社区糖尿病专病护理服务需求的帕累托分析与对策研究

Pareto Analysis of the Needs of Community-based Diabetes Care in Community-dwelling Residents with Diabetes or Prediabetes and Suggested Countermeasures

背景糖尿病是全球患病率较高的慢性非传染性疾病之一,社区护理在全国性糖尿病服务体系实施过程中有举足轻重的作用,不同情况的糖尿病患者社区护理需求存在差异。目的基于帕累托法则,研究社区糖尿病患者或糖尿病前期患者对护理服务的需求特点。方法于2017年10月—2018年1月,对上海市虹口区嘉兴路社区卫生服务中心辖区内的糖尿病患者或糖尿病高危人群实施问卷调查,主要调查内容为社区糖尿病专病护理服务项目的需求,包括数据采集、健康教育、个体干预及质量控制4大类58项。分别根据需求度与主动需求度对服务项目进行分类,用帕累托图法分析社区糖尿病患者的主要需求服务项目、次要需求服务项目及一般需求服务项目。结果发放问卷318份,回收有效问卷318份,问卷有效回收率为100.0%。基于需求度的帕累托分类结果显示,调查对象的主要需求和次要需求服务项目占总项目数的86.2%,贡献了87.1%的累计构成比;基于主动需求度的帕累托分类结果显示,主要需求和次要需求服务项目占总项目数的58.6%,贡献了89.3%的累计构成比,服务人群的主要需求集中在数据采集、个体干预的"血糖监测"和"用药干预"、健康教育的"健康教育内容"等方面。结论社区糖尿病专病护理服务项目不存在明显的需求差异,但存在明显的主动需求差异。因此,社区糖尿病专病护理一方面应努力提高服务提供的能力,尽可能满足需方的多样化需求;另一方面,要抓住服务对象的主动需求偏好,加大相应服务的宣传和推广,为逐步开展其他服务项目打下有利的基础。

Background Diabetes is a chronic non-communicable disease whose global prevalence is relatively high.Community-based diabetes care,a part of the national diabetes care system,plays an important role in the implementation of diabetes care.The needs of community-based diabetes care vary from person to person.Objective To investigate the needs characteristics of community-based diabetes care in community-dwelling residents with diabetes or prediabetes based on the Pareto principle.Methods From October 2017 to January 2018,a questionnaire survey was conducted among diabetic patients or individuals at high risk of diabetes in the service area of Hongkou District Jiaxing Road Community Health Center,Shanghai.The major contents of survey included was the eeds for community-based diabetes care,including 4 categories(data collection,health education,individual intervention and quality control)covering 58 items.The service items were classified according to the level of demand and the level of active demand.And the primary,secondary and general service items that the patients needed were analyzed by Pareto diagram.Results A total of 318 patients participated in the survey.All of them completed the questionnaire effectively,achieving a response rate of 100.0%.Pareto classification of demand level showed that the primary and secondary demand items accounted for 86.2%of the total,contributing 87.1%of the cumulative constituent ratios;Pareto classification of active demand level showed that the primary and secondary demand items accounted for 58.6%of the total,contributing 89.3%of the cumulative constituent ratios.The main needs of the participants included data collection,items of"blood glucose monitoring"and"medication intervention"belonging to individual intervention,and the item of"health education content"belonging to health education.Conclusion The patients with diabetes or prediabetes showed no significant difference in the level of demand for the service items included by community-based diabetes care,but demonstrated significant difference in the level of active demand for some service items.In view of this,community healthcare institutions should improve their capabilities to provide community-based diabetes care to satisfy multiple needs of patients with diabetes or prediabtes as much as possible.Moreover,they should publicize and popularize the preferred services of such patients,which can also contribute to the development of other services.