Helping People Change Insights and Outcomes帮助人们改变见解和成果.ppt

* * High anxiety: see this at time of diagnosis - can interfere with learning, make injections and blood glucose testing difficult (patient is tense which increases pain and difficulty getting enough blood), increases disorganization moderate anxiety is good: a motivator. Adherence is best at time of diagnosis. We often don’t use this enough… after diagnosis and honeymoon sets in tell folks things are going great based on hemoglobin results. Often adherence deteriorates as patient becomes less anxious and since this has little or not effect on haic, this goes undetected and bad habits develop use moderate anxiety: at time of diagnosis, after hypoglycemic reactions, onset of complications in relatives or friends low anxiety: denial (may be the result of excessively high initial anxiety) * * REFERENCES Lipton, R., Losey, L., Giachello, A., Mendez, J., Girotti, M. (1998). Attitudes and issues in treating Latino patients with Type 2 diabetes: Views of healthcare providers. The Diabetes Educator, 24, 67-71 Marteau, R., Johnston, M., Baum, J., Bloch, S. (1987) Goals of treatment in diabetes: A comparison of doctors and parents of children with diabetes. Journal of Behavioral Medicine, 10, 33-48 The Anxiety/Performance Curve Low High Anxiety Performance Low High Common Patient Concerns Insulin (or other medication) effects Pain (associated with injections, glucose testing) Hypoglycemia Weight gain (associated with intensive therapy) Expense, insurance access, employment Interpersonal (family, social) disruptions Complications Helping People Manage Diabetes 1. Clear communication of medical/health advice 2. Teach knowledge and skills necessary for good disease management 3. Make assessing behavior part of standard care 4. Encourage patient honesty 5. Build consensus about disease management 6. Attend to patient feelings, worries, concerns * 14 * * * * * * Watkins et al1967 serious insulin administration errors in 35% of 115 adults observed Johnson et al 1982 serious