糖尿病患者社区标准化代谢性疾病管理中心首诊意愿及影响因素分析  

Analysis of First Diagnosis Intention and Influencing Factors in Community Metabolic Management Center of Patients with Diabetes Mellitus

作　　者：王淼淼 马磊[2] 邹倩 祝延红 WANG Miaomiao;MA Lei;ZOU Qian(School of Public Health,School of Medicine,Shanghai Jiao Tong University,Shanghai,200240,China)

机构地区：[1]上海交通大学医学院公共卫生学院,上海200240 [2]上海交通大学医学院附属第一人民医院,上海200080

出　　处：《中国卫生质量管理》2023年第3期93-98,共6页Chinese Health Quality Management

基　　金：市一医院与松江区第三周期人才学科建设和疾病联合攻关合作计划“基于激励机制创新的慢性病分级诊疗体系优化的政策研究”。

摘　　要：目的调查上海市松江区标准化代谢性疾病管理中心(MMC)在管糖尿病患者社区MMC首诊意愿,分析影响因素,为推进分级诊疗和优化糖尿病管理提供参考。方法于2021年8月-10月,自行设计调查问卷,对松江区MMC在管的264名糖尿病患者进行现场调查。采用SPSS 24.0软件对数据进行统计分析,采用Logistic回归模型分析社区MMC首诊意愿影响因素。结果264名松江区MMC在管糖尿病患者社区MMC首诊意愿率为32.2%。回归分析显示,与其他职业相比,离退休、自由职业、企业工作糖尿病患者社区MMC首诊意愿较低;与月收入<5000元相比,月收入为5000元~<20000元糖尿病患者社区MMC首诊意愿较低;“MMC 1+X”模式知晓度越高,认为社区MMC医生注重沟通、社区MMC药品能够满足需求程度越大,分级诊疗认可度越高,糖尿病患者社区MMC首诊意愿越强。结论上海市松江区MMC在管糖尿病患者社区MMC首诊意愿较低,需从加大宣传力度、完善硬件设施、重视医疗保险控费引导作用、持续提升社区MMC卫生服务能力等方面优化管理模式。Objective To investigate the first diagnosis intention of patients with diabetes in the community Metabolic Management Center(MMC)in Songjiang District of Shanghai,analyze the influencing factors,and provide reference for promoting hierarchical diagnosis and treatment and optimizing diabetes management.Methods From August to October 2021,a self-designed questionnaire was used to conduct a field investigation on 264 diabetic patients in MMC in Songjiang District.SPSS 24.0 software was used for statistical analysis of the data,and Logistic regression model was used to analyze the factors influencing the intention of first diagnosis of MMC in the community.Results A total of 264 people were surveyed in this study,of which the initial intention rate of community MMC was 32.2%.Regression analysis showed that the first consultation rate at the primary level was lower among the people who were freelancers,corporate workers.Compared with the income of 5000 Yuan per month,the patients with Fmonthly income of 5000 Yuan to less than 20000 Yuan were less willing to receive the first visit of MMC.The higher the awareness of"MMC 1+X"mode,the greater the degree to which MMC doctors paid attention to communication,the greater the degree to which MMC drugs could meet the needs,the higher the degree of recognition of hierarchical diagnosis and treatment,and the higher the intention of first diagnosis of MMC in the community of diabetic patients.Conclusion In Songjiang District of Shanghai,the first diagnosis intention in the community MMC among patients with diabetes was low.Therefore,it is necessary to optimize the management mode by strengthening the publicity,improving hardware facilities,attaching importance to the guiding role of medical insurance fee control,and continuously improving the health service ability of community MMC.

关 键 词：分级诊疗 基层首诊 标准化代谢性疾病管理中心 糖尿病 首诊意愿 

分 类 号：R197.6[医药卫生—卫生事业管理] R587.1[医药卫生—公共卫生与预防医学]