北京市城区家庭医生式服务签约糖尿病患者服药依从性影响因素研究

Influencing factors of medication adherence among patients with diabetes signing family doctor service contract in Beijing urban areas

目的了解北京市城区家庭医生式服务签约糖尿病患者服药依从性影响因素,为今后提高签约糖尿病患者的服药依从性水平提供依据。方法采用立意抽样法,于2015年6月—9月选取北京市城区4家社区卫生服务中心的320例糖尿病患者进行问卷调查。采用单因素分析和多因素logistic回归确定影响服药依从性的因素。结果共发放调查问卷320份,回收有效问卷317份,其中服药依从性好的173例(54.6%)。经logistic回归分析,服药依从性与患者年龄[比值比(odds ratio,OR)=1.918,P=0.011)]、文化程度(OR=2.462,P=0.008)、糖尿病相关知识知晓度(OR=1.773,P=0.027)、是否接受过家庭医生式服务(OR=2.521,P=0.029)以及社会功能状态(P=0.003)有关。结论家庭医生式服务团队应注重提高有效签约率,提高签约居民对家庭医生式服务的利用;加强对中青年以及文化程度较低的糖尿病患者的随访和干预;对社会功能状态较差的患者,提高其情绪管理能力以及自我健康管理水平,从而提高签约糖尿病患者的服药依从性水平,保证其血糖水平得到良好控制,提高生存质量。

Objective To investigate the factors influencing the medication adherence among patients with diabetes signing family doctor service contract in Beijing urban areas, and provide the basis for improving the level of medication adherence, Methods A total of 320 patients with diabetes from four community health service centers in Beijing urban areas were selected to answer the questionnaires using convenient sampling from June to September 2015. Univariate analysis and binary logistic regression were used for the influencing factors analysis. Results A total of 320 questionnaires were distributed, and 317 valid questionnaires were recovered, in which the rate of high medication adherence was 54.6%. The results of logistic regression showed that the main impact factors on medication adherence were age [odds ratio （OR）=1.918, P=0.011）], degree of education （OR=2.462, P=0.008）, knowledge related to diabetes （OR=1.773, P=0.027）, adopting of family doctor service or not （OR=2.521, P=0.029） and social function status （P=0.003）. Conclusions The family doctor service team should implement the practice of the family doctor service to ensure that the contracted residents can make full use of the family doctor services; and strengthen the follow-up and interventions for patients less aged or with low degree of education. For those with poor social function, more attention should be paid to their self-health management behavior to improve the level of patients＇ compliance. As a result, the levels of blood glucose will be well controlled to reduce possibilities of complications and improve their health status and quality of life.