| Background With the rapid development of social economy and the acceleration of population aging,the number of diabetic patients is increasing.China’s elderly population base is large,and the prevalence of diabetes in the elderly population is at a high level.Elderly diabetic patients have many complications,high risk of disability or semi-disability,poor self-management ability,poor blood sugar control,etc.,which brings more pressure to the development of diabetes health management.The health status of older diabetics is a greater concern.As the main chronic disease of the country to implement comprehensive prevention and management strategies,the graded diagnosis and treatment has promoted the community management of diabetes,pointed out the important direction of China’s future medical reform,and also reflected the urgency of the development of community diabetes management.Community medical institutions are an important cornerstone for improving the graded diagnosis and treatment of diseases,and are the main position for realizing the health management of chronic diseases.Community management of elderly diabetic populations is conducive to further strengthening the prevention and treatment of diseases of patients,improving the health level of the elderly and chronic disease groups,and promoting the realization of healthy aging.Objective Summarize the management status of patients with elderly diabetes in the community,initially evaluate the management effect of the elderly diabetes community,and discover the problems in the management process and analyze the causes,and then make relevant suggestions.Method Through literature analysis,systematically collect relevant policy documents and literature at home and abroad,organize and summarize the collected materials,write a review,refer to relevant scales,and inspire research ideas as the basis for theoretical research.The on-site investigation method was used to select Hefei A community health service center and B community health center as the survey carrier,docked with the relevant responsible persons of community medical institutions,and retrospectively collected and on-site data of community medical institutions in combination with the questionnaire designed in the early stage.Questionnaire surveys were conducted for elderly diabetic patients included in community chronic disease management and medical staff involved in community chronic disease management,and health-related systematic data of elderly diabetic patients were retrospectively collected.Semi-structured interviews were conducted with elderly diabetic patients in the community and relevant leaders of community medical institutions,and the research data were supplemented through participatory observation.For quantitative data,Epidata 3.1 software is used to establish a database,data entry and verification,and EXCEL and SPSS27.0 software are used for data processing and analysis to ensure the validity and accuracy of data.For the qualitative data,through induction,classification,comparison and summary,the collected materials are thought and processed,gradually deepened,their internal laws are revealed,and the nature and characteristics of the facts stated by elderly diabetic patients and community chronic disease managers are qualitatively analyzed,explained,and corroborated accordingly.Outcome A total of 673 valid questionnaires were collected in this survey,including 2 questionnaires from community medical institutions,604 questionnaires for elderly diabetic patients,and 67 questionnaires for community chronic disease managers.In addition,semi-structured interviews were conducted with 4 community chronic disease managers and 20 elderly diabetics.The two community health service centers are both urban medical alliance units,which are primary medical institutions that promote the graded diagnosis and treatment of diseases,and each has two health service stations to provide convenient services for the elderly.The institution is equipped with a chronic disease information management system,and the basic equipment for diabetes management is fully equipped.The institution has not carried out full-time health management related departments for the elderly,and the family doctor team carries out chronic disease management,and provides health examination and blood glucose monitoring,health assessment and classification intervention,health guidance and health education management services for elderly diabetic patients.A community health service center has 23366 elderly people,4589 elderly diabetic patients,and the prevalence of elderly diabetes is 19.64%;The number of elderly people in community health service centers was 35340,the number of elderly diabetes patients was 5120,and the prevalence of elderly diabetes was 14.49%.The gender distribution of elderly diabetic patients was relatively balanced,the average age was 74±9 years,the average course of disease was 8.6±8.7 years,the average management time was 10.9±5.2(M±Q)years,and the number of patients with hypertension accounted for 75.7%,and the complications of diabetes were generally good.80% of patients arrive in the community for ≤ 20 minutes,and receive communitymanaged services including health checkups,medication use,blood pressure and blood glucose measurement,regular follow-up visits and health education.The total institutional satisfaction score was 32.7±4.5((M±Q)points,with the top three satisfaction rates being medical attitude,medical technology and procedures,and the last three being medical expenditure,prevention and treatment publicity and medical initiative.In terms of management effect,the fasting blood glucose range of patients was 3.2-20.8mmol/L,and the average blood glucose value was 7.5±2.8(M±Q)mmol/L,and the blood glucose control compliance rate was 38.1%.There were significant differences in the distribution of blood glucose control levels in elderly diabetic patients with different blood types,occupations,payment types,whether to go to the community to measure blood glucose,total cholesterol and triglyceride target values(P <0.05)。 The compliance rates of blood pressure,total cholesterol,high-density lipoprotein,triglycerides,low-density lipoprotein and body mass index were 19.9%,31.8%,76.3%,59.6%,15.1% and 40.7%,respectively.There were 238 normal BMI people,8 wasting,270 overweight and 88 obese.The average score of diabetes knowledge was 7±2.5(M±Q)points,and the poor,average and good groups accounted for 18.2%,50.2% and 31.6% respectively.There were significant differences in the distribution of knowledge and mastery levels among elderly diabetic patients by age,occupation,whether they received regular follow-up,whether they received health education,and whether they were informed by family members(P<0.05).In terms of medication compliance,the patient medication taking rate reached 92.5%,the average compliance score of medication patients was(7.2±1.3)points,and the proportion of single drug users(64%)was greater than that of combination drug(36%).Community chronic disease managers are mainly women(77.6%),all of whom have received diabetes-related health management training in the past year,mainly internal training,online training and special training,and 94% of chronic disease managers believe that the existing knowledge and skills basically meet and fully meet their work needs.The average score of community diabetes prevention and treatment knowledge was 13±3(M±Q)points,with the highest accuracy rate in the clinical manifestation and diagnosis knowledge dimension,and the lowest in the referral knowledge dimension.The group with good knowledge mastery,general group and poor knowledge mastery group accounted for 31.3%,58.2% and 10.4% respectively.Conclusion First,the infrastructure and equipment for community medical institutions to carry out diabetes management services under the background of hierarchical diagnosis and treatment are basically satisfied,but there is still a certain gap to further meet the multilevel needs of elderly diabetes community management services,and the level of grassroots information management and the allocation and use of intelligent facilities still need to be strengthened;Second,community medical institutions provide basic public health services to elderly diabetic patients,but there are irregular processes,simple content and lack of health education;Third,elderly diabetic patients are mostly comorbid diseases,poor control of health indicators,substandard management effects,and gaps with patients’ expectations;Fourth,the community elderly diabetes management model relying on the family doctor team still has low workload and job salary satisfaction,community first diagnosis and two-way referral are difficult to implement,and the lack of professional talents and imperfect incentive mechanism make it difficult to fully cover continuous services. |
PDF Full Text Request