中国全科医学 ›› 2024, Vol. 27 ›› Issue (05): 589-596.DOI: 10.12114/j.issn.1007-9572.2023.0361

• 论著·专病管理·糖尿病 • 上一篇    

基层医师对糖尿病中医类指南知悉程度与使用现状的影响因素研究

贾丽燕1, 赵能江1, 闫冰1, 张智海1, 占娜2, 林远冰2, 刘建平3, 杨叔禹1,4,*()   

  1. 1.361001 福建省厦门市,厦门大学附属第一医院
    2.350122 福建省福州市,福建中医药大学
    3.100029 北京市,北京中医药大学
    4.361001 福建省厦门市,厦门大学医学院中西医结合学系
  • 收稿日期:2023-06-29 修回日期:2023-09-30 出版日期:2024-02-15 发布日期:2023-11-21
  • 通讯作者: 杨叔禹

  • 作者贡献:贾丽燕、杨叔禹提出研究思路,设计研究方案;贾丽燕、赵能江、闫冰负责研究过程的实施;贾丽燕、张智海、占娜、林远冰负责数据收集和整理;贾丽燕负责统计学处理、结果的分析与解释、论文撰写与修改;刘建平、杨叔禹参与论文修改;贾丽燕、杨叔禹对论文负责;所有作者确认论文终稿。
  • 基金资助:
    国家中医药管理局2021年基层中医药有关委托办事项目(国中医药医政函〔2021〕141号); 全国名老中医药专家传承工作室建设项目(国中医药人教函〔2022〕75号)

Analysis of the Factors Impacting the Awareness and Utilization of Traditional Chinese Medicine Guidelines for Diabetes among Primary Care Practitioners

JIA Liyan1, ZHAO Nengjiang1, YAN Bing1, ZHANG Zhihai1, ZHAN Na2, LIN Yuanbing2, LIU Jianping3, YANG Shuyu1,4,*()   

  1. 1. The First Affiliated Hospital of Xiamen University, Xiamen 361001, China
    2. Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
    3. Beijing University of Chinese Medicine, Beijing 100029, China
    4. Department of Integrated Chinese and Western Medicine, School of Medicine, Xiamen University, Xiamen 361001, China
  • Received:2023-06-29 Revised:2023-09-30 Published:2024-02-15 Online:2023-11-21
  • Contact: YANG Shuyu

摘要: 背景 基层医师在基层医疗卫生服务中发挥重要作用,临床实践指南是指导临床实践的重要工具,了解基层医师对指南的知悉程度与使用现状,可为基层指南推广与培训、提高基层医疗质量提供新思路。 目的 调查、了解基层医师对糖尿病中医类指南的知悉程度与参考使用现状,并探讨其影响因素。 方法 2021-09-22—10-29,通过线上调查方式向中华中医药学会糖尿病基层防治专家指导委员会发放电子问卷,并采用滚雪球抽样的方法扩散至更多医师。问卷包括3部分:基本信息、医师使用中医药防治糖尿病现状与需求、医师对糖尿病指南认知现状与需求调查。采用有序多分类Logistic回归分析探讨基层医师对糖尿病中医类指南知悉程度与使用现状的影响因素。 结果 共回收基层医师填写的有效问卷382份。35.34%(135/382)的医师对糖尿病中医类指南非常熟悉或比较熟悉,28.80%(110/382)的医师经常参考使用糖尿病中医类指南。单因素分析结果显示,不同性别、专业方向、所在科室、每周诊疗糖尿病患者数量、对中医药治疗糖尿病疗效评价、医师所在单位是否可以购买指南推荐的中药饮片或中成药、对指南知悉程度的基层医师对糖尿病中医指南参考情况比较,差异有统计学意义(P<0.05)。有序多分类Logistic回归分析结果显示,基层医师对糖尿病中医类指南知悉程度的影响因素为对中医药疗效评价为"非常有效"(OR=5.783,95%CI=1.283~26.102),医师所在单位可以购买指南推荐的中药饮片或中成药(OR=2.399,95%CI=1.548~3.717),既往接受过糖尿病防治指南的专题培训(OR=1.751,95%CI=1.149~2.667)3个因素;基层医师对糖尿病中医类指南参考情况的影响因素为医师对指南的知悉程度[非常或比较熟悉(OR=15.721,95%CI=7.584~32.557)、一般熟悉(OR=5.392,95%CI=2.841~10.237)],工作年限≤5年(OR=14.083,95%CI=1.390~142.594),不同专业[中医专业(OR=6.869,95%CI=1.483~31.849)、中西医结合专业(OR=6.613,95%CI=1.551~28.219)],不同地理区域[东北部(OR=2.962,95%CI=1.064~8.240)、东南部(OR=2.686,95%CI=1.004~7.178)]4个因素。 结论 基层医师对糖尿病中医类指南的知悉程度和参考使用情况尚需提高。对指南的知悉程度、工作年限、专业方向、地理区域是影响医师参考使用指南的重要因素。今后应加强对基层医师的培训力度,尤其是对西北部和西南部地区、具有中医专业背景的基层医师应加强中医防治糖尿病相关指南的培训。

