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‫ﺑﻪ ﻧﺎم ﺧﺪاوﻧﺪ ﺟﺎن و ﺧﺮد‬

‫ﻧﺸﺮﻳﻪ ﭘﮋوﻫﺶ ﺗﻮاﻧﺒﺨﺸﻲ در ﭘﺮﺳﺘﺎري‬ ‫ﻓﺼﻠﻨﺎﻣﻪ ﻋﻠﻤﻲ‪-‬ﭘﮋوﻫﺸﻲ اﻧﺠﻤﻦ ﻋﻠﻤﻲ ﭘﺮﺳﺘﺎري اﻳﺮان‬ ‫دوره اول‪ ،‬ﺷﻤﺎره ‪ - 3‬ﺑﻬﺎر ‪1394‬‬ ‫•ﺻﺎﺣﺐ اﻣﺘﻴﺎز‪ :‬اﻧﺠﻤﻦ ﻋﻠﻤﻲ ﭘﺮﺳﺘﺎري اﻳﺮان‬ ‫•ﻣﺪﻳﺮ ﻣﺴﺆول‪ :‬دﻛﺘﺮ ﻛﻴﺎن ﻧﻮروزي‬ ‫•ﺳﺮدﺑﻴﺮ‪ :‬دﻛﺘﺮ ﻣﺴﻌﻮد ﻓﻼﺣﻲ ﺧﺸﻜﻨﺎب‬ ‫•ﻣﺪﻳﺮ اﺟﺮاﻳﻲ‪ :‬زﻫﺮا ﺗﻤﻴﺰي‬ ‫•ﻛﺎرﺷﻨﺎس ﻧﺸﺮﻳﻪ‪ :‬اﻛﺮم ﭘﻮروﻟﻲ‬ ‫•ﺷﻤﺎره ﻣﺠﻮز وزارت ﻓﺮﻫﻨﮓ و ارﺷﺎد اﺳﻼﻣﻲ‪ 32961/92 :‬ﻣﻮرخ ‪1392/11/23‬‬ ‫•ﺷﻤﺎره ﺑﻴﻦ اﻟﻤﻠﻠﻲ ﻧﺸﺮﻳﻪ ﭼﺎﭘﻲ‪ ISSN: ٢٣٨٣-۴٣۴X :‬ﻣﻮرخ ‪1393/10/10‬‬ ‫•ﺷﻤﺎره ﺑﻴﻦاﻟﻤﻠﻠﻲ ﻧﺸﺮﻳﻪ اﻟﻜﺘﺮوﻧﻴﻜﻲ‪ e-ISSN: ٢٣٨٣-۴٣۵٨ :‬ﻣﻮرخ ‪1393/10/10‬‬

‫اﻋﻀﺎي ﻫﻴﺄت ﺗﺤﺮﻳﺮﻳﻪ )ﺑﻪ ﺗﺮﺗﻴﺐ ﺣﺮوف اﻟﻔﺒﺎ(‪:‬‬

‫• داوران اﻳﻦ ﺷﻤﺎره )ﺑﻪ ﺗﺮﺗﻴﺐ ﺣﺮوف اﻟﻔﺒﺎ(‪:‬‬

‫ دﻛﺘﺮ ﻧﺮﮔﺲ ارﺳﻼﻧﻲ‪ ،‬اﺳﺘﺎدﻳﺎر داﻧﺸﮕﺎه ﻋﻠﻮم ﺑﻬﺰﻳﺴﺘﻲ و ﺗﻮاﻧﺒﺨﺸﻲ‬‫ دﻛﺘﺮ ﻓﺎﻃﻤﻪ اﻟﺤﺎﻧﻲ‪ ،‬داﻧﺸﻴﺎر داﻧﺸﮕﺎه ﺗﺮﺑﻴﺖ ﻣﺪرس‬‫ دﻛﺘﺮ اﺻﻐﺮ داﻟﻮﻧﺪي‪ ،‬اﺳﺘﺎدﻳﺎر ﭘﺮﺳﺘﺎري داﻧﺸﮕﺎه ﻋﻠﻮم ﺑﻬﺰﻳﺴﺘﻲ و ﺗﻮاﻧﺒﺨﺸﻲ‬‫ دﻛﺘﺮ ﻧﺎﻫﻴﺪ رژه‪ ،‬داﻧﺸﻴﺎر داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺷﺎﻫﺪ‬‫ دﻛﺘﺮ ﻣﺮﻳﻢ رواﻧﻲ ﭘﻮر داﻧﺸﻴﺎر ﭘﺮﺳﺘﺎري داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺑﻮﺷﻬﺮ‬‫ دﻛﺘﺮ ﻋﺒﺎس ﻋﺒﺎدي‪ ،‬داﻧﺸﻴﺎر داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺑﻘﻴﻪ اﷲ‬‫ دﻛﺘﺮ ﻣﺴﻌﻮد ﻓﻼﺣﻲ ﺧﺸﻜﻨﺎب‪ ،‬داﻧﺸﻴﺎر داﻧﺸﮕﺎه ﻋﻠﻮم ﺑﻬﺰﻳﺴﺘﻲ و ﺗﻮاﻧﺒﺨﺸﻲ‬‫ دﻛﺘﺮ ﺳﺎدات ﺳﻴﺪﺑﺎﻗﺮ ﻣﺪاح‪ ،‬اﺳﺘﺎدﻳﺎر آﻣﻮزش ﭘﺮﺳﺘﺎري داﻧﺸﮕﺎه ﻋﻠﻮم ﺑﻬﺰﻳﺴﺘﻲ و ﺗﻮاﻧﺒﺨﺸﻲ‬‫ دﻛﺘﺮ ﻓﺮﺣﻨﺎز ﻣﺤﻤﺪي‪ ،‬داﻧﺸﻴﺎر ﭘﺮﺳﺘﺎري داﻧﺸﮕﺎه ﻋﻠﻮم ﺑﻬﺰﻳﺴﺘﻲ و ﺗﻮاﻧﺒﺨﺸﻲ‬‫ دﻛﺘﺮ ﺳﻬﻴﻞ ﻧﺠﻔﻲ‪ ،‬اﺳﺘﺎدﻳﺎر ﭘﺮﺳﺘﺎري داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺑﻘﻴﻪ اﷲ‬‫ دﻛﺘﺮ ﻣﻨﻴﺮ ﻧﻮﺑﻬﺎر‪ ،‬داﻧﺸﻴﺎر ﭘﺮﺳﺘﺎري داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺳﻤﻨﺎن‬‫ دﻛﺘﺮ ﻛﻴﺎن ﻧﻮروزي ﺗﺒﺮﻳﺰي‪ ،‬اﺳﺘﺎدﻳﺎر داﻧﺸﮕﺎه ﻋﻠﻮم ﺑﻬﺰﻳﺴﺘﻲ و ﺗﻮاﻧﺒﺨﺸﻲ‬‫ دﻛﺘﺮ ﻋﻠﻴﺮﺿﺎﻧﻴﻜﺒﺨﺖ ﻧﺼﺮآﺑﺎدي‪ ،‬اﺳﺘﺎد داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان‬‫ دﻛﺘﺮ ﻣﺠﻴﺪه ﻫﺮوي ﻛﺮﻳﻤﻮي‪ ،‬داﻧﺸﻴﺎر داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺷﺎﻫﺪ‬‫‪ -‬دﻛﺘﺮ ﻓﺮﻳﺪه ﻳﻐﻤﺎﻳﻲ‪ ،‬داﻧﺸﻴﺎر داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺷﻬﻴﺪ ﺑﻬﺸﺘﻲ‬

‫ﻓﺎﻃﻤﻪ ﭘﺎﺷﺎﻳﻲ‬ ‫زﻫﺮا ﺗﻤﻴﺰي‬ ‫ﻧﺴﺮﻳﻦ ﺟﻌﻔﺮي ﮔﻠﺴﺘﺎن‬ ‫ﻃﻴﺒﻪ ﺣﺴﻦ ﺗﻬﺮاﻧﻲ‬ ‫دﻛﺘﺮ آﻧﺎﻫﻴﺘﺎ ﺧﺪاﺑﺨﺸﻲ ﻛﻮﻻﻳﻲ‬ ‫دﻛﺘﺮ ﻣﺮﻳﻢ رواﻧﻲ ﭘﻮر‬ ‫دﻛﺘﺮ ﻛﻮروش زارع‬ ‫دﻛﺘﺮ ﻣﺤﻤﺪ ﻋﻠﻲ ﺳﻠﻴﻤﺎﻧﻲ‬ ‫ﻣﺮﺗﻀﻲ ﺷﻤﺴﻲ زاده‬ ‫دﻛﺘﺮ رﺿﺎ ﺿﻴﻐﻤﻲ‬ ‫رﺿﺎ ﻗﺎﻧﻌﻲ ﻗﺸﻼق‬ ‫داود ﻋﺮب ﻗﻬﺴﺘﺎﻧﻲ‬ ‫زﻫﺮا ﻣﺨﺘﺎري‬ ‫ﻳﺰدان ﻣﻮﺣﺪي‬ ‫دﻛﺘﺮ ﻣﻨﻴﺮ ﻧﻮﺑﻬﺎر‬

‫• وﻳﺮاﺳﺘﺎر اﻧﮕﻠﻴﺴﻲ ‪ :‬دﻛﺘﺮ ﻛﻴﺎن ﻧﻮروزي‬ ‫• وﻳﺮاﺳﺘﺎر ﻓﺎرﺳﻲ‪ :‬دﻛﺘﺮ ﻛﻴﺎن ﻧﻮروزي‬

‫•ﺣﺮوﻓﭽﻴﻨﻲ و ﺻﻔﺤﻪ آراﻳﻲ‪ :‬ﻣﻬﻨﺪس ﺻﺎدق ﺗﻮﻛﻠﻲ‬ ‫•ﻃﺮاح ﺟﻠﺪ‪ :‬ﻣﻬﻨﺪس ﺻﺎدق ﺗﻮﻛﻠﻲ‬ ‫•ﻧﺎﺷﺮ‪ :‬اﻧﺠﻤﻦ ﻋﻠﻤﻲ ﭘﺮﺳﺘﺎري اﻳﺮان‬ ‫•ﻧﺸﺎﻧﻲ‪ :‬ﺗﻬﺮان ﻣﻴﺪان ﺗﻮﺣﻴﺪ‪-‬داﻧﺸﻜﺪه ﭘﺮﺳﺘﺎري و ﻣﺎﻣﺎﻳﻲ ﺗﻬﺮان‬ ‫•ﻛﺪﭘﺴﺘﻲ‪ 1419733171 :‬ﺻﻨﺪوق ﭘﺴﺘﻲ‪ 14195/398 :‬ﺗﻠﻔﻦ و ﻧﻤﺎﺑﺮ‪66592535 :‬‬ ‫‪E-mail: [email protected], Website: http://ijrn.ir‬‬

‫ﭘﮋوﻫﺶ ﺗﻮاﻧﺒﺨﺸﻲ در ﭘﺮﺳﺘﺎري دوره اول‪ ،‬ﺷﻤﺎره ‪ 3‬ﺑﻬﺎر ‪24- 32 1394‬‬

‫ﺗﻌﻴﻴﻦ رواﻳﻲ ﻣﻼك ﻣﻘﻴﺎس ﺗﺒﻌﻴﺖ از رژﻳﻢ داروﻳﻲ ﻣﻮرﻳﺴﻜﻲ در ﺑﻴﻤﺎران دﻳﺎﺑﺘﻲ ﻧﻮع دو‬ ‫‪6‬‬

‫رﺿﺎ ﻗﺎﻧﻌﻲ ﻗﺸﻼق‪* ،1‬ﻋﺒﺎس ﻋﺒﺎدي‪ ،2‬ﻋﻠﻲ اﻛﺒﺮ وﻳﺴﻲ راﻳﮕﺎﻧﻲ‪ ،3‬ﻛﻴﺎن ﻧﻮروزي ﺗﺒﺮﻳﺰي‪ ،4‬اﺻﻐﺮ داﻟﻮﻧﺪي‪ ،5‬ﺣﺴﻦ ﻣﺤﻤﻮدي‬

