我国六省市糖尿病肾病筛查与管理现状的定性研究

Qualitative research on the status quo of screening and management of diabetic kidney disease in six provinces and cities in China

目的分析我国六省市糖尿病肾病(DKD)筛查与管理的现状。方法采用质性研究焦点小组访谈的方法,依据半结构化访谈提纲,对天津市、重庆市、甘肃省、湖北省、黑龙江省、广东省等六省市的综合医院、基层医疗卫生服务机构的临床医护人员及疾病控制机构的公共卫生人员进行线上访谈。运用主题分析法对访谈转录材料进行分析,使用MAXQDA分析软件进行数据管理和分析。结果本研究共开展访谈6场,访谈对象49名。81.6%(40名)的受访对象认为DKD筛查非常重要;53.1%认为患者不太容易获得DKD早筛服务;认为DKD早筛服务技术难度适中、简单、十分简单的人数分别占比40.8%、26.5%和14.3%;16.3%认为DKD早筛服务成本比较贵,83.7%认为成本不太贵或者便宜;75.5%的受访对象认为患者能接受DKD早筛服务。各级各类医疗卫生机构充分落实医改政策、转变观念主动服务患者、整合外部资源等方面的因素有利于DKD筛查和管理服务的开展。基层缺乏开展DKD筛查服务的技术和人员、患者对于基层医疗机构的服务能力缺乏信任、患者认知水平较低以及新型冠状病毒感染疫情则对DKD筛查和管理服务的开展产生不利影响。结论我国DKD的筛查和管理服务的开展较少,糖尿病及DKD的管理和照护碎片化现象严重。

Objective To investigate and analyse the current status of screening and management of diabetic kidney disease(DKD)in six provinces and cities in China.Methods The qualitative research method of focus group interview was adopted,based on the semi-structured interview outline,the clinical medical and disease control personnel in Tianjin,Chongqing,Gansu,Hubei,Heilongjiang,and Guangdong were interviewed.The interview transcripts were analyzed using thematic analysis,and MAXQDA analysis software was used for data management and analysis.Results A total of 6 interviews were conducted with 49 interviewees.Forty respondents(81.6%)claimed that DKD screening was critical;53.1%think that it was not easy for patients to obtain DKD screening services;40.8%,26.5%and 14.3%of the people believed that the technology of DKD screening services was moderate,simple or very simple,respectively.Of the respondents,16.3%thought that the cost of DKD screening service was relatively expensive,while 83.7%thought that the cost was inexpensive;75.5%of the respondents believed that the patients could receive early DKD screening service.The factors of fully implementing medical reform policies,changing concepts and actively serving patients,and integrating external resources in medical and health institutions at all levels and of all types were conducive to the development of DKD screening and management services.The lack of technology and personnel for DKD screening services at the grassroots level,the lack of trust in the service capabilities of grassroots medical institutions by patients,the low level of patient awareness,and the novel coronavirus infection epidemic had an adverse impact on the development of DKD screening and management services.Conclusion The screening and management services for DKD are relatively limited in China,and there is a significant fragmentation in the management and care of diabetes and DKD.