关键词: 糖尿病, 中医药疗法, 指南, 基层医疗, 社区卫生服务, 影响因素分析

Abstract:

Background

Primary care physicians (PCPs), who play a crucial role in providing primary healthcare services, utilize clinical practice guidelines as valuable tools for guiding their practice. By investigating these physicians' awareness and usage of guidelines, we can offer innovative strategies for promoting guideline adherence and enhancing physicians' training. This, in turn, can ultimately improve the quality of primary healthcare.

Objective

To explore the level of awareness and the current status of reference use of traditional Chinese medicine (TCM) guidelines for diabetes among PCPs, and to identify the influencing factors.

Methods

From September 22 to October 29, 2021, an online questionnaire survey was conducted among physicians affiliated with the Specialist Committee for Primary Diabetes Care of China Association of Chinese Medicine, using the snowball sampling method to ensure a broader representation of physicians. The questionnaire consists of three parts: basic information, current status and needs of physicians in using TCM for diabetes prevention and treatment, and a survey on physicians' current awareness and needs regarding diabetes guidelines. Ordered multiclass Logistic regression analysis was used to identify the influencing factors of PCPs' awareness and usage of TCM guidelines for diabetes.

Results

A total of 382 questionnaires were collected from PCPs, 35.34% (135/382) of the physicians were very familiar or fairly familiar with TCM guidelines for diabetes, while 28.80% (110/382) of the physicians referred to these guidelines regularly for diabetes management. The results of the univariate analysis showed that, PCPs with differences in gender, specialty, department, number of diabetic patients treated per week, evaluation of TCM treatment efficacy, availability of TCM herbs and Chinese patent drugs in physicians' institutions, and physicians' awareness of guidelines, showed statistically significant differences in their reference status of TCM guidelines for diabetes (P<0.05). The results of the ordered multinomial Logistic regression analysis showed that, the factors influencing PCPs' awareness of TCM guidelines for diabetes included PCPs' evaluation of TCM treatment efficacy (OR=5.783, 95%CI=1.283-26.102), availability of TCM herbs and Chinese patent drugs in physicians' institutions (OR=2.399, 95%CI=1.548-3.717), and their previous participation in specialized training on diabetes prevention and control guidelines (OR=1.751, 95%CI=1.149-2.667). The factors influencing PCPs' reference to TCM guidelines for diabetes included the physicians' level of familiarity with the guidelines [very or fairly familiar (OR=15.721, 95%CI=7.584-32.557), somewhat familiar (OR=5.392, 95%CI=2.841-10.237) ], work experience less than 5 years (OR=14.083, 95%CI=1.390-142.594), different specialties [TCM (OR=6.869, 95%CI=1.483-31.849), integrated Chinese and western medicine (OR=6.613, 95%CI=1.551-28.219) ], and geographical regions [northeast (OR=2.962, 95%CI=1.064-8.240), southeast (OR=2.686, 95%CI=1.004-7.178) ].

Conclusion

The awareness and reference usage of TCM guidelines for diabetes among PCPs need to be improved. Factors such as guideline awareness, work experience, professional orientation, and geographical region play a significant role in influencing physicians' utilization of the guidelines. In the future, training for PCPs should be strengthened, particularly focusing on the northwest and southwest regions, and PCPs with a background in TCM should receive more training on TCM-related guidelines for diabetes prevention and treatment.

Key words: Diabetes mellitus, Traditional Chinese medicine therapy, Guideline, Primary healthcare, Community health services, Root cause analysis