三级医院与社区医院联合管理居家腹膜透析患者实践效果的初探

A Study of the Effective Model of Combination Management of Tertiary Hospitals and Community Hospitals for Home Peritoneal Dialysis Patients

目的探讨三级医院与社区联合管理居家腹膜透析患者的实践效果。方法选择2012年12月-2013年5月终末期肾病腹膜透析患者50例,其中男26例,女24例,年龄(47.1±13.9)岁,随机分为医院组30例,医院社区联合组20例。医院组采取专科医护对腹膜透析患者进行定期门诊与随访,医院社区联合组采取三级医院对社区全科医师进行腹膜透析基本诊疗及规范化管理知识的培训与通讯交流,共同管理治疗居家腹膜透析患者。所有腹膜透析患者观察管理9个月。结果至观察终点医院组、医院社区联合组患者透析充分性达标率,血红蛋白、血钾、血磷、血钙、血清白蛋白水平,二氧化碳结合力,血压达标率,腹膜炎发生率差异均无统计学意义(P>0.05);月均医疗费差异无统计学意义(P>0.05)。医院社区联合组与医院组月交通费分别为(123.5±19.2)、(205.3.±92.3)元,差异有统计学意义(P<0.05)。结论三级医院与社区联合规范化管理治疗居家腹膜透析患者,降低了患者交通费用,提高了社区全科医师对腹膜透析适应证及基本知识的掌握水平。

Objective To explore the practice effect of the combination management of tertiary hospital and community hospital for home peritoneal dialysis patients. Methods A total of 50 patients of end-stage renal disease from December 2012 to May 2013 were involved in this study, including 26 males, and 24 females with the average age of 47.1± 13.9. The patients were randomly divided into hospital group （30 patients） and combination group （20 patients）. For the patients in the hospital group, the specialists take care of them with regular outpatient service and follow-up; for the patients in the combination group, they were taken care by doctors from both tertiary hospital and community hospital, while the community general practitioners were trained by the tertiary hospital regularly with peritoneal dialysis basic treatment and standardization management and communication. All the patients were managed for 9 months. Results At the end of the observation,the dialysis adequacy success rate, hemoglobin, blood potassium, phosphorus, calcium, albumin, CO2CP, blood pressure success rate, the incidence of peritonitis, and average monthly medical treatment expense between the two groups were not statistically different （P 〉 0.05）; the difference in cost of transportation was statistically significant （P 〈 0.05）. Conclusion The standardization manage of combination of tertiary hospital and community for patients with home peritoneal dialysis may reduces the patients＇ expense in transportation, and improve the community general practitioners＇ level of basic knowledge and indication of peritoneal dialysis.