Huang Cuiling, Lan Chengdian, Chen Zhangyan, Yu Ying, Gao Jian, Yang Hua
Department of General Practice, Zhongshan Hospital Fudan University（Xiamen Branch）, Xiamen, Fujian, China.
Department of General Practice, Zhongshan Hospital Fudan University, Shanghai, Shanghai, China.
BMJ Open. 2025 Jan 30;15(1):e085784. doi: 10.1136/bmjopen-2024-085784.
To evaluate the knowledge, attitude and practice (KAP) regarding screening and managing diabetic microvascular complications, encompassing diabetic retinopathy (DR), diabetic kidney disease (DKD) and diabetic neuropathy (DN), among general practitioners (GPs).
Cross-sectional study.
The online questionnaire survey was conducted between April and July 2023.
GPs from community health centres (CHCs) in all 16 districts of Shanghai were recruited.
The data of sociodemographic characteristics, KAP scales, training experience and screening instruments for community screening and managing diabetic microvascular complications were collected. Multiple stepwise linear regression was used to explore the influencing factors of KAP. Restricted cubic spline curves with four knots (5%, 35%, 65%, 95%) were used to determine the association between KAP score and duration of general practice.
A total of 1243 questionnaires were included in the analysis. The total KAP score was 66.6±8.8/100, and the knowledge, attitude and practice scores were 64.7±8.7, 83.5±10.5 and 51.6+17.8, respectively. Male (β=-2.419, p=0.012), shorter practice duration (β=-1.033, p=0.031), practice in rural area (β=3.230, p=0.001), not attending training in diabetic microvascular complications (β=-6.346, p<0.001), not managing diabetic patients (β=-4.503, p<0.001), less number of diabetes patients under management (β=-0.007, p=0.035), less number of screening instruments based on self-report of GP (β=-1.681, p<0.001), lower knowledge score (β=-0.190, p<0.001) and lower attitude score (β=-0.414, p<0.001) were associated with lower practice score of GPs. The KAP total score increased with the working years of general practice; however, this effect was no longer observed in knowledge score after 15 years, while the attitude and practice scores showed a continuously increasing trend.
GPs showed insufficient knowledge and poor clinical practice on screening and managing diabetic microvascular complications. There is an urgent need to improve their capacity to provide better care for those with diabetic microvascular complications through targeted training.
评估全科医生（GP）在糖尿病微血管并发症筛查与管理方面的知识、态度和实践（KAP）情况，其中包括糖尿病视网膜病变（DR）、糖尿病肾病（DKD）和糖尿病神经病变（DN）。
横断面研究。
于2023年4月至7月进行在线问卷调查。
招募了上海所有16个区社区卫生服务中心（CHC）的全科医生。
收集社会人口学特征、KAP量表、培训经历以及社区糖尿病微血管并发症筛查与管理的筛查工具等数据。采用多重逐步线性回归探索KAP的影响因素。使用具有四个节点（5%、35%、65%、95%）的受限立方样条曲线来确定KAP得分与全科医生执业年限之间的关联。
共1243份问卷纳入分析。KAP总分66.6±8.8/100，知识、态度和实践得分分别为64.7±8.7、83.5±10.5和51.6+17.8。男性（β=-2.419，p=0.012）、执业年限较短（β=-1.033，p=0.031）、在农村地区执业（β=3.230，p=0.001）、未参加糖尿病微血管并发症培训（β=-6.346，p<0.001）、不管理糖尿病患者（β=-4.503，p<0.001）、管理的糖尿病患者数量较少（β=-0.007，p=0.035）、根据全科医生自我报告的筛查工具数量较少（β=-1.681，p<0.001）、知识得分较低（β=-0.190，p<0.001）和态度得分较低（β=-0.414，p<0.001）与全科医生较低 的实践得分相关。KAP总分随全科医生工作年限增加而升高；然而，15年后知识得分不再呈现这种效应，而态度和实践得分呈持续上升趋势。
全科医生在糖尿病微血管并发症筛查与管理方面知识不足且临床实践较差。迫切需要通过针对性培训提高他们为糖尿病微血管并发症患者提供更好护理的能力。
