基于家庭医生制社区糖尿病管理模式效果分析.docVIP

基于家庭医生制社区糖尿病管理模式效果分析 　　摘 要 目的：分析家庭医生制服务下糖尿病管理模式对社区糖尿病患者血糖相关指标的影响。方法：选取2012年10月-2013年10月中心在管2型糖尿病患者930人，与签约家庭医生的520人作为管理组，提供家庭医生团队管理，未与签约家庭医生的410人为对照组，以常规慢性病管理方式管理。结果：管理1年后，签约组糖尿病患者血糖、糖化血红蛋白、低密度脂蛋白、血压值和体重指数优于对照组，且差异有统计学意义（P0.05）。结论：基于家庭医生制服务的社区糖尿病管理模式对社区糖尿病患者血糖控制相关指标管理有效，对提高糖尿病社区管理有积极作用。 　　关键词 糖尿病 家庭医生服务制 社区管理 效果分析 　　中图分类号：R197.1/R587.1 文献标志码：A 文章编号：1006-1533（2016）14-0046-03 　　Analysis of the effect of the community diabetes management mode based on family doctor system 　　LIANG Changxiu， YU Lu， XU Ruyun， ZHANG Feng， GU Xiaoping， CHEN Jin， HUANG Lili， WANG Ying 　　（ Kangjian Community Health Service Center of Xuhui District， Shanghai 200233， China） 　　ABSTRACT Objective： To analyze the effect of diabetes management mode on the level of blood glucose and other indexes in the community diabetic patients under the family doctor service system. Methods： From Oct. 2012 to Oct. 2013， 930 cases of type 2 diabetes were selected in the center， five hundred and thirty diabetic patients who signed the contract with the family doctors were as a management group and managed by the family doctor team， while another 410 diabetic patients who did not contract with the family doctors were as a control group and managed with the conventional chronic disease management. Results： After one year management， blood glucose， hemoglobin A1c， low density lipoprotein cholesterol， blood pressure and body mass index of the management group were better than those of the control group， and the differences between the two groups had the statistical significance（P0.05）. Conclusion： The community diabetes management mode based on the family doctor service system is effective in the management of blood glucose control related indexes in the community patients with diabetes. 　　KEY WORDS diabetes； family doctor service system； community management； effect analysis 　　糖尿病是由遗传和环境因素相互作用所引起的以血中葡萄糖水平长期增高为基本特征的代谢性疾病。瑞金医院宁光教授和国家疾病预防控制中心赵文华研究员共同牵头完成的“2010年中国慢病监测糖尿病专题调查”，显示我国18岁以上成年人中糖尿病患病率为11.6%，糖尿病前期人群达5