Development of The Self-Management Program for Diabetes mellitus patients with third stage Chronic Kidney Disease at Somdet District, Kalasin Province

Abstract

     This research and development study aimed to develop self-management supporting process for slow progression of chronic kidney disease among patients with diabetes mellitus and third stage of chronic kidney disease patients. The stady was conducted in somdet hospital of Kalasin province. Four phase of the program were 1) situational analysis phase form interview are 9 multidisciplinary teams and 10 diabetic patients and third stage of chronic kidney disease and review medical record 20 copies of hemodialysis patients. 2) development phase, validation and pilot study .clinical Indicator format, knowledge assessment model for chronic kidney patients, self-management behavior for diabetic patients and satisfaction questionnaire of professional nurses and multidisciplinary team. Examined by 5 experts and tests for reliability were 0.80, 0.86 และ 0.80 respectively. 3) implement by one group was tested before and after the experiment. The study group were 100 diabetes mellitus patients and third stage of chronic kidney disease patients which randomized into self-management support by a multidisciplinary team and followed up for 12 months. 4) evaluation phase and clinical outcomes. The program was carried out from June 2022 to May 2023. The data were analyzed using descriptive statistics compare the difference in average knowledge scores, self-management behavior of chronic kidney patients and clinical indicators before and after the use of paired t-tests at .05 significance level. And paired t-test.

     The results revealed that from the situation analysis and based on the chronic care model was developed which has four components, including delivery system design, self-management support, clinical information system, and decision support. After the model was implemented score of knowledge after using the third stage chronic kidney disease model was higher than before the experiment. Mean scores of self-management behaviors before and after the use of the third-stage chronic kidney disease model as a whole and at the individual level were significantly different at the .05 level. Clinical indicators include HbA1c level, creatinine level and Glomerular filtration rate. There were statistically significant differences at .05 level. The systolic and diastolic blood pressure, BMI and fasting blood sugar are not different. Multidisciplinary team has satisfaction level at high level.