卫生服务体系整合型改革中基层运行环境对糖尿病患者血糖控制的影响

Effect of primary operating environment on glycemic control of diabetic patients with type 2 diabetes in an integrated health service system reform

目的:本研究分析多个维度的整合环境对2型糖尿病患者血糖控制情况的影响,为整合型卫生服务体系改革和提高糖尿病管理质量提供政策依据。方法:采用多阶段抽样,对6个省市75家基层医疗卫生机构及429例2型糖尿病患者进行问卷调查,构建两水平logistic回归模型分析血糖控制的关键影响因素。结果:74.13%的2型糖尿病患者自评血糖水平已得到有效控制;将基层医疗卫生机构运行环境分为服务提供、人力资源、资源供应、信息系统和管理机制5个维度,均对糖尿病患者血糖控制情况有不同程度的影响;最近一年,在固定医生处接受治疗、接受过4次以上随访的糖尿病患者、基层医疗卫生机构医务人员综合知识测试正确率高、电子健康档案与病历信息互通共享均与患者血糖控制水平正相关。结论:构建全方位整合型环境,有利于推进基层医防服务整合、提高糖尿病管理服务质量、改善患者血糖控制。

Objectives:To analyze the impacts from integrated environment of primary health institutions at multiple dimensions on glycemic control in patients with Type 2 diabetes,and provide policy basis for the reform of integrated health service system and the improvement of quality of diabetes management.Methods:A questionnaire survey based on multi-stage sampling was carried out among a total of 75 primary health institutions in 6 cities and 429 patients with Type 2 diabetes.A two-level logistic regression model was built to analyzes the key impact factors of glycemic control.Results:Effective self-rated glycemic control was achieved in 74.13%of the surveyed patients with Type 2 diabetes.The operating environment of primary health institutions was divided into five dimensions,i.e.service delivery,human resources,medical resource provision,health information system,and management mechanism.Each of these dimensions may have a different impact on glycemic control in patients with diabetes.Patients have received treatment from regular physicians and have received more than 4 times of follow-up visits in recent one year.The rate of correct answers to the comprehensive knowledge test for medical/health workers at primary medical and health institutions was high,and electronic health files and medical records are interconnected and sharing in information showed a significant positive correlation with optimal glycemic control in patients with type 2 diabetes.Conclusions:The building of a comprehensive and integrated environment is conductive to promoting the integration of medical and preventive services of primary healthcare institutions,improving the quality of diabetes management services,and enhancing glycemic control in patients with type 2 diabetes.