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目的研究社区老年糖尿病并发肺结核患者的健康素养水平与预后的关系,为社区的干预提供依据。方法应用两阶段整群系统抽样方法选择唐山市社区373例糖尿病并发肺结核患者为研究对象,评价患者的健康素养水平、康复依从性、社区服务利用情况、结核病灶及血糖控制情况等;采用χ~2检验和多因素logistic回归分析健康素养水平与预后的关系。结果基本健康素养组结核病灶控制总有效率82.7%,血糖控制良好率88.8%,显著高于低健康素养组(61.1%和66.3%),差异有统计学意义(P<0.05);logistic回归分析显示影响糖尿病并发肺结核患者预后的因素包括:健康素养、依从性、社区卫生服务利用情况、结核类型、血糖控制情况以及合并其他疾病等(OR=5.997、5.548、5.816、0.151、0.066、0.162,P<0.05);基本健康素养组在依从性行为包括吸烟、饮酒及饮食、用药、康复锻炼五方面优于低健康素养组,差异有统计学意义(P<0.05);基本健康素养组在社区卫生服务(免费健康教育和咨询、免费体检、免费流感疫苗接种、免费血压、血糖监测、生活方式及康复指导)的利用情况优于低健康素养组,差异有统计学意义(P<0.05)。结论唐山市社区糖尿病并发肺结核患者健康素养水平越高,其社区卫生服务利用情况越高、遵医行为越好,有利于提高预后效果。
Objective To study the relationship between the level of health literacy and the prognosis of elderly patients with diabetes mellitus and pulmonary tuberculosis in community and provide basis for community intervention. Methods A total of 373 patients with T2DM in Tangshan community were enrolled in this study. The level of health literacy, rehabilitation compliance, community service utilization, tuberculosis and glycemic control were evaluated by two-stage cluster sampling method. 2 test and multivariate logistic regression analysis of the relationship between health literacy and prognosis. Results The total effective rate of tuberculosis control in basic health literacy group was 82.7%, the good rate of blood sugar control was 88.8%, which was significantly higher than that in low health literacy group (61.1% and 66.3%, P <0.05). Logistic regression analysis The factors that influence the prognosis of diabetic patients with pulmonary tuberculosis include health literacy, compliance, utilization of community health services, tuberculosis type, glycemic control and other diseases (OR = 5.997,5.548,5.816,0.151,0.066,0.162, P <0.05). The basic health literacy group was better than the low health literacy group in compliance behaviors including smoking, drinking and diet, medication and rehabilitation exercise, the difference was statistically significant (P <0.05). The basic health literacy group was superior in community health The utilization of services (free health education and counseling, free medical examination, free influenza vaccination, free blood pressure, blood glucose monitoring, lifestyle and rehabilitation guidance) outperformed the low health literacy group with statistically significant differences (P <0.05). Conclusion The higher the level of health literacy of community-based TB patients with tuberculosis in Tangshan community, the higher the utilization of community health services and the better performance of community follow-up will help to improve the prognosis.