومی غیر دانشگاهی مشغول فعالیت بودند؛ انجام گرفت؛ بیماران بر اساس پرسشنامه هایی که اجزای مختلف SDT را در آن ها میسنجید PCDSوshort form HCCQو فرم ویرایش شده TSRQ و پرسشنامه ITAS ویرایش شده؛ و پزشکان هم با پرسشنامه طراحی شده جهت بررسی موانع انسولین درمانی که روایی آن ها با روش تحلیل محتوا و پایایی آن با روش همبستگی درونی (آلفای کرونباخ ) تایید شدند؛ تحت بررسی قرار گرفتند. نتایج: تنها 17.2% از بیماران از متوسط به بالا خود را در معرض عوارض می دانستند. PCDS از مقدار قابل توجهی برخوردار است (14.44 ) هرچند که با افزایش سن همبستگی منفی داشت و HCCQ از مقدار پایینی برخوردار بود در حدود 15.63 (6-30) که نشان از رابطه نامناسب میان پزشک و بیمار داشت. انگیزه های درونی افراد به مراتب کمتر از انگیزه های بیرونی آنان بود. علاوه بر آن تنها 33.6% از پزشکان اهداف درمانی خود را براساس گایدلاین های معتبر تعیین می کردند. و 54.3% از بیماران از موثر بودن انسولین اطلاعی نداشتند و 19.9% از بیماران آن را ناکارآمد میدانستند. و از دلایل عمده عدم پذیرش انسولین درمانی از سوی بیماران "عدم پذیرش وخامت بیماری" 67.5% و "ناراحت کننده بودن تزریق مطرح گردید" 51.7%. اما ازدید پزشکان "وحشت و ترس بیماران از سوزن و تزریق" 83.3% و "دردناک بودن تزریق"  با 46.7% ، از دلایل اصلی عدم پذیرش انسولین درمانی از سوی بیماران هستند. جمعبندی: عدم شکل گیری رابطه مناسب میان پزشکان و بیماران و در نتیجه آن عدم درک متقابل؛ از عوامل مهم در عدم پذیرش و اجرا انسولین درمانی است. كليد واژه ها : دیابت نوع دو، انسولین درمانی، کمپلیانس مشخصات دانشجو: نام: آرمین رجب  رشته تحصيلي: پزشکی       مقطع: دکتری عمومی      گروه آموزشي : داخلی (بیمارستان امام خمینی-امیراعلم)          پست الكترونيك دانشجو: mcra1989@gmail.com اساتيد راهنما و داور: استاد راهنما: دکتر منوچهر نخجوانی استاد راهنما(دانشکده بهداشت): دکتر سیدرضامجدزاده استاد مشاور: دکتر اسداله رجب  اساتيد داور: دکتر جواد بهجتی اردکانی ؛ دکتر فاطمه اصفهانیان زمان دفاع :    روز دوشنبه تاريخ   29اردیبهشت 1395   ساعت 10:30 مكان دفاع به آدرس: مجتمع بیمارستانی امام خمینی-بیمارستان ولیعصر-بخش غدد اطلاعات به زبان انگليسي Title:    Causes of low compliance to insulin therapy in type 2 diabetes mellitus patient in Tehran Abstract: Introduction: Insulin therapy as an effective treatment in controlling blood sugar levels is known. Despite this less than expected and the use of long patients remain in a state of hyperglycemia. This is from three aspects. With patients, health service providers and health systems. Method: A qualitative and quantitative study in 151 patients with type II diabetes had an indication for insulin therapy and rehabilitation centers in Tehran, and 30 non-academic general practitioners working in public clinics was performed.  Patients on different components of SDT in the improvement PCDS and short form HCCQ and form edited TSRQ and questionnaires ITAS edited were studied .physicians with a questionnaire designed to assess barriers to insulin therapy were studied. All questionaries’ validity with content analysis method and reliability by internal consistency (Cronbach Cronbach) were confirmed. Result: But only 17.2% of patients sense moderate to high risk of complications for themselves. PCDS of considerable value (14.44), however, had a negative correlation with age. HCCQ the amount was low at around 15.63, which shows the relationship between doctor and patient was inappropriate. Also results show that Inner motivation of people far less than their extrinsic motivations. In addition, only 33.6% of doctors your health goals set by guidelines were valid. And 54.3% of patients were unaware of the effectiveness of insulin. And the main barriers to the acceptance of insulin therapy on the patients' severity of illness rejection "67.5% and" uncomfortable being proposed injection "51.7%. But doctors feel that “fear of needles” 83.3% of the patients is the main reasons for non-acceptance of insulin therapy. Conclusion: Absence of proper relationship between doctors and patients result in their mutual misunderstanding of each other. It is an important reason affecting non-acceptance of insulin therapy. 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