‫ﭼﻜﻴﺪه‬ ‫ﻣﻘﺪﻣﻪ‪ :‬ﻋﺪم ﺗﺒﻌﻴﺖ از درﻣﺎن در ﺑﻴﻤﺎران دﻳﺎﺑﺘﻲ ﻣﻨﺠﺮ ﺑﻪ ﻛﻨﺘﺮل ﺿﻌﻴﻒ ﻗﻨﺪ ﺧﻮن و اﻓﺰاﻳﺶ ﺧﻄﺮ اﺑﺘﻼ ﺑﻪ ﻋﻮارض ﻣﺰﻣﻦ دﻳﺎﺑﺖ‪ ،‬ﺑﺴﺘﺮي‬ ‫ﺷﺪن در ﺑﻴﻤﺎرﺳﺘﺎن و ﻣﺮگوﻣﻴﺮ ﻣﻲﺷﻮد‪ .‬ﻣﻴﺰان ﻣﻨﺎﺳﺐ ﻫﻤﻮﮔﻠﻮﺑﻴﻦ ﮔﻠﻴﻜﻮزﻳﻠﻪ ﺑﻪﻋﻨﻮان ﺷﺎﺧﺺ ﻣﺪﻳﺮﻳﺖ ﻣﺆﺛﺮ ﺑﻴﻤﺎري دﻳﺎﺑﺖ در ﻧﻈﺮ ﮔﺮﻓﺘﻪ‬ ‫ﻣﻲﺷﻮد‪ .‬ﻫﺪف اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺑﺮرﺳﻲ رواﻳﻲ ﻣﻼك ﻣﻘﻴﺎس ﺗﺒﻌﻴﺖ از درﻣﺎن ﻣﻮرﻳﺴﻜﻲ ﺑﺎ اﺳﺘﻔﺎده از ﻣﻴﺰان ﻫﻤﻮﮔﻠﻮﺑﻴﻦ ﮔﻠﻴﻜﻮزﻳﻠﻪ ﺑﻴﻤﺎران دﻳﺎﺑﺘﻲ‬ ‫ﻧﻮع دو اﺳﺖ‪.‬‬ ‫روش‪ :‬در اﻳﻦ ﻣﻄﺎﻟﻌﻪ روشﺷﻨﺎﺳﻲ ﺗﻮﺻﻴﻔﻲ ﻫﻤﺒﺴﺘﮕﻲ‪ 204 ،‬ﺑﻴﻤﺎر ﻣﺒﺘﻼ ﺑﻪ دﻳﺎﺑﺖ ﻧﻮع دو ﻣﺮاﺟﻌﻪﻛﻨﻨﺪه ﺑﻪ واﺣﺪ دﻳﺎﺑﺖ ﺷﻬﺮ ﻛﺮﻣﺎﻧﺸﺎه‬ ‫در ﺧﺮداد و ﺗﻴﺮﻣﺎه ﺳﺎل ‪ 1393‬ﺑﺎ روش ﻧﻤﻮﻧﻪﮔﻴﺮي در دﺳﺘﺮس وارد ﻣﻄﺎﻟﻌﻪ ﺷﺪﻧﺪ‪ .‬ﺑﺮاي ﺟﻤﻊآوري دادهﻫﺎ از ﻓﺮم اﻃﻼﻋﺎت ﺟﻤﻌﻴﺖ ﺷﻨﺎﺧﺘﻲ‪،‬‬ ‫ﭘﺮﺳﺸﻨﺎﻣﻪ ﺗﺒﻌﻴﺖ از درﻣﺎن ‪ 8‬ﺳﺆاﻟﻲ ﻣﻮرﻳﺴﻜﻲ)‪ (MMAS-8‬و ﻧﺘﺎﻳﺞ آزﻣﺎﻳﺶﻫﺎي ﻫﻤﻮﮔﻠﻮﺑﻴﻦ ﮔﻠﻴﻜﻮزﻳﻠﻪ )‪ (HbA1c‬اﻳﻦ ﺑﻴﻤﺎران اﺳﺘﻔﺎده‬ ‫ﺷﺪ‪ .‬دادهﻫﺎ ﺑﺎ اﺳﺘﻔﺎده از ﻧﺮماﻓﺰار ‪ PASW‬و روشﻫﺎي ﺗﻮﺻﻴﻔﻲ‪ ،‬آزﻣﻮن ﺗﻲ ﺗﺴﺖ ﻣﺴﺘﻘﻞ‪ ،‬ﻫﻤﺒﺴﺘﮕﻲ ﭘﻴﺮﺳﻮن‪ ،‬ﺗﺴﺖ دﻗﻴﻖ ﻓﻴﺸﺮ و ﻛﺎي‬ ‫اﺳﻜﻮﺋﺮ در ﺳﻄﺢ ﻣﻌﻨﻲ داري ‪ p≤0/05‬ﺗﺠﺰﻳﻪوﺗﺤﻠﻴﻞ ﺷﺪﻧﺪ‪.‬‬ ‫ﻳﺎﻓﺘﻪﻫﺎ‪ :‬ﻧﻤﻮﻧﻪﻫﺎ ﺷﺎﻣﻞ ‪ 33/4‬درﺻﺪ ﻣﺮد و ‪ 66/6‬درﺻﺪ زن ﺑﺎ ﻣﻴﺎﻧﮕﻴﻦ ﺳﻨﻲ ‪ 57/1±9/6‬ﺳﺎل ﺑﻮدﻧﺪ و ‪ 52‬درﺻﺪ اﻓﺮاد ﻣﻮرد ﻣﻄﺎﻟﻌﻪ‬ ‫ﺑﻲﺳﻮاد ﺑﻮدﻧﺪ‪ 129 .‬ﻧﻔﺮ )‪ 63/2‬درﺻﺪ( از ﺑﻴﻤﺎران داراي ﻫﻤﻮﮔﻠﻮﺑﻴﻦ ﮔﻠﻴﻜﻮزﻳﻠﻪ ‪ 7‬درﺻﺪ و ﻛﻤﺘﺮ )ﻣﻄﻠﻮب( و ﺑﺮ اﺳﺎس ﻧﻤﺮه اﺑﺰار ﻣﻮرﻳﺴﻜﻲ‬ ‫ﺗﻨﻬﺎ ‪ 15‬ﻧﻔﺮ )‪ 7/4‬درﺻﺪ( ﺗﺒﻌﻴﺖ از درﻣﺎن ﻣﻄﻠﻮب داﺷﺘﻨﺪ‪ .‬ﺑﻴﻦ ﺗﺒﻌﻴﺖ از درﻣﺎن و ﺟﻨﺴﻴﺖ ارﺗﺒﺎط ﻣﻌﻨﻲ داري وﺟﻮد داﺷﺘﻪ در ﺣﺎﻟﻲ ﻛﻪ ﺑﻴﻦ‬ ‫ﻧﻤﺮه ﭘﺎﻳﺒﻨﺪي ﺑﻪ درﻣﺎن ﺑﺎ ﻫﻤﻮﮔﻠﻮﺑﻴﻦ ﮔﻠﻴﻜﻮزﻳﻠﻪ ﻫﻴﭻ ارﺗﺒﺎط ﻣﻌﻨﻲ داري ﻣﺸﺎﻫﺪه ﻧﺸﺪ‪.‬‬ ‫ﻧﺘﻴﺠﻪﮔﻴﺮي‪ :‬ﺑﻪ ﺷﻜﻞ ﻏﻴﺮﻣﻨﺘﻈﺮهاي ﺑﻴﻦ ﻧﻤﺮه ﺗﺒﻌﻴﺖ از درﻣﺎن ﻣﻘﻴﺎس ﻣﻮرﻳﺴﻜﻲ ﺑﺎ ﻫﻤﻮﮔﻠﻮﺑﻴﻦ ﮔﻠﻴﻜﻮزﻳﻠﻪ ارﺗﺒﺎﻃﻲ وﺟﻮد ﻧﺪاﺷﺖ‪.‬‬ ‫ﻛﻠﻴﺪواژهﻫﺎ‪ :‬ﺗﺒﻌﻴﺖ از رژﻳﻢ داروﺋﻲ‪ ،‬دﻳﺎﺑﺖ‪ ،‬ﻫﻤﻮﮔﻠﻮﺑﻴﻦ ﮔﻠﻴﻜﻮزﻳﻠﻪ‪.‬‬ ‫ﺗﺎرﻳﺦ درﻳﺎﻓﺖ‪1393/10/15 :‬‬

‫ﺗﺎرﻳﺦ ﭘﺬﻳﺮش‪1393/12/25 :‬‬

‫‪ - 1‬داﻧﺸﺠﻮي دﻛﺘﺮي ﭘﺮﺳﺘﺎري‪ ،‬ﮔﺮوه ﭘﺮﺳﺘﺎري‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﺑﻬﺰﻳﺴﺘﻲ و ﺗﻮاﻧﺒﺨﺸﻲ‪ ،‬ﺗﻬﺮان‪ ،‬اﻳﺮان‪.‬‬ ‫‪ - 2‬داﻧﺸﻴﺎر‪ ،‬داﻧﺸﻜﺪه ﭘﺮﺳﺘﺎري‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺑﻘﻴﻪاﷲ )ﻋﺞ(‪ ،‬ﺗﻬﺮان‪ ،‬اﻳﺮان )ﻧﻮﻳﺴﻨﺪه ﻣﺴﺆول(‪.‬‬ ‫ﭘﺴﺖ اﻟﻜﺘﺮوﻧﻴﻜﻲ‪[email protected] :‬‬ ‫‪ - 3‬داﻧﺸﺠﻮي دﻛﺘﺮي ﭘﺮﺳﺘﺎري‪ ،‬ﮔﺮوه ﭘﺮﺳﺘﺎري‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﺑﻬﺰﻳﺴﺘﻲ و ﺗﻮاﻧﺒﺨﺸﻲ‪ ،‬ﺗﻬﺮان‪ ،‬اﻳﺮان‪.‬‬ ‫‪ - 4‬اﺳﺘﺎدﻳﺎر‪ ،‬ﮔﺮوه ﭘﺮﺳﺘﺎري‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﺑﻬﺰﻳﺴﺘﻲ و ﺗﻮاﻧﺒﺨﺸﻲ‪ ،‬ﺗﻬﺮان‪ ،‬اﻳﺮان ‪.‬‬ ‫‪ - 5‬اﺳﺘﺎدﻳﺎر‪ ،‬ﮔﺮوه ﭘﺮﺳﺘﺎري‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﺑﻬﺰﻳﺴﺘﻲ و ﺗﻮاﻧﺒﺨﺸﻲ‪ ،‬ﺗﻬﺮان‪ ،‬اﻳﺮان ‪.‬‬ ‫‪ - 6‬داﻧﺸﺠﻮي دﻛﺘﺮي آﻣﻮزش ﺑﻬﺪاﺷﺖ و ارﺗﻘﺎي ﺳﻼﻣﺖ‪ ،‬داﻧﺸﻜﺪه ﺑﻬﺪاﺷﺖ و ﺗﻐﺬﻳﻪ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﺒﺮﻳﺰ‪ ،‬اﻳﺮان ‪.‬‬

‫رﺿﺎ ﻗﺎﻧﻌﻲ ﻗﺸﻼق و ﻫﻤﻜﺎران‬

‫ﺗﻌﻴﻴﻦ رواﻳﻲ ﻣﻼك ﻣﻘﻴﺎس ﺗﺒﻌﻴﺖ از رژﻳﻢ‪...‬‬

‫ﻋﺪم ﺗﺒﻌﻴﺖ از رژﻳﻢدرﻣﺎﻧﻲ در ﺑﻴﻤﺎران دﻳﺎﺑﺘﻴﻚ ﺑﺎ ﺑﺴﺘﺮي‬

‫ﻣﻘﺪﻣﻪ‬

‫ﺷﺪنﻫﺎي ﻣﻜﺮر در ﺑﻴﻤﺎرﺳﺘﺎن‪ ،‬ﻋﺪم درﻳﺎﻓﺖ ﻣﻨﺎﻓﻊ درﻣﺎن‪،‬‬

‫ﺑﻴﻤﺎري دﻳﺎﺑﺖ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ اﻳﻦﻛﻪ ﻫﻤﻪ ﮔﺮوهﻫﺎي ﺳﻨﻲ را‬

