社区“5+1”糖尿病分阶段达标管理模式对2型糖尿病并发症筛查的干预效果
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摘要
目的了解社区"5+1"糖尿病分阶段达标管理模式(以下简称"5+1"模式)在不同经济发展水平地区社区糖尿病患者中并发症筛查的干预效果,为"5+1"模式在不同地区的推广提供参考依据。方法于2015年6月至2017年12月,采用分层整群抽样的方法选取江苏省南京市、山西省晋中市和宁夏回族自治区银川市3个城市6个区的12家社区卫生服务中心的2 467名2型糖尿病患者为研究对象,进行社区糖尿病管理干预试验。以社区卫生服务中心为基本单位,将每个区内的2家社区卫生服务中心随机分为干预组和对照组,干预组采用"5+1"模式管理,共1 253例患者,对照组采用"基本公共卫生服务"模式管理,共1 214例患者。采用面对面的问卷调查方式收集患者的一般人口学特征和糖尿病相关并发症筛查情况,录入项目组自主研发的"糖尿病分阶段达标管理系统"。采用倾向得分匹配法(PSM)对随访满2年的患者进行分地区匹配,共筛选出1 514名患者进行分析。采用SPSS 22.0软件进行t检验、方差分析和χ~2检验。结果干预后,干预组眼底检查率、足部检查率、尿微量白蛋白检查率和心电图检查率均较干预前升高,差异均有统计学意义(P<0.01);足部检查率、尿微量白蛋白检查率和心电图检查率均高于对照组,差异均有统计学意义(P<0.01)。干预后,江苏地区干预组患者的足部检查率、尿微量白蛋白检查率高于山西和宁夏地区干预组患者,差异有统计学意义(P<0.01)。结论 "5+1"模式在不同地区表现出不同的干预效果,可依据当地经济发展水平和医疗卫生资源环境等调整干预措施和方式,以最大化"5+1"模式的干预效果。
Objective To understand the intervention effects of "5+1" grading management mode of diabetes in communities on the screening of T2 DM complications in communities of areas with different economical levels,and to provide the basis for spreading the "5+1" grading management mode of diabetes. Methods From June of 2015 to December of 2017,the stratified cluster sampling method was used to select 2 467 T2 DM patients from 12 communities in 6 districts of 3 cities(Nanjing,Jinzhong and Yinchuan) as the subjects for intervention experiments of T2 DM management in communities. The service center of community was served as a basic unit. Two service centers of community in each district were divided randomly into study group(1 253 cases) and control group(1 214 cases). The study group received "5 +1" grading management mode,and the control group received "basic public health service" management mode. The investigation was performed by the questionnaire face to face. The data about general demography and the complications related to T2 DM of patients were collected. The data were put into "Staged Diabetes Targeting Management System". Propensity Score Matching(PSM) was used to distribute the subjects following up for 2 years according to the areas. The t test,χ~2 test and ANOVA were used to analyze the data of screened 1 514 cases. The used software was SPSS 22.0. Results After intervention,the screening rates of fundus examination,foot examination,urine microalbumin examination and electrocardiogram examination in the study group were significantly higher than those in the study group before intervention(P<0.01);the screening rates of foot examination,urine microalbumin examination and electrocardiogram examination in the study group were significantly higher than those in the control group after intervention(P<0.01). After intervention,the screening rates of foot examination and urine microalbumin examination in Jiangsu area were significantly higher than those in Shanxi and Ningxia areas(P <0.01).Conclusion The effects of "5 +1" mode were different in different areas,the intervention measures and modes could be adjusted according to economic level and health resource,resulting to the maximized intervention effects of "5+1" mode.
