Exploratory research of health services use of hierarchical medical system in elderly patients with type 2 diabetes mellitus in the community / 中华老年医学杂志

ABSTRACT

Objective To investigate the health services use of hierarchical medical system in elderly patients with type 2 diabetes mellitus in the community and to provide information for improving hierarchical medical system.Methods A survey of 684 T2DM patients aged 60 years and older was conducted in the Hua Mu Community Health Service Center in Shanghai from September 2014 to August 2016.And the data about health services visits for T2DM and its complications were collected in the latest one year.Based on different habits for patients receiving medical service,all patients were divided into two groupsthe hierarchical treatment group and control group.All clinical and follow-up data were compared between two groups.Results 368 patients (53.8 ％)took on a priority in clinical visits to community health service center.There were no significant differences in age,gender,education,marriage,income,health insurance and duration of diabetes between the two groups(all P＞0.05).The acquired written health information about diet and exercise were much more in hierarchical treatment group than in the control group during one year.Although the rate of screening of diabetic nephropathy was similar between the two groups (P ＞ 0.05),the rate for retinopathy,neuropathy,vascular and diabetic foot was lower in hierarchical treatment group than in control group (all P ＜ 0.05).Moreover,the levels of glycosylated hemoglobin,urine albumin-to-creatinine ratio,total cholesterol,triglyceride,low-density lipoprotein cholesterol were similar between the two groups (all P＞0.05),but the level of high-density lipoprotein cholesterol in hierarchical treatment group was lower(P＜0.05).Furthermore,the rates of emergency visiting and hospitalization were lower in hierarchical treatment group than in the control group(both P＜0.001),and there was no significant difference in the average length of hospital stay between two groups (P ＞ 0.05).Conclusions Hierarchical medical system is favourable for the rational use of medical resources,but it is not yet quite perfect.Further improvements are still needed.