“1+1+1”家庭医生签约服务模式下糖尿病患者生命质量调查及影响因素研究

The quality of life and influencing factors in diabetic patients managed by“1+1+1”contracted family physician services in the community

目的探究"1+1+1"组合签约家庭医生服务模式下糖尿病患者的生命质量状况,分析影响因素。方法于2018年7—9月,采用整群分层随机抽样,纳入413例已接受"1+1+1"家庭医生签约服务者为研究对象,将糖尿病患者203例归入糖尿病组,健康人群210例归入对照组。使用自制一般情况问卷、生存质量评价量表(SF-36量表)进行调查,比较两组的生命质量;应用单因素分析和线性逐步回归模型分析糖尿病患者生命质量的影响因素。结果两组生命质量总分分别为(711.36±103.40)、(736.72±85.42)分。糖尿病组的生命质量总分、健康变化、生理功能、总体健康、生理内容综合测量得分低于对照组(t=-2.712、-2.326、-4.872、-5.509、-3.504,均P<0.05);但在生理职能、躯体疼痛、情感职能、精神健康、生命活力、社会职能、心理内容综合测量方面两组差异无统计学意义(均P>0.05)。分析影响因素,单因素分析显示,年龄、文化程度、睡眠质量评分、应激事件、平时精神状况、家庭医生签约服务年限是糖尿病患者生命质量的影响因素(t/F=3.373、3.216、5.716、58.146、28.325、14.450,均P<0.05)。多重逐步线性回归分析显示,应激事件、平时精神状况、年龄、家庭医生签约服务年限是糖尿病患者生命质量的主要影响因素(t=7.157、4.741、-2.779、2.129,均P<0.05)。结论提示在"1+1+1"组合签约家庭医生服务模式下,糖尿病患者生命质量的心理内容评分接近健康人群。应激事件、平时精神状况、年龄、家庭医生签约服务年限可影响糖尿病患者的生命质量,家庭医生应针对性关注应激事件、患者平时精神状况变化以及对高龄患者的签约服务。

Objective To investigate the quality of life of diabetes patients managed by the“1+1+1”contracted family physician services and to analyze the influencing factors.Methods A survey on quality of life of diabetic patients in the community was conducted in Shanghai Huacao township from July 2018 to September 2018.A total of 413 residents managed by the contracted family physician services in 3 villages of Huacao township were selected by stratified cluster random sampling as study subjects,including 203 diabetes patients and the 210 healthy subjects(control group).The self-prepared questionnaire was applied for survey of general information and the quality of life was evaluated with the MOS 36-item short form health survey(SF-36)in two groups.The linear stepwise regression model was deployed to analyze the factors related to the quality of life of diabetes patients.Results The total scores of SF-36 were(711.36±103.40)and(736.72±85.42)in diabetic group and control group,respectively.The total score and the scores of reported health transition,physical function,general health,physiological contents in diabetic group were significantly lower than those of control group(t=-2.712,-2.326,-4.872,-5.509,-3.504,P<0.05);however,there were no significant differences in role-physical,bodily pain,role-emotional,mental health,vitality,social function,and psychological contents between the two groups(P>0.05).The univariate regression analysis indicates that age,educational degree,score on the quality of sleep,stressful life event,usual mental state,and the years of contracted family doctor service were associated with the quality of life of diabetes patients(t/F=3.373,3.216,5.716,58.146,28.325,14.450,P<0.05).Stepwise multiple linear regression analysis showed that stressful life event,usual mental state,and the years of contracted family doctor service were the independent factors related to the quality of life in diabetes patients(t=7.157,4.741,-2.779,2.129,P<0.05).Conclusion Under the“1+1+1”contracted family doctor service mode,the quality of life of diabetes patients in the community is very close to that of the healthy population in several dimensions.The study has also revealed that the duration of contracted family physician service and other factors can influence the quality of life of diabetic patients.