Objective To understand the intervention effects of "5+1" grading management mode of diabetes in communities on the screening of T2 DM complications in communities of areas with different economical levels,and to provide the basis for spreading the "5+1" grading management mode of diabetes. Methods From June of 2015 to December of 2017,the stratified cluster sampling method was used to select 2 467 T2 DM patients from 12 communities in 6 districts of 3 cities(Nanjing,Jinzhong and Yinchuan) as the subjects for intervention experiments of T2 DM management in communities. The service center of community was served as a basic unit. Two service centers of community in each district were divided randomly into study group(1 253 cases) and control group(1 214 cases). The study group received "5 +1" grading management mode,and the control group received "basic public health service" management mode. The investigation was performed by the questionnaire face to face. The data about general demography and the complications related to T2 DM of patients were collected. The data were put into "Staged Diabetes Targeting Management System". Propensity Score Matching(PSM) was used to distribute the subjects following up for 2 years according to the areas. The t test,χ~2 test and ANOVA were used to analyze the data of screened 1 514 cases. The used software was SPSS 22.0. Results After intervention,the screening rates of fundus examination,foot examination,urine microalbumin examination and electrocardiogram examination in the study group were significantly higher than those in the study group before intervention(P<0.01);the screening rates of foot examination,urine microalbumin examination and electrocardiogram examination in the study group were significantly higher than those in the control group after intervention(P<0.01). After intervention,the screening rates of foot examination and urine microalbumin examination in Jiangsu area were significantly higher than those in Shanxi and Ningxia areas(P <0.01).Conclusion The effects of "5 +1" mode were different in different areas,the intervention measures and modes could be adjusted according to economic level and health resource,resulting to the maximized intervention effects of "5+1" mode.
引文
[1] Wang L,Gao P,Zhang M,et al. Prevalence and ethnic pattern of diabetes and prediabetes in China in 2013[J]. JAMA,2017,317(24):2515-2523.
[2]贾伟平.血糖控制的新理念新趋势[J].上海医学,2008,31(11):761-762.
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[4]娄青林,卞茸文,刘冬梅,等.社区“5+1”分阶段糖尿病达标管理模式对2型糖尿病患者的干预效果及其影响因素研究[J].中国全科医学,2015,18(22):2713-2717.
[5]俞匀,娄青林,唐伟.分阶段达标管理模式对社区老年2型糖尿病患者干预效果分析[J].老年医学与保健,2017,23(6):516-519.
[6]中华人民共和国卫生健康委员会基层卫生健康司.卫生部关于印发《国家基本公共卫生服务规范(2011年版)》的通知[EB/OL].[2018-11-05].http://www.nhfpc.gov.cn/jws/s3577/201105/51780.shtml.
[7] Liu Z,Fu C,Wang W,et al. Prevalence of chronic complications of type 2 diabetes mellitus in outpatients-a cross-sectional hospital based survey in urban China[J]. Health Qual Life Outcomes,2010,8(1):62-9.DOI:10.1186/1477-7525-8-62
[8]朱平,许樟荣.糖尿病并发症筛查的意义与方法[J].中国医刊,2017,52(2):1-2.
[9]吴航,孙子林.着眼糖尿病并发症,降糖与减肥并重—2017年版AACE/ACE 2型糖尿病综合管理方案共识声明解读[J].中国全科医学,2017,20(21):2555-2560.
[10]刘颖,梅伟群,李志琛,等. 1162例2型糖尿病患者慢性并发症筛查结果分析[J].武汉大学学报(医学版),2014,35(2):222-227.
[11]赵文惠,张金苹,帅瑛.北京市社区2型糖尿病患者微血管并发症筛查率与糖尿病知识水平关系分析[J].中华糖尿病杂志,2015,7(8):478-481.
[12]王君,周正元,张宁,等.社区糖尿病患者足部护理行为现况及影响因素分析[J].中国慢性病预防与控制,2018,26(4):254-261.
[13]黄凌宁,罗莉.糖尿病足早期筛查与诊断技术进行社区推广应用的价值[J].中国老年学杂志,2014,34(13):3550-3551.
