我国糖尿病患者家庭医生签约服务效果的Meta分析

Meta-analysis on the effects of general practitioner contract service among diabetic patients in China

目的系统评价我国家庭医生签约服务对社区糖尿病患者血糖控制和依从性的效果，为推广糖尿病患者的家庭医生管理提供依据。方法计算机检索CNKI、VIP、CBM与万方等数据库，检索时限均为建库至2018年1月31日，收集所有对糖尿病患者实施家庭医生签约服务与常规社区干预相关研究的文献。由2位论文评阅者按纳入与排除标准独立筛选文献，并对纳入文献提取数据。采用Stata12.0软件进行Meta分析。结果共纳入38篇试验研究，共计8 809例糖尿病患者，实施家庭医生签约服务4 551人，实施常规社区干预4 258人。与实施常规社区干预比较，家庭医生管理组各生化指标除高密度脂蛋白胆固醇和低密度脂蛋白胆固醇以外均见显著下降，其中糖化血红蛋白下降最多为1.07%（SMD=-1.070，95%CI=-1.309、-0.831），而对舒张压的控制亦未见显著差异（SMD=-0.171，95%CI=-0.366、0.025，P〉0.05）；家庭医生管理组的糖尿病患者遵医用药、控制饮食、血糖监测和体育锻炼的比例分别增加23.9% （RR=1.239，95%CI=1.147、1.338）、28.7%（RR=1.287，95%CI=1.021、1.622）、39.4% （RR=1.394，95%CI=1.226、1.584）与38.0%（RR=1.380，95%CI=1.209、1.576）。结论家庭医生签约服务对糖尿病患者血糖与依从性的控制更为有效，并且随访依从性更好。

Objective To systematically review the effectiveness of general practitioner contract service on blood glucose management and treatment compliance in diabetes patients in the community, and provide a basis and reference for general practitioner to manage diabetes patients. Methods We searched electronic databases including CNKI, VIP,CBM and WanFang Data for published articles from inception to Jan. 31 2018. Collected all literature on the study of general practitioner contract service and conventional community intervention in diabetic patients. According to the inclusion and exclusion criteria, two reviewers screened literature and extracted data of included studiesindependently. Then, meta-analysis was performed using Stata 12.0 software.Results Totally, 38 experiment studies were collected involving 8 809 diabetic patients, including 4 551 patients who received the contract service of general practitioner and 4 258 patients who received conventional community intervention. Compared with conventional community intervention group, the biochemical indexes in the contract service of general practitioner group were significantly lowerthan that of the control groups, except for high-density lipoprotein-cholesterol and low-density lipoprotein-cholesterol level. The level of HbA1c among intervention group was decreased with 1.07% compared with that of control group （SMD=-1.070, 95%CI=-1.309,-0.831）. Diastolic blood pressure （DBