基于全科医生视角的 2 型糖尿病合并慢性肾脏病监测和管理中阻碍因素的质性研究
Barriers in Monitoring and Management of Chronic Kidney Disease in Type 2 Diabetes Based on the Perspective of General Practitioners：a Qualitative Research
背景 我国 2 型糖尿病患病率不断升高，全科医生在 2 型糖尿病及其并发症防治中发挥重要作用，慢性肾脏病（CKD）是糖尿病患者常见的并存疾病，但目前我国对基层医疗中 2 型糖尿病合并 CKD 综合防治的相关研究证据较少。目的 基于全科医生视角了解社区在 2 型糖尿病合并 CKD 监测和管理中存在的阻碍因素。方法 于 2022年 5—7 月，在北京市某城区采用滚雪球抽样法抽取全科医生进行“一对一”半结构化访谈，基于理论域框架（TDF）制订访谈提纲。采用 NVivo 11 软件对访谈内容进行编码、归类，采用主题框架分析法对资料进行整理、分析，并提炼主题。结果 本研究共访谈 13 名全科医生，受访者从事全科岗位工作的年限为 8~22 年。研究总结出与 TDF 中 6 个领域有关的阻碍因素，分别为知识 / 技能、对结果的信念、动机和目标、医疗背景、资源、行为规范。经过再次提炼，发现缺乏系统的 CKD 相关知识和技能、基层医务人员激励机制不完善、基层医疗机构与上级医院缺乏通畅转诊流程、患者自我管理能力欠佳等是社区在 2 型糖尿病合并 CKD 监测和管理中存在的阻碍因素。结论 全科医生在对 2 型糖尿病合并 CKD 患者的监测和管理中存在不同层面的阻碍因素，需要加强全科医生相关知识及技能培训，完善基层医疗卫生机构激励机制，建立基层医疗卫生机构与上级医院的有效转诊流程，提高患者自我管理能力，以提升基层医疗卫生机构对于 2 型糖尿病合并 CKD 的防治能力。
Background The prevalence rate of type 2 diabetes is increasing in China. General practitioners play an important role in the prevention and treatment of type 2 diabetes and its complications. Chronic kidney diseaseCKD is a common co-existing disease in patients with diabetes. Howeverat presentthere is little research evidence on type 2 diabetes combined with CKD in primary care in China. Objective To investigate the obstructive factors in the monitoring and management of type 2 diabetes mellitus with CKD from the perspective of general practitioners. Methods From May to July 2022a one-tohalf structured interview was conducted with snowball sampling among general practitioners in an urban area of Beijingand the interview outline was formulated based on the theoretical domains frameworkTDF. NVivo 11 software was used to encode and classify the interview contents. Subject frame analysis method was used to sort out and analyze the dataand extract the theme. Results 13 general practitioners were interviewed in this studyand the years of working in general practice ranged from 8to 22 years. The study identified barriers related to six domains in TDFnamely knowledge/skillsbeliefs about outcomesmotivation and goalsmedical backgroundresources and norms of conduct. After refining againthe themes were lack of systematic knowledge and skills related to CKDimperfect incentive mechanism of primary medical stafflack of smooth referral process between primary medical institutions and higher hospitalspoor self-management ability of patients and other obstacles. Conclusion There are many factors preventing general practitioners from monitoring and managing patients with type 2 diabetes complicated with CKD in the community. It is necessary to strengthen the knowledge and skills training of general practitioners with diabetes mellitus complicated with CKDimprove the ability of general practitioners to monitor and manage CKDimprove the incentive mechanism of primary medical institutions and establish an effective referral process with superior hospitalsstrengthen the health education of patientsimprove the self-management ability of patientsand enhance the prevention and treatment ability of primary medical institutions with type 2 diabetes complicated with CKD.
杨海燕、路孝琴、金光辉、李婷
10.12114/j.issn.1007-9572.2023.0388
医药卫生理论医学研究方法内科学
糖尿病，2型慢性肾脏病理论域框架定性研究阻碍因素
iabetes mellitus，type 2hronic kidney diseaseheoretical domains frameworkQualitative researchBarriers
杨海燕,路孝琴,金光辉,李婷.基于全科医生视角的 2 型糖尿病合并慢性肾脏病监测和管理中阻碍因素的质性研究[EB/OL].(2023-09-01)[2025-08-02].https://chinaxiv.org/abs/202309.00021.点此复制
评论