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  

Effect of National Basic Public Health Service Utilization on regular medication behavior and glycemic control in type 2 diabetes mellitus

作　　者：刘美岑 刘远立[1] 尤莉莉[1] LIU Mei-cen;LIU Yuan-li;YOU Li-li(School of Health Policy and Management,Chinese Academy of Medical Science&Pking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院卫生健康管理政策学院,北京100730

出　　处：《公共卫生与预防医学》2022年第4期1-7,共7页Journal of Public Health and Preventive Medicine

基　　金：国家基本公共卫生服务十年效果评估(国家卫生健康委委托项目);美国中华医学基金会项目(CMB)基金资助(18-296)。

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岁及以上年龄2型糖尿病患者,男性占41.00%,65岁及以上年龄占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(χ^(2)_(趋势)=4.816,P<0.05),但血糖控制满意率趋势差异无统计学意义(χ^(2)_(趋势)=0.080,P>0.05)。多因素回归结果显示,高中及以上学历(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岁及以上年龄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、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.The effect of NBPHS utilization on the regular medication rate and glycemic control rate of type 2 diabetes patients was analyzed by logistic regression.Sensitivity analysis was carried out using the multilevel logistic method and the total score calculation method for basic public health services in different countries.Results A total of 1527 patients with type 2 diabetes aged 35 and over were recruited,41.00%were male,66.08%were aged 65 years old and above,and 39.64%were ill for 10 years and over.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(χ^(2)_(trend)=4.816,P<0.05),but there was no statistical difference in the trend of glycemic control rate(χ^(2)_(trend)=0.080,P>0.05).The multivariate regression analysis 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)were protective factors for the regular medication.Compared with the local household registration population,the local resident population(OR=0.54)was a risk factor for regular medication.Unmarried or divorced or

关 键 词：基本公共卫生服务 糖尿病 规律服药 血糖控制 

分 类 号：R181[医药卫生—流行病学]