社区慢性病管理的失访状况及影响因素探讨  

Status and Associated Factors of Lost to Follow-up in Community-based Chronic Disease Management

作　　者：李磊[1] 吴晓静[1] 闫文杰 秦军茹 刘薇薇[1] 

机构地区：[1]北京大学第三医院第二门诊部,北京市100191 [2]北大国际医院特需医疗部,北京市102206

出　　处：《中国全科医学》2017年第25期3079-3083,共5页Chinese General Practice

摘　　要：目的了解社区慢性病管理的失访状况并探讨可能的影响因素,为降低失访率提供依据。方法选取2016年2月—2017年1月在北京市海淀区育新社区卫生服务站慢性病管理科建档并接受管理的患者1 008例,根据随访情况分为随访组和失访组。通过查阅慢性病管理档案,收集慢性病患者的人口社会学特征;采用医患关系深度量表和就诊满意度调查表对患者进行问卷调查,了解医患关系和就诊满意度情况;通过电话调查了解失访患者的失访原因。结果 1 008例慢性病管理患者中,失访患者232例,失访率为23.0%。不同年龄、工作状况、文化程度、付费方式、病种数量以及是否与子女同住的患者失访率比较,差异有统计学意义(P<0.05);不同性别、婚姻状况的患者失访率比较,差异无统计学意义(P>0.05)。随访组和失访组分别有205例、65例患者完成问卷调查。随访组与失访组患者医患关系深度量表总分、各条目得分以及满意度得分比较,差异均有统计学意义(P<0.05)。接受电话调查的65例失访患者中,主要失访原因分别为搬家后在其他社区卫生服务机构就诊(47.7%,31/65),因报销原因更改就诊社区卫生服务机构(21.5%,14/65),更愿意选择去专科/专家门诊就诊(13.8%,9/65)。结论社区慢性病管理的失访率仍偏高,对于年龄<65岁、在职、文化程度偏低、自费、单病种以及家庭支持程度不足的患者人群需采取相应措施,加强随访管理,提高慢性病管理质量和效率。Objective To investigate the status of lost to follow - up in community - based chronic disease management and to explore the possible associated factors, so as to offer a reference for reducing the rate of lost to follow - up. Methods The enrolled participants were 1 008 cases of chronic disease comprising patients being followed up （follow -up group） and those lost to follow - up （ lost to follow - up group） who received file establishment and chronic disease management services delivered by Yuxin Community Health Service Station located in Haidian District, Beijing from February 2016 to January 2017. By reviewing the files, we collected their sociodemographic characteristics. A face - to - face survey was conducted in the follow - up group and a telephone survey was carried out in the lost to follow up group with the Patient - Doctor Depth - of - Relationship Scale （ PDDRS, Chinese version） for investigating the depth of patient - doctor relationship, and a self - developed Patient Satisfaction with the Medical Visit Questionnaire for investigating their satisfaction with the medical visit. And the lost to follow up group were surveyed about the reasons for lost to follow - up by telephone additionally. Results Of the 1 008 cases, 232 were lost to follow up with a rate of 23.0%. The rate of lost to follow- up significantly varied by age, employment status, educational attainment, methods for paying the medical expenses, number of diseases, and status of living with children （ P 〈 0. 05 ） , but not by sex and marital status （ P 〉 0. 05 ） . Two hundred and five in the follow - up group and 65 in the lost to follow - up group completed the survey. The two groups of participants had obvious differences in the total scores and item scores of PDDRS and level of satisfaction with the medical visit （ P 〈 0. 05 ） . The main reasons for lost to follow - up were seeking medical care in other community health service institutions after moving （47.7% （31/65） 1, changing the appointed com

关 键 词：社区卫生服务 慢性病管理 失访 影响因素分析 

分 类 号：R197[医药卫生—卫生事业管理]