糖尿病前期社区健康管理存在的问题及策略建议  

Problems of Community Health Management in Prediabetic State and Corresponding Recommendations

作　　者：陈凯悦 李祥龙 冯钰珩 励晓红[1,2,3] 郭莺 CHEN Kaiyue;LI Xianglong;FENG Yuheng;LI Xiaohong;GUO Ying(School of Public Health,Fudan University,Shanghai 200032,China;China Research Center on Disability Issues,Fudan University,Shanghai 200032,China;Key Laboratory of Health Technology Assessment,National Health Commission,Fudan University,Shanghai 200032,China;Shanghai Baoshan District Wusong Central Hospital(Zhongshan Hospital Wusong Branch,Fudan University)Dean's Office,Shanghai 200940,China;Zhongshan Hospital Fudan University Discipline Inspection Commission,Shanghai 200032,China)

机构地区：[1]复旦大学公共卫生学院,上海市200032 [2]复旦大学中国残疾问题研究中心,上海市200032 [3]国民健康社会风险预警协同创新中心,上海市200032 [4]上海市宝山区吴淞中心医院(复旦大学附属中山医院吴淞医院)院长办公室,200940 [5]复旦大学附属中山医院纪律检查委员会,上海市200032

出　　处：《中国全科医学》2024年第28期3567-3573,3580,共8页Chinese General Practice

基　　金：国家自然科学基金资助项目(72274036);上海市卫生健康委员会卫生健康政策研究课题(2023HP82)。

摘　　要：背景2型糖尿病是危害我国人群健康的重大公共卫生问题,糖尿病前期人群是庞大的糖尿病后备军,对其进行适当干预可以预防或延缓糖尿病,但现阶段社区健康管理效果不佳。目的了解糖尿病前期社区健康管理实践中存在的问题及其影响因素,提出系统且可操作的糖尿病前期健康管理措施及相关策略建议。方法于2023年3—4月系统检索中国知网、万方数据知识服务平台、维普网、PubMed、Web of Science数据库中与糖尿病前期社区健康管理相关的文献,并基于多方视角于2023年4—5月在上海市社区、医院、疾病预防控制中心对20名社区卫生服务中心工作人员、卫生行政人员、临床内分泌科医生、疾病预防控制中心健康管理工作人员、糖尿病患者或前期人群及其家属、存在糖尿病危险因素者进行糖尿病前期社区健康管理现状、有关态度及看法等观点、服务接受程度等问题的访谈,基于文献和访谈形成的问题集进行鱼骨图分析,梳理糖尿病前期社区健康管理相关问题之间的层次并绘制鱼骨图。结果最终纳入14篇相关文献,总结基于文献和访谈归纳出的22条当前糖尿病前期社区健康管理所存在的问题,得出患者方面、干预范围、服务能力和信息系统4个方面的问题,并提出疾病风险认知水平、自我管理技能水平、经费预算、工作经验、工作量、服务可及性、电子健康档案建设水平和信息共享范围8个影响因素。结论糖尿病前期人群是社区健康管理的重要对象,政策变迁过程反映出对糖尿病前期人群的重视加强,但多方证据证明其目前仍是薄弱环节。针对当前实践中存在的问题,需提高社区卫生服务人员相关专业知识技能等管理能力,基于医联体建设优化信息系统平台,进一步形成集筛查、管理、干预于一体的更具可行性的连续性糖尿病前期健康管理模式。Background Type 2 diabetes is a major public health problem that jeopardizes the health of the population in China.The prediabetic state population is a huge reserve force for diabetes,for which appropriate intervention can prevent or delay diabetes,but community health management is ineffective at this stage.Objective To investigate the problems and influencing factors in community health management practice in prediabetic state,and propose systematic and operable strategies and recommendations on health management measures.Methods A systematic search was conducted from March to April 2023 to retrieve literature related to community health management of prediabetes in CNKI,Wanfang Data,CQVIP,PubMed,and Web of Science.The key informant interviews based on multiple perspectives were conducted from April to May 2023 in Shanghai communities,hospitals,and CDCs,which included 20 community health service center staff,health administrators,clinical endocrinologists,CDC health management staff,diabetes patients or prediabetes and their family members,and people with diabetes risk factors.The interviews content covered the current status of community health management of prediabetes,related attitudes and perceptions of prediabetes,and acceptance of relevant services.Fishbone diagram analysis were used for data analysis to sort out the hierarchy between the problems related to community health management of prediabetes.Results 14 relevant literature were eventually included to summarize 22 existing problems in community health management of prediabetic state based on literature and interviews,derive the problems in 4 dimension:patients,intervention scope,service ability and information system,and propose 8 influencing factors:disease risk perception level,self-management skill level,funding budget,work experience,workload,service accessibility,electronic health record construction level and information sharing scope level.Conclusion The prediabetic state population is an important target of community health management,and

关 键 词：糖尿病前期 健康管理 基本公共卫生服务 解决策略 

分 类 号：R587.1[医药卫生—内分泌]