山东省糖尿病患者治疗依从性影响因素的定性分析
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摘要
目的:从卫生体系的角度系统分析影响糖尿病患者治疗依从性的因素,并提出改善建议。方法:采用焦点小组讨论法收集资料,运用Nvivo11及主题框架法进行定性资料的编码和分析。结果:影响糖尿病患者治疗依从性的因素包括:患者的知识水平较低、健康意识薄弱、生活习惯和经济状况较差;卫生服务提供者的知识技能缺乏、糖尿病管理服务不足以及各机构间合作欠缺;基本药物的限制和不完善的医疗保险报销政策。结论:社区糖尿病管理应更加重视卫生系统中关键要素的调整,通过改善服务的连续性和协调性来提高糖尿病患者的治疗依从性。
Objective: To analyze the factors influencing the treatment compliance of DM2 patient from the perspectives of community health care providers and to give some suggestions on improving the performance of community-based diabetes management. Methods: Eight focus group interviews were used for data collection,and we use the Nvivo11 and thematic framework analysis to code and analyze qualitative data. Results: The factors affecting the treatment compliance of T2 DM patients were categorized into patient-related factors,provider-related factors and health system-related factors. Patient-related factors included insufficient knowledge,bad health awareness and life habits and poor economic status of patients. Provider-related factors included the lack of knowledge and skills,insufficient provision of diabetes management services and poor service coordination between providers.Health system-related factors included basic drug use restriction and incorrect reimbursement of health insurance. Conclusion:Community-based diabetes management should pay more attention to adjustment of the key elements in health system which may be useful for improving the continuity and coordination of service.
Objective: To analyze the factors influencing the treatment compliance of DM2 patient from the perspectives of community health care providers and to give some suggestions on improving the performance of community-based diabetes management. Methods: Eight focus group interviews were used for data collection,and we use the Nvivo11 and thematic framework analysis to code and analyze qualitative data. Results: The factors affecting the treatment compliance of T2 DM patients were categorized into patient-related factors,provider-related factors and health system-related factors. Patient-related factors included insufficient knowledge,bad health awareness and life habits and poor economic status of patients. Provider-related factors included the lack of knowledge and skills,insufficient provision of diabetes management services and poor service coordination between providers.Health system-related factors included basic drug use restriction and incorrect reimbursement of health insurance. Conclusion:Community-based diabetes management should pay more attention to adjustment of the key elements in health system which may be useful for improving the continuity and coordination of service.
引文
[1]ASCHNER P. New IDF clinical practice recommendations for managing type 2 diabetes in primary care[J].Diabetes research&clinical practice,2017(132):169-170.
[2]秦文哲,徐凌忠,毕鹏飞.老年慢性病患者用药依从性研究进展[J].中国卫生事业管理,2018,35(5):350-353.
[3]郁海东.社区健康教育对老年糖尿病合并高血压患者治疗依从性的影响研究[J].中国社会医学杂志,2014,31(4):293-295.
[4]张亚妮.家庭支持对糖尿病患者居家治疗依从性的影响[J].西部医学,2015,27(2):301-303.
[5]WHO. Everybody's business:Strengthening health systems to improve health outcomes. WHO's framework for action[R]. Geneva Switzerland:WHO,2007.
[6]许荣,黄樱,张玉玲,等. 2型糖尿病患者治疗依从性影响因素分析及预防对策研究[J].赣南医学院学报,2017,37(2):230-232.
[7]韩开益,姚静静,王海鹏,等.山东省农村糖尿病管理现状定性研究[J].中国公共卫生,2017,32(10):1493-1497.
[8]龚静,元国平,袁芳,等.2型糖尿病患者食物手测量交换份法干预效果评价[J].预防医学,2018,30(1):63-66.
[9]何静,何爱琼,刘芳宇.多媒体影像健康教育对巴中市某医院糖尿病患者依从性的影响[J].医学与社会,2016,29(4):55-57.
[10]李菁,李峥,MARIE NOLAN,等.影响糖尿病患者自我管理的心理社会因素的研究进展[J].中华护理杂志,2014,49(2):207-211.