[14]中华人民共和国国家统计局.江苏省城镇居民人均可支配收入[EB/OL].[2018-06-18].http://data.stats.gov.cn/easyquery.htm?cn=E0103&zb=A0A02®=320000&sj=2016.
[15]中华人民共和国国家统计局.宁夏回族自治区城镇居民人均可支配收入[EB/OL].[2018-06-18].http://data.stats.gov.cn/easyquery.htm?cn=E0103&zb=A0A02®=640000&sj=2016.
[16]中华人民共和国国家统计局.山西省城镇居民人均可支配收入[EB/OL].[2018-06-18].http://data.stats.gov.cn/easyquery.htm?cn=E0103&zb=A0201®=140000&sj=2016.
[17]叶迎风,张馨予,窦冠珅,等. 2型糖尿病三种并发症筛查的成本研究[J].上海预防医学,2018,30(6):493-496.
[2]贾伟平.血糖控制的新理念新趋势[J].上海医学,2008,31(11):761-762.
[3]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版)[J].中华内分泌代谢杂志,2014,30(10):447-498.
[4]娄青林,卞茸文,刘冬梅,等.社区“5+1”分阶段糖尿病达标管理模式对2型糖尿病患者的干预效果及其影响因素研究[J].中国全科医学,2015,18(22):2713-2717.
[5]俞匀,娄青林,唐伟.分阶段达标管理模式对社区老年2型糖尿病患者干预效果分析[J].老年医学与保健,2017,23(6):516-519.
[6]中华人民共和国卫生健康委员会基层卫生健康司.卫生部关于印发《国家基本公共卫生服务规范(2011年版)》的通知[EB/OL].[2018-11-05].http://www.nhfpc.gov.cn/jws/s3577/201105/51780.shtml.
[7] Liu Z,Fu C,Wang W,et al. Prevalence of chronic complications of type 2 diabetes mellitus in outpatients-a cross-sectional hospital based survey in urban China[J]. Health Qual Life Outcomes,2010,8(1):62-9.DOI:10.1186/1477-7525-8-62
[8]朱平,许樟荣.糖尿病并发症筛查的意义与方法[J].中国医刊,2017,52(2):1-2.
[9]吴航,孙子林.着眼糖尿病并发症,降糖与减肥并重—2017年版AACE/ACE 2型糖尿病综合管理方案共识声明解读[J].中国全科医学,2017,20(21):2555-2560.
[10]刘颖,梅伟群,李志琛,等. 1162例2型糖尿病患者慢性并发症筛查结果分析[J].武汉大学学报(医学版),2014,35(2):222-227.
[11]赵文惠,张金苹,帅瑛.北京市社区2型糖尿病患者微血管并发症筛查率与糖尿病知识水平关系分析[J].中华糖尿病杂志,2015,7(8):478-481.
[12]王君,周正元,张宁,等.社区糖尿病患者足部护理行为现况及影响因素分析[J].中国慢性病预防与控制,2018,26(4):254-261.
[13]黄凌宁,罗莉.糖尿病足早期筛查与诊断技术进行社区推广应用的价值[J].中国老年学杂志,2014,34(13):3550-3551.
[14]中华人民共和国国家统计局.江苏省城镇居民人均可支配收入[EB/OL].[2018-06-18].http://data.stats.gov.cn/easyquery.htm?cn=E0103&zb=A0A02®=320000&sj=2016.
[15]中华人民共和国国家统计局.宁夏回族自治区城镇居民人均可支配收入[EB/OL].[2018-06-18].http://data.stats.gov.cn/easyquery.htm?cn=E0103&zb=A0A02®=640000&sj=2016.
[16]中华人民共和国国家统计局.山西省城镇居民人均可支配收入[EB/OL].[2018-06-18].http://data.stats.gov.cn/easyquery.htm?cn=E0103&zb=A0201®=140000&sj=2016.
[17]叶迎风,张馨予,窦冠珅,等. 2型糖尿病三种并发症筛查的成本研究[J].上海预防医学,2018,30(6):493-496.