初级卫生保健中的资源与组织和糖化血红蛋白（HbA）水平相关：一项针对230958名2型糖尿病患者的全国性研究。
Resources and organisation in primary health care are associated with HbA level: A nationwide study of 230958 people with Type 2 diabetes mellitus.
作者信息
Husdal Rebecka, Rosenblad Andreas, Leksell Janeth, Eliasson Björn, Jansson Stefan, Jerdén Lars, Stålhammar Jan, Steen Lars, Wallman Thorne, Svensson Ann-Marie, Thors Adolfsson Eva
机构信息
Centre for Clinical Research Västmanland, Uppsala University, Västerås, Sweden; Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden.
Centre for Clinical Research Västmanland, Uppsala University, Västerås, Sweden.
出版信息
Prim Care Diabetes. 2018 Feb;12(1):23-33. doi: 10.1016/j.pcd.2017.09.003. Epub 2017 Sep 28.
AIMS
To examine the association between personnel resources and organisational features of primary health care centres (PHCCs) and individual HbA level in people with Type 2 diabetes mellitus (T2DM).
METHODS
People with T2DM attending 846 PHCCs (n=230958) were included in this cross-sectional study based on PHCC-level data from a questionnaire sent to PHCCs in 2013 and individual-level clinical data from 2013 for people with T2DM reported in the Swedish National Diabetes Register, linked to individual-level data on socio-economic status and comorbidities. Data were analysed using a generalized estimating equations linear regression models.
RESULTS
After adjusting for PHCC- and individual-level confounding factors, personnel resources associated with lower individual HbA level were mean credits of diabetes-specific education among registered nurses (RNs) (-0.02mmol/mol for each additional credit; P<0.001) and length of regular visits to RNs (-0.19mmol/mol for each additional 15min; P<0.001). Organisational features associated with HbA level were having a diabetes team (-0.18mmol/mol; P<0.01) and providing group education (-0.20mmol/mol; P<0.01).
CONCLUSIONS
In this large sample, PHCC personnel resources and organisational features were associated with lower HbA level in people with T2DM.
目的
探讨基层医疗中心（PHCC）的人力资源和组织特征与2型糖尿病（T2DM）患者个体糖化血红蛋白（HbA）水平之间的关联。
方法
本横断面研究纳入了846家基层医疗中心的T2DM患者（n = 230958），数据基于2013年发送给基层医疗中心的问卷中的基层医疗中心层面数据，以及瑞典国家糖尿病登记处报告的2013年T2DM患者个体层面临床数据，并与社会经济状况和合并症的个体层面数据相关联。使用广义估计方程线性回归模型分析数据。
结果
在调整基层医疗中心和个体层面的混杂因素后，与个体较低HbA水平相关的人力资源包括注册护士（RN）中糖尿病专项教育的平均学分（每增加1个学分，HbA降低0.02mmol/mol；P < 0.001）以及定期拜访RN的时长（每增加15分钟，HbA降低0.19mmol/mol；P < 0.001）。与HbA水平相关的组织特征包括设有糖尿病团队（HbA降低0.18mmol/mol；P < 0.01）和提供团体教育（HbA降低0.20mmol/mol；P < 0.01）。
结论
在这个大样本中，基层医疗中心的人力资源和组织特征与T2DM患者较低的HbA水平相关。
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