不同医保支付方式对2型糖尿病患者血糖行为结局的影响
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摘要
背景我国糖尿病患者数量位居全球首位,患病类型以2型糖尿病(T2DM)为主。糖尿病及其并发症给个人、家庭及社会造成巨大经济损失。近年来发现如果有足够的医疗保障覆盖,绝大部分T2DM并发症及合并症可以被预防或延后。目的调查不同医疗政策背景下医保支付方式对2型糖尿病患者血糖行为结局的影响。方法选取2017年4月—2018年1月在广州市某三级甲等医院或社区医院住院的T2DM患者70例、澳门镜湖医院糖尿病中心或住院部住院的T2DM患者82例为研究对象。由课题组统一提供血糖仪、试纸、采血针、血液检查等用品,指导患者进行为期12周的自我血糖监测,比较两地T2DM患者就诊付费方式、血糖监测依从性、糖化血红蛋白(HbA1c)水平等。结果试验期间两地患者就诊付费方式差异有统计学意义(P<0.05)。在出院12周的干预过程中,广州地区同期血糖记录情况明显优于澳门地区(P<0.001)。就诊付费方式是出院12周自测血糖总次数的影响因素(P<0.05)。出院12周两地患者HbA1c水平比较,差异无统计学意义(P>0.05)。HbA1c改变量与血糖监测次数呈正相关(rs=0.182,P<0.05)。结论不同医疗政策背景下医保支付方式对T2DM患者血糖行为结局的影响不同,适当提供自测血糖耗材可提高T2DM患者自我监测血糖的依从性,自测血糖干预可以帮助T2DM患者更好地控制血糖。
Background The number of diabetes patients in China ranks first all over the world,and most of them are type 2 diabetes mellitus(T2DM).Diabetes and its complications cause huge economic burdens on the patient,families,and the society.Recently,it has been found that most of T2DM complications could be prevented or delayed if there is adequate universal medical coverage.Objective To investigate the effects of payment methods by medical insurance supported by different policies on self-management behavioral outcomes in T2DM patients.Methods A total of 152 T2DM patients participated in the study,including 70 from a tertiary grade A hospital or a community hospital in Guangzhou,and 82 from the Diabetes Center or Inpatient Department,Kiang Wu Hospital in Macau during April 2017 to January 2018.All of them received 12-week self-monitoring of blood glucose with the same guidance and equipments(blood glucose meter,diabetes test strips,blood collection needle,and consumptions related to lab blood tests)provided by our research group.Comparisons of treatment payment methods,self-monitoring of blood glucose compliance,and glycated hemoglobin(HbA1 c)were conducted between the two groups.Results There was a significant difference in the treatment payment method between the two groups of patients during the study(P<0.05).During the 12-week postdischarge intervention,the blood glucose records of patients from Guangzhou were significantly better than those of patients from Macau(P<0.001).The treatment payment method was one of the influencing factors for the total frequencies of blood glucose measurements within the intervention period(P<0.05).There were no significant differences in pre-and post-intervention HbA1 c levels between the two groups(P>0.05).Changes in HbA1 c were positively correlated with the frequency of self-monitoring of blood glucose(rs=0.182,P<0.05).Conclusion Payment methods by medical insurance supported by different policies exert different effects on self-management behavioral outcomes in T2DM patients.Providing adequate self-monitoring of blood glucose consumables can improve the self-monitoring of blood glucose compliance.Self-monitoring blood glucose intervention can help T2DM patients control their blood glucose better.
Background The number of diabetes patients in China ranks first all over the world,and most of them are type 2 diabetes mellitus(T2DM).Diabetes and its complications cause huge economic burdens on the patient,families,and the society.Recently,it has been found that most of T2DM complications could be prevented or delayed if there is adequate universal medical coverage.Objective To investigate the effects of payment methods by medical insurance supported by different policies on self-management behavioral outcomes in T2DM patients.Methods A total of 152 T2DM patients participated in the study,including 70 from a tertiary grade A hospital or a community hospital in Guangzhou,and 82 from the Diabetes Center or Inpatient Department,Kiang Wu Hospital in Macau during April 2017 to January 2018.All of them received 12-week self-monitoring of blood glucose with the same guidance and equipments(blood glucose meter,diabetes test strips,blood collection needle,and consumptions related to lab blood tests)provided by our research group.Comparisons of treatment payment methods,self-monitoring of blood glucose compliance,and glycated hemoglobin(HbA1 c)were conducted between the two groups.Results There was a significant difference in the treatment payment method between the two groups of patients during the study(P<0.05).During the 12-week postdischarge intervention,the blood glucose records of patients from Guangzhou were significantly better than those of patients from Macau(P<0.001).The treatment payment method was one of the influencing factors for the total frequencies of blood glucose measurements within the intervention period(P<0.05).There were no significant differences in pre-and post-intervention HbA1 c levels between the two groups(P>0.05).Changes in HbA1 c were positively correlated with the frequency of self-monitoring of blood glucose(rs=0.182,P<0.05).Conclusion Payment methods by medical insurance supported by different policies exert different effects on self-management behavioral outcomes in T2DM patients.Providing adequate self-monitoring of blood glucose consumables can improve the self-monitoring of blood glucose compliance.Self-monitoring blood glucose intervention can help T2DM patients control their blood glucose better.
