Forandringsforslag til en behovsdrevet behandlingstilgang til personer med diabetes: Udviklet i samarbejde med Steno Diabetes Center Nordjylland

Abstract

Baggrund: Steno Diabetes Center Nordjylland (SDCN) vil ændre behandlingstilgangen i ambulatorierne til personer med diabetes fra en fast standardiseret behandlingstilgang til en behovsdreven behandlingstilgang. Formålet er, at personer ikke længere skal komme til behandlinger, de ikke oplever et behov for. Det skal frigive ressourcer til de personer med diabetes, der har et større behov for behandling og samtidig øge patienttilfredsheden på tværs af alle personer tilknyttet ambulant behandling. Den nye behandlingstilgang vil for nogle medføre en øget egenhåndtering, hvorfor det er problematisk, hvis de ikke er i stand hertil. Formål: At undersøge hvilke barrierer og facilitatorer personer med diabetes, tilknyttet ambulant behandling i Region Nordjylland, oplever i forbindelse med at egenhåndtere diabetes. Viden herom skulle bidrage med forandringsforslag til fremtidig praksis, så personer med diabetes understøttes bedst muligt i egenhåndteringen. Metoder: Specialet tog udgangspunkt i en filosofisk hermeneutisk videnskabsteoretisk position. Der blev udført interviews af 8 personer med diabetes, og empirien blev analyseret ud fra en hermeneutisk analysestrategi. Herudover blev der udført en systematisk litteratursøgning samt et interview af en diabetessygeplejerske tilknyttet ambulant behandling i Region Nordjylland, som blev brugt til diskussionen af resultaterne. Resultater: Facilitatorer for egenhåndtering var accept af diabetes, social støtte fra omgangskredsen og den sundhedsprofessionelle, digital hjælp og medicinsk teknologi. Barrierer for egenhåndtering er manglende social støtte fra omgangskredsen, fysiske og følelsesmæssige konsekvenser af diabetes, komorbiditeter, økonomiske udfordringer, manglende initiering af kontakt ved behov for hjælp samt udfordringer ved at vurdere sit behov for hjælp. Konklusion: Med afsæt i resultaterne blev der udviklet forandringsforslag til fremtidig praksis, som skal kunne imødekomme disse barrierer og facilitatorer. For at imødekomme de utilsigtede negative konsekvenser, som den behovsdrevne behandlingstilgang kan være forbundet med, anbefales det, at SDCN tager højde for de facilitatorer og barrierer, der er for egenhåndtering gennem inddragelse af forandringsforslagene udviklet i specialet.

Background: Steno Diabetes Center Nordjylland (SDCN) wants to change the approach for treatment in the outpatient clinics for people with diabetes from a fixed standardized treatment to an individual needs-driven treatment. The aim is that people no longer have to come to treatments they do not feel a need for. This will release ressources for those with greater needs for treatment and at the same time increase patient satisfaction across all people associated with outpatient treatment. For some, the new treatment approach will lead to increased self-management, which is why it is problematic, if they are not able to do this. Purpose: The purpose of this project was to examine which barriers and facilitators people with diabetes, associated with an outpatient treatment in Region Nordjylland, experience in relation to self-management of diabetes. This knowledge was supposed to contribute to proposals for change for future practice, so that people with diabetes are supported in the best possible way in self-management. Methods: This project was based on a philosophical hermeneutic scientific theoretical approach. Interviews were conducted with 8 people with diabetes, which was analyzed with a hermeneutic analysis strategy. In addition, a systematic literature search was carried out as well as an interview of a diabetes nurse associated with SDCN, which was used for the discussion of the results. Resultater: Facilitators for self-management were acceptance of diabetes, social support from the circle of friends and the health professional, digital help and medical technology. Barriers for self-management were lack of social support from the social network, physical and emotional consequences of diabetes, comorbidities, financial challenges, failure to initiate contact when help is needed and challenges in assessing one's need for help. Based on the results, proposals were developed for what changes can be made in future practice to meet these barriers and facilitators. Conclusion: In order to meet the unintended consequences that the needs-driven treatment approach may be associated with, it is recommended that the SDCN, as far as possible, takes into account the facilitators and barriers to self-management through the inclusion of the change proposals developed in this project.

A master thesis from Aalborg University

Forandringsforslag til en behovsdrevet behandlingstilgang til personer med diabetes: Udviklet i samarbejde med Steno Diabetes Center Nordjylland

[Proposals for change for a needs-driven treatment approach for people with diabetes: Developed in collaboration with Steno Diabetes Center Nordjylland]