全科医疗核心特征功能对糖尿病患者治疗依从性的影响研究

背景糖尿病患者的治疗依从性对疾病控制具有重要作用。基层全科医疗综合、连续等特点与糖尿病治疗的特点较为契合，但目前全科医疗核心特征功能与糖尿病患者治疗依从性之间的关系尚未明确。目的探究全科医疗核心特征功能（首诊/第一线照护、连续性、可及性、综合性、协调性及以患者为中心）对2型糖尿病患者治疗依从性（药物治疗、饮食治疗、运动治疗、自我监测和定期复查）的影响，为今后通过强化全科医疗核心特征功能来提升2型糖尿病患者治疗依从性提供更加精确的方向。方法于2019年8—9月采用便利抽样法，选取广州市沙园社区卫生服务中心签约家庭医生服务的2型糖尿病患者为研究对象，采用自设问卷〔患者一般信息调查表、中文版全科医疗核心特征功能量表（ASPC）、糖尿病患者院外治疗遵医行为问卷〕对其进行调查。比较不同特征2型糖尿病患者总体治疗依从情况，采用多重线性回归分析全科医疗核心特征功能对2型糖尿病患者治疗依从性的影响。结果共回收有效问卷224份。224例2型糖尿病患者治疗依从性总得分为（80.57±11.27）分，ASPC总得分为（72.95±11.40）分。不同性别、糖尿病相关知识了解程度的2型糖尿病患者治疗依从性总得分比较，差异有统计学意义（P<0.05）。2型糖尿病患者ASPC总得分及各维度得分可影响其治疗依从性总得分、定期复查依从性得分（P<0.10）；2型糖尿病患者ASPC服务可及性、协调性服务维度得分对其药物治疗依从性得分有影响（P<0.10）；2型糖尿病患者ASPC协调性服务维度得分可影响其饮食治疗依从性得分（P<0.10）；2型糖尿病患者ASPC总得分及除协调性服务维度外的其他各维度得分对其自我监测依从性得分有影响（P<0.10）。结论强化全科医疗核心特征功能各维度均有助于提升2型糖尿病患者总体治疗依从性、定期复查依从性。可通过强化可及性、协调性维度，提升2型糖尿病患者药物治疗依从性；可通过强化协调性维度，提升2型糖尿病患者饮食治疗依从性；可通过强化首诊/第一线照护、可及性、连续性、综合性及以患者为中心维度，提升2型糖尿病患者药物治疗依从性。尚未发现全科医疗核心特征功能与2型糖尿病患者运动治疗依从性之间的联系。未来，可能需要从为2型糖尿病患者提供更多运动相关的资源、环境支持等方面寻找切入点，进而提升2型糖尿病患者的运动治疗依从性。

Effect of Core Values of General Practice on Adherence of Patients with Diabetes

Background Treatment adherence is closely related to disease control for patients with diabetes.Primary care is general,and continuous,which may satisfy the general and continuous healthcare needs of diabetic patients.But the association of core values of general practices with adherence of diabetic patients is not yet clear.Objective To explore the effect of core values of general practice(first contact/first line care,continuity,accessibility,comprehensiveness,coordination and patient-oriented)on the adherence(medication adherence,diet adherence,exercise adherence,self-monitoring adherence and regular hospital visits adherence)of type 2 diabetic patients,providing a reference for improving the adherence of such patients by precisely enhancing the core values of general practices.Methods A survey was conducted between August and September 2019 with a convenience sample of type 2 diabetics receiving contacted family doctor services from Shayuan Community Health Center of Guangzhou using a questionnaire consisting of three parts〔demographic information,the Chinese version of Primary Care Assessment Survey(ASPC),and Adherence to Out-of-hospital Treatment of Type 2 Diabetics(AOTTD)〕.Treatment adherence was compared by various personal factors.Multiple linear regression was used to analyze the association of the core values of general practice with treatment adherence.Results Altogether,224 cases who handed in responsive questionnaires were included for final analysis.The average scores of AOTTD,and ASPC of the respondents were(80.57±11.27)and(72.95±11.40),respectively.The scores of AOTTD differed significantly by sex and understanding level of type 2 diabetes(P<0.05).The total score of ASPC and the score of its each domain were associated with the total score of AOTTD,or the domain score of regular hospital visits(P<0.10).The scores of two domains(accessibility and coordination)of the ASPC were associated with the medication adherence score(P<0.10).The domain score of coordination was associated with the diet adherence score(P<0.10).The score of each domain of the ASPC(except for coordination)was associated with the self-monitoring adherence score(P<0.10).Conclusion For type 2 diabetics,strengthening each of the core values of general practice could contribute to the increase of their treatment adherence,and regular hospital visits adherence.Improving the accessibility of general practice could enhance their medication adherence.Improving the coordination of general practice could enhance their medication adherence and diet adherence.Improving first contact/first line care,continuity,accessibility,comprehensiveness,coordination and patient-oriented values of general practice could contribute to the increase of their medication adherence.But no association was found between the core values of general practice and patients'exercise adherence,which suggests that providing more exercise resources and environmental support for these patients may be a solution.