中华内分泌代谢杂志
中華內分泌代謝雜誌
중화내분비대사잡지
CHINESE JOURNAL OF ENDOCRINOLOGY AND METABOLISM
2012年
4期
286-289
,共4页
赵列宾%陈宇红%董斌%李昱东%周莹霞%陆骆%张传政%李立强%王志泉%张明延%张磊%久井良之%肖文慧%崔平%赵明瑶%孙海燕%陈英耀%于广军%赵丹丹%宁光
趙列賓%陳宇紅%董斌%李昱東%週瑩霞%陸駱%張傳政%李立彊%王誌泉%張明延%張磊%久井良之%肖文慧%崔平%趙明瑤%孫海燕%陳英耀%于廣軍%趙丹丹%寧光
조렬빈%진우홍%동빈%리욱동%주형하%륙락%장전정%리립강%왕지천%장명연%장뢰%구정량지%초문혜%최평%조명요%손해연%진영요%우엄군%조단단%저광
糖尿病%社区%全科-专科合作%互联网
糖尿病%社區%全科-專科閤作%互聯網
당뇨병%사구%전과-전과합작%호련망
Diabetes mellitus%Community%GPs-Specialist cooperation%Internet
目的 建立基于互联网的全科-专科合作管理糖尿病的模式,探讨其在社区管理糖尿病患者的效果.方法 采用组间对照实验,从上海市五里桥社区已建立健康档案的2型糖尿病人中人选415例,分成联合组和对照组.建立全科-专科联合诊治团队,培训社区医护人员,制订社区药物治疗、患者健康教育和自我管理规范,以及血糖、血压控制目标.对联合组患者在社区定期开展血糖监测,每月由社区团队进行随访,每季度开展健康主题讨论会.在项目启动和观察12个月时,分别测定2组空腹血糖、餐后2h血糖、HbA1C、血压、甘油三酯、总胆固醇、体重指数和腰臀比,计算血糖、血压达标率.对未达标的患者,开展基于互联网的全科-专科视频病例讨论会以及有针对性的专科转诊.同时,问卷了解患者月糖尿病治疗药物费用、糖尿病知识知晓率、健康相关行为,以及对全科-专科合作社区糖尿病管理模式的评价.结果 观察12个月时,联合组的空腹血糖、餐后2h血糖、HbA1C、收缩压和舒张压较基线时有明显下降,且空腹血糖、餐后2h血糖、HbA1C、收缩压显著低于对照组,其达标率也好于对照组(P＜0.05).与基线比较,观察12个月时联合组的健康知识知晓况状的改善率(29.1％对5.5％)、食用健康食品况状的改善率(9.6％对-10.4％)、按时血糖检测况状的改善率(30.3％对10.8％)、对在社区诊治糖尿病支持况状的改善率(35.7％对9.4％)、对联合管理模式接受况状的改善度(63.8％对17.9％)等均较对照组有明显提升(P＜0.01),且对照组观察12个月时每月降糖药物治疗费用较基线有所增加(32.26元对-3.39元,P＜0.05).结论 基于互联网及全科-专科合作管理糖尿病的模式,在未增加糖尿病药物治疗费用前提下,具有很好帮助患者实现血糖控制、增加健康行为和提升在社区诊治依从性等作用,其在药物治疗、血糖管理、会诊转诊、健康教育和治疗花费等方面的机制值得深入研究.
目的 建立基于互聯網的全科-專科閤作管理糖尿病的模式,探討其在社區管理糖尿病患者的效果.方法 採用組間對照實驗,從上海市五裏橋社區已建立健康檔案的2型糖尿病人中人選415例,分成聯閤組和對照組.建立全科-專科聯閤診治糰隊,培訓社區醫護人員,製訂社區藥物治療、患者健康教育和自我管理規範,以及血糖、血壓控製目標.對聯閤組患者在社區定期開展血糖鑑測,每月由社區糰隊進行隨訪,每季度開展健康主題討論會.在項目啟動和觀察12箇月時,分彆測定2組空腹血糖、餐後2h血糖、HbA1C、血壓、甘油三酯、總膽固醇、體重指數和腰臀比,計算血糖、血壓達標率.對未達標的患者,開展基于互聯網的全科-專科視頻病例討論會以及有針對性的專科轉診.同時,問捲瞭解患者月糖尿病治療藥物費用、糖尿病知識知曉率、健康相關行為,以及對全科-專科閤作社區糖尿病管理模式的評價.結果 觀察12箇月時,聯閤組的空腹血糖、餐後2h血糖、HbA1C、收縮壓和舒張壓較基線時有明顯下降,且空腹血糖、餐後2h血糖、HbA1C、收縮壓顯著低于對照組,其達標率也好于對照組(P＜0.05).與基線比較,觀察12箇月時聯閤組的健康知識知曉況狀的改善率(29.1％對5.5％)、食用健康食品況狀的改善率(9.6％對-10.4％)、按時血糖檢測況狀的改善率(30.3％對10.8％)、對在社區診治糖尿病支持況狀的改善率(35.7％對9.4％)、對聯閤管理模式接受況狀的改善度(63.8％對17.9％)等均較對照組有明顯提升(P＜0.01),且對照組觀察12箇月時每月降糖藥物治療費用較基線有所增加(32.26元對-3.39元,P＜0.05).結論 基于互聯網及全科-專科閤作管理糖尿病的模式,在未增加糖尿病藥物治療費用前提下,具有很好幫助患者實現血糖控製、增加健康行為和提升在社區診治依從性等作用,其在藥物治療、血糖管理、會診轉診、健康教育和治療花費等方麵的機製值得深入研究.
목적 건립기우호련망적전과-전과합작관리당뇨병적모식,탐토기재사구관리당뇨병환자적효과.방법 채용조간대조실험,종상해시오리교사구이건립건강당안적2형당뇨병인중인선415례,분성연합조화대조조.건립전과-전과연합진치단대,배훈사구의호인원,제정사구약물치료、환자건강교육화자아관리규범,이급혈당、혈압공제목표.대연합조환자재사구정기개전혈당감측,매월유사구단대진행수방,매계도개전건강주제토론회.재항목계동화관찰12개월시,분별측정2조공복혈당、찬후2h혈당、HbA1C、혈압、감유삼지、총담고순、체중지수화요둔비,계산혈당、혈압체표솔.대미체표적환자,개전기우호련망적전과-전과시빈병례토론회이급유침대성적전과전진.동시,문권료해환자월당뇨병치료약물비용、당뇨병지식지효솔、건강상관행위,이급대전과-전과합작사구당뇨병관리모식적평개.결과 관찰12개월시,연합조적공복혈당、찬후2h혈당、HbA1C、수축압화서장압교기선시유명현하강,차공복혈당、찬후2h혈당、HbA1C、수축압현저저우대조조,기체표솔야호우대조조(P＜0.05).여기선비교,관찰12개월시연합조적건강지식지효황상적개선솔(29.1％대5.5％)、식용건강식품황상적개선솔(9.6％대-10.4％)、안시혈당검측황상적개선솔(30.3％대10.8％)、대재사구진치당뇨병지지황상적개선솔(35.7％대9.4％)、대연합관리모식접수황상적개선도(63.8％대17.9％)등균교대조조유명현제승(P＜0.01),차대조조관찰12개월시매월강당약물치료비용교기선유소증가(32.26원대-3.39원,P＜0.05).결론 기우호련망급전과-전과합작관리당뇨병적모식,재미증가당뇨병약물치료비용전제하,구유흔호방조환자실현혈당공제、증가건강행위화제승재사구진치의종성등작용,기재약물치료、혈당관리、회진전진、건강교육화치료화비등방면적궤제치득심입연구.
Objective To assess the effectiveness of tele-medicine and self-management goal(SMG) setting technique used in the diabetes management in the community setting.Methods It is a control-group study.415 type 2 diabetic residents were recruited from the Shanghai Wuliqiao community based on existing medical records.The subjects were divided into two groups,the study group was cared by general practitioners (GPs) specialists cooperation through the tele-medicine mechanism,the other was a control group.For the study group,a cooperation pathway between community health care centers and general hospitals were established.Standardized training and guidelines were provided to community health workers,regarding the setting of management goals of blood glucose and blood pressure,treatment plan,patient education,and SMG techniques.Fasting blood glucose ( FBG ) and 2 h postprandial blood glucose (2hBG) in the study group were monitored,followed by community health workers visiting monthly with seminars for diabetes education.At the baseline and the 12tb month,FBG,2hBG,HbA1C,blood pressure,triglyceride,total cholesterol,body mass index,waist-hip ratio were determined in each group.A survey was conducted to evaluate the costs of diabetes treatments,the knowledge base related to their disease,lifestyle,and the awareness of the new care model.The rates of achieving the goal of blood glucose,blood pressure,and HbA1Ccontrol were calculated.Internet case discussion between GPs-Specialists and referral to certain specialists were implemented when some patients did not reach the control goal.Results By the 12 month follow up,FBG,2hBG,HbAIc,blood pressure of the study group were lower than the baseline,and as well as the control group with statical significance (P＜0.05).There are other improvcments:diabetes knowledge (29.1％ vs 5.5％ ),healthy diet (9.6％ vs -10.4％ ),blood glucose monitoring (30.3％ vs 10.8％ ),support for diabetes care in community (35.7％ vs 9.4％ ),and the preference of the new model (63.8％ vs 17.9％ ) with statistical significauce (P＜0.01 ).As for the medical costs,the study group's monthly costs were consistently lower than the control's.( -3.39Yuan vs 32.26 Yuan,P＜0.05).Conclusions The new diabetes care model based on GPs-Specialists tele-medicine and SMG in community opens the door to the community based care model formulation in regard to the health quality and costs control.The deployment of more technologies and management techniques could be explored further to improve the outcomes of community based chronic disease care model.
