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目的了解山东省农村糖尿病管理现状及其与规范要求的差距,并探讨阻碍相关人群利用基本卫生服务的原因,为制定相应的政策提供参考依据。方法根据《国家基本公共卫生服务规范2011年版》制定半结构化问卷,采用关键人物访谈法于2016年7月在山东省梁山县、平阴县和莒南县7个乡镇对当地县级疾病预防控制中心、乡镇卫生院、村卫生室整群抽取的24名相关工作人员以及方便抽取的56例糖尿病患者、糖尿病高危人群进行访谈。结果定性研究结果显示,山东省农村糖尿病管理现状与国家基本公共卫生服务规范要求相比还存在一定差距,主要表现:(1)多数患者并未接受过相关健康教育;(2)部分地区患者未接受每季度的免费空腹血糖监测;(3)流动人口中的糖尿病患者无法接受相关服务;(4)患者缺乏明确转诊路径,转诊程序欠缺相应的制度性支持等。影响差距的主要因素包括:(1)乡镇层面开展健康教育的方式过于被动;(2)部分村民文化程度较低;(3)基本公共卫生服务项目人均经费较低等。结论农村糖尿病相关基本公共卫生服务提供仍需改善,相关部门应通过更加主动、具有输出力度的健康教育方式以及将外来流动人口糖尿病患者纳入本地基本公共卫生服务慢性病患者健康管理服务等相关措施及政策来优化服务提供体系,满足广大农村糖尿病患者以及高危人群的需要。
Objective To understand the status quo of diabetes management in rural areas of Shandong Province and the gap between them and the regulatory requirements and to explore the reasons for hindering the use of basic health services by related populations and to provide a reference for the formulation of appropriate policies. Methods According to the “National Basic Public Health Service Standard Version 2011”, a semi-structured questionnaire was established. In July 2016, seven townships in Liangshan County, Pingyin County and Junan County in Shandong Province were enrolled in the local county-level disease prevention Control centers, township hospitals, village clinics collected from the 24 related staff and convenient extraction of 56 cases of diabetic patients, high-risk groups of diabetes for interviews. Results The results of qualitative research showed that there was still a gap between the status quo of diabetes management in rural areas of Shandong Province and the requirements of the national basic public health service. The main findings were as follows: (1) Most of the patients did not receive relevant health education; (2) Receive free fasting blood glucose monitoring on a quarterly basis; (3) diabetes in the floating population can not receive the relevant services; (4) the patient lacks a clear referral path and the referral process lacks appropriate institutional support. The main factors that affect the gap include: (1) the way of health education at the township level is too passive; (2) the education level of some villagers is low; (3) the average per capita funding of basic public health service projects is relatively low. Conclusions The provision of basic public health services related to diabetes in rural areas still needs to be improved. Related departments should adopt more active and output-oriented health education methods and include relevant measures and policies such as providing health care services for people with chronic diseases in basic public health services To optimize the service delivery system to meet the needs of the majority of rural patients with diabetes and high-risk groups.