国家基本公共卫生服务利用对2型糖尿病患者规律服药行为及血糖控制的影响研究

The Effect of National Basic Public Health Service Utilization on Regular Medication Behavior and Glycemic Control in Type 2 Diabetes Mellitus

摘要:

目的 探索我国基本公共卫生服务利用对2型糖尿病患者规律服药行为及血糖控制的影响，为2型糖尿病患者健康管理实践提供支持。方法 基于多阶段分层抽样方法，于2019年11~12月在我国浙江省、山西省及重庆市的10个社区卫生服务中心或乡镇卫生院选取35岁及以上2型糖尿病患者开展问卷调查，获取其社会人口学信息、最近一年基本公共卫生服务利用、最近6个月规律服药以及血糖控制等资料，分析不同特征患者的规律服药率和血糖控制满意率，并利用多因素logistic回归分析国家基本公共卫生服务利用对2型糖尿病患者规律服药率和血糖控制满意率的影响。采用多水平logistic方法、不同国家基本公共卫生服务利用总分计算方法进行敏感性分析。结果 共纳入1527例35岁及以上2型糖尿病患者，男性占41.00%，65岁及以上占66.08%，病程10年及以上占39.64%。患者总体规律服药率为89.26%，总体血糖控制满意率为65.23%，服务利用总分为11.83±2.246（范围0-15分），随着服务利用总分增加2型糖尿病患者规律服药率呈一定上升趋势(χ2趋势 =4.816，P＜0.05)，但血糖控制满意率趋势未呈现出统计学差异(χ2趋势 =0.080，P＞0.05)。多因素回归结果显示，高中及以上(OR高中及以上=2.20)、病程时长增加(OR 5-9年=1.62，OR 10年及以上=3.92)、服务利用总分高(OR Q3=2.01)是规律服药的保护因素；相比本地户籍人口，本地常住人口(OR =0.54)是规律服药的危险因素。未婚/离异/丧偶(OR =0.61)、病程时长增加(OR 10年及以上=0.60)是血糖控制满意的危险因素，家庭人均月收入增加(OR 2000-5000元=1.52，OR 5000元以上=1.76)是血糖控制满意的保护因素。结论 国家基本公共卫生服务利用促进了35岁及以上2型糖尿病患者规律服药率，且服务利用程度越高，对其影响越大。应重点关注低学历水平、非本地户籍、病程较短、无伴侣的患者，加强其对国家基本公共卫生服务的利用，促进其健康意识及健康行为的改变。

Abstract:

Abstract: Objective To explore the effect of the utilization of National Basic Public Health Service (NBPHS) on the regular medication behavior and glycemic control of patients aged 35 and over with type 2 diabetes, and to provide support for the health management practice of type 2 diabetes patients in China.Methods Based on the multi-stage stratified sampling method, a questionnaire survey was conducted in 10 community health service centers or township health centers in Zhejiang Province, Shanxi Province and Chongqing City in China from November to December 2019. The data of socio-demographic characteristics, utilization of NBPHS in the last year, regular medication in the last six months and glycemic control were collected. And the effect of national basic public health service utilization on the regular medication rate and glycemic control rate of type 2 diabetes patients was analyzed by logistic regression. sensitivity analysis were applied.Results A total of 1527 patients aged 35 and over with type 2 diabetes were recruited, with the proportion of 41.00% men, 66.08% aged 65 and over and the course of 10 years and above accounted for 39.64%. The survey showed that the regular medication rate was 89.26%, the glycemic control rate was 65.23%, and the score on utilization of NBPHS was 11.83±2.246 (range 0-15) . With the more utilization of NBPHS, regular medication rate in patients with type 2 diabetes increased (χ2 trend =4.816, P<0.05), the glycemic control rate was no statistical trend (χ2 trend =0.080, P>0.05). Multivariate regressions showed that secondary school and above (OR=2.20), longer duration of disease (OR 5-9 years =1.62, OR 10 year and above =3.92) and higher utilization score of NBPHS(OR Q3=2.01) are protective factors of the regular medication; compared to local resident, domestic resident population (OR =0.54) is a risk factor. Unmarried or divorced or widowed (OR =0.61) and longer duration of disease (OR 10 years and above =0.60) are risk factors for satisfactory glycemic control, and increased monthly income per household (OR 2000-5000 yuan=1.52 , OR More than 5000 yuan =1.76) is a protective factor for satisfactory glycemic control.Conclusion The utilization of NBPHS has promoted the regular medication rate of patients with type 2 diabetes, and the higher utilization takes better effect. Emphasis should be paid on patients with low education, non-local resident, short duration of disease and without couple and strengthen their utilization of NBPHS and promote the change of their health awareness and health behavior.