个案管理模式用于药物治疗双重糖尿病效果评价

Evaluation on Overall Application of Case Management Modelin Medication Treatment of Double Diabetes

目的探讨个案管理模式在药物治疗双重糖尿病中的应用及对临床疗效和医疗费用的影响。方法将36例诊断为双重糖尿病患者随机均分为观察组和对照组,均给予基础药物治疗,对照组在此基础上进行传统健康教育,观察组在此基础上采取个案管理的干预模式;随访6个月,比较两组患者干预前后体重指数(BMI)、空腹血糖、餐后2 h血糖、糖化血红蛋白、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、血肌酐(CREA)等指标,同时比较患者随访过程中并发症的发生情况及医疗费用差异。结果与干预前比较,对照组患者干预后空腹血糖及餐后2 h血糖明显下降,但糖化血红蛋白及BMI,ALT,AST等未见明显改善,干预后CREA增高(P<0.05);观察组患者干预后除CREA无明显差异外,其他指标均显著下降(P<0.05)。对照组患者并发症发生率显著高于观察组(11.11%比5.56%)。两组患者常规检测费用未见明显差异,但对照组药品费用及住院费用显著高于观察组(P<0.05)。结论个案管理模式用于药物治疗双重糖尿病患者,能稳定控制其血糖水平,降低相关并发症的发生。同时亦能显著降低相关医疗费用的支出。

Objective To investigate the application of the case management mode in the medication treatment of double diabetes and its influence on clinical curative effect and medical cost. Methods 36 patients with double diabetes were divided into the observation group and the control group randomly. The two groups were treated by the basic medication therapy. On this basis the control group was performed the traditional healthy education,while the observation group adopted the interventional mode of case management. The two groups were followed up for 6 months. The indexes of fasting blood glucose,2 h postprandial blood glucose（ PBG）,BMI,Hb A1 C,ALT,AST and CREA were compared between before and after treatment. At the same time,the occurrence situation of complications during follow up process and the medical costs were also observed and compared. Results The fasting blood glucose and 2 h PBG after intervention in the control group were decreased significantly compared with before intervention. But Hb A1 c,BMI,ALT,AST and CREA after intervention had no obvious improvement. CREA after intervention in the control group was increased compared with before intervention,the difference had statistical significance（ P〈0. 05）. The other indexes after intervention in the observation group,except CREA without obvious difference,were significantly decreased compared with before intervention（ P〈0. 05）. The occurrence rate of complications in the control group was significantly higher than that in the observation group（ 11. 11% vs 5. 56%）. The conventional detection costs had no significant difference between the two groups,but the medication cost and hospitalization cost in the control group was significantly higher than those in the observation group（ P〈0. 05）. Conclusion The application of the case management mode in the medication treatment of double diabetes can stably control the blood glucose level and reduces the occurrence of related complications. At the same time it can also reduce the related medical expenses significantly.