重庆市糖尿病患者管理现状及影响因素与就诊费用分析

发布时间：2018-06-02 20:29

本文选题：2型糖尿病 + 慢性非传染性疾病管理　；参考：《重庆医科大学》2017年硕士论文

【摘要】：目的:以我国基本公共卫生服务规范为指导,以重庆市健康随访管理工作手册为依据,调查了慢性非传染性疾病管理系统中2型糖尿病患者的随访频率和卫生服务利用状况,并分析其影响因素。同时,调查2型糖尿病患者的医疗花费,比较有、无特殊疾病医疗保险患者之间的就诊费用及可能影响申请该医疗保险的因素。方法:在重庆市两地区,进行了一项横断面调查。共502名患者完成了调查。采用结构化问卷,调查内容包括:人口学基本信息,随访及卫生服务利用情况,与糖尿病有关的药房、门诊、住院就诊费用等。使用SAS 9.1软件进行数据统计分析,连续性变量用中位数(四分位间距)M(Q)来表示,采用Wilcoxon秩和检验。计数资料分析采用卡方检验,有统计学差异的变量再纳入多因素非条件逐步Logistic回归模型分析影响因素。结果:在健康管理方面,有64.99%的患者一年的随访次数超过4次。每年进行糖化血红蛋白检测、血脂、肾功能和眼底检查的比例分别为8.06%、54.23%、44.56%和43.55%。Logistic分析结果显示,拥有城镇职工基本医疗保险,申请到特殊疾病医疗保险和病程大于5年的患者,更容易坚持定期随访和进行糖尿病的相关检测。就诊费用方面,门诊组有特病医保的患者年人均总费用2160元(3081元)较无特病医保的患者高[1000元(2100元),P0.01],年次均自费比例(54.04%)低于无特病医保患者的自费比例(93.78%)。就申请特病医保而言,中等收入水平(OR=1.94)、高收入水平(OR=2.11)、参加城镇职工医疗保险(OR=4.19)、病程5年(OR=2.04)都是其可能的影响因素,具有这些特征的患者相对更多地申请到特病医保。结论:重庆市健康随访管理工作手册中推荐2型糖尿病患者,每年进行随访的频率和检测的项目,在一定程度上,患者并没有严格参照执行。与患者的医疗保险类型和病程长短有关,建议在病程的早期阶段,加强健康教育和生活行为方式干预。同时,为缓解2型糖尿病患者经济负担,政府应大力宣传特病医保的相关政策,鼓励患者主动了解,积极申报。另外,医保部门与医疗机构应加强监管,简化办理流程,建议增加特殊疾病定点零售药店的数量和覆盖面,提高特病医保利用的可及性。最后,应更加关注低收入人群和病程相对较短的患者,增强他们抵御疾病经济风险的能力,提高特病医保的利用及公平性。
[Abstract]:Objective: to investigate the frequency of follow-up and the utilization of health services in patients with type 2 diabetes mellitus in chronic non-communicable disease management system under the guidance of China's basic public health service standard and Chongqing health follow-up management manual. The influencing factors are analyzed. At the same time, the medical expenses of patients with type 2 diabetes mellitus were investigated. Methods: a cross-sectional investigation was carried out in two areas of Chongqing. A total of 502 patients were investigated. A structured questionnaire was used, which included basic demographic information, follow-up and utilization of health services, diabetes related pharmacies, outpatient, hospitalization expenses, etc. The data were analyzed by SAS 9.1 software. The continuity variable was expressed by the median (quartile spacing) and the Wilcoxon rank sum test was used. The counting data were analyzed by chi-square test, and the variables with statistical difference were added into the multi-factor unconditioned stepwise Logistic regression model to analyze the influencing factors. Results: in health management, 64.99% of the patients were followed up more than 4 times a year. The rates of glycosylated hemoglobin, blood lipids, renal function and fundus examination were 8.06%, 54.23% and 44.56%, respectively. The results of 43.55%.Logistic analysis showed that the patients who had basic medical insurance for urban workers, applied for medical insurance for special diseases and the course of disease for more than 5 years. It is easier to follow up regularly and to perform diabetes related tests. In terms of medical expenses, the total annual per capita cost of patients with special medical insurance in the outpatient group was 2160 yuan or 3 081 yuan), which was higher than that of the patients without special disease insurance [1000 yuan, 2,100 yuan per year, P0.01], and the proportion of annual average self-expense was 54.04), which was lower than that of the patients without special disease insurance. As far as the application for special medical insurance is concerned, the middle income level is 1.94, the high income level is 2.11, the participation in medical insurance for urban workers is 4.19, and the course of disease is 5 years. The patients with these characteristics are more likely to apply for special medical insurance. Conclusion: to a certain extent, patients with type 2 diabetes mellitus were not strictly followed up in Chongqing health follow-up management manual, the frequency of follow-up and the items of examination were not strictly carried out. It is suggested that health education and lifestyle intervention should be strengthened in the early stage of the disease course. At the same time, in order to alleviate the financial burden of type 2 diabetes patients, the government should publicize the relevant policies of medical insurance for special diseases, encourage patients to take the initiative to understand and declare actively. In addition, health care departments and medical institutions should strengthen supervision, simplify the processing process, propose to increase the number and coverage of designated retail pharmacies for special diseases, and improve the accessibility of medical insurance for special diseases. Finally, we should pay more attention to the low income group and patients with relatively short course of disease, enhance their ability to resist the economic risk of disease, and improve the utilization and fairness of special medical insurance.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.1

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