Study On The Implementation Status Of Diabetes Management In Primary Health Care Institutions And Its Facilitators And Barriers

Objective:To understand the implementation status of diabetes management,explore the facilitators and barriers of its implementation,so as to provide basis for improving diabetes management and promote the standardized and effective implementation of diabetes management projects.Methods : 1.Questionnaire survey: 3978 diabetes patients ≥ 35 years old who were included in the "National Basic Public Health Service Project Assessment Study on Management of Chronic Disease Patients" and followed up in 8 provinces were the subjects of the study.Questionnaire surveys and blood glucose measurements were conducted on the patients’ acceptance of diabetes management and management effects.SPSS 23.0 software was used for analysis,including descriptive analysis,chi-square test,t-test and binary logistic regression analysis.2.Qualitative research: 48 interviewees,including public health professionals,managers of primary medical and health institutions and primary medical personnel involved in health management of diabetes patients in Huai’an,Nanchang,Xiaogan and Yuxi,were interviewed online.Data were collected through in-depth personal interviews and focus group interviews.The data collected by the qualitative research institute were transcribed word by word,and the transcribed text was coded and analyzed by the thematic framework method and Nvivo11.0 qualitative analysis software.Results : Analysis of the current situation of diabetes management: the standardized management rate of diabetes patients was 71.3%.The rate of better knowledge and blood sugar control of diabetes patients in the standardized management group was higher than that in the non-standardized management group,and the smoking rate and drinking rate were lower than those in the non-standardized management group,with a statistically significant difference(P<0.05).Standardized management has a positive correlation with better knowledge awareness(P<0.05),and a negative correlation with smoking and drinking(P<0.05).Analysis of facilitators and barriers of diabetes management: the facilitators of diabetes management implementation include the improvement of management content,considering patients’ needs,multi-party cooperation,policy and financial support,improving hardware facilities construction,internal information exchange,establishing good working relationship,leadership input,high accessibility of knowledge and information,incentive mechanism,training,positive attitude to intervention,high self-efficacy,publicity strategies,supervision and assessment mechanism and improved patient cooperation;barriers include implementation complexity,few physical examination items,few types of drugs,lack of effective coordination mechanism,insufficient funds,limited hardware facilities,lack of interconnection of information systems,lack of tacit cooperation,untimely and incomplete knowledge and information,tight staff,lack of professional knowledge,and poor patient’s disease awareness and management compliance.Conclusion:The standardized management of diabetes has made some progress,but there is still room for improvement.Standardized management is positively related to better knowledge of diabetes patients,negatively related to smoking and drinking,and has an important impact on blood glucose control.Using the consolidated framework for implementation research(CFIR)can effectively identify facilitators and barriers in the implementation of diabetes management,and provide a basis for subsequent improvement and strengthening of diabetes management.