[11]张旭熙,吴士艳,王冯彬,等.社区糖尿病患者获得社会支持与自我管理行为的相关关系[J].北京大学学报(医学版),2017,49(3):455-461.
[12]孙娟,张会敏,朱丽丽.以家庭为中心的健康教育对社区糖尿病患者自我管理水平的影响[J].中国老年学杂志,2016,36(17):4194-4196.
[13]王建敏.社区2型糖尿病患者参与自我管理小组活动的效果分析[J/OL].[2018-08-22].中国医院药学杂志:1-3. http://58. 194. 172. 12:80/rwt/CNKI/http/NNYHGLUDN3WXTLUPMW4A/kcms/detail/42. 1204.R.20180122.1433.006.html.
[14]汪苗,邢彩霞.新医改背景下城市慢病健康管理问题探析[J].医学与哲学(B),2017,38(2):87-90.
[15]杨叔禹,陈粮.慢病先行三师共管分级诊疗改革让群众得实惠——厦门市推进分级诊疗改革探索之路[J].现代医院管理,2016,14(4):1-6.
[16]董香书,PROOCHISTA ARIANA,肖翔.中国农村医生离职倾向研究——基于工作收入、医院管理与医患关系的实证分析[J].经济评论,2013(2):30-39.
[2]秦文哲,徐凌忠,毕鹏飞.老年慢性病患者用药依从性研究进展[J].中国卫生事业管理,2018,35(5):350-353.
[3]郁海东.社区健康教育对老年糖尿病合并高血压患者治疗依从性的影响研究[J].中国社会医学杂志,2014,31(4):293-295.
[4]张亚妮.家庭支持对糖尿病患者居家治疗依从性的影响[J].西部医学,2015,27(2):301-303.
[5]WHO. Everybody's business:Strengthening health systems to improve health outcomes. WHO's framework for action[R]. Geneva Switzerland:WHO,2007.
[6]许荣,黄樱,张玉玲,等. 2型糖尿病患者治疗依从性影响因素分析及预防对策研究[J].赣南医学院学报,2017,37(2):230-232.
[7]韩开益,姚静静,王海鹏,等.山东省农村糖尿病管理现状定性研究[J].中国公共卫生,2017,32(10):1493-1497.
[8]龚静,元国平,袁芳,等.2型糖尿病患者食物手测量交换份法干预效果评价[J].预防医学,2018,30(1):63-66.
[9]何静,何爱琼,刘芳宇.多媒体影像健康教育对巴中市某医院糖尿病患者依从性的影响[J].医学与社会,2016,29(4):55-57.
[10]李菁,李峥,MARIE NOLAN,等.影响糖尿病患者自我管理的心理社会因素的研究进展[J].中华护理杂志,2014,49(2):207-211.
[11]张旭熙,吴士艳,王冯彬,等.社区糖尿病患者获得社会支持与自我管理行为的相关关系[J].北京大学学报(医学版),2017,49(3):455-461.
[12]孙娟,张会敏,朱丽丽.以家庭为中心的健康教育对社区糖尿病患者自我管理水平的影响[J].中国老年学杂志,2016,36(17):4194-4196.
[13]王建敏.社区2型糖尿病患者参与自我管理小组活动的效果分析[J/OL].[2018-08-22].中国医院药学杂志:1-3. http://58. 194. 172. 12:80/rwt/CNKI/http/NNYHGLUDN3WXTLUPMW4A/kcms/detail/42. 1204.R.20180122.1433.006.html.
[14]汪苗,邢彩霞.新医改背景下城市慢病健康管理问题探析[J].医学与哲学(B),2017,38(2):87-90.
[15]杨叔禹,陈粮.慢病先行三师共管分级诊疗改革让群众得实惠——厦门市推进分级诊疗改革探索之路[J].现代医院管理,2016,14(4):1-6.
[16]董香书,PROOCHISTA ARIANA,肖翔.中国农村医生离职倾向研究——基于工作收入、医院管理与医患关系的实证分析[J].经济评论,2013(2):30-39.