Department of Epidemiology and Biostatistics, University at Albany (SUNY) School of Public Health, East Campus GEC147, One University Place, Rensselaer, NY 12144, USA.
Prev Chronic Dis. 2012;9:E07. Epub 2011 Dec 15.
Local health departments (LHDs) vary in their capacity to perform public health services by the size of population they serve. Little is known about the extent of emerging primary prevention activities at small LHDs. The objectives of this study were to describe various diabetes-related patient care and primary prevention services offered by small LHDs (those serving a population of less than 150,000) and explore factors associated with the diversity of these services.
During 2009 through 2010, we interviewed directors of a nationally representative sample of small LHDs by telephone to obtain information about staff structure, diabetes services, and partnerships. We obtained data for demographic characteristics and health status of the population from secondary sources. We analyzed the number of patient care services and primary prevention programs through multivariate regression analyses.
Fifty-eight small LHDs completed the survey, a response rate of 81%. Most (n = 47) had at least 1 diabetes-related patient care service; referral to diabetes specialists was the most frequently identified service (n = 44). Nearly half of small LHDs also engaged in obesity prevention for adults (n = 26) or children (n = 26), but only 7 had a diabetes prevention program. Diversity of patient care services was positively associated with the proportion of the population that was rural, time commitment of a certified diabetes educator, and total staff size. Diversity of primary prevention programs was positively associated with intensity of collaboration with the state diabetes program and total staff size and inversely associated with the proportion of racial/ethnic minorities in the jurisdiction.
Most small LHDs function as a link to local diabetes care services. Staff capacity, collaboration with the state health department, and local population factors appear to influence the diversity of diabetes-related services at small LHDs.
地方卫生部门（LHD）提供公共卫生服务的能力因其服务人口规模而异。对于小型 LHD 开展新兴初级预防活动的程度知之甚少。本研究的目的是描述小型 LHD（服务人口少于 15 万）提供的各种与糖尿病相关的患者护理和初级预防服务，并探讨与这些服务多样性相关的因素。
在 2009 年至 2010 年期间，我们通过电话采访了全国小型 LHD 代表性样本的主任，以获取有关员工结构、糖尿病服务和合作伙伴关系的信息。我们从二手资料获得人口统计特征和人口健康状况的数据。我们通过多变量回归分析分析了患者护理服务和初级预防计划的数量。
58 个小型 LHD 完成了调查，响应率为 81%。大多数（n=47）至少有 1 项与糖尿病相关的患者护理服务；向糖尿病专家转诊是最常见的服务（n=44）。近一半的小型 LHD 还参与了针对成人（n=26）或儿童（n=26）的肥胖预防，但只有 7 个开展了糖尿病预防计划。患者护理服务的多样性与农村人口比例、认证糖尿病教育者的时间投入以及员工总数呈正相关。初级预防计划的多样性与与州糖尿病计划的合作强度以及员工总数呈正相关，与管辖范围内少数民族比例呈负相关。
大多数小型 LHD 作为当地糖尿病护理服务的联系点。员工能力、与州卫生部门的合作以及当地人口因素似乎影响了小型 LHD 与糖尿病相关服务的多样性。