引文
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[7]宋安琪.医疗保险对慢性病患者就医行为及医疗负担的影响[D].哈尔滨:哈尔滨医科大学,2017.
[8]冉雪蓉,伍红艳,王龙,等.基于人群健康管理视角分析促进2型糖尿病早诊早治措施经济性的国外研究进展[J].中国全科医学,2018,21(34):4278-4282.DOI:10.12114/j.issn.1007-9572.2018.00.245.RAN X R,WU H Y,WANG L,et al.Recent advances in the economic evidence abroad of early detection and treatment of type 2diabetes:a review from the health management perspective[J].Chinese General Practice,2018,21(34):4278-4282.DOI:10.12114/j.issn.1007-9572.2018.00.245.
[9]赵雪,黄金,杨玲凤,等.2型糖尿病患者授权能力与医疗支持的相关性研究[J].中华护理杂志,2018,53(3):299-304.DOI:10.3761/j.issn.0254-1769.2018.03.010.ZHAO X,HUANG J,YANG L F,et al.Correlation between empowerment and medical support in patients with type 2 diabetes mellitus[J].Chinese Journal of Nursing,2018,53(3):299-304.DOI:10.3761/j.issn.0254-1769.2018.03.010.
[10]嵇加佳,刘林,楼青青,等.2型糖尿病患者自我管理行为及血糖控制现状的研究[J].中华护理杂志,2014,49(5):617-620.DOI:10.3761/j.issn.0254-1769.2014.05.026.JI J J,LIU L,LOU Q Q,et al.Self-management behaviors and glycemic control in patients with type 2 diabetes mellitus[J].Chinese Journal of Nursing,2014,49(5):617-620.DOI:10.3761/j.issn.0254-1769.2014.05.026.
[11]KEMPF K,KRUSE J,MARTIN S.ROSSO-in-praxi:a selfmonitoring of blood glucose-structured 12-week lifestyle intervention significantly improves glucometabolic control of patients with type2 diabetes mellitus[J].Diabetes Technology&Therapeutics,2010,12(7):547-553.DOI:10.1089/dia.2010.0008.
[12]于平平,肖湘成,王琳云,等.社区2型糖尿病患者的自我管理行为与其血糖控制的相关性研究[J].中南大学学报(医学版),2013,38(4):425-431.DOI:10.3969/j.issn.1672-7347.2013.04.015.YU P P,XIAO X C,WANG L Y,et al.Correlation between self-management behaviors and blood glucose control in patients with type 2 diabetes mellitus in community[J].Journal of Central South University(Medical Science),2013,38(4):425-431.DOI:10.3969/j.issn.1672-7347.2013.04.015.
[13]张会,张德桂,胡桑,等.2型糖尿病患者自我感受负担自我管理水平及应对方式的调查分析[J].安徽医学,2018,39(8):1004-1007.DOI:10.3969/j.issn.1000-0399.2018.08.031.ZHANG H,ZHANG D G,HU S,et al.Investigation and analysis of self perceived burden,self-management level and coping style in patients in type 2 diabetes mellitus[J].Anhui Medical Journal,2018,39(8):1004-1007.DOI:10.3969/j.issn.1000-0399.2018.08.031.
[14]诸骏仁,高润霖,赵水平,等.中国成人血脂异常防治指南(2016年修订版)[J].中国循环杂志,2016,31(10):937-953.DOI:10.3969/j.issn.1000-3614.2016.10.001.ZHU J R,GAO R L,ZHAO S P,et al.Guidelines for the prevention and treatment of dyslipidemia in Chinese adults(revised edition 2016)[J].Chinese Circulation Journal,2016,31(10):937-953.DOI:10.3969/j.issn.1000-3614.2016.10.001.2019032020190409
[2]International Diabetes Federation.IDF diabetes atlas 7th edition(2015)[EB/OL].(2015-12-01)[2018-07-12].https://www.idf.org/our-activities/advocacy-awareness/resources-and-tools/13:diabetes-atlas-seventh-edition.html.