‫ﻫﺰﻳﻨﻪﻫﺎي درﻣﺎﻧﻲ ﺑﺎﻻ و ﺗﻌﺪاد زﻳﺎد وﻳﺰﻳﺖﻫﺎي ﭘﺰﺷﻚ ارﺗﺒﺎط‬

‫درﮔﻴﺮ ﻣﻲﻛﻨﺪ ﺑﻪ ﻳﻚ ﻧﮕﺮاﻧﻲ ﻋﻤﺪه ﺗﺒﺪﻳﻞﺷﺪه اﺳﺖ‪ .‬ﺑﺮآورد ﺷﺪه‬

‫دارد )‪ .(13‬ﻣﻴﺰان ﻣﺮگوﻣﻴﺮ در ﺑﻴﻤﺎراﻧﻲ ﻛﻪ ﺑﻪ درﻣﺎنﻫﺎﻳﺸﺎن‬

‫اﺳﺖ ﻛﻪ ﺗﺎ ﺳﺎل ‪ 2025‬اﻳﻦ ﺑﻴﻤﺎري ﺑﻴﺶ از ‪ 300‬ﻣﻴﻠﻴﻮن ﻧﻔﺮ را‬

‫ﭘﺎﻳﺒﻨﺪ ﻧﻴﺴﺘﻨﺪ دو ﺑﺮاﺑﺮ ﺑﻴﺸﺘﺮ از ﺳﺎﻳﺮ ﺑﻴﻤﺎران ﻣﻲﺑﺎﺷﺪ )‪ .(14‬ﻧﺘﺎﻳﺞ‬

‫در ﺳﺮاﺳﺮ دﻧﻴﺎ درﮔﻴﺮ ﺳﺎزد )‪ .(1‬دﻳﺎﺑﺖ در ﺳﺎل ‪ 2011‬ﻋﺎﻣﻞ‬

‫ﺑﺮﺧﻲ از ﻣﻄﺎﻟﻌﺎت ﻧﺸﺎن دادهاﻧﺪ ﻛﻪ ‪ 4‬ﺗﺎ ‪ 31‬درﺻﺪ ﺑﻴﻤﺎران دﻳﺎﺑﺘﻲ‬

‫اﺻﻠﻲ ‪ 4/6‬ﻣﻴﻠﻴﻮن ﻣﺮگ در ﺳﺮاﺳﺮ دﻧﻴﺎ ﺑﻮده و اﻣﺮوزه ﻳﻜﻲ از‬

‫ﻫﺮﮔﺰ اﻗﺪام ﺑﻪ ﺗﻬﻴﻪ داروﻫﺎي ﺗﺠﻮﻳﺰﺷﺪه در ﻧﺴﺦ داروﻳﻲ ﺧﻮد‬

‫ﭘﻨﺞ ﻋﻠﺖ اﺻﻠﻲ ﻣﺮگوﻣﻴﺮ در ﻛﺸﻮرﻫﺎي ﭘﺮدرآﻣﺪ دﻧﻴﺎ ﻣﻲﺑﺎﺷﺪ‬

‫ﻧﻤﻲﻛﻨﻨﺪ و ﺑﺮﺧﻲ دﻳﮕﺮ ﻧﻴﺰ ﭘﺲ از ﺗﻬﻴﻪ ﻧﺴﺨﻪ داروﻳﻲ ﺧﻮد از‬

‫)‪ .(2‬دﻳﺎﺑﺖ ﻧﻮع دو ﻣﻨﺠﺮ ﺑﻪ ﻛﺎﻫﺶ اﻣﻴﺪ ﺑﻪ زﻧﺪﮔﻲ )ﺗﺎ ‪ 8‬ﺳﺎل(‪،‬‬

‫ﻣﺼﺮف آن ﺧﻮدداري ﻣﻲﻛﻨﻨﺪ ﺑﻪﻃﻮريﻛﻪ ‪ 30‬ﺗﺎ ‪ 50‬درﺻﺪ‬

‫اﻓﺰاﻳﺶ ﺑﺮوز ﺑﻴﻤﺎريﻫﺎﻳﻲ ﻣﺎﻧﻨﺪ ﻗﻠﺒﻲ ﻋﺮوﻗﻲ‪ ،‬ﻣﻐﺰي‪ ،‬ﻋﺮوق‬

‫ﺑﻴﻤﺎران دﻳﺎﺑﺘﻴﻚ در ﻃﻮل ﺳﻪ ﻣﺎه اول دارودرﻣﺎﻧﻲ از ﻣﺼﺮف‬

‫ﻣﺤﻴﻄﻲ‪ ،‬ﻣﺸﻜﻼت ﺑﻴﻨﺎﻳﻲ‪ ،‬ﻋﺼﺒﻲ‪ ،‬ﻛﻠﻴﻮي‪ ،‬زﺧﻢ ﭘﺎي دﻳﺎﺑﺘﻴﻚ و‬

‫داروﻫﺎي ﻓﺸﺎرﺧﻮن و ﭼﺮﺑﻲ ﻛﻪ ﻧﻘﺶ ﻣﻬﻤﻲ در ﻛﺎﻫﺶ ﺣﻮادث‬

‫اﻓﺴﺮدﮔﻲ ﻣﻲﺷﻮد )‪ .(3،4‬ﺧﻮﺷﺒﺨﺘﺎﻧﻪ درﻣﺎن اﻳﻦ ﺑﻴﻤﺎري ﺑﺎ‬

‫ﻗﻠﺒﻲ ﻋﺮوﻗﻲ دارد ﺧﻮدداري ﻣﻲﻛﻨﻨﺪ )‪ .(15‬ﻃﺒﻖ ﺗﻮﺻﻴﻪ اﻧﺠﻤﻦ‬

‫داروﻫﺎي ﻣﻮﺟﻮد از ﻗﺒﻴﻞ ﻛﺎﻫﻨﺪهﻫﺎي ﻗﻨﺪ ﺧﻮن‪ ،‬ﻓﺸﺎرﺧﻮن و‬

‫دﻳﺎﺑﺖ اﻣﺮﻳﻜﺎ ﻣﻴﺰان ﻫﻤﻮﮔﻠﻮﺑﻴﻦ ﮔﻠﻴﻜﻮزﻳﻠﻪ ﻛﻤﺘﺮ از ‪ 7‬درﺻﺪ‬

‫ﭼﺮﺑﻲ ﺧﻮن ﺗﺎ ﺣﺪود زﻳﺎدي ﺷﺎﻧﺲ ﺑﺮوز ﻋﻮارض ﺑﻴﻤﺎري و‬

‫ﺑﻪﻋﻨﻮان ﺷﺎﺧﺺ ﻣﺪﻳﺮﻳﺖ ﻣﺆﺛﺮ ﺑﻴﻤﺎري دﻳﺎﺑﺖ در ﻧﻈﺮ ﮔﺮﻓﺘﻪ‬

‫ﺣﻮادث ﻗﻠﺒﻲ ﻋﺮوﻗﻲ را در اﻳﻦ ﺑﻴﻤﺎران ﻛﺎﻫﺶ داده اﺳﺖ )‪.(5‬‬

‫ﻣﻲﺷﻮد‪ ،‬ﺑﻪﻃﻮريﻛﻪ ﻛﺎﻫﺶ ﻳﻚدرﺻﺪي در ﻣﻴﺰان ﻫﻤﻮﮔﻠﻮﺑﻴﻦ‬

‫ﻫﺪف ﻧﻬﺎﻳﻲ ﻫﺮﮔﻮﻧﻪ ﺗﺠﻮﻳﺰ داروﻳﻲ ﺣﺼﻮل ﻧﺘﺎﻳﺞ درﻣﺎﻧﻲ ﻣﻄﻠﻮب‬

‫ﮔﻠﻴﻜﻮزﻳﻠﻪ ﺑﺎ ﻛﺎﻫﺶ ‪ 37‬درﺻﺪي ﺣﻮادث ﻣﻴﻜﺮوواﺳﻜﻮﻻر و‬

‫و ﻣﺪﻳﺮﻳﺖ ﻫﺮ ﭼﻪ ﺑﻬﺘﺮ ﺑﻴﻤﺎري اﺳﺖ‪ .‬ﻣﺪﻳﺮﻳﺖ ﻣﻨﺎﺳﺐ دﻳﺎﺑﺖ ﻳﻚ‬

‫ﻛﺎﻫﺶ ‪ 21‬درﺻﺪي ﻣﺮگوﻣﻴﺮ ﻧﺎﺷﻲ از دﻳﺎﺑﺖ در ارﺗﺒﺎط اﺳﺖ‬

‫ﻣﻮﺿﻮع ﭼﺎﻟﺶﺑﺮاﻧﮕﻴﺰ اﺳﺖ )‪ (6،7‬ﻛﻪ در اﻳﻦ ﻣﻴﺎن ﺗﺒﻌﻴﺖ از‬

‫)‪ Wabe .(15‬و ﻫﻤﻜﺎران ﻣﻲﻧﻮﻳﺴﻨﺪ ﻛﻪ ﺗﺒﻌﻴﺖ از رژﻳﻢدرﻣﺎﻧﻲ‬

‫درﻣﺎن ﻣﻬﻢﺗﺮﻳﻦ ﻋﺎﻣﻞ ﻛﻠﻴﺪي ﻛﺎﻫﺶ ﻋﻮارض و ﻣﺮگوﻣﻴﺮ‬

‫ﺑﺎ ﻛﺎﻫﺶ ﻫﻤﻮﮔﻠﻮﺑﻴﻦ ﮔﻠﻴﻜﻮزﻳﻠﻪ ﻫﻤﺒﺴﺘﮕﻲ دارد ﺑﻪﻃﻮريﻛﻪ ﺑﺎ‬

‫ﺑﻴﻤﺎران دﻳﺎﺑﺘﻲ ﻣﺤﺴﻮب ﻣﻲﺷﻮد )‪ Restrepo .(8‬و ﻫﻤﻜﺎراﻧﺶ‬

‫اﻓﺰاﻳﺶ ‪ 10‬درﺻﺪي ﭘﺎﻳﺒﻨﺪي ﺑﻪ درﻣﺎن‪ ،‬ﻣﻴﺰان ﻫﻤﻮﮔﻠﻮﺑﻴﻦ‬

‫ﺗﺒﻌﻴﺖ از درﻣﺎن را ﺑﻪﺻﻮرت ﻣﻴﺰان ﺗﻄﺎﺑﻖ رﻓﺘﺎر ﻓﺮد ﺑﺎ‬

‫ﮔﻠﻴﻜﻮزﻳﻠﻪ ‪ 0/14‬ﺗﺎ ‪ 0/16‬درﺻﺪ ﻛﺎﻫﺶ ﻣﻲﻳﺎﺑﺪ )‪.(8‬‬

‫ﺗﻮﺻﻴﻪﻫﺎي ﺳﻼﻣﺘﻲ و درﻣﺎنﻫﺎي داروﻳﻲ ﺗﻌﺮﻳﻒ ﻣﻲﻛﻨﻨﺪ )‪.(9‬‬

‫ﺑﺮاي ﺑﺮرﺳﻲ و ارزﻳﺎﺑﻲ ﺗﺒﻌﻴﺖ از درﻣﺎن ﻫﻴﭻ اﺑﺰار اﺳﺘﺎﻧﺪارد‬

‫رﻓﺘﺎرﻫﺎي ﺗﺒﻌﻴﺖ از رژﻳﻢدرﻣﺎﻧﻲ ﺷﺎﻣﻞ رﻓﺘﺎرﻫﺎي ﻣﺮﺗﺒﻂ ﺑﺎ رژﻳﻢ‬

‫ﻃﻼﻳﻲ وﺟﻮد ﻧﺪارد و روشﻫﺎي ﺧﻮد ﮔﺰارﺷﻲ )اﺑﺰارﻫﺎي ﻣﻮﺟﻮد(‬

‫داروﻳﻲ‪ ،‬ﺗﻮﺻﻴﻪﻫﺎي ﻏﺬاﻳﻲ‪ ،‬ﻓﻌﺎﻟﻴﺖ ﺟﺴﻤﻲ‪ ،‬ﺧﻮدﻛﻨﺘﺮﻟﻲ ﻗﻨﺪ ﺧﻮن‬

‫ﻧﺴﺒﺖ ﺑﻪ روشﻫﺎي ﺑﻴﻮﻟﻮژﻳﻜﻲ ﺗﺒﻌﻴﺖ از درﻣﺎن را ﻛﻤﺘﺮ از ﺣﺪ‬

‫و ﻣﺮاﻗﺒﺖ از ﭘﺎﻫﺎ ﻣﻲﺑﺎﺷﺪ )‪ .(10‬ﺑﺮاي ﺗﻮﺻﻴﻒ ﺗﺒﻌﻴﺖ از درﻣﺎن از‬

‫واﻗﻌﻲ ﻧﺸﺎن ﻣﻲدﻫﻨﺪ و اﻳﻦ در ﺣﺎﻟﻲ اﺳﺖ ﻛﻪ اﺳﺘﻔﺎده از ﻳﻚ‬

‫ﺳﻪ واژه ‪ concordance ،adherence‬و ‪compliance‬‬

‫اﺑﺰار ﺧﻮد ﮔﺰارﺷﻲ ﺳﺎده و درﻋﻴﻦﺣﺎل روا و ﭘﺎﻳﺎ ﻣﻲﺗﻮاﻧﺪ ﻣﻨﺠﺮ ﺑﻪ‬

‫اﺳﺘﻔﺎده ﻣﻲﺷﻮد‪ ،‬اﻳﻦ واژهﻫﺎ اﻏﻠﺐ ﺑﻪﻃﻮر ﻧﺎدرﺳﺖ ﺑﻪﺟﺎي‬

‫درك ﺑﻬﺘﺮي از ﺗﺒﻌﻴﺖ از درﻣﺎن در ﻣﺤﻴﻂ ﺑﺎﻟﻴﻨﻲ ﺷﻮد )‪.(17،16‬‬

‫ﻫﻤﺪﻳﮕﺮ ﺑﻪﻛﺎرﺑﺮده ﻣﻲﺷﻮﻧﺪ؛ ‪ adherence‬ﺑﻪ ﻣﻌﻨﺎي ﺗﺒﻌﻴﺖ‬

‫‪ Gonzalez‬ﻣﻌﺘﻘﺪ اﺳﺖ ﺑﻴﺸﺘﺮ ﻣﻄﺎﻟﻌﺎﺗﻲ ﻛﻪ ﺑﻪ ﺑﺮرﺳﻲ اﻋﺘﺒﺎر‬

‫ﺑﻮده و ﺑﻪﻋﻨﻮان ﻫﺪف اﺻﻠﻲ در ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﻣﻲﺷﻮد‪،‬‬

