目的 通过对影响2型糖尿病患者规范化管理行为的因素进行分析,进一步完善2型糖尿病链式分层管理模式.方法 ( 1)将入选我院2型糖尿病链式分层管理软件满一年以上的患者690例,分为糖化血红蛋白控制达标组(＜7.0％)、未达标组(≥7.0％),对两组患者的饮食控制、运动、用药、血糖自我监测、参加健康讲座的情况进行统计分析.(2)将入选的690例患者分为规范化管理组及非规范化管理组,将两组的年龄、性别、学历、职业状态、人均月收入、医疗保障、糖尿病病程、对糖尿病认知、双向转诊、慢性并发症情况进行统计分析.结果 (1)糖化血红蛋白控制达标组在运动、血糖监测方面、参加健康教育方面比率均高于未达标组(比率分别为70.1％与54.2％,x2=6.163,P=0.018；60.4％ 与43.8％,x2=6.268,P=0.016；56.0％与41.7％,x2=4.577,P=0.045),差异均有统计学意义.(2)规范化管理组在年龄、学历、医疗保障、对糖尿病认知、双向转诊,并发症方面与未规范化管理组比较差异均有统计学意义[年龄:(61.08±10.04)岁与(57.75±9.89)岁,t=2.539,P=0.012；低学历比率:8.3％与17.2％,x2=6.426,P=0.041;自费比率:4.6％与11.5％,x2=3.543,P=0.048;糖尿病认知差的比率:19.4％与41.0％,x2=17.518,P=0.000;未转或拒绝转诊比率4.6％与14.8％,x2=7.662,P=0.022;合并慢性并发症比率:41.7％与26.2％,x2=6.130,P=0.017].(3)经Logistic逐步回归分析显示:年龄、人均月收入、医疗保障、对糖尿病认知、未转或拒绝转诊、慢性并发症是影响患者规范化管理的影响因素(OR=0.954,P=0.006; OR=4.101,P=0.018；OR=7.617,P=0.003；OR=0.030,P=0.000；OR=9.079,P=0.000; OR=0.456,P=0.031).结论 应该针对影响患者规范化管理的影响因素包括年龄、人均月收入、医疗保障、对糖尿病认知、未转或拒绝转诊率、慢性并发症积极制定策略,完善2型糖尿病链式分层管理模式,使糖尿病患者早期参与规范化管理,延缓并发症的出现.
目的 通過對影響2型糖尿病患者規範化管理行為的因素進行分析,進一步完善2型糖尿病鏈式分層管理模式.方法 ( 1)將入選我院2型糖尿病鏈式分層管理軟件滿一年以上的患者690例,分為糖化血紅蛋白控製達標組(＜7.0％)、未達標組(≥7.0％),對兩組患者的飲食控製、運動、用藥、血糖自我鑑測、參加健康講座的情況進行統計分析.(2)將入選的690例患者分為規範化管理組及非規範化管理組,將兩組的年齡、性彆、學歷、職業狀態、人均月收入、醫療保障、糖尿病病程、對糖尿病認知、雙嚮轉診、慢性併髮癥情況進行統計分析.結果 (1)糖化血紅蛋白控製達標組在運動、血糖鑑測方麵、參加健康教育方麵比率均高于未達標組(比率分彆為70.1％與54.2％,x2=6.163,P=0.018；60.4％ 與43.8％,x2=6.268,P=0.016；56.0％與41.7％,x2=4.577,P=0.045),差異均有統計學意義.(2)規範化管理組在年齡、學歷、醫療保障、對糖尿病認知、雙嚮轉診,併髮癥方麵與未規範化管理組比較差異均有統計學意義[年齡:(61.08±10.04)歲與(57.75±9.89)歲,t=2.539,P=0.012；低學歷比率:8.3％與17.2％,x2=6.426,P=0.041;自費比率:4.6％與11.5％,x2=3.543,P=0.048;糖尿病認知差的比率:19.4％與41.0％,x2=17.518,P=0.000;未轉或拒絕轉診比率4.6％與14.8％,x2=7.662,P=0.022;閤併慢性併髮癥比率:41.7％與26.2％,x2=6.130,P=0.017].(3)經Logistic逐步迴歸分析顯示:年齡、人均月收入、醫療保障、對糖尿病認知、未轉或拒絕轉診、慢性併髮癥是影響患者規範化管理的影響因素(OR=0.954,P=0.006; OR=4.101,P=0.018；OR=7.617,P=0.003；OR=0.030,P=0.000；OR=9.079,P=0.000; OR=0.456,P=0.031).結論 應該針對影響患者規範化管理的影響因素包括年齡、人均月收入、醫療保障、對糖尿病認知、未轉或拒絕轉診率、慢性併髮癥積極製定策略,完善2型糖尿病鏈式分層管理模式,使糖尿病患者早期參與規範化管理,延緩併髮癥的齣現.
