社区慢性病防治的全科医疗服务及成效

General Practice Service and Effect of Chronic Disease Treatment in the Community

目的 探讨社区慢性病防治的全科医疗模式和成效。方法 对深圳市皇岗社区健康服务中心自 1998年6月成立以来 ,坚持全科医学的基本原则和方法 ,开展社区慢性病综合防治的实践进行总结和分析。结果 2 0 0 3年底 ,社区高血压登记患病率为 6 2 % ,糖尿病登记患病率达到 4 1% ,分别比 1998年底提升了 2 37倍和 3 16倍 ;高血压和糖尿病登记患者建档率、建档患者随访管理率、相关知识知晓率及治疗率均达到 10 0 0 % ;高血压控制达标率为82 0 % ,糖尿病控制达标率为 80 0 % ,分别比 1998年底提升了 2 0 6 % (P <0 0 5 )和 2 5 0 % (P <0 0 5 )。

Objective This thesis investigates the general practice pattern and effect of chronic disease treatment.Methods Since the opening of Huanggang Community Health Service Center of Shenzhen city in June 1998, it insisted on the basic principles and methodology of general practice. The thesis analyzes and concludes the comprehensive treatment of chronic diseases in the communityResults At the end of 2003, in the community, registered hypertension case rate reached 6.17%, and registered diabetes case rate reached 4.11%, which are 2.37 times and 3.16 times more than 1998 respectively. Filing rate, visit rate, the relative knowledge rate and treatment rate of registered hypertension and diabetes patients have all reached 100%. Hypertension control rate reached 82%, and diabetes 80%, which rise 20.6%(χ 2=3.89,P<0.05) and 25%(χ 2=3.9,P<0.05)than that 1998.Conclusion General practice service in the community is the best approach to chronic disease comprehensive treatment.