‫ﺳﻨﺠﺶ ﺗﺒﻌﻴﺖ از درﻣﺎن ﭘﺮداﺧﺘﻪاﻧﺪ ﻣﺘﻜﻲ ﺑﻪ ﻣﻄﺎﻟﻌﻪ اﻧﺤﺼﺎري‬

‫‪ compliance‬ﺑﻪ ﻣﻌﻨﺎي ﭘﻴﺮوي ﺑﻮده و ﺷﺎﻣﻞ ﭘﻴﺎﻣﺪ اﻳﻦ ﻓﺮاﻳﻨﺪ‬

‫ﻫﻤﻮﮔﻠﻮﺑﻴﻦ ﮔﻠﻴﻜﻮزﻳﻠﻪ ﺑﻮده و اﻏﻠﺐ از ﻣﻘﻴﺎس ﺗﺒﻌﻴﺖ از درﻣﺎن‬

‫اﺳﺖ و در ﻧﻬﺎﻳﺖ ‪ concordance‬ﺑﻪ ﻣﻌﻨﺎي ﺗﻄﺎﺑﻖ‬

‫ﻣﻮرﻳﺴﻜﻲ اﺳﺘﻔﺎده ﻛﺮدهاﻧﺪ )‪ .(18‬ﺑﻪﻋﻨﻮانﻣﺜﺎل در ﻣﻄﺎﻟﻌﻪاي ﻛﻪ‬

‫ﺗﻌﺮﻳﻒﺷﺪه و ﻓﺮاﻳﻨﺪي اﺳﺖ ﻛﻪ ﺑﺮاي ﺑﻪ ﻛﺎر ﺑﺮدن اﻳﻦ ﻫﺪف‬

‫ﺑﻪ ﺑﺮرﺳﻲ ارﺗﺒﺎط ﺑﻴﻦ ﺗﺒﻌﻴﺖ از درﻣﺎن ﺧﻮد ﮔﺰارﺷﻲ ﺑﺎ‬

‫ﻣﻮرد اﺳﺘﻔﺎده ﻗﺮار ﻣﻲﮔﻴﺮد و دﻻﻟﺖ ﺑﺮ اﻳﻦ دارد ﻛﻪ ﺑﻴﻤﺎر ﺗﺎ ﭼﻪ‬

‫ﻫﻤﻮﮔﻠﻮﺑﻴﻦ ﮔﻠﻴﻜﻮزﻳﻠﻪ در ﺑﺰرﮔﺴﺎﻻن ﻣﺒﺘﻼ ﺑﻪ دﻳﺎﺑﺖ ﻧﻮع دو‬

‫ﺣﺪ از دﺳﺘﻮرات ﭘﺰﺷﻚ اﻃﺎﻋﺖ ﻣﻲﻛﻨﺪ )‪.(12 ،11‬‬ ‫ﭘﮋوﻫﺶ ﺗﻮاﻧﺒﺨﺸﻲ در ﭘﺮﺳﺘﺎري‬

‫‪25‬‬

‫دوره اول ﺷﻤﺎره ‪ 3‬ﺑﻬﺎر ‪1394‬‬

‫رﺿﺎ ﻗﺎﻧﻌﻲ ﻗﺸﻼق و ﻫﻤﻜﺎران‬

‫ﺗﻌﻴﻴﻦ رواﻳﻲ ﻣﻼك ﻣﻘﻴﺎس ﺗﺒﻌﻴﺖ از رژﻳﻢ‪...‬‬

‫ﭘﺮداﺧﺘﻪ اﺳﺖ از ﻣﻘﻴﺎس ﺗﺒﻌﻴﺖ از درﻣﺎن ﻣﻮرﻳﺴﻜﻲ اﺳﺘﻔﺎدهﺷﺪه‬

‫ﻣﻮرﻳﺴﻜﻲ ﺗﻮﺳﻂ ﻧﮕﺎرﻧﺪه و ﻫﻤﻜﺎران ﺑﻪ ﻓﺎرﺳﻲ ﺗﺮﺟﻤﻪ و رواﻳﻲ و‬

‫اﺳﺖ )‪ .(19،18‬در رواﻳﻲ ﻣﻼك‪ ،‬ﻧﺘﺎﻳﺞ ﺣﺎﺻﻞ از ﻳﻚ اﺑﺰار ﺑﺎ ﻳﻚ‬

‫ﭘﺎﻳﺎﻳﻲ آن ﻧﻴﺰ ﺗﺄﻳﻴﺪﺷﺪه اﺳﺖ )‪ .(21‬ﭘﺎﻳﺎﻳﻲ اﻳﻦ ﭘﺮﺳﺸﻨﺎﻣﻪ در‬

‫ﻣﻼك ﻣﻌﻴﻦ و اﺳﺘﺎﻧﺪارد ﻣﻮرد ﻣﻘﺎﻳﺴﻪ ﻗﺮار ﻣﻲﮔﻴﺮد و‬

‫ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﺑﺮ اﺳﺎس ﺿﺮﻳﺐ آﻟﻔﺎي ﻛﺮوﻧﺒﺎخ ‪ 0/72‬ﻣﺤﺎﺳﺒﻪ‬

‫درﺻﻮرﺗﻲﻛﻪ ﻧﺘﺎﻳﺞ اﺑﺰار ﺟﺪﻳﺪ ﺑﺎ ﻧﺘﺎﻳﺞ ﻣﻼك اﺳﺘﺎﻧﺪارد ﻣﺸﺎﺑﻪ‬

‫ﮔﺮدﻳﺪ‪ .‬ﺟﻬﺖ اﻧﺠﺎم ﻣﻄﺎﻟﻌﻪ ﭘﮋوﻫﺸﮕﺮ واﺣﺪﻫﺎي ﻣﻮردﭘﮋوﻫﺶ را‬

‫ﺑﻮده و ﻫﻤﺒﺴﺘﮕﻲ ﺑﺎﻻﻳﻲ داﺷﺘﻪ ﺑﺎﺷﺪ‪ ،‬اﺑﺰار ﺟﺪﻳﺪ داراي اﻋﺘﺒﺎر‬

‫در ﻳﻚﻓﺎﺻﻠﻪ زﻣﺎﻧﻲ دوﻣﺎﻫﻪ از ﺑﻴﻦ ﺑﻴﻤﺎران دﻳﺎﺑﺘﻲ ﻧﻮع دو‬

‫ﺧﻮاﻫﺪ ﺑﻮد‪ .‬ازآﻧﺠﺎﻳﻲﻛﻪ رواﻳﻲ ﻣﻼك اﺑﺰار ﺗﺒﻌﻴﺖ از درﻣﺎن‬

‫ﻣﺮاﺟﻌﻪﻛﻨﻨﺪه ﺑﻪ واﺣﺪ دﻳﺎﺑﺖ ﻛﺮﻣﺎﻧﺸﺎه ﻛﻪ ﺟﻮاب آزﻣﺎﻳﺶ‬

‫ﻣﻮرﻳﺴﻜﻲ ﻣﻮردﺑﺮرﺳﻲ ﻗﺮار ﻧﮕﺮﻓﺘﻪ اﺳﺖ و از ﺳﻮﻳﻲ دﻳﮕﺮ ﺗﻌﻴﻴﻦ‬

‫ﻫﻤﻮﮔﻠﻮﺑﻴﻦ ﮔﻠﻴﻜﻮزﻳﻠﻪ ﺟﺪﻳﺪ ﺧﻮد را ﺑﻪ ﻫﻤﺮاه داﺷﺘﻨﺪ اﻧﺘﺨﺎب و‬

‫اﻋﺘﺒﺎر اﺑﺰارﻫﺎ ﻗﺒﻞ از ﺑﻪﻛﺎرﮔﻴﺮي آن داراي اﻫﻤﻴﺖ ﺑﺴﻴﺎر زﻳﺎد‬

‫ﭘﺲ از ﺗﻮﺿﻴﺢ اﻫﺪاف ﻣﻄﺎﻟﻌﻪ‪ ،‬روش اﻧﺠﺎم ﻛﺎر و اﺧﺬ رﺿﺎﻳﺖﻧﺎﻣﻪ‬

‫اﺳﺖ ﻟﺬا ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﺑﻪ ﺑﺮرﺳﻲ رواﻳﻲ ﻫﻤﺰﻣﺎن اﺑﺰار ﺗﺒﻌﻴﺖ از‬

‫ﻛﺘﺒﻲ از آنﻫﺎ‪ ،‬ﭘﺮﺳﺸﻨﺎﻣﻪﻫﺎ را در اﺧﺘﻴﺎر ﺑﻴﻤﺎران ﻗﺮار ﮔﺮﻓﺘﻪ و‬

‫درﻣﺎن ﻣﻮرﻳﺴﻜﻲ ﺑﺎ ﻣﻴﺰان ﻫﻤﻮﮔﻠﻮﺑﻴﻦ ﮔﻠﻴﻜﻮزﻳﻠﻪ )ﺑﻪﻋﻨﻮان‬

‫درﺻﻮرﺗﻲﻛﻪ ﺑﻴﻤﺎران ﺳﻮاد ﺧﻮاﻧﺪن و ﻧﻮﺷﺘﻦ ﻧﺪاﺷﺘﻨﺪ‪ ،‬ﭘﺮﺳﺸﻨﺎﻣﻪ‬

‫ﻣﻼك اﺳﺘﺎﻧﺪارد( ﺑﻴﻤﺎران دﻳﺎﺑﺘﻲ ﻧﻮع دو ﻣﺮاﺟﻌﻪﻛﻨﻨﺪه ﺑﻪ واﺣﺪ‬

‫ﺗﻮﺳﻂ ﻫﻤﻜﺎر ﭘﺮﺳﺘﺎر آﻣﻮزشدﻳﺪه ﺑﻪﺻﻮرت رودررو ﺗﻜﻤﻴﻞ‬

‫دﻳﺎﺑﺖ ﻛﺮﻣﺎﻧﺸﺎه ﭘﺮداﺧﺘﻪ اﺳﺖ‪.‬‬

‫ﮔﺮدﻳﺪ‪ .‬ﻻزم ﺑﻪ ذﻛﺮ اﺳﺖ ﺑﻪ دﻟﻴﻞ رﻋﺎﻳﺖ ﻣﻮازﻳﻦ اﺧﻼﻗﻲ اﺻﻞ‬ ‫ﻣﺤﺮﻣﺎﻧﻪ ﺑﻮدن اﻃﻼﻋﺎت ﺑﻴﻤﺎران ﻣﻮردﺗﻮﺟﻪ ﻗﺮار ﮔﺮﻓﺖ‪ .‬ﭘﺲ از‬

‫روش ﻣﻄﺎﻟﻌﻪ‬

‫ﺗﻜﻤﻴﻞ ﭘﺮﺳﺸﻨﺎﻣﻪ‪ ،‬دادهﻫﺎ ﺑﺎ اﺳﺘﻔﺎده از ﻧﺮماﻓﺰار ‪ PASW‬و‬

‫در اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺗﻮﺻﻴﻔﻲ ﻫﻤﺒﺴﺘﮕﻲ رواﻳﻲ ﻣﻼك ﻣﻘﻴﺎس‬

‫اﻧﺠﺎم آزﻣﻮنﻫﺎي ﺗﻮﺻﻴﻔﻲ‪ ،‬ﻛﺎي اﺳﻜﻮﺋﺮ‪ ،‬ﺗﺴﺖ دﻗﻴﻖ ﻓﻴﺸﺮ‪ ،‬ﺗﻲ‬

‫‪Morisky‬‬

‫ﺗﺴﺖ ﻣﺴﺘﻘﻞ و ﺿﺮﻳﺐ ﻫﻤﺒﺴﺘﮕﻲ ﭘﻴﺮﺳﻮن در ﺳﻄﺢ ﻣﻌﻨﻲ داري‬

‫ﻫﺸﺖ ﺳﻮأﻟﻲ ﺗﺒﻌﻴﺖ از درﻣﺎن ﻣﻮرﻳﺴﻜﻲ‬

‫)‪ Medication Adherence Scale (MMAS-8‬ﺑﺎ‬

‫‪ 0/05‬ﻣﻮرد ﺗﺠﺰﻳﻪوﺗﺤﻠﻴﻞ ﻗﺮار ﮔﺮﻓﺘﻨﺪ‪.‬‬

‫ﻣﻴﺰان ﻫﻤﻮﮔﻠﻮﺑﻴﻦ ﮔﻠﻴﻜﻮزﻳﻠﻪ ﺑﻴﻤﺎران دﻳﺎﺑﺘﻴﻚ ﻧﻮع دو‬ ‫ﻣﺮاﺟﻌﻪﻛﻨﻨﺪه ﺑﻪ واﺣﺪ دﻳﺎﺑﺖ ﻛﺮﻣﺎﻧﺸﺎه در ﻃﻮل ﺧﺮداد و ﺗﻴﺮﻣﺎه‬

‫ﻳﺎﻓﺘﻪﻫﺎ‬

‫ﺳﺎل ‪ 1393‬ﻣﻮردﺑﺮرﺳﻲ ﻗﺮار ﮔﺮﻓﺖ‪ .‬در اﻳﻦ ﻣﻄﺎﻟﻌﻪ ‪ 204‬ﺑﻴﻤﺎر‬

‫ﻧﺘﺎﻳﺞ ﻧﺸﺎن داد ﻛﻪ ‪ 66/7‬درﺻﺪ از واﺣﺪﻫﺎي ﻣﻮرد ﭘﮋوﻫﺶ‬

‫دﻳﺎﺑﺘﻴﻚ ﺑﻪ روش ﻧﻤﻮﻧﻪﮔﻴﺮي در دﺳﺘﺮس اﻧﺘﺨﺎب ﺷﺪﻧﺪ‪.‬‬

‫زن و ‪ 33/3‬درﺻﺪ از آنﻫﺎ ﻣﺮد ﺑﻮدﻧﺪ‪ .‬ﻣﻴﺎﻧﮕﻴﻦ و اﻧﺤﺮاف ﻣﻌﻴﺎر‬

‫ﻣﻌﻴﺎرﻫﺎي ورود ﺑﻪ ﻣﻄﺎﻟﻌﻪ ﺷﺎﻣﻞ اﺑﺘﻼء ﺑﻪ دﻳﺎﺑﺖ ﻧﻮع دو ﺑﻪ ﻣﺪت‬

‫ﺳﻨﻲ ﻧﻤﻮﻧﻪ ﻫﺎ ‪ 57/1±9/6‬ﺳﺎل و در ﻣﺤﺪوده ﺳﻨﻲ ‪ 33‬ﺗﺎ ‪84‬‬

‫ﺑﻴﺶ از ﻳﻚ ﺳﺎل‪ ،‬داﺷﺘﻦ ﭘﺮوﻧﺪه در واﺣﺪ دﻳﺎﺑﺖ‪ ،‬ﺑﻪ ﻫﻤﺮاه‬

‫ﺳﺎل ﻗﺮار داﺷﺘﻨﺪ‪ .‬ﻣﻴﺎﻧﮕﻴﻦ ﺳﻨﻲ ﻣﺮدان )‪ (59/5‬ﺑﻪ ﻃﻮر ﻣﻌﻨﻲ‬

‫داﺷﺘﻦ ﺟﻮاب آزﻣﺎﻳﺶ ﻫﻤﻮﮔﻠﻮﺑﻴﻦ ﮔﻠﻴﻜﻮزﻳﻠﻪ و ﻣﺼﺮف داروﻫﺎي‬

‫داري ﺑﻴﺸﺘﺮ از زﻧﺎن )‪ (55/9‬ﺑﻮد )‪ .(p=0/01‬ﻃﻮل ﻣﺪت اﺑﺘﻼء ﺑﻪ‬

‫ﺧﻮراﻛﻲ ﻛﺎﻫﻨﺪه ﻗﻨﺪ ﺧﻮن ﺑﻮد‪ .‬ﺑﺮاي ﺟﻤﻊآوري دادهﻫﺎ از ﻓﺮم‬

‫ﺑﻴﻤﺎري دﻳﺎﺑﺖ در اﻏﻠﺐ واﺣﺪﻫﺎي ﻣﻮرد ﭘﮋوﻫﺶ )‪ 38/7‬درﺻﺪ(‬

‫ﺟﻤﻌﻴﺖ ﺷﻨﺎﺧﺘﻲ و ﭘﺮﺳﺸﻨﺎﻣﻪ ﺗﺒﻌﻴﺖ از درﻣﺎن ﻣﻮرﻳﺴﻜﻲ و ﻣﻴﺰان‬

‫ﻳﻚ ﺗﺎ ﭘﻨﺞ ﺳﺎل ﺑﺎ ﻣﻴﺎﻧﮕﻴﻦ و اﻧﺤﺮاف ﻣﻌﻴﺎر ‪ 8/1±5/7‬ﺳﺎل ﺑﻮده‪،‬‬

‫ﻫﻤﻮﮔﻠﻮﺑﻴﻦ ﮔﻠﻴﻜﻮزﻳﻠﻪ اﺳﺘﻔﺎده ﺷﺪ‪ .‬ﻓﺮم ﺟﻤﻌﻴﺖ ﺷﻨﺎﺧﺘﻲ ﺷﺎﻣﻞ‬

‫‪ 52‬درﺻﺪ از واﺣﺪﻫﺎي ﻣﻮردﭘﮋوﻫﺶ ﺑﻲﺳﻮاد‪ 66/8 ،‬درﺻﺪ از آن‬

‫ﻣﺘﻐﻴﺮﻫﺎﻳﻲ از ﻗﺒﻴﻞ ﺳﻦ‪ ،‬ﺟﻨﺴﻴﺖ‪ ،‬وﺿﻌﻴﺖ ﺗﺄﻫﻞ‪ ،‬ﺗﺤﺼﻴﻼت و ‪...‬‬

‫ﻫﺎ ﺑﺎ ﻫﻤﺴﺮ و ﻓﺮزﻧﺪان ﺧﻮد زﻧﺪﮔﻲ ﻣﻲﻛﺮدﻧﺪ‪ .‬ﻣﺸﺨﺼﺎت‬

‫ﺑﻮد‪ .‬ﭘﺮﺳﺸﻨﺎﻣﻪ ﺗﺒﻌﻴﺖ از درﻣﺎن ﻣﻮرﻳﺴﻜﻲ داراي ﻫﻔﺖ ﮔﺰﻳﻨﻪ دو‬

‫ﺟﻤﻌﻴﺖﺷﻨﺎﺳﻲ ﺑﻴﻤﺎران دﻳﺎﺑﺘﻴﻚ داراي ﺗﺒﻌﻴﺖ از درﻣﺎن ﻣﻄﻠﻮب و‬

‫ﻧﻤﺮهاي )ﺑﻠﻲ ﺻﻔﺮ و ﺧﻴﺮ ﻳﻚ اﻣﺘﻴﺎز( و ﻳﻚ ﮔﺰﻳﻨﻪ ﭘﻨﺞ ﻧﻤﺮهاي‬

‫ﻧﺎﻣﻄﻠﻮب در ﺟﺪول )‪ (1‬ﻧﺸﺎن دادهﺷﺪه اﺳﺖ‪.‬‬

‫)ﻫﺮﮔﺰ= ﺻﻔﺮ‪ ،‬ﺑﻨﺪرت= ‪ ،1‬ﮔﺎﻫﻲ اوﻗﺎت= ‪ ،2‬اﻏﻠﺐ اوﻗﺎت=‪3‬‬ ‫ﻫﻤﻴﺸﻪ=‪ 4‬اﻣﺘﻴﺎز( اﺳﺖ و ﻛﺴﺐ ﻧﻤﺮه ‪ 6‬ﺑﻪ ﺑﺎﻻ ﺑﻪﻣﻨﺰﻟﻪ ﺗﺒﻌﻴﺖ‬ ‫ﻣﻄﻠﻮب از درﻣﺎن ﻣﻲ ﺑﺎﺷﺪ )‪ .(20‬ﭘﺮﺳﺸﻨﺎﻣﻪ ﺗﺒﻌﻴﺖ از درﻣﺎن‬ ‫ﭘﮋوﻫﺶ ﺗﻮاﻧﺒﺨﺸﻲ در ﭘﺮﺳﺘﺎري‬

‫‪26‬‬

‫دوره اول ﺷﻤﺎره ‪ 3‬ﺑﻬﺎر ‪1394‬‬

‫رﺿﺎ ﻗﺎﻧﻌﻲ ﻗﺸﻼق و ﻫﻤﻜﺎران‬

‫ﺗﻌﻴﻴﻦ رواﻳﻲ ﻣﻼك ﻣﻘﻴﺎس ﺗﺒﻌﻴﺖ از رژﻳﻢ‪...‬‬

‫ﺟﺪول ﺷﻤﺎره ‪ :1‬ﻣﺸﺨﺼﻪﻫﺎي دﻣﻮﮔﺮاﻓﻴﻚ ﺑﻴﻤﺎران دﻳﺎﺑﺘﻲ ﺑﺎ ﺗﺒﻌﻴﺖ از درﻣﺎن ﻣﻄﻠﻮب و ﻧﺎﻣﻄﻠﻮب‬ ‫ﺗﺒﻌﻴﺖ از درﻣﺎن ﻣﻄﻠﻮب‬ ‫ﻣﺘﻐﻴﺮﻫﺎ‬

‫ﺳﻦ‬

‫ﺗﺤﺼﻴﻼت‬

‫وﺿﻌﻴﺖ زﻧﺪﮔﻲ‬

‫‪HbA1c‬‬

‫ﺗﻌﺪاد‬ ‫‪14‬‬ ‫‪1‬‬ ‫‪2‬‬ ‫‪13‬‬ ‫‪5‬‬ ‫‪10‬‬ ‫‪2‬‬ ‫‪10‬‬ ‫‪3‬‬ ‫‪0‬‬ ‫‪0‬‬ ‫‪5‬‬ ‫‪10‬‬

‫)‪ 189‬ﻧﻔﺮ(‬ ‫درﺻﺪ‬ ‫ﺗﻌﺪاد‬ ‫‪77/8‬‬ ‫‪147‬‬ ‫‪22/2‬‬ ‫‪42‬‬ ‫‪34/9‬‬ ‫‪66‬‬ ‫‪65/1‬‬ ‫‪123‬‬ ‫‪49/2‬‬ ‫‪93‬‬ ‫‪50/8‬‬ ‫‪96‬‬ ‫‪14/8‬‬ ‫‪28‬‬ ‫‪68/8‬‬ ‫‪130‬‬ ‫‪11/6‬‬ ‫‪22‬‬ ‫‪1/1‬‬ ‫‪2‬‬ ‫‪3/7‬‬ ‫‪7‬‬ ‫‪37‬‬ ‫‪70‬‬ ‫‪63‬‬ ‫‪119‬‬

‫‪P‬‬

‫آزﻣﻮن آﻣﺎري‬

‫‪0/1‬‬ ‫‪0/07‬‬ ‫‪0/1‬‬

‫‪0/8‬‬

‫آزﻣﻮن ﻛﺎي اﺳﻜﻮﺋﺮ و ﺗﺴﺖ دﻗﻴﻖ ﻓﻴﺸﺮ‬

‫ﺟﻨﺲ‬

‫زﻳﺮ ‪ 65‬ﺳﺎل‬ ‫ﺑﺎﻻي ‪ 65‬ﺳﺎل )ﺳﺎﻟﻤﻨﺪ(‬ ‫ﻣﺮد‬ ‫زن‬ ‫ﺑﺎﺳﻮاد‬ ‫ﺑﻲﺳﻮاد‬ ‫ﺑﺎ ﻫﻤﺴﺮ‬ ‫ﻫﻤﺴﺮ و ﻓﺮزﻧﺪان‬ ‫ﻓﺮزﻧﺪان‬ ‫ﺳﺎﻳﺮ ﺑﺴﺘﮕﺎن‬ ‫ﺗﻨﻬﺎ‬ ‫ﻣﻄﻠﻮب ) ﺗﺎ ‪(%7‬‬ ‫ﻧﺎﻣﻄﻠﻮب )ﺑﻴﺶ از ‪(%7‬‬

‫)‪ 15‬ﻧﻔﺮ(‬ ‫درﺻﺪ‬ ‫‪93/3‬‬ ‫‪6/7‬‬ ‫‪13/3‬‬ ‫‪86/7‬‬ ‫‪33/3‬‬ ‫‪66/7‬‬ ‫‪13/3‬‬ ‫‪66/7‬‬ ‫‪20‬‬ ‫‪0‬‬ ‫‪0‬‬ ‫‪33/3‬‬ ‫‪66/7‬‬

‫ﺗﺒﻌﻴﺖ از درﻣﺎن ﻧﺎﻣﻄﻠﻮب‬

‫‪0/5‬‬

‫ﻣﻴﺎﻧﮕﻴﻦ و اﻧﺤﺮاف ﻣﻌﻴﺎر ﻫﻤﻮﮔﻠﻮﺑﻴﻦ ﮔﻠﻴﻜﻮزﻳﻠﻪ ﺑﻴﻤﺎران‬

‫ﻫﻤﺒﺴﺘﮕﻲ ﻣﻌﻨﻲ داري وﺟﻮد ﻧﺪارد‪ .‬ﻋﺪم ﺗﺒﻌﻴﺖ از درﻣﺎن ﻣﺸﻜﻞ‬

‫دﻳﺎﺑﺘﻲ ﻧﻮع دو واﺣﺪﻫﺎي ﻣﻮردﭘﮋوﻫﺶ ‪ 8/1±2/3‬ﺑﻮد‪ 129 .‬ﻧﻔﺮ‬

‫ﻣﻬﻢ و ﺷﺎﻳﻊ در ﻣﺮاﻗﺒﺖ از ﺑﻴﻤﺎران ﻣﺒﺘﻼ ﺑﻪ دﻳﺎﺑﺖ اﺳﺖ ﻛﻪ روي‬

‫)‪ 63/24‬درﺻﺪ( از واﺣﺪﻫﺎي ﻣﻮردﭘﮋوﻫﺶ داراي ﻫﻤﻮﮔﻠﻮﺑﻴﻦ‬

‫ﭘﻴﺎﻣﺪ درﻣﺎن ﺗﺄﺛﻴﺮ ﺳﻮﺋﻲ دارد‪ .‬ﺑﺴﻴﺎري از ﻣﻄﺎﻟﻌﺎت روي ﺷﻨﺎﺳﺎﻳﻲ‬

‫ﮔﻠﻴﻜﻮزﻳﻠﻪ ﻧﺎﻣﻄﻠﻮب )ﺑﻴﺸﺘﺮ از ‪ 7‬درﺻﺪ( و ‪ 75‬ﻧﻔﺮ )‪ 36/76‬درﺻﺪ(‬

‫ﻋﻮاﻣﻞ ﺧﻄﺮ ﻣﺮﺗﺒﻂ ﺑﺎ ﺗﺒﻌﻴﺖ از درﻣﺎن و ارزﻳﺎﺑﻲ ﻣﺪاﺧﻼﺗﻲ ﺑﺮاي‬

‫داراي ﻫﻤﻮﮔﻠﻮﺑﻴﻦ ﮔﻠﻴﻜﻮزﻳﻠﻪ ﻣﻄﻠﻮب )‪ 7‬درﺻﺪ و ﻛﻤﺘﺮ( ﺑﻮدﻧﺪ و‬

‫ﺑﻬﺒﻮد آن ﭘﺮداﺧﺘﻪاﻧﺪ‪ .‬ارزش اﻏﻠﺐ اﻳﻦ ﻣﻄﺎﻟﻌﺎت ﺑﻪ دﻟﻴﻞ‬

‫اﻳﻦ در ﺣﺎﻟﻲ ﺑﻮد ﻛﻪ ﺑﺮ اﺳﺎس ﻧﻤﺮه اﺑﺰار ﻣﻮرﻳﺴﻜﻲ ﺗﻨﻬﺎ ‪ 15‬ﻧﻔﺮ‬

‫ﭼﺎﻟﺶﻫﺎي اﺑﺰارﻫﺎي اﻧﺪازهﮔﻴﺮي و ﺳﻨﺠﺶ ﭘﺎﻳﺒﻨﺪي ﺑﻪ درﻣﺎن‬

‫)‪ 7/4‬درﺻﺪ( ﻧﻤﺮه ‪ 6‬و ﺑﺎﻻﺗﺮ را ﻛﺴﺐ ﻛﺮده ﺑﻮدﻧﺪ و ﺗﺒﻌﻴﺖ از‬

‫ﻣﺤﺪود ﺷﺪه اﺳﺖ‪ .‬در اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺑﻴﻦ ﻣﻴﺰان ﻫﻤﻮﮔﻠﻮﺑﻴﻦ‬

