社区糖尿病患者分级诊疗依从性影响因素分析

Analysis of factors influencing community diabetic patients on the compliance of tiered medical services

目的从人口学因素和自我意识水平两方面研究分析社区2型糖尿病患者分级诊疗依从性的影响因素,以糖尿病为例,探讨完善我国慢性病分级诊疗的有效措施。方法采用方便抽样对前往上海市青浦区、徐汇区、奉贤区3个区的4个社区卫生服务中心就诊的符合纳入标准的2型糖尿病患者进行问卷调查。采用t检验、单因素方差分析和Pearson相关分析分析影响调研对象分级诊疗依从性的因素,最终建立多元分层回归模型。结果本次研究回收问卷536份,回收率为92.41%,其中有效问卷518份,有效率为96.64%。收集的有效问卷中以老年人为主,平均年龄(70.41±10.37)岁;病程时长≥10年的占43.63%,其中72.97%的受访者已签约家庭医生。单因素分析结果提示病程时长、是否签约家庭医生与糖尿病患者分级诊疗依从性相关,相关性分析结果显示自我效能、自我判断和分级诊疗认知水平是影响糖尿病患者分级诊疗依从性的因素。多元回归模型显示,患者年龄、是否使用胰岛素、自我效能和分级诊疗认知水平是预测患者依从性的主要因子,具体表现为年龄越大、不使用胰岛素、自我效能越高、分级诊疗认知水平得分越高的糖尿病患者分级诊疗依从性较好。结论目前社区2型糖尿病患者分级诊疗依从性尚可,为提高依从性,应尊重群众意愿,积极宣传引导;深入机构间协作,明确转诊标准;提高基层服务能力,培养优秀的全科医生。

Objective From demographic factors and self-awareness level, this paper analyzed the influencing factors of the compliance of community patients with type 2 diabetes in tiered medical services, taking diabetes as an example, and explored effective measures to improve the tiered medical services of chronic diseases in China. Methods Convenient sampling was used to conduct a questionnaire survey on type 2 diabetic patients who met the inclusion criteria in four community health service centers in Qingpu District, Xuhui District and Fengxian District of Shanghai. T-test, one-way ANOVA and Pearson correlation analysis were used to analyze the factors affecting the patients’ compliance with tiered medical services. Finally, a multivariate hierarchical regression model was established. Results In this study, 536 questionnaires were collected, with a recovery rate of 92.41%, of which 518 were valid, with an effective rate of 96.64%. Among the valid questionnaires collected, the elderly were the main ones, with an average age of(70.41±10.37) years. There were 42.1% of the respondents had had diabetes more than 10 years, and 73.0% of them had signed a family doctor. Univariate analysis showed that the course of the disease, whether to sign a family doctor and severity of illness were related to the compliance of diabetic patients with tiered medical services. The correlation analysis showed that self-efficacy, self-judgment and cognitive level of tiered medical services were the factors influencing the compliance of diabetic patients with tiered medical services. Multivariate regression model showed that age, insulin using, self-efficacy and cognitive level of tiered medical services were the main factors predicting patient compliance. Specifically, the older the patients were, the less insulin they were suitable, the higher their self-efficacy, and the higher their cognitive level of tiered medical services, the better their compliance with tiered medical services. Conclusion The compliance of community type 2 diabetic patients with tiered medical services is still acceptable. In order to improve the compliance, we should respect the wishes of the masses, actively publicize and guide, deepen inter-agency cooperation, clarify the referral criteria, improve grass-roots service ability and train excellent general practitioners.