本文選題：2型糖尿病 + 慢性非傳染性疾病管理��； 參考：《重慶醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:以我國基本公共衛(wèi)生服務(wù)規(guī)范為指導(dǎo),以重慶市健康隨訪管理工作手冊為依據(jù),調(diào)查了慢性非傳染性疾病管理系統(tǒng)中2型糖尿病患者的隨訪頻率和衛(wèi)生服務(wù)利用狀況,并分析其影響因素。同時(shí),調(diào)查2型糖尿病患者的醫(yī)療花費(fèi),比較有、無特殊疾病醫(yī)療保險(xiǎn)患者之間的就診費(fèi)用及可能影響申請?jiān)撫t(yī)療保險(xiǎn)的因素。方法:在重慶市兩地區(qū),進(jìn)行了一項(xiàng)橫斷面調(diào)查。共502名患者完成了調(diào)查。采用結(jié)構(gòu)化問卷,調(diào)查內(nèi)容包括:人口學(xué)基本信息,隨訪及衛(wèi)生服務(wù)利用情況,與糖尿病有關(guān)的藥房、門診、住院就診費(fèi)用等。使用SAS 9.1軟件進(jìn)行數(shù)據(jù)統(tǒng)計(jì)分析,連續(xù)性變量用中位數(shù)(四分位間距)M(Q)來表示,采用Wilcoxon秩和檢驗(yàn)。計(jì)數(shù)資料分析采用卡方檢驗(yàn),有統(tǒng)計(jì)學(xué)差異的變量再納入多因素非條件逐步Logistic回歸模型分析影響因素。結(jié)果:在健康管理方面,有64.99%的患者一年的隨訪次數(shù)超過4次。每年進(jìn)行糖化血紅蛋白檢測、血脂、腎功能和眼底檢查的比例分別為8.06%、54.23%、44.56%和43.55%。Logistic分析結(jié)果顯示,擁有城鎮(zhèn)職工基本醫(yī)療保險(xiǎn),申請到特殊疾病醫(yī)療保險(xiǎn)和病程大于5年的患者,更容易堅(jiān)持定期隨訪和進(jìn)行糖尿病的相關(guān)檢測。就診費(fèi)用方面,門診組有特病醫(yī)保的患者年人均總費(fèi)用2160元(3081元)較無特病醫(yī)保的患者高[1000元(2100元),P0.01],年次均自費(fèi)比例(54.04%)低于無特病醫(yī)�；颊叩淖再M(fèi)比例(93.78%)。就申請?zhí)夭♂t(yī)保而言,中等收入水平(OR=1.94)、高收入水平(OR=2.11)、參加城鎮(zhèn)職工醫(yī)療保險(xiǎn)(OR=4.19)、病程5年(OR=2.04)都是其可能的影響因素,具有這些特征的患者相對更多地申請到特病醫(yī)保。結(jié)論:重慶市健康隨訪管理工作手冊中推薦2型糖尿病患者,每年進(jìn)行隨訪的頻率和檢測的項(xiàng)目,在一定程度上,患者并沒有嚴(yán)格參照執(zhí)行。與患者的醫(yī)療保險(xiǎn)類型和病程長短有關(guān),建議在病程的早期階段,加強(qiáng)健康教育和生活行為方式干預(yù)。同時(shí),為緩解2型糖尿病患者經(jīng)濟(jì)負(fù)擔(dān),政府應(yīng)大力宣傳特病醫(yī)保的相關(guān)政策,鼓勵患者主動了解,積極申報(bào)。另外,醫(yī)保部門與醫(yī)療機(jī)構(gòu)應(yīng)加強(qiáng)監(jiān)管,簡化辦理流程,建議增加特殊疾病定點(diǎn)零售藥店的數(shù)量和覆蓋面,提高特病醫(yī)保利用的可及性。最后,應(yīng)更加關(guān)注低收入人群和病程相對較短的患者,增強(qiáng)他們抵御疾病經(jīng)濟(jì)風(fēng)險(xiǎn)的能力,提高特病醫(yī)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.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R587.1

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