中国全科医学 ›› 2023, Vol. 26 ›› Issue (34): 4290-4295.DOI: 10.12114/j.issn.1007-9572.2023.0087

• 论著·社区糖尿病管理研究 • 上一篇    下一篇

糖尿病患者社区卫生服务体验与血糖控制效果的关系研究

杨慧1,2, 胡汝为1,*(), 刘汝青1, 卢俊峰1, 吴兢兰1   

  1. 1.510080 广东省广州市,中山大学公共卫生学院
    2.200032 上海市,复旦大学公共卫生学院
  • 收稿日期:2023-03-29 修回日期:2023-07-26 出版日期:2023-12-05 发布日期:2023-08-03
  • 通讯作者: 胡汝为

  • 作者贡献:胡汝为制定总体研究目标,对文章整体负责、监督管理;杨慧进行文章构思与设计、结果分析与解释,并撰写论文;刘汝青进行文章的质量控制及审校;卢俊峰进行文章的修订;吴兢兰进行数据收集。
  • 基金资助:
    国家社会科学基金资助项目(17BG190); 美国中华医学基金会公开竞争项目(15-224)

Relationship between Community Health Service Experience and Glycemic Control Outcomes in Patients with Diabetes Mellitus

YANG Hui1,2, HU Ruwei1,*(), LIU Ruqing1, LU Junfeng1, WU Jinglan1   

  1. 1. School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
    2. School of Public Health, Fudan University, Shanghai 200032, China
  • Received:2023-03-29 Revised:2023-07-26 Published:2023-12-05 Online:2023-08-03
  • Contact: HU Ruwei

摘要: 背景 社区卫生服务是延缓糖尿病进展和管理糖尿病并发症的有效途径。已有研究表明,糖尿病患者在社区卫生服务中心获得的就诊主观体验有助于改善患者的健康结局,但较少有研究分析糖尿病患者在社区卫生服务中心获得的具体服务过程及项目客观体验与血糖控制效果的关系。 目的 探讨糖尿病患者的社区卫生服务体验与血糖控制效果的关系。 方法 采用横断面调查研究设计和多阶段整群随机抽样方法,在广州市中心城区抽取6家社区卫生服务中心的各1个家庭医生团队,招募于2019年9—11月到相应家庭医生团队处就诊的336例糖尿病患者为研究对象。通过问卷调查,获得患者的基本情况、空腹血糖(FPG)水平、基本医疗质量评估量表(PCAT)得分等信息。根据FPG水平评估患者的血糖控制效果,根据PCAT得分评估患者的社区卫生服务体验。采用Logistic回归模型评估糖尿病患者社区卫生服务体验对血糖控制效果的影响。 结果 纳入糖尿病患者的血糖控制率为73.2%(246/336)。血糖控制良好者的PCAT总分及各维度得分均高于血糖控制不良患者(P<0.05)。多因素Logistic回归分析结果显示,糖尿病患者PCAT总分对血糖控制效果有影响〔OR(95%CI)=0.12(0.06,0.23)〕,PCAT各维度得分对血糖控制效果亦有影响(P<0.05)。亚组分析结果显示,对于不同性别、医疗保险类型、高血压病史的糖尿病患者,PCAT总分对血糖控制效果均有影响(P<0.05)。 结论 良好的社区卫生服务体验是糖尿病患者血糖控制效果的保护因素,提升社区卫生服务体验对糖尿病患者的血糖控制具有重要意义。

关键词: 糖尿病, 血糖控制, 社区卫生服务, 就医体验

Abstract:

Background

Community health services play an effective role in delaying the progression of diabetes and managing diabetes complications. Previous studies have suggested that the subjective experiences of visits to community health centers by patients with diabetes contributes to their improved health outcomes. However, few studies have evaluated the correlation of glycemic control outcomes with specific service processes and objective experiences of programs received by diabetic patients in the community health service centers.

Objective

To explore the correlation between the community health service experiences and glycemic control outcomes in patients with diabetes mellitus.

Methods

A cross-sectional survey design and multi-stage, cluster random sampling method was used to select six community health service centers in the central urban area of Guangzhou, with one family doctor team randomly selected from each center. A total of 336 patients with diabetes who visited the corresponding family doctor teams from September to November 2019 were recruited as the study subjects. A questionnaire was conducted to collect baseline information, fasting plasma glucose (FPG) level, and Primary Care Assessment Tool (PCAT) scores. The glycemic control outcomes of patients were assessed based on the FPG level, and their experiences of community health services were assessed based on the PCAT scores. Logistic regression models were used to evaluate the effect of community health service experiences on glycemic control outcomes in diabetic patients.

Results

The glycemic control rate of the included diabetic patients was 73.2% (246/336). The total PCAT score and the scores for each dimension of PCAT with good glycemic control outcomes were higher than those of patients with poor glycemic control outcomes, and the difference was statistically significant (P<0.05). The results of multivariate Logistic regression showed an effect of total PCAT score on glycemic control outcomes in diabetic patients〔OR (95%CI) =0.12 (0.06, 0.23) 〕, as well as the scores for each dimension of PCAT (P<0.05). The results of subgroup analysis showed that for diabetic patients with different genders, types of health insurance and hypertension history, the total score of PCAT had an effect on the glycemic control outcomes (P<0.05) .

Conclusion

Community health service experience is a protective factor for the glycemic control outcomes of diabetic patients. Enhancing community health service experience is of great significance for improving the glycemic control outcomes in patients with diabetes.

Key words: Diabetes mellitus, Glycemic control, Community health services, Medical experience