[3]世界卫生组织.2016年世界卫生日:打败糖尿病[EB/OL].[2018-07-12].http://www.who.int/diabetes/zh/.
[4]世界卫生组织.全球糖尿病报告[EB/OL].(2016-04-06)[2018-07-12].http://www.who.int/diabetes/global-report/zh/.
[5]世界卫生组织.2010年世界卫生报告[EB/OL].(2010-11-29)[2018-07-12].http://www.who.int/whr/2010/zh/.
[6]刘璟瑜,贺攀峰,李素芳,等.医疗自付费用对T2DM血糖和抑郁的影响[J].现代临床医学,2018,44(4):247-250.DOI:10.11851/j.issn.1673-1557.2018.04.003.LIU J Y,HE P F,LI S F,et al.Correlation between medical self payment and blood glucose and depression in patients with type2 diabetes mellitus[J].Journal of Modern Clinical Medicine,2018,44(4):247-250.DOI:10.11851/j.issn.1673-1557.2018.04.003.
[7]宋安琪.医疗保险对慢性病患者就医行为及医疗负担的影响[D].哈尔滨:哈尔滨医科大学,2017.
[8]冉雪蓉,伍红艳,王龙,等.基于人群健康管理视角分析促进2型糖尿病早诊早治措施经济性的国外研究进展[J].中国全科医学,2018,21(34):4278-4282.DOI:10.12114/j.issn.1007-9572.2018.00.245.RAN X R,WU H Y,WANG L,et al.Recent advances in the economic evidence abroad of early detection and treatment of type 2diabetes:a review from the health management perspective[J].Chinese General Practice,2018,21(34):4278-4282.DOI:10.12114/j.issn.1007-9572.2018.00.245.
[9]赵雪,黄金,杨玲凤,等.2型糖尿病患者授权能力与医疗支持的相关性研究[J].中华护理杂志,2018,53(3):299-304.DOI:10.3761/j.issn.0254-1769.2018.03.010.ZHAO X,HUANG J,YANG L F,et al.Correlation between empowerment and medical support in patients with type 2 diabetes mellitus[J].Chinese Journal of Nursing,2018,53(3):299-304.DOI:10.3761/j.issn.0254-1769.2018.03.010.
[10]嵇加佳,刘林,楼青青,等.2型糖尿病患者自我管理行为及血糖控制现状的研究[J].中华护理杂志,2014,49(5):617-620.DOI:10.3761/j.issn.0254-1769.2014.05.026.JI J J,LIU L,LOU Q Q,et al.Self-management behaviors and glycemic control in patients with type 2 diabetes mellitus[J].Chinese Journal of Nursing,2014,49(5):617-620.DOI:10.3761/j.issn.0254-1769.2014.05.026.
[11]KEMPF K,KRUSE J,MARTIN S.ROSSO-in-praxi:a selfmonitoring of blood glucose-structured 12-week lifestyle intervention significantly improves glucometabolic control of patients with type2 diabetes mellitus[J].Diabetes Technology&Therapeutics,2010,12(7):547-553.DOI:10.1089/dia.2010.0008.
[12]于平平,肖湘成,王琳云,等.社区2型糖尿病患者的自我管理行为与其血糖控制的相关性研究[J].中南大学学报(医学版),2013,38(4):425-431.DOI:10.3969/j.issn.1672-7347.2013.04.015.YU P P,XIAO X C,WANG L Y,et al.Correlation between self-management behaviors and blood glucose control in patients with type 2 diabetes mellitus in community[J].Journal of Central South University(Medical Science),2013,38(4):425-431.DOI:10.3969/j.issn.1672-7347.2013.04.015.
[13]张会,张德桂,胡桑,等.2型糖尿病患者自我感受负担自我管理水平及应对方式的调查分析[J].安徽医学,2018,39(8):1004-1007.DOI:10.3969/j.issn.1000-0399.2018.08.031.ZHANG H,ZHANG D G,HU S,et al.Investigation and analysis of self perceived burden,self-management level and coping style in patients in type 2 diabetes mellitus[J].Anhui Medical Journal,2018,39(8):1004-1007.DOI:10.3969/j.issn.1000-0399.2018.08.031.
[14]诸骏仁,高润霖,赵水平,等.中国成人血脂异常防治指南(2016年修订版)[J].中国循环杂志,2016,31(10):937-953.DOI:10.3969/j.issn.1000-3614.2016.10.001.ZHU J R,GAO R L,ZHAO S P,et al.Guidelines for the prevention and treatment of dyslipidemia in Chinese adults(revised edition 2016)[J].Chinese Circulation Journal,2016,31(10):937-953.DOI:10.3969/j.issn.1000-3614.2016.10.001.2019032020190409
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