목적 통과대영향2형당뇨병환자규범화관리행위적인소진행분석,진일보완선2형당뇨병련식분층관리모식.방법 ( 1)장입선아원2형당뇨병련식분층관리연건만일년이상적환자690례,분위당화혈홍단백공제체표조(＜7.0％)、미체표조(≥7.0％),대량조환자적음식공제、운동、용약、혈당자아감측、삼가건강강좌적정황진행통계분석.(2)장입선적690례환자분위규범화관리조급비규범화관리조,장량조적년령、성별、학력、직업상태、인균월수입、의료보장、당뇨병병정、대당뇨병인지、쌍향전진、만성병발증정황진행통계분석.결과 (1)당화혈홍단백공제체표조재운동、혈당감측방면、삼가건강교육방면비솔균고우미체표조(비솔분별위70.1％여54.2％,x2=6.163,P=0.018；60.4％ 여43.8％,x2=6.268,P=0.016；56.0％여41.7％,x2=4.577,P=0.045),차이균유통계학의의.(2)규범화관리조재년령、학력、의료보장、대당뇨병인지、쌍향전진,병발증방면여미규범화관리조비교차이균유통계학의의[년령:(61.08±10.04)세여(57.75±9.89)세,t=2.539,P=0.012；저학력비솔:8.3％여17.2％,x2=6.426,P=0.041;자비비솔:4.6％여11.5％,x2=3.543,P=0.048;당뇨병인지차적비솔:19.4％여41.0％,x2=17.518,P=0.000;미전혹거절전진비솔4.6％여14.8％,x2=7.662,P=0.022;합병만성병발증비솔:41.7％여26.2％,x2=6.130,P=0.017].(3)경Logistic축보회귀분석현시:년령、인균월수입、의료보장、대당뇨병인지、미전혹거절전진、만성병발증시영향환자규범화관리적영향인소(OR=0.954,P=0.006; OR=4.101,P=0.018；OR=7.617,P=0.003；OR=0.030,P=0.000；OR=9.079,P=0.000; OR=0.456,P=0.031).결론 응해침대영향환자규범화관리적영향인소포괄년령、인균월수입、의료보장、대당뇨병인지、미전혹거절전진솔、만성병발증적겁제정책략,완선2형당뇨병련식분층관리모식,사당뇨병환자조기삼여규범화관리,연완병발증적출현.
Objective To analysis the influence factors of standardization in the hierarchical chain management of type 2 diabetes and to enhance the hierarchical chain management of type 2 diabetes.Methods ( 1 ) Six hundred and ninty patients with type 2 diabetes completed 1 years management were divided into well-controlled glycosylated hemoglobin ( HbAlc ) group (＜7.0％ ) and bad-controlled glycosylated hemoglobin (HbAlc) group ( ≥ 7.0％ ).The conditions of diet,physical activity,medication,self-blood sugar monitoring and participation in health seminars were investigated and analyzed.(2) The patients were divided into standardized management group and not standardized management group.Their age,sex,educational background,occupation,monthly income per person,medical security,the course,cognition for glycuresis,two-way transfer,and chronic complications were investigated and statistically analyzed.Results ( 1 ) The proportions of physical activity (70.1％ vs 54.2％,x2=6.163,P=0.018),self-blood sugar monitoring(60.4％ vs 43.8％,x2=6.268,P=0.016) and participation in health seminars (56.0％ vs 41.7％,x2=4.577,P=0.045) in the well-controlled HbAlc group were significantly higher than those in the bad-controlled HbAlc group.(2) Their age [(61.08 ±10.04) years old vs ( 57.75 ± 9.89 ) years old,t=2.539,P=0.012],educational background ( ratio of low educational attainment:8.3 ％ vs 17.2％,x2=6.426,P=0.041 ),medical security (own expense ratios:4.6％ vs 11.5％,x2=3.543,P=0.048 ),awareness of diabetes ( ratio of poor awareness of diabetes:19.4％ vs 41.0％,x2=17.518,P=0.000 ),two-way transfer ( ratio of not transfer treatment:4.6％ vs 14.8％,x2=7.662,P=0.022) and chronic complications ( ratio of chronic complication:41.7 ％ vs 26.2％,x2=6.130,P=0.017) were significantly different between the standardized management group and not standardized management group.(3) Logistic regression analyses indicated that the age ( OR=0.954,P=0.006),monthly income per person ( OR=4.101,P=0.018 ),medical security ( OR=7.617,P=0.003 ),cognition for glycuresis ( OR=0.030,P=0.000),two-way transfer ( OR=9.079,P=0.000) and chronic complications ( OR=0.456,P=0.031 ) were the risk factors of standardized management.Conclusion We should focus on the impact factors affecting the standardized management of patients including age,monthly income per person,medical security,awareness of diabetes,ratio of not transfer treatment,positive strategies for chronic complications,improve the hierarchical chain management of type 2 diabetes,and then make the diabetic patients to early participate in standardization management of diabetes mellitus and delay the appearance of complications.
