基层医生糖尿病诊疗与患者管理情况及影响因素分析

The diagnosis, treatment and management levels of diabetes and influencing factors among 316 physicians in districts and communities

目的了解基层医生糖尿病诊疗和患者管理情况及影响因素,为进一步改进和完善基层医生培训工作提供参考依据。方法采用整群随机抽样法,抽取参加2013年＂中国糖尿病综合管理项目基层医生培训＂的基层医生为研究对象,在培训开始前通过问卷调查收集研究对象糖尿病早发现、诊断治疗、患者管理情况及影响因素信息。结果 316名不同专业基层医生在日常诊疗过程中,67.4%（95%CI：61.9%-72.5%）的医生诊疗过糖尿病,不同专业诊疗几率不同,差异有统计学意义（χ^2=52.574,P〈0.01）,内分泌科医生最高（87.5%,95%CI：75.9%-94.8%）,外科医生最低（28.1%,95%CI：13.7%-46.7%）;基层医生对糖尿病早发现条目的正向应答率为75.6%-88.9%;诊断治疗条目正向应答率较低,为46.2%-74.4%;基层医生对糖尿病早发现、诊断治疗、患者管理的21个条目的正向应答得分为（17.4±3.7）分,得分随专业技术职称和参加在职培训频率的升高而升高,差异有统计学意义（P〈0.01）;过去2年内接受糖尿病相关内容培训的基层医生正向应答得分高于未参加者,差异有统计学意义（F=17.214,P〈0.01）;各专业基层医生得分差异有统计学意义（F=3.064,P〈0.01）,从事内分泌科以外的其他内科医生正向应答得分为（18.8±2.5）分,外科为（16.3±4.0）分,妇产科为（15.0±4.9）分。结论加强基层医生糖尿病知识培训是提高糖尿病防控的重要措施,基层医生糖尿病培训应注重糖尿病早发现、早诊断知识和技能的培训。

Objective To understand the diagnosis, treatment and management levels of diabetes and influencing factors among physicians in districts and communities, and to provide reference for training physicians in districts and communities. Methods The random cluster sampling method was used to select the physicians who participated in the training of ＂China Initiative for Diabetes Excellence＂ in 2013. The information about early-detection, diagnosis, treatment and management of diabetes and its influencing factors was collected before the training program using a structured questionnaire. Results The subjects were 316 physicians engaged in different specialties, 67.4%（95%CI： 61.9%-72.5%） of subjects had diagnosed and treated diabetes. There was significant difference of probability of the diagnosis and treatment of diabetes among 316 physicians engaged in different specialties（P〈0.01）, the probability of the diagnosis and treatment of diabetes was highest in endocrinologists（87.5%, 95%CI： 75.9%-94.8%） and the lowest in surgeons（28.1%, 95%CI： 13.7%-46.7%）. The rate of positive response to early-detection of diabetes was between 75.6%-88.9% and to diagnosis and treatment was between 46.2%-74.4%. The score of positive response to 21 items of early-detection, diagnosis, treatment and management of diabetes in physicians was 17.4 ±3.7. The score increased significantly with professional titles and training frequency（P〈0.05, P〈0.01）. The score of positive response in physicians trained for diabetes in last 2 years was significantly higher than that in physicians untrained for diabetes in last 2 years（P〈0.01）. There was significant difference of score for physicians engaged in different specialties（P〈0.01）, the scores of non-endocrinal physicians, surgeons and obstetrics-gynecologists were 18.8±2.5, 16.3±4.0 and 15.0±4.9, respectively. Conclusion Enhancement of training for physicians in districts and communities is an important measure to control and prevent diabetes. The knowledge and skills on early-detection and early-diagnosis of diabetes for physicians of districts and communities in training program should be paid attention to.