‫درﻣﺎن ﻣﻄﻠﻮب داﺷﺘﻨﺪ‪ .‬ﻧﺘﺎﻳﺞ ﺑﻴﺎﻧﮕﺮ آن ﺑﻮد ﻛﻪ ﻣﻴﺰان ﻫﻤﻮﮔﻠﻮﺑﻴﻦ‬

‫ﮔﻠﻴﻜﻮزﻳﻠﻪ ﺑﺎ ﻧﻤﺮه ﺗﺒﻌﻴﺖ از درﻣﺎن ﺑﺮ اﺳﺎس اﺑﺰار ﻣﻮرﻳﺴﻜﻲ‬

‫ﮔﻠﻴﻜﻮزﻳﻠﻪ ﻣﺮدان )‪ (7/6±2/1‬ﻛﻤﺘﺮ از زﻧﺎن )‪ (8/3±2/4‬ﺑﻮد‬

‫ﻫﻤﺒﺴﺘﮕﻲ ﻣﻌﻜﻮس و ﻣﻌﻨﻲ داري وﺟﻮد ﻧﺪاﺷﺖ ﻛﻪ ﻳﺎﻓﺘﻪ ﻋﺠﻴﺐ‬

‫اﮔﺮﭼﻪ اﻳﻦ ﺗﻔﺎوت ﺑﺎ اﺳﺘﻔﺎده از آزﻣﻮن آﻣﺎري ﺗﻲ ﻣﺴﺘﻘﻞ ﻣﻌﻨﻲدار‬

‫و دور از ﺗﺼﻮري ﻣﻲﺑﺎﺷﺪ‪ .‬در ﻣﻄﺎﻟﻌﺎت ﻣﺨﺘﻠﻒ ﺑﺮاي ﻛﻨﺘﺮل‬

‫ﻧﺒﻮد )‪ .(p=0/053‬ﻫﻤﭽﻨﻴﻦ ﻧﺘﺎﻳﺞ ﻧﺸﺎن داد ﻛﻪ ﺑﺎ اﺳﺘﻔﺎده از‬

‫ﻣﺘﺎﺑﻮﻟﻴﻜﻲ و ارﺗﻘﺎء رﻓﺘﺎر ﺗﺒﻌﻴﺖ از رژﻳﻢدرﻣﺎﻧﻲ ﺑﻴﻤﺎران دﻳﺎﺑﺘﻴﻚ از‬

‫آزﻣﻮن آﻣﺎري ﻛﺎي اﺳﻜﻮﺋﺮ ﻫﻴﭻ ارﺗﺒﺎط ﻣﻌﻨﻲ داري ﺑﻴﻦ‬

‫ﻣﺪاﺧﻼت ﮔﻮﻧﺎﮔﻮﻧﻲ از ﻗﺒﻴﻞ وﻳﺰﻳﺖ در ﻣﻨﺰل‪ ،‬ﻣﺎﺳﺎژ درﻣﺎﻧﻲ )‪،(22‬‬

‫ﻣﺸﺨﺼﺎت ﺟﻤﻌﻴﺖﺷﻨﺎﺳﻲ )ﺳﻦ‪ ،‬ﺟﻨﺲ‪ ،‬ﺗﺤﺼﻴﻼت‪ ،‬وﺿﻌﻴﺖ‬

‫ﭘﻴﮕﻴﺮيﻫﺎي ﺗﻠﻔﻨﻲ )‪ (25،23‬و ﺑﺮﻧﺎﻣﻪ ﺗﻮاﻧﻤﻨﺪﺳﺎزي )‪(26‬‬

‫زﻧﺪﮔﻲ( و ﻣﻴﺰان ﻫﻤﻮﮔﻠﻮﺑﻴﻦ ﮔﻠﻴﻜﻮزﻳﻠﻪ )ﻣﻄﻠﻮب و ﻧﺎﻣﻄﻠﻮب(‬

‫اﺳﺘﻔﺎدهﺷﺪه اﺳﺖ‪ .‬در ﻣﻄﺎﻟﻌﻪ دﻫﻲ و ﻫﻤﻜﺎران وﻳﺰﻳﺖ در ﻣﻨﺰل‬

‫آنﻫﺎ ﺑﺎ ﺗﺒﻌﻴﺖ از درﻣﺎن وﺟﻮد ﻧﺪاﺷﺖ‪ .‬ﻋﻼوه ﺑﺮاﻳﻦ ﻧﺘﺎﻳﺞ آزﻣﻮن‬

‫ﺑﻴﻤﺎران ﻣﻨﺠﺮ ﺑﻪ ﻛﺎﻫﺶ ﻫﻤﻮﮔﻠﻮﺑﻴﻦ ﮔﻠﻴﻜﻮزﻳﻠﻪ ﺑﻴﻤﺎران ﺷﺪه ﺑﻮد‬

‫ﻫﻤﺒﺴﺘﮕﻲ ﭘﻴﺮﺳﻮن ﻧﺸﺎن داد ﻛﻪ ﺑﻴﻦ ﻧﻤﺮه ﻛﻠﻲ ﭘﺎﻳﺒﻨﺪي ﺑﻪ‬

‫)‪(27‬؛ ﺑﻪ ﻧﻈﺮ ﻣﻲرﺳﺪ وﻳﺰﻳﺖ در ﻣﻨﺰل ﺑﺎ اراﺋﻪ ﻣﺸﺎورهﻫﺎي‬

‫درﻣﺎن و ﻫﻤﻮﮔﻠﻮﺑﻴﻦ ﮔﻠﻴﻜﻮزﻳﻠﻪ ﻫﻤﺒﺴﺘﮕﻲ ﻣﻌﻜﻮﺳﻲ وﺟﻮد ﻧﺪارد‬

‫ﭘﺮﺳﺘﺎري ﺑﻪ ﺑﻴﻤﺎران ﻣﻨﺠﺮ ﺑﻪ اﻓﺰاﻳﺶ اﻃﻼﻋﺎت در ﺧﺼﻮص‬

‫)‪ (r=+0/37‬ﺑﻪ ﻋﺒﺎرﺗﻲ اﻓﺰاﻳﺶ ﻧﻤﺮه ﺗﺒﻌﻴﺖ از درﻣﺎن ﺑﺎ ﻛﺎﻫﺶ‬

‫رژﻳﻢدرﻣﺎﻧﻲ ﺑﻴﻤﺎران ﺷﺪه ﺑﺎﺷﺪ‪ .‬ﻧﺘﺎﻳﺞ ﻣﻄﺎﻟﻌﻪ ﭘﺮﻳﺰاد و ﻫﻤﻜﺎران‪،‬‬

‫ﻣﻴﺰان ﻫﻤﻮﮔﻠﻮﺑﻴﻦ ﮔﻠﻴﻜﻮزﻳﻠﻪ ﻫﻤﺮاه ﻧﺒﻮده اﺳﺖ‪.‬‬

‫ﺑﺮﻫﺎﻧﻲ و ﻫﻤﻜﺎران و ذاﻛﺮي ﻣﻘﺪم و ﻫﻤﻜﺎران ﻧﺸﺎن داد ﻛﻪ‬

‫ﺑﺤﺚ‬

‫ﭘﻴﮕﻴﺮي از ﻃﺮﻳﻖ ﺗﻠﻔﻦ و ﭘﻴﺎﻣﻚ روي ﻛﺎﻫﺶ ﻫﻤﻮﮔﻠﻮﺑﻴﻦ‬

‫ﻧﺘﺎﻳﺞ ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﻧﺸﺎن داد ﺑﻴﻦ ﻣﻴﺰان ﻫﻤﻮﮔﻠﻮﺑﻴﻦ‬

‫ﮔﻠﻴﻜﻮزﻳﻠﻪ و ﺗﺒﻌﻴﺖ از رژﻳﻢ داروﻳﻲ ﻣﺆﺛﺮ ﺑﻮده اﺳﺖ )‪.(25-23‬‬

‫ﮔﻠﻴﻜﻮزﻳﻠﻪ ﺑﺎ ﻧﻤﺮه ﺗﺒﻌﻴﺖ از درﻣﺎن ﺑﺮ اﺳﺎس اﺑﺰار ﻣﻮرﻳﺴﻜﻲ‬ ‫ﭘﮋوﻫﺶ ﺗﻮاﻧﺒﺨﺸﻲ در ﭘﺮﺳﺘﺎري‬

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‫دوره اول ﺷﻤﺎره ‪ 3‬ﺑﻬﺎر ‪1394‬‬

‫رﺿﺎ ﻗﺎﻧﻌﻲ ﻗﺸﻼق و ﻫﻤﻜﺎران‬

‫ﺗﻌﻴﻴﻦ رواﻳﻲ ﻣﻼك ﻣﻘﻴﺎس ﺗﺒﻌﻴﺖ از رژﻳﻢ‪...‬‬

‫اﻳﻦ ﻣﻄﺎﻟﻌﺎت ﻳﻚﻗﺪم ﻓﺮاﺗﺮ از ﻧﺘﺎﻳﺞ دﻫﻲ و ﻫﻤﻜﺎران رﻓﺘﻪ و‬

‫ﻧﺴﺒﺖ ﺑﻪ ﺳﺎﻳﺮ دادهﻫﺎي ﺟﻤﻊآوريﺷﺪه ﺑﺎ اﺳﺘﻔﺎده از اﺑﺰارﻫﺎي‬

‫ﻣﺸﻜﻞ ﻣﺴﺎﻓﺖ ﺟﻐﺮاﻓﻴﺎﻳﻲ را ﺣﻞ ﻧﻤﻮده و اراﺋﻪ ﻣﺸﺎورهﻫﺎي‬

‫دﻳﮕﺮ ﻗﺎﺑﻠﻴﺖ اﻃﻤﻴﻨﺎن ﻛﻤﺘﺮي دارﻧﺪ )‪.(31‬‬

‫ﭘﺮﺳﺘﺎري را در زﻣﺎن ﺳﺮﻳﻊﺗﺮ ﻓﺮاﻫﻢ ﺳﺎﺧﺘﻪ اﺳﺖ‪ .‬اﮔﺮﭼﻪ ﻧﺘﺎﻳﺞ‬ ‫ﻣﻄﺎﻟﻌﺎت ‪ Maljanian‬و ‪ Wong‬ﻧﺸﺎن داده اﺳﺖ ﻛﻪ‬

