基层医疗机构2型糖尿病患者家庭医生团队中医药健康管理服务现状调查分析

TCM Health Management Services for Type 2 Diabetes Delivered by the Family Doctor Team in Primary Care:a Survey

背景基层医疗机构是2型糖尿病防治的主战场,近年来中医药适宜技术在基层医疗机构发展迅速,但家庭医生团队管理中未能很好地发挥中医药健康管理的优势,中医药健康管理工作开展困难。目的了解成都市武侯区2型糖尿病患者家庭医生团队中医药健康管理服务现状,为更好地设计和推广基层医疗机构2型糖尿病患者中医药健康管理服务模型提供依据。方法采用问卷调查法,于2017年12月对成都市武侯区全部13家社区卫生服务中心,每家中心根据简单随机抽样法选择5个家庭医生团队,共涉及65个家庭医生团队,198名团队成员。采用自行设计的《糖尿病患者中医药健康管理业务模型设计调查问卷表》调查,主要内容包括团队成员基本情况、糖尿病患者中医药健康管理现状、团队开展中医药健康管理的认可度及服务频率、患者对中医药健康管理接受度和糖尿病患者开展中医药健康管理制约因素五大项。结果 65个家庭医生团队中,51个(78.5%)团队有中医类别医生参与;198名家庭医生团队成员中,对所管糖尿病患者已开展中医药健康管理171名(86.4%)。171名中开展体质辨识服务170名(99.4%),提供中医药适宜技术103名(60.2%);服务频率59名(34.5%)1次/年,51名(29.8%)3个月1次;130名(76.0%)是团队内部自行协商预约提供服务,41名(24.0%)是团队与其他团队沟通联系提供中医药健康管理服务。198名家庭医生团队成员中,180名(90.9%)认为对自己所管理的糖尿病患者开展中医药健康管理是有意义的;177名(89.4%)愿意学习和运用中医药健康管理技术;163名(82.3%)认为患者愿意接受中医药服务。177名完成家庭医生认可的合理可行的中医药服务频率调查,91名(51.4%)认可3个月1次。"家庭医生团队工作任务重没时间开展"是制约糖尿病患者中医药健康管理开展的首要因素,得分为(6.32±2.70)分;其次为"所在中心无糖尿病患者中医药健康管理绩效考核或考核力度不够",得分为(5.10±2.36)分。结论目前武侯区基层医疗机构2型糖尿病患者家庭医生团队管理服务规范,糖尿病患者中医药健康管理存在服务内容局限、服务方式单一、服务感受度不高等现况,中医药健康管理服务开展上有待加强,应增强服务管理方重视度,强化服务供方的服务意识及技能,确保2型糖尿病患者家庭医生团队中医药健康管理服务有序、有效开展。

Background Primary medical institutions play a major role in the prevention and treatment of type 2 diabetes.In recent years,although traditional Chinese medicine(TCM) appropriate techniques have been used extensively in primary medical institutions,the implementation of TCM health management services is unsatisfactory in general,which is partly due to the failure of the family doctor team in playing their due role in delivering such services.Objective To investigate the TCM health management services for type 2 diabetes delivered by the family doctor team in Wuhou District of Chengdu, providing a reference for tackling problems during the development and promotion of appropriate delivery patterns of such services in primary care.Methods In December 2017,a questionnaire survey was conducted in all the 13 community health centers in Wuhou District of Chengdu.By use of simple random sampling,5 family doctor teams were selected from each center,and 65 family doctor teams were sampled in total,including 198 team members.The Questionnaire for Design of TCM Health Management Service Model for Diabetes developed by our research team was used in the survey,including basic personal characteristics of the family doctor team members,status of the implementation of TCM health management services for diabetes,frequency and approval level,acceptance level and restrictive factors of delivering TCM health management services by the family doctor team.Results Among 65 family doctor teams,51(78.5%) had TCM doctors.Among the 198 respondents,171(86.4%) had provided TCM health management services for diabetes,more concretely,the rates of providing identification of body constitution services,and the services using TCM appropriate techniques,were 99.4%(170/171),and 60.2%(103/171), respectively.The delivery frequency of TCM health management services was once a year in 34.5%(59/171) of them,and once every 3 months in 29.8%(51/171).The services were delivered by 130 cases(76.0%) on the basis of the negotiation between the team members and patient appointments,and by 41 (24.0%) on the basis of cooperation between family doctor teams.Of the 198 cases,180 (90.9%) believed that it was meaningful to carry out TCM health management services for diabetic patients,177 (89.4%) were willing to learn and use TCM health management techniques,and 163 (82.3%) believed that patients were willing to receive TCM services.177 cases completed the survey on the delivery frequency of reasonable and feasible TCM services approved by themselves,and 91 (51.4%) approved the frequency of once in 3 months.In terms of the restrictive factors of delivering TCM health management services,“Having too much workload to deliver TCM health management services for diabetes” ranked the first,with a score of (6.32±2.70),followed by “There are no or lack of adequate criteria for the evaluation of the performance of family doctor team in delivering TCM health management services for diabetes in their community health center”,with a score of (5.10±2.36).Conclusion The TCM health management services for diabetes delivered by family doctor teams in Wuhou District of Chengdu are eligible,but limited,and the delivery pattern is simple, with unsatisfactory approval.Therefore,in order to ensure the implementation of such services in an effective and orderly way, healthcare managers should make more efforts and pay more attention to the implementation of such services,and family doctors should improve their service awareness and professional capabilities.