Abstract | Cilj istraživanja:
Usporediti učestalost posjeta pacijenata liječenih od šećerne bolesti u ordinacijama obiteljske
medicine u ruralnoj i urbanoj sredini, utvrditi postoji li korelacija imeđu broja posjeta i kontrole
ispitivane kronične bolesti te utvrditi postoji li rizik korištenja ruralnih ambulanti za kontrolu
kronične bolesti.
Ispitanici i metode:
Podaci su prikupljeni iz medicinskih dokumentacija dviju ordinacija obiteljske medicine, jedne
iz urbanog, a druge iz ruralnog područja. Ukupno je uključeno 140 pacijenata kojima je u
razdoblju od 2008. do 2017. godine prvi puta dijagnosticirana šećerna bolest, a svakog pacijenta
se pratilo jednak vremenski period (365 dana) od dana dijagnosticiranja šećerne bolesti. U
slučaju nedostatne medicinske evidencije, težih akutnih i kroničnih bolesti te dijagnoze osnovne
bolesti u razdoblju prije ili poslije promatranog ispitanici nisu uključeni u istraživanje. Glavne
mjere ishoda bile su broj posjeta ordinaciji OM zbog ispitivane (osnovne) bolesti i to zbog
pogoršanja osnovne bolesti ili zbog kontrole osnovne bolesti te postignuta kontrola ispitiva ne
bolesti na kraju jednogodišnjeg razdoblja. Sporedne mjere ishoda su bile broj izdanih recepata
za liječenje osnovne bolesti, vrsta i broj lijekova za liječenje ispitivane bolesti, komplikac ije
ispitivane bolesti te ukupan broj posjeta ordinaciji kroz ispitivano razdoblje. Statistička analiza
je rađena u statističkom programu STATISTICA 12, a zaključci se donose pri značajnosti od
5%.
Rezultati:
Kod većeg broja promatranih pacijenata iz urbanog i ruralnog područja normalne vrijednost i
glukoze u krvi na kraju jednogodišnjeg razdoblja nisu postignute (p=0,726). Nije utvrđeno
postojanje statistički značajne razlike u vrijednosti glukoze na kraju jednogodišneg razdoblja
(p=0,395). U obje promatrane skupine bolest je najčešće dijagnosticirao liječnik obiteljske
medicine. Kod najvećeg broja promatranih pacijenata urbanog područja liječenje je započeto
higijensko-dijetetskim mjerama, dok je kod najvećeg broja promatranih pacijenata ruralnog
područja liječenje započeto medikametonom terapijom odmah. Testiranjem je utvrđena
povezanost između mjesta življenja i metode koja je korištena kod početka liječenja (χ2 =62,78;
p<0,001). Kod obje promatrane skupine pacijenata metformin je najčešći lijek korišten za
početno liječenje šećerne bolesti te se propisuje u jednakoj mjeri kod obje promatrane skupine
(p=0,210). Pacijenti ruralnog područja češće su posjećivali liječnika obiteljske medicine zbog kontole šećerne bolesti (p=0,040), dok je ukupan broj svih posjeta veći na urbanom području
(p=,001).
Zaključci:
Urbana i ruralna sredina ne razlikuju se po stopi postizanja ciljnih vrijednosti glukoze u krvi
nakon godine dana liječenja. Kod većeg broja obje skupine pacijenata ciljne vrijednosti glukoze
u krvi nisu postignute. Lijekovi su propisivani u skladu s važećim smjernicama za liječenje
šećerne bolesti, a prvi propisani lijek na početku liječenja kod pacijenata ruralnog i urbanog
područja je metformin. Pacijenti ruralnog područja češće su posjećivali liječnika obiteljske
medicine zbog kontole šećerne bolesti, dok je ukupan broj svih posjeta veći na urbanom
području. |
Abstract (english) | The aim of the research:
The aim of this research is to compare the frequency of going to the physician by patients with
diabetes treated in family physician's offices in rural and urban area. Furthermore, the research
is aimed to determine if there is any correlation between the number of patients' visits and the
control of the chronic illness being examined, and to ascertain if there is any risk of going to
the rural physician's offices in order to control the chronic illness.
Participants (patients) and methods:
The data were collected from the medical records from the two family physician's offices, one
from the urban and one from the rural area. 140 patients in total, who were diagnosed with
having diabetes for the first time in the period from 2008 to 2017, participated in the research.
Every patient was monitored for the equal period of time (365 days), from the day that the
diabetes was diagnosed. In case there was a lack of medical record, a severe acute and chronic
illnesses or diagnosed primary illness in the time before and after the monitored period, the
patients were not included in the research. The main outcome measures were the visits to the
family physician offices for the examined (primary) illness, either because the primary illness
got worse or due to the control of the primary illness, and the control that was achieved at the
end of the one year period. The secondary outcome measures were the number of prescriptions
issued in order to treat the primary illness, type and number of medicines for treating the
examined illness, complications of the examined illness and the exact number of attending the
physician’s office during the period of examination. Statistical analysis was done with the
statistical program “STATISTICA 12“, and conclusions are drawn with significance of 5%.
Results
At the end of the one-year period in great number of monitored patients from both urban and
rural area the normal blood glucose level was not achieved (p=0,726). No statistica l ly
significant difference was noted in the blood glucose level at the end of the one-year period
(p=0,395). In both monitored groups the illness was most frequently diagnosed by the family
physician. In the greatest number of monitored urban area patients the treatment initiated with
hygiene and dietary measures, whereas in the greatest number of monitored rural area patients
the treatment started immediately with medicines. The testing showed the connection between
the residence and the treatment method that was employed at the beginning of the treatment
(χ2 =62,78; p<0,001). In both monitored groups the mostly used medicine for prediabetes treatment is metformin (the group of biguanides) that is prescribed to the same extent in both
monitored groups (p=0210). The rural area patients went to the family physician’s office more
often to control the diabetes (p=0,040), while the total number of all visits is greater in the urban
area (p=,001).
Conclusion
To conclude, the urban and rural areas do not differentiate according to the range of
achievement of the target blood glucose levels after one-year treatment. In great number of both
groups of patients target blood glucose levels were not achieved. The medicines were prescribed
in accordance with valid guidelines for diabetes treatment, and the first medicine that was
prescribed at the beginning of the treatment in patients from rural and urban area was
metformin. The patients from rural area went to the family physician’s office more often in
order to control their diabetes, while the total number of all patients’ visits is bigger in the urban
area. |