后续护理对于疾病管理至关重要,但具有挑战性,特别是在医疗保健资源和临床能力有限的农村地区。然而,从农村初级保健医生(PCP)的角度进行的研究很少。我们评估了农村PCP对高血压和2型糖尿病(两种最常见的长期疾病)进行随访的频率。
我们进行了一个多中心,自我管理的调查研究建立在四个省农村PCP现有的一般实践课程计划的基础上。有关后续护理服务的信息是从参加集中课堂教学的农村PCP中收集的,多项选择题。进行二元logistic回归分析,以检查与未达到高血压和2型糖尿病随访目标频率相关的医师水平因素。分别。最终样本包括来自52个乡镇地区的农村PCP。在统计分析中使用复杂样品模块以说明多级样品设计。
总有效率为91.4%。在农村实践中,约有五分之一的PCP没有达到随访护理的目标频率(高血压为18.7%;2型糖尿病为21.6%)。医生的教育水平较高,每天看到的患者数量增加,未提供家庭访视是未达到两种情况的目标随访频率的危险因素.此外,在2型糖尿病管理中,工作经验较少的乡村医生往往不太频繁地提供后续护理.
鉴于可能存在临床惯性和工作量相关因素,仅致力于加强乡村医生教育的努力可能不会直接转化为对服务提供的强烈动机和积极承诺。在后续护理服务中确定的未达到目标的风险因素可能为农村初级保健实践中的能力建设计划提供了领域。
Follow-up care is crucial but challenging for disease management particularly in rural areas with limited healthcare resources and clinical capacity, yet few studies have been conducted from the perspective of rural primary care physicians (PCPs). We assessed the frequency of follow-up care delivered by rural PCPs for hypertension and type 2 diabetes - the two most common long-term conditions.
We conducted a multi-centre, self-administered survey study built upon existing general practice course programmes for rural PCPs in four provinces. Information on follow-up care delivery were collected from rural PCPs attending centralised in-class teaching sessions using a set of close-ended, multiple choice questions. Binary logistic regression analysis was performed to examine physician-level factors associated with non-attainment of the target frequency of follow-up care for hypertension and type 2 diabetes, respectively. The final sample consisted of rural PCPs from 52 township-level regions. The Complex Samples module was used in the statistical analysis to account for the multistage sample design.
The overall response rate was 91.4%. Around one fifth of PCPs in rural practices did not achieve the target frequency of follow-up care delivery (18.7% for hypertension; 21.6% for type 2 diabetes). Higher education level of physicians, increased volume of daily patients seen, and no provision of home visits were risk factors for non-attainment of the target frequency of follow-up care for both conditions. Moreover, village physicians with less working experiences tended to have less frequent follow-up care delivery in type 2 diabetes management.
Efforts that are solely devoted to enhancing rural physicians\' education may not directly translate into strong motivation and active commitment to service provision given the possible existence of clinical inertia and workload-related factors. Risk factors identified for target non-attainment in the follow-up care delivery may provide areas for capacity building programmes in rural primary care practice.