‫ﻧﺘﻴﺠﻪﮔﻴﺮي ﻧﻬﺎﻳﻲ‬

‫ﭘﻴﮕﻴﺮي ﺗﻠﻔﻨﻲ ﺗﺄﺛﻴﺮي ﺑﺮ ﻣﻴﺰان ﻫﻤﻮﮔﻠﻮﺑﻴﻦ ﮔﻠﻴﻜﻮزﻳﻠﻪ ﺑﻴﻤﺎران‬

‫روش و اﺑﺰار اﺳﺘﺎﻧﺪارد ﻃﻼﻳﻲ ﺑﺮاي ﺑﺮرﺳﻲ ﺗﺒﻌﻴﺖ از درﻣﺎن‬

‫دﻳﺎﺑﺘﻲ ﻧﺪارد )‪ .(29،28‬از ﻃﺮﻓﻲ ﻣﻄﺎﻟﻌﻪ ﺷﺎﻳﻘﻴﺎن و ﻫﻤﻜﺎران‬

‫وﺟﻮد ﻧﺪارد و ﺗﻄﺎﺑﻖ ﻣﻴﺰانﻫﺎي ﺑﻪدﺳﺖآﻣﺪه از اﺑﺰارﻫﺎي ﻣﺨﺘﻠﻒ‬

‫ﻧﺸﺎن داده اﺳﺖ ﻛﻪ رﻓﺘﺎرﻫﺎي ﺧﻮدﻣﺮاﻗﺒﺘﻲ )ﻧﻪﻓﻘﻂ ﭘﺎﻳﺒﻨﺪي ﺑﻪ‬

‫ﺧﻮد ﮔﺰارﺷﻲ ﻫﻢ ﻣﺘﻨﻮع و ﻫﻢ ﻣﺸﻜﻞ ﻣﻲﺑﺎﺷﻨﺪ و روشﻫﺎي‬

‫رژﻳﻢ داروﻳﻲ( ‪ 40‬درﺻﺪ وارﻳﺎﻧﺲ ﻫﻤﻮﮔﻠﻮﺑﻴﻦ ﮔﻠﻴﻜﻮزﻳﻠﻪ را ﺗﺒﻴﻴﻦ‬

‫ﺳﻨﺠﺶ ﻛﻴﻔﻲ ﻫﻢ ﺑﺎ ﻳﻜﺪﻳﮕﺮ ارﺗﺒﺎﻃﻲ ﻧﺪارﻧﺪ؛ زﻳﺮا ﻫﺮﭼﻨﺪ‬

‫ﻣﻲﻛﺮد )‪ .(30‬ﺑﺎاﻳﻦوﺟﻮد ‪ Gonzalez‬و ﻫﻤﻜﺎران ﺑﻴﻦ ﺗﺒﻌﻴﺖ از‬

‫ﺳﻨﺠﺶﻫﺎي ﺧﻮد ﮔﺰارﺷﻲ در ﻣﺤﻴﻂﻫﺎي ﺑﺎﻟﻴﻨﻲ ﺑﻪ ﺳﻬﻮﻟﺖ اﻧﺠﺎم‬

‫رژﻳﻢدرﻣﺎﻧﻲ ﺑﺎ ﻫﻤﻮﮔﻠﻮﺑﻴﻦ ﮔﻠﻴﻜﻮزﻳﻠﻪ راﺑﻄﻪاي را ﻳﺎﻓﺖ ﻧﻜﺮدهاﻧﺪ‬

‫ﻣﻲﺷﻮد اﻣﺎ ﻣﻤﻜﻦ اﺳﺖ رواﻳﻲ آنﻫﺎ ﺗﺤﺖ ﺗﺄﺛﻴﺮ ﺗﻮرش ﻫﺎي‬

‫)‪ .(18‬درﻣﺠﻤﻮع ﺑﺎور ﺑﺮ اﻳﻦ اﺳﺖ ﻛﻪ رﻓﺘﺎرﻫﺎي ﺗﺒﻌﻴﺖ از درﻣﺎن‬

‫ﻧﺎﺷﻲ از درﺟﻪ ﺗﻤﺎﻳﻞ اﻓﺮاد و ﮔﺰارش ﻛﺎذب آنﻫﺎ ﻗﺮار ﺑﮕﻴﺮد‪ .‬ﺑﺮ‬

‫ﻫﻤﻮاره ﺑﺎ ﺳﻄﺢ ﭘﺎﻳﻴﻦ ﻫﻤﻮﮔﻠﻮﺑﻴﻦ ﮔﻠﻴﻜﻮزﻳﻠﻪ و ﻋﻮارض ﻛﻤﺘﺮ‬

‫اﺳﺎس ﻳﺎﻓﺘﻪﻫﺎي اﻳﻦ ﭘﮋوﻫﺶ ﻻزم اﺳﺖ ﭘﺮﺳﺘﺎران ﺑﺎﻟﻴﻨﻲ ﺑﺮاي‬

‫ﺑﻴﻤﺎري ﻫﻤﺮاه اﺳﺖ‪ .‬در ﺗﺒﻴﻴﻦ ﻧﺘﻴﺠﻪ اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺷﺎﻳﺪ ﺑﺘﻮان‬

‫ﺑﺮرﺳﻲ وﺿﻌﻴﺖ ﺗﺒﻌﻴﺖ از درﻣﺎن ﺑﻴﻤﺎران‪ ،‬دﻳﺪﮔﺎه ﻛﻞﻧﮕﺮي داﺷﺘﻪ‬

‫اﻳﻦﮔﻮﻧﻪ اﻇﻬﺎرﻧﻈﺮ ﻛﺮد ﻛﻪ ﺑﺮرﺳﻲ رﻓﺘﺎر ﺗﺒﻌﻴﺖ از درﻣﺎن ﺑﻴﻤﺎران‬

‫ﺑﺎﺷﻨﺪ و ﻧﺒﺎﻳﺪ ﺑﺮ اﺑﺰارﻫﺎﻳﻲ ﻛﻪ ﺗﻨﻬﺎ ﻳﻚ ﺑﻌﺪ ﺗﺒﻌﻴﺖ از درﻣﺎن را‬

‫دﻳﺎﺑﺘﻴﻚ ﺗﻨﻬﺎ ﺑﻪ اﺳﺘﻨﺎد ﻧﻤﺮه ﻣﻘﻴﺎس ﻣﻮرﻳﺴﻜﻲ ﻗﺎﺑﻞ اﻋﺘﻤﺎد‬

‫ﻣﻲﺳﻨﺠﺪ ﺗﻜﻴﻪ ﻛﻨﻨﺪ‪ .‬اﺑﺰار ﻣﻮرﻳﺴﻜﻲ ﻓﻘﻂ ﺑﺮ وﺿﻌﻴﺖ درﻣﺎن‬

‫ﻧﻴﺴﺖ ﭼﺮاﻛﻪ رﻓﺘﺎر ﺗﺒﻌﻴﺖ از درﻣﺎن ﻓﺮاﺗﺮ از دارودرﻣﺎﻧﻲ ﺑﻮده‬

‫داروﻳﻲ ﺗﻤﺮﻛﺰ دارد درﺣﺎﻟﻲﻛﻪ رژﻳﻢﻫﺎي ﻏﺬاﻳﻲ‪ ،‬ﻓﻌﺎﻟﻴﺘﻲ‪ ،‬ﺧﻮد‬

‫درﺣﺎﻟﻲﻛﻪ ﻣﻘﻴﺎس ﻣﻮرﻳﺴﻜﻲ ﺗﻨﻬﺎ ﺑﺮ رﻓﺘﺎر ﻣﺼﺮف داروﻳﻲ ﺗﻤﺮﻛﺰ‬

‫ﭘﺎﻳﺸﻲ ﻣﻨﻈﻢ ﻗﻨﺪ ﺧﻮن و ﻣﺮاﻗﺒﺖ از ﭘﺎ اﺑﻌﺎد دﻳﮕﺮ رﻓﺘﺎرﻫﺎي‬

‫داﺷﺘﻪ و رژﻳﻢﻫﺎي ﻏﺬاﻳﻲ‪ ،‬رژﻳﻢ ﻓﻌﺎﻟﻴﺘﻲ‪ ،‬ﻣﺮاﻗﺒﺖ از ﭘﺎﻫﺎ و ﺧﻮد‬

‫ﺗﺒﻌﻴﺖ از رژﻳﻢدرﻣﺎﻧﻲ ﻫﺴﺘﻨﺪ ﻛﻪ ﺑﺎﻳﺪ ﻣﺪﻧﻈﺮ ﻗﺮار ﮔﻴﺮﻧﺪ‪ .‬ﻫﻤﭽﻨﻴﻦ‬

‫ﭘﺎﻳﺸﻲ ﻗﻨﺪ ﺧﻮن را در ﻧﻈﺮ ﻧﮕﺮﻓﺘﻪ اﺳﺖ‪ .‬اﻧﺠﻤﻦ دﻳﺎﺑﺖ اﻣﺮﻳﻜﺎ در‬

‫ﺑﺮ ﭘﺎﻳﻪ ﻧﺘﺎﻳﺞ اﻳﻦ ﻣﻄﺎﻟﻌﻪ در ﻣﺸﺎورهﻫﺎي ﭘﺮﺳﺘﺎري ﻣﻲﺗﻮان ﺑﻪ‬

‫راﺳﺘﺎي ﺑﺮرﺳﻲ روﻧﺪ ﺗﺒﻌﻴﺖ از رژﻳﻢدرﻣﺎﻧﻲ ﺑﻴﻤﺎراﻧﻲ ﻛﻪ ﻛﻨﺘﺮل‬

‫ﺑﻴﻤﺎران دﻳﺎﺑﺘﻲ اﻫﻤﻴﺖ ﻣﻌﺎدل ﺗﻤﺎﻣﻲ ﺟﻨﺒﻪﻫﺎي ﺗﺒﻌﻴﺖ از درﻣﺎن را‬

‫ﻗﻨﺪ ﺧﻮن ﺿﻌﻴﻔﻲ دارﻧﺪ اﻧﺠﺎم ‪ 4‬ﺑﺎر آزﻣﺎﻳﺶ ﻫﻤﻮﮔﻠﻮﺑﻴﻦ‬

‫ﮔﻮﺷﺰد ﻛﺮد‪ .‬ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ اﻳﻦﻛﻪ ﻣﻮﺿﻮع رواﻳﻲ ﻳﻚ ﻣﻘﻴﺎس ﺗﻨﻬﺎ‬

‫ﮔﻠﻴﻜﻮزﻳﻠﻪ در ﺳﺎل را ﭘﻴﺸﻨﻬﺎد ﻧﻤﻮده اﺳﺖ )‪ .(8‬ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ اﻳﻦﻛﻪ‬

‫ﻣﺤﺪود ﺑﻪ رواﻳﻲ ﻫﻤﺰﻣﺎن ﻧﻤﻲﺷﻮد‪ ،‬ﭘﻴﺸﻨﻬﺎد ﻣﻲﺷﻮد رواﻳﻲ‬

‫رژﻳﻢﻫﺎي درﻣﺎﻧﻲ ﺑﻴﻤﺎران ﻣﺒﺘﻼ ﺑﻪ دﻳﺎﺑﺖ ﭼﻨﺪﺑﻌﺪي ﻫﺴﺘﻨﺪ‬

‫ﭘﻴﺶﺑﻴﻨﻲ ﻣﻘﻴﺎس ﺗﺒﻌﻴﺖ از درﻣﺎن ﻣﻮرﻳﺴﻜﻲ ﻧﻴﺰ در ﺑﻴﻤﺎران‬

‫ﻣﻤﻜﻦ اﺳﺖ ﺗﺒﻌﻴﺖ از ﻳﻜﻲ از اﺟﺰاء رﺑﻄﻲ ﺑﻪ ﺗﺒﻌﻴﺖ از ﺳﺎﻳﺮ‬

‫دﻳﺎﺑﺘﻲ ﻧﻮع دو ﺑﺮرﺳﻲ ﺷﻮد‪.‬‬

‫اﺟﺰاي دﻳﮕﺮ ﻧﺪاﺷﺘﻪ ﺑﺎﺷﺪ‪ .‬ﺑﺮاي ﻣﺜﺎل در ﻣﻄﺎﻟﻌﻪ ‪ kravitz‬ﺑﻪ‬

‫ﺗﺸﻜﺮ و ﻗﺪرداﻧﻲ‬

‫ﻧﻘﻞ از ‪ ،Delamater‬ﻣﻴﺰان ﺗﺒﻌﻴﺖ از رژﻳﻢ ﻏﺬاﻳﻲ ‪ 65‬درﺻﺪ‬

‫ﺑﺪﻳﻦوﺳﻴﻠﻪ از ﻣﺴﺌﻮﻟﻴﻦ و ﻫﻤﻜﺎران واﺣﺪ دﻳﺎﺑﺖ ﻛﺮﻣﺎﻧﺸﺎه و‬

‫ﺑﻮده درﺣﺎﻟﻲﻛﻪ ﻣﻴﺰان ﭘﺎﻳﺒﻨﺪي ﺑﻪ رژﻳﻢ ﻓﻌﺎﻟﻴﺘﻲ ‪ 19‬درﺻﺪ‬

‫ﺗﻤﺎﻣﻲ ﺑﻴﻤﺎران دﻳﺎﺑﺘﻲ ﻣﺮاﺟﻌﻪﻛﻨﻨﺪه ﺑﻪ اﻳﻦ ﻣﺮﻛﺰ ﻛﻪ در اﻳﻦ‬

‫ﮔﺰارش ﺷﺪه اﺳﺖ )‪ .(7‬ﺟﻤﻊآوري دادهﻫﺎي ﺧﻮد ﮔﺰارش دﻫﻲ‬

‫ﭘﮋوﻫﺶ ﻣﺎ را ﻳﺎري ﻧﻤﻮدﻧﺪ‪ ،‬ﺻﻤﻴﻤﺎﻧﻪ ﺗﺸﻜﺮ و ﻗﺪرداﻧﻲ ﻣﻲﺷﻮد‪.‬‬

‫ﻧﺴﺒﺖ ﺑﻪ دادهﻫﺎي ﻓﻴﺰﻳﻮﻟﻮژﻳﻜﻲ ﻣﺸﻜﻞﺗﺮ اﺳﺖ در اﻳﻦ راﺑﻄﻪ‬ ‫‪ Moldrup‬ﻣﻲﻧﻮﻳﺴﺪ ﺳﺎلﻫﺎ اﻋﺘﻘﺎد ﺑﺮ اﻳﻦ ﺑﻮد ﻛﻪ اﮔﺮ ﭘﺰﺷﻚ‬ ‫ﻳﺎ ﻣﺤﻘﻘﻲ از ﺑﻴﻤﺎر در ﺧﺼﻮص ﻣﺼﺮف داروﻫﺎي ﺗﺠﻮﻳﺰﺷﺪه‬ ‫ﭘﺮﺳﺶ ﻧﻤﺎﻳﺪ ﺑﺪون ﺷﻚ ﭘﺎﺳﺦ ﺑﻴﻤﺎر "ﻧﻪ" ﺧﻮاﻫﺪ ﺑﻮد‪ .‬ﺑﻪ ﻫﻤﻴﻦ‬ ‫دﻟﻴﻞ دادهﻫﺎي ﺟﻤﻊآوريﺷﺪه ﺧﻮد ﮔﺰارﺷﻲ دﻫﻲ ﺗﺒﻌﻴﺖ از درﻣﺎن‬ ‫ﭘﮋوﻫﺶ ﺗﻮاﻧﺒﺨﺸﻲ در ﭘﺮﺳﺘﺎري‬

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‫دوره اول ﺷﻤﺎره ‪ 3‬ﺑﻬﺎر ‪1394‬‬

‫رﺿﺎ ﻗﺎﻧﻌﻲ ﻗﺸﻼق و ﻫﻤﻜﺎران‬

...‫ﺗﻌﻴﻴﻦ رواﻳﻲ ﻣﻼك ﻣﻘﻴﺎس ﺗﺒﻌﻴﺖ از رژﻳﻢ‬

‫ﻣﻨﺎﺑﻊ‬ 1- Ahmad NS, Ramli A, Islahudin F, Paraidathathu T. Medication adherence in patients with type 2 diabetes mellitus treated at primary health clinics in Malaysia. Patient Prefer Adherence. 2013; 7(1):525-530 2- Garsia-Perez LE, Dilla T. Adherence to therapies in patients with type 2 diabetes. Diabetes Ther. 2013; 4(2):175-194. 3- Hemmati Maslakpak M, Parizad N, Khalkhali H: The Effect of Tele-Education by Telephone and Short Message Service on Glycaemic Control in Patient with Type 2 Diabetes. Journal of Nursing and Midwifery Urmia University of Medical Sciences. 2012; 10(4): 580588. (Persian). 4- Dormandy JA, Charbonnel B, Eckland DJ, Erdmann E, Massi-Benedetti M, Moules IK, et al. Secondary prevention of macrovascular events in patients with type 2 diabetes in the PROactive Study (PROspective pioglitAzone Clinical Trial In macroVascular Events): a randomised controlled trial. The Lancet 2005; 366(9493):1279-1289. 5- Blackburn DF, Swidrovich J, Lemstra M: Non-adherence in type 2 diabetes: practical considerations for interpreting the literature. Patient preference and adherence. 2013, 7 (1):183. 6- Kalyango JN, Owino E, Nambuya A. Non-adherence to diabetes treatment at Mulago hospital in Uganda: prevalence and associated factors. African Health Sciences. 2008; 8 (2): 67-73. 7- Delamater AM. Improving patient adherence. Clinical Diabetes 2006; 24 (2): 71-77. 8- Wabe NT, Angamo MT, Hussein S. [Medication adherence in diabetes mellitus and self-management practices among type 2 diabetics in Ethiopia]. North American Journal of Medical Sciences. 2011; 3 (9): 418-23. 9- Restrepo RD, Alvarez MT, Wittnebel LD, Sorenon H, Wettstein R, Vines D, et al. Medication adherence issue in patients treated for COPD. International Journal of COPD. 2008; 3 (3): 371-384. 10- Gonzalez JS, McCarl LA, Wexler DD, Cagliero E, Dalahanty K, Soper TD, et al. Cognitive behavioral theraphy for adherence and depression (CBT-AD) in type 2 diabetes. J Cogn Psychother 2010; 24 (4): 329-343. 11- Banning M. Older people and adherence with medication: a review of the literature. International Journal of Nursing Studies. 2008; 45(10): 1550-1561. 12- Pitkala KH, Strandberg TE, Tilvis RS. Interest in healthy lifestyle and adherence to medications: impact on mortality among elderly cardiovascular patients in the DEBATE study. Patient Educ Couns. 2007; 67: 44-49. 13- Clark M. Adherence to treatment in patients with type 2 diabetes. Journal of Diabetes Nursing. 2004; 8(10): 386-91. 14- Takemura M, Mitsui K, Itotani R, Ishitoko M, Suzuki S, Matsumoto M, et al. Relationship between repeated instruction on inhalation therapy, medication adherence, and 1394 ‫ ﺑﻬﺎر‬3 ‫دوره اول ﺷﻤﺎره‬

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‫ﭘﮋوﻫﺶ ﺗﻮاﻧﺒﺨﺸﻲ در ﭘﺮﺳﺘﺎري‬

‫رﺿﺎ ﻗﺎﻧﻌﻲ ﻗﺸﻼق و ﻫﻤﻜﺎران‬

...‫ﺗﻌﻴﻴﻦ رواﻳﻲ ﻣﻼك ﻣﻘﻴﺎس ﺗﺒﻌﻴﺖ از رژﻳﻢ‬

health status in chronic obstructive pulmonary disease. International Journal of COPD. 2011; 6: 97-104. 15- Lee WC, Balu S, Cobden D, Joshi AV, Pasho CL. Medication adherence and the associated health economic impact among patients with type 2 diabetes mellitus converting to insulin pen therapy: an analysis of third-party managed care claims data. Clinical Therapeutics. 2006; 28 (10): 1712-1725. 16- Lee WY, Ahn J, Kim JH, Hong YP, Hong SK, Kim YT, et al. Reliability and validity of self-reported measure of medication adherence in patients with type 2 diabetes mellitus in Korea. International Medical Research. 2013; 41(4):1098-1110 17- Al-Qazaz HK, Hassali MA, Shafie AA, Sulaiman SA, Sundram S, Morisky D. The eight-item Morisky medication adherence scale MMAS: Translation and validation of the Malaysian version. Diabetes Research and Clinical Practice. 2010; 90(2): 216-221. 18- Gonzalez JS, Schneider HE, Wexler DJ, Psaros C, Delahanty LM, Cagliero E, et al. Validity of medication adherence self-reports in adults with type 2 diabetes. Diabetes Care. 2013; 36(4): 831-837. 19- Raum E, Kramer HU, Ruter G, Rothenbacher D, Rosemann T, Szecsenyi J, et al. Medication non-adherence and poor glycaemic control in patients with type 2 diabetes mellitus. Diabetes Research and Clinical Practice. 2012; 97(3): 377-384. 20- Morisky DE, Ang A, Krousel-Wood M, Ward H. Predictive Validity of a Medication Adherence Measure for Hypertension Control. Journal of Clinical Hypertension. 2008; 10 (5):348-354. 21- Negarande R, Mahmoodi H, Noktedan H, Heshamt R, Shakibazadeh E. Teach back and pictorial image educational strategies on knowledge about diabetes and medication/dietary adherence among low health literate patients with type 2 diabetes. Primary Care Diabetes. 2013;7(2): 111-118. 22- Ghasemi Pour M, Abdoli S, Valiani M, Feizi A. The Effect of Massage Therapy on Glycemic Control (FBS, HBA1C) in Women with Diabetes Type 2. Journal of Research Development in Nursing & Midwifery. 2013; 10 (0):81-89. (Persian). 23- Parizad N, Hemmati Maslakpak M, Khalkhali HR. The effect of tele-education by telephone and short message service on laboratory parameters in patients with type 2 diabetes. Journal of Ardabil University of Medical Sciences. 2014; 14(1):7-17. (Persian). 24- Borhani F, Ranjbar H, Abbaszadeh A, Abazari F, Ranjbar A. The effect of Telenursing on HbA1c hemoglobin in patients with type 2 diabetes mellitus. J Army Univ Med Sci. 2013; 11(2): 130-137. (Persian). 25- Zakerimoghadam M, Bassampour S, Rjab A, Faghihzadeh S, Nesari M. Effect of Nurse-led Telephone Follow ups (Tele-Nursing) on Diet Adherence among Type 2 Diabetic Patients. Hayat. 2009; 14 (2):63-71. (Persian). 26- Shahbodaghi Z, Borhani F. The effects of empowerment program on hemoglobin HbA1c, type 2 diabetes patients. Medical-Surgical Nursing Journal. 2012; 1 (2): 24-30. (Persian). 1394 ‫ ﺑﻬﺎر‬3 ‫دوره اول ﺷﻤﺎره‬

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‫ﭘﮋوﻫﺶ ﺗﻮاﻧﺒﺨﺸﻲ در ﭘﺮﺳﺘﺎري‬

‫رﺿﺎ ﻗﺎﻧﻌﻲ ﻗﺸﻼق و ﻫﻤﻜﺎران‬

...‫ﺗﻌﻴﻴﻦ رواﻳﻲ ﻣﻼك ﻣﻘﻴﺎس ﺗﺒﻌﻴﺖ از رژﻳﻢ‬

27- Dehi M, Aghajari P, Shahshahani M, Takfalah L, Jahangiri L. The effect of home visit on diabetes control among women in villages of Maraghe, 2013. Journal of Clinical Research in Paramedical Sciences. 2013; 2 (1): 36-42. (Persian). 28- Maljanian R, Grey N, Staff I, Conroy L. Intensive telephone follow up to a hospital based disease management model for patients with diabetes mellitus. Dis Manag. 2005; 8 (1): 15-25. 29- Wong FK, Mok MP, Chan T, Tsang MW. Nurse follow up of patients with diabetes: randomized controlled trail. J Adv Nurs. 2005; 50 (4): 391-402. 30- Shayeghian Z, Aguilar-Vafaie M, Besharat MA, Amiri P, Parvin M, Roohi Gillani K. The association between self-care and control of blood sugar and health-related quality of life in type 2 diabetes patients. Iranian Journal of Endocrinology and Metabolism. 2014; 15 (6): 545-51. (Persian). 31- Moldrup C SJ, Sondergaard B. “Patients don’t lie”; a view on adherence in asthma. Pharmacy world & science. 2010; 32(6):795-798.

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‫ﭘﮋوﻫﺶ ﺗﻮاﻧﺒﺨﺸﻲ در ﭘﺮﺳﺘﺎري‬

‫رﺿﺎ ﻗﺎﻧﻌﻲ ﻗﺸﻼق و ﻫﻤﻜﺎران‬

...‫ﺗﻌﻴﻴﻦ رواﻳﻲ ﻣﻼك ﻣﻘﻴﺎس ﺗﺒﻌﻴﺖ از رژﻳﻢ‬

Determining Concurrent Validity of the Morisky Medication Adherence Scale in Patients with Type 2 Diabetes Ghanei Gheshlagh R1, Ebadi A2, Veisi Raygani AK3, Nourozi Tabrizi K4, Dalvandi A5, Mahmoodi H6 Abstract Introduction: poor adherence to medication regimen in diabetic patients leads to poor control of blood glucose levels, high risk for diabetes complications, hospitalizations and increased mortality rates. An appropriate level of glycosylated hemoglobin is considered a good diabetic management in these patients. The aim of this study was to investigate the concurrent validity of Morisky Medication Adherence Scale with glycosylated hemoglobin in patients with type 2 diabetes. Methods: In this methodologic descriptive correlational study, 204 patients referred to Kermanshah diabetes center were recruited through convenience sampling method since June to July 2014. Data were collected using socio-demographic form, Morisky Medication adherence scale (MMAS-8) and HbA1c test as gold standard. Data were analyzed with descriptive statistics, independent T-test, Pearson's Correlation, Fisher’s exact test, and ChiSquare using PASW (Predictive Analytics Software). Results: 33.4% of the participants were male and the rest were female. The mean age of participants was 57.1±9.6 years. 52% were illiterate. 129 patients (63.2%) had glycosylated hemoglobin's equal or less than 7% which is considered good diabetes management whereas based on Morisky medication adherence scale scores only 15 patients (7.4%) had a good medication regimen adherence. There was a significant relationship between adherence and gender. And more importantly and unexpectedly, there was no significant negative correlation between adherence scores with glycosylated hemoglobin levels (r=+0/37, p>0/05). Conclusion: Unexpectedly there is no statistically or clinically significant relationship between Morisky Medication Adherence Scale with glycosylated hemoglobin levels. Keywords: Medication Adherence, Diabetes, Glycosylated Hemoglobin. Received: 5 January 2015

Accepted: 16 March 2015

1- PhD student of Nursing, Department of Nursing, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, Iran. 2- Associate Professor, Department of Medical Surgical Nursing, School of Nursing, Baqyatallah University of Medical Sciences, Tehran, Iran. (Corresponding Author) E-mail: [email protected]. 3- PhD student of Nursing, Department of Nursing, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, Iran. 4- Assistant Professor, Department of Nursing, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran. Iran. 5- Assistant Professor, Department of Nursing, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran. Iran. 6- PhD Student of Health Education and Promotion, Faculty of Health and Promotion, Tabriz University of Medical Sciences, Iran. 1394 ‫ ﺑﻬﺎر‬3 ‫دوره اول ﺷﻤﺎره‬

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