糖尿病患者教育の標準化/適正化に向けた療養指導体制の実態調査

わが国の糖尿病患者の療養指導体制を明らかにする目的で実態調査を行った. 対象は日本糖尿病学会に所属する臨床業務に携わる医師で, 3,000名に調査票を郵送し605名(回収率20.2%)から回答を得た. 調査内容は医療の質に関し, 構造指標として病床規模や専門外来・スタッフの配置を, プロセス指標としてアセスメントや治療, 患者・家族教育の内容及びフォローアップシステムを, アウトカム指標として診療の評価指標を選定した. 結果, 回答者の約3割の医療施設で専門外来や専門スタッフの配置をしており, 食事・運動などの生活指導以外に行動変容教育や心理・社会的支援が実施され, それは専門医やCDE配置の有無や病床規模の大きさと有意に関連し, 専門スタッフの配置があり, 病床規模が大きい方が実施割合が高くなっていた. 診療のアウトカム評価は治療成績を反映する検査データ(HbA1c)で行われていた. 糖尿病患者の療養指導の質の確保には専門スタッフの配置の重要性が明らかになったが, 病床規模の大きい病院に偏在していることから, 今後は診療所や小規模病院の専門外来の増設やスタッフの充実に加え, 専門スタッフをもつ大病院と地域とのネットワークの構築が課題である.

The purpose of this study was to clarify the patient care and education system related to diabetes in Japan. Three thousand physicians who belonged to the Japan Diabetes Society were randomly selected. A questionnaire was sent to them and 605 responded (collection rate 20.2%). Items in the questionnaire included the number of beds in their hospitals, the presence of a specialized outpatient-unit and the staffing for diabetics care as structural indicators of the quality of medical care, assessment and treatment, contents of patient/family education and their follow-up system as process indicators, and treatment evaluation index as outcome indicators. The results showed that about 30% of respondents' hospitals and clinics had specialized units and staffing for diabetic outpatients, that they provided patient education for behavioral modification and social-psychological support in addition to basic life style guidance on diet and exercise. These findings were significantly related to the presence of approved specialized physicians and to the size of the hospital. About a half of their evaluation consisted of test data reflecting treatment results. To assure diabetic care and education quality, it was evident that placement of specialized staff was important, however, such staff were unevenly distributed. Developing community networks between big hospitals with specialized staff and clinics and small hospitals, as well as increasing the number of specialized outpatient units and staff in clinics and small hospitals is the next step.