CAJ | 학술논문

在糖尿病高患病率、高致残率的背景下，提出了老年糖尿病患者居家健康管理模式，并阐述了该模式的目标人群及服务流程。该模式将医疗服务的覆盖范围延伸到家庭，为老年糖尿病患者提供了可靠、专业的健康指导，同时在信息技术的支撑下为患者带来了智能、便捷的健康服务。但模式也在定价问题、用户依从性、服务人员数量、用户流动性、技术实现等方面存在难点。针对上述难点，提出了分类定价、家属劝说、成立呼叫中心、就近选取服务对象、加大政策导向等对策。下阶段的研究工作将围绕深入开展居家健康管理，评价模式效果，建立医养结合新模式等内容进行。
재당뇨병고환병솔、고치잔솔적배경하，제출료노년당뇨병환자거가건강관리모식，병천술료해모식적목표인군급복무류정。해모식장의료복무적복개범위연신도가정，위노년당뇨병환자제공료가고、전업적건강지도，동시재신식기술적지탱하위환자대래료지능、편첩적건강복무。단모식야재정개문제、용호의종성、복무인원수량、용호류동성、기술실현등방면존재난점。침대상술난점，제출료분류정개、가속권설、성립호규중심、취근선취복무대상、가대정책도향등대책。하계단적연구공작장위요심입개전거가건강관리，평개모식효과，건립의양결합신모식등내용진행。
With the high prevalence rate and the high disability rate of diabetes, this paper puts forwards the mode of tele-home health management for elderly patients with diabetes, and expounds the target population and service process. With the support of information technology, the mode extends the coverage of medical service to families, and provides elderly patients with diabetes a reliable, professional health guidance intelligently and conveniently. But there are also some aspects to be improved in terms of price, patients’ compliance and mobility, service personnel number, and technology implementation. To solve these problems, countermeasures such as classification of pricing, persuasion from patients ’ families, establishment of the call center, service object from short distance, policy guidance are put forward. Future research will focus on how to carry out the mode and evaluate its effect and establish a new model of combining medical care with medical maintenance.