目的 调查分析社区卫生服务中心糖尿病门诊建档患者失访原因并评价干预效果.方法 选取2015年1月1日前于上海市普陀区曹杨街道社区卫生服务中心糖尿病门诊建档且失访的患者150例,采用问卷调查的形式,了解患者一般资料和失访原因,并对患者进行为期12个月的强化随访干预,比较随访前后患者健康知识的掌握情况和血糖水平.结果 糖尿病患者失访原因主要为对随访重视不够、身体原因、错误认知等.随访干预后,糖尿病患者健康知识掌握情况优于干预前;患者空腹血糖及餐后2 h血糖均低于干预前,差异均有统计学意义(P<0.05).结论 糖尿病患者失访原因较多,应加强对患者失访干预,发挥患者主观能动性,以促进行为改变.%Objective To investigate the reasons for loss to follow-up in diabetic patients in Caoyang community,and to evaluate the effects of follow-up intervention. Methods A total of 150 diabetic patients lost to follow-up before January 1st 2015 in Caoyang Community Health Service Center of Putuo District,Shanghai were selected. The reasons for loss to follow-up were investigated by questionnaire. The patients were followed up for 12 months. The health knowledge and blood sugar level were compared before and after intervention. Results The main reasons for loss to follow-up were insufficient attention to follow-up,physical reasons and cognitive errors. After 12-month follow-up intervention,the health knowledge level was significantly improved (P < 0. 05). And the fasting blood glucose and 2-hour postprandial blood glucose levels significantly decreased (P < 0. 05). Conclusion There are many reasons for loss to follow-up in diabetic patients. It is necessary to strengthen the follow-up intervention for the patients,and help them to develop subjective motivation to promote behavior changes.
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