Ni Yunxia, Liu Suzhen, Li Jiping, Li Simin, Dong Ting
West China Hospital/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, China.
Medicine (Baltimore). 2020 May 22;99(21):e20322. doi: 10.1097/MD.0000000000020322.
The aim of this study was to investigate service needs and health care utilization among people with type 2 diabetes, further to identify the relationship between service needs and health care utilization.We used a self-reported questionnaire to collect data regarding demographic and diabetes characteristics, service needs toward self-management and follow-up care, and 4 health care utilizations during past year. Multiple linear regression and binary logistic regression were used to test the impacts of demographic and diabetes characteristics on service needs and health care utilizations, respectively. Spearman rank correlations were used to explore correlation between service needs and health care utilization.We recruited 1796 participants with type 2 diabetes from 20 community health centers across 12 cities of Sichuan Province in China. Needs of self-management and follow-up had significant positive correlations with health care utilization. Participants rated that nutrition was the most needed aspects of self-management (78.5%), and out-patient visit was the most popular type of follow-up (66.8%). Educational level and treatment modality were predictors of self-management needs. Low educational level (elementary school or blow, β = 0.11, P = .008; middle school, β = 0.10, P = .015) and insulin treatment (β = 0.08, P = .007) were positive factors of self-management needs. Younger age (age < 45 years old, β = 0.07, P = .046), being employed (β = 0.14, P < .001), and underdeveloped region (β = 0.16, P < .001) were positive factors of follow-up care needs. Elementary educational level (OR: 0.53; CI: 0.30-0.96) and underdevelopment region (OR: 0.01; CI: 0.01-0.07) were protective factors of general practitioner visit, in contrast, those factors were risk factors of specialist visit (elementary educational level, OR: 1.69; CI: 1.13-2.5; underdevelopment region, OR: 2.93; CI: 2.06-4.16) and emergency room visit (elementary educational level, OR: 2.97; CI: 1.09, 8.08; underdevelopment region, OR: 6.83; CI: 2.37-14.65).The significant positive relationship between service needs and health care utilization demonstrated the role of service needs in influencing health care utilization. When self-management education is provided, age, educational level, employment status, treatment modality, and region should be considered to offer more appropriate education and to improve health care utilization.
本研究旨在调查2型糖尿病患者的服务需求和医疗保健利用情况，进而确定服务需求与医疗保健利用之间的关系。我们使用一份自填式问卷收集有关人口统计学和糖尿病特征、自我管理和后续护理的服务需求，以及过去一年中4种医疗保健利用情况的数据。多元线性回归和二元逻辑回归分别用于检验人口统计学和糖尿病特征对服务需求和医疗保健利用的影响。Spearman等级相关性用于探索服务需求与医疗保健利用之间的相关性。我们从中国四川省12个城市的20个社区卫生中心招募了1796名2型糖尿病患者。自我管理和后续护理需求与医疗保健利用之间存在显著的正相关。参与者认为营养是自我管理中最需要的方面（78.5%），门诊就诊是最常见的后续护理类型（66.8%）。教育水平和治疗方式是自我管理需求的预测因素。低教育水平（小学及以下，β = 0.11，P = 0.008；初中，β = 0.10，P = 0.015）和胰岛素治疗（β = 0.08，P = 0.007）是自我管理需求的积极因素。年龄较小（年龄<45岁，β = 0.07，P = 0.046）、就业（β = 0.14，P < 0.001）和地区欠发达（β = 0.16，P < 0.001）是后续护理需求的积极因素。小学教育水平（OR：0.53；CI：0.30 - 0.96）和地区欠发达（OR：0.01；CI：0.01 - 0.07）是全科医生就诊的保护因素，相比之下，这些因素是专科医生就诊（小学教育水平，OR：1.69；CI：1.13 - 2.5；地区欠发达，OR：2.93；CI：2.06 - 4.16）和急诊室就诊（小学教育水平，OR：2.97；CI：1.09，8.08；地区欠发达，OR：6.83；CI：2.37 - 14.65）的风险因素。服务需求与医疗保健利用之间的显著正相关表明了服务需求在影响医疗保健利用方面的作用。在提供自我管理教育时，应考虑年龄、教育水平、就业状况、治疗方式和地区，以提供更合适的教育并提高医疗保健利用。
