Stein Dorit T, Sudharsanan Nikkil, Dewi Shita, Manne-Goehler Jennifer, Witoelar Firman, Geldsetzer Pascal
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
Institute of Global Health, Heidelberg University, Heidelberg, Baden-Württemberg, Germany.
BMJ Open Diabetes Res Care. 2020 Oct;8(1). doi: 10.1136/bmjdrc-2020-001415.
Indonesia is experiencing a rapid rise in the number of people with diabetes. There is limited evidence on how well primary care providers are equipped to deal with this growing epidemic. This study aimed to determine the level of primary healthcare providers' knowledge of diabetes, change in knowledge from 2007 to 2014/2015 and the extent to which changes in the diabetes workforce composition, geographical distribution of providers, and provider characteristics explained the change in diabetes knowledge.
In 2007 and 2014/2015, a random sample of public and private primary healthcare providers who reported providing diabetes care across 13 provinces in Indonesia completed a diabetes clinical case vignette. A provider's diabetes vignette score represents the percentage of all correct clinical actions for a hypothetical diabetes patient that were spontaneously mentioned by the provider. We used standardization and fixed-effects linear regression models to determine the extent to which changes in diabetes workforce composition, geographical distribution of providers, and provider characteristics explained any change in diabetes knowledge between survey rounds, and how knowledge varied among provinces.
The mean unadjusted vignette score decreased from 37.1% (95% CI 36.4% to 37.9%) in 2007 to 29.1% (95% CI 28.4% to 29.8%, p<0.001) in 2014/2015. Vignette scores were, on average, 6.9 (95% CI -8.2 to 5.6, p<0.001) percentage points lower in 2014/2015 than in 2007 after adjusting for provider cadre, geographical distribution, and provider experience and training. Physicians and providers with postgraduate diabetes training had the highest vignette scores.
Diabetes knowledge among primary healthcare providers in Indonesia decreased, from an already low level, between 2007 and 2014/2015. Policies that improve preservice training, particularly at newer schools, and investment in on-the-job training in diabetes might halt and reverse the decline in diabetes knowledge among Indonesia's primary healthcare workforce.
印度尼西亚糖尿病患者人数正在迅速上升。关于初级保健提供者应对这一日益严重的流行病的能力如何，相关证据有限。本研究旨在确定初级医疗保健提供者的糖尿病知识水平、2007年至2014/2015年期间知识的变化，以及糖尿病从业人员构成的变化、提供者的地理分布和提供者特征在多大程度上解释了糖尿病知识的变化。
在2007年和2014/2015年，从印度尼西亚13个省份中随机抽取报告提供糖尿病护理的公立和私立初级医疗保健提供者样本，让他们完成一份糖尿病临床病例 vignette。提供者的糖尿病 vignette 得分代表提供者自发提及的针对假设糖尿病患者的所有正确临床行动的百分比。我们使用标准化和固定效应线性回归模型来确定糖尿病从业人员构成的变化、提供者的地理分布和提供者特征在多大程度上解释了两轮调查之间糖尿病知识的任何变化，以及不同省份之间知识的差异情况。
未经调整的 vignette 得分平均值从2007年的37.1%（95%置信区间36.4%至37.9%）降至2014/2015年的29.1%（95%置信区间28.4%至29.8%，p<0.001）。在调整了提供者类别、地理分布以及提供者经验和培训后，2014/2015年的 vignette 得分平均比2007年低6.9（95%置信区间 -8.2至5.6，p<0.001）个百分点。医生和接受过糖尿病研究生培训的提供者 vignette 得分最高。
2007年至2014/2015年期间，印度尼西亚初级医疗保健提供者的糖尿病知识从原本就较低的水平有所下降。改善职前培训（特别是在较新的学校）以及对糖尿病在职培训进行投资的政策，可能会阻止并扭转印度尼西亚初级医疗保健人员糖尿病知识的下降趋势。
