慢性病患者社区健康管理服务利用情况及影响因素研究

Utilization and Associated Factors of Community Health Management Services in Hypertensive and Diabetic Patients

背景2009年高血压和糖尿病被纳入国家基本公共卫生服务范畴,目前社区慢性病患者社区健康管理服务的利用情况如何有待深入研究。目的了解深圳市社区慢性病患者利用或参加社区健康管理服务的现状及影响因素。方法基于2018年9—11月深圳市慢性病及危险因素的调查数据,采用χ^(2)检验和多分类Logistic回归模型,分析性别、年龄、户籍、婚姻状况、月收入、职业类型、在深居住年限、是否购买医保、疾病确诊医疗机构级别等对服务利用度的影响。结果本次调查共获得有效样本10042例,其中自我报告确诊高血压和糖尿病患者各1132和402例。1132例高血压患者中,530例(46.82%)表示参加了社区健康服务中心提供的高血压随访管理,其中436例(82.31%)表示医生提供了测量血压服务,399例(75.25%)表示医生提供了用药指导服务;402例糖尿病患者中,194例(48.26%)表示参加了社区健康服务中心提供的糖尿病随访管理,其中(共计193例,1例缺失)173例(89.37%)表示医生提供了测量血糖服务,154例(79.62%)表示医生提供了用药指导服务;高血压患者和糖尿病患者均表示医生进行戒烟或少吸烟、戒酒或少饮酒指导的比例较低,均低于40%。多分类Logistic回归分析结果显示,性别、年龄、月收入、在深居住年限、有无医保是影响高血压患者社区健康管理服务利用情况的因素(P<0.05),年龄、职业类型、月收入是影响糖尿病患者社区健康管理服务利用情况的因素(P<0.05)。结论不到一半的社区慢性病患者利用或参加了社区健康管理服务。女性、18~44岁中青年、中低收入、在深居住年限较短和无医保的高血压患者、体力劳动为主的糖尿病患者利用率较低。建议针对上述重点人群加强基本公共卫生服务的宣传教育,同时进一步提高社区健康服务中心医生对患者进行健康生活方式(如吸烟、饮酒等)健康教育的意识。

Background Hypertension and diabetes have been included in the list of China's essential public health services since 2009.During these years,the use and associated factors of community health management services in community-living hypertensive and diabetic patients are not very clear and need to be further studied.Objective To investigate the use and potential associated factors of community health management services in Shenzhen community-living hypertensive and diabetic residents.Methods Data stemmed from the results of Shenzhen Epidemiological Survey on Chronic Non-communicable Diseases and Risk Factors conducted between September and November 2018.The chi-square test and multinomial Logistic regression were used to examine the association of sex,age,place of hukou registration(Shenzhen or not),marital status,monthly household income per capita,occupation type,years of living in Shenzhen,prevalence of medical insurance enrollment,and the level of medical institutions making a definite diagnosis with the use of community health management services.Results Altogether,10042 participants were finally enrolled,including 1132 with self-reported hypertension,and 402 with self-reported diabetes.Among the hypertensive participants,530(46.82%)indicated that they received follow-up management of hypertension from the community health center.Specifically,436(82.31%)received blood pressure measurement by the doctor,and 399(75.25%)received medication guidance from the doctor.Of the diabetic patients,194(48.26%)indicated that they received follow-up management of diabetes from the community health center.Specifically,173(89.37%)of the 193 cases(one case was excluded due to missed information)received blood glucose measurement by the doctor,and 154(79.62%)received medication guidance from the doctor.The prevalence of hypertensive participants receiving guidance on smoking cessation or smoking less from the doctor was relatively low(lower than 40%),and so was that of diabetic participants.The prevalence of hypertensive participants receiving guidance on drinking cessation or drinking less from the doctor was relatively low(lower than 40%),and so was that of diabetic participants.Multinomial Logistic regression analysis revealed that sex,age,monthly household income per capita,years of living in Shenzhen,and prevalence of medical insurance enrollment were associated with the utilization of community health management services in hypertensive patients(P<0.05).Age,occupational type,and monthly household income per capita were associated with the utilization of community health management services in diabetic patients(P<0.05).Conclusion Less than half of the community-living hypertensive and diabetic participants used or were involved in community health management services.Being female,18-44-year-old,low or moderate monthly household income per capita,and short years of living in Shenzhen were associated with lower rate of utilizing such services.Moreover,hypertensive cases without medical insurance,and diabetics engaging in a manual labor job were far less likely to utilize the services.In view of this,it is suggested to strengthen the publicity of essential public health services in the above-mentioned priority groups.Besides that,the awareness of doctors in community health centers should be strengthened to provide patients with guidance on developing healthy lifestyles,such as stopping smoking and drinking.