上海市社区2型糖尿病患者家庭医生签约管理效果评价

Effect of community management of type 2 diabetes patients with signing on family doctor service in Shanghai

目的 了解2型糖尿病患者家庭医生签约的效果及存在问题,从而对完善签约管理服务提出建议.方法 采取整群随机抽样方法,2014年9月至2015年4月选取上海市2个区中6家社区卫生服务中心,将在该社区过去1年内就诊3次以上的2型糖尿病患者纳入调查,将社区中登记在册已签约家庭医生1年以上的患者作为签约组,纳入研究的患者填写基础调查问卷及进行生化指标检查.结果 纳入的5078例社区2型糖尿病患者,总体签约率为40.8%（2053/5031）.全科医生为签约患者制定血糖控制建议[61.7%（1261/2053）比34.5%（1026/2978）]、饮食控制建议[64.6%（1320/2053）比35.7%（1061/2978）]、运动建议[63.4%（1295/2053）比34.8%（1033/2978）]的比例高于未签约患者（χ^2=356.507,400.649,393.996,均P〈0.01）.签约组患者药物依从性良好者占80.2%（1615/2053）、自觉进行锻炼者比例为81.8%（1679/2053）,均高于未签约组[分别为77.6%（2272/2978）、74.5%（2215/2978）],差异有统计学意义（χ^2=3.894,38.084,均P〈0.05）.签约患者空腹血糖达标率[40.0%（823/2053）比35.9%（1069/2978）]、糖化血红蛋白达标率[47.3%（971/2053）比45.4%（1352/2978）]、餐后2 h血糖达标率[35.2%（722/2053）比32.5%（968/2978）]均高于未签约患者（χ^2=18.495,5.218,5.006,均P〈0.05）.结论 2型糖尿病患者家庭医生签约率较低,全科医生对社区2型糖尿病患者健康相关行为改善及血糖控制起到积极作用.

Objective To assess the effect of community management of type 2 diabetes mellitus （T2DM）patients with signing on family doctor service in Shanghai.Methods Six community health service centers in two Shanghai districts were selected by cluster random sampling method from April 2014 to March 2017.T2DM patients,who visited the community health service centers more than three times in the last one year, were enrolled in the study.The questionnaire survey was conducted and lab tests were documented.Results A total of 5 078 T2DM patients were enrolled in this study,among whom 2 033 had signed contract service with family doctors（signing group）with a signing rate of 40.8%.Compared to non-signing group,the patients in the signing group were better followed the recommendations of blood glucose control[64.6%（1 320/2 053）vs.35.7%（1 061/2 978）], diet[64.6%（1 320/2 053）vs.35.7%（1 061/2 978）]and physical activity[63.4%（1 295/2 053）vs.34.8%（1 033/2 978）]（χ^2=356.507, 400.649 and 393.996, P〈0.01）.The medication compliance rate and regular exercise rate in signing group were higher than those in non-signing group[80.2%（1 615/2 053）vs.77.6%（2 272/2 978）, χ^2=3.894,P〈0.05;81.8%（1 679/2 053）vs.74.5%（2 215/2 978）,χ^2=38.084, P〈0.05]. The control rates of GLU,2 h PPG,HbA1c,and blood pressure in signing group were higher than those in non-signing group[40.0%（823/2 053）vs.35.9%（1 069/2 978）,47.3%（971/2 053）vs.45.4%（1 352/2 978）,35.2%（722/2 053）vs.32.5%（968/2 978）, χ^2=18.495,5.218, 5.006, all P〈0.05].Conclusion The community management with signing on family doctor service enhances the improvement of health related behaviors in patients with type 2 diabetes; but currently the rate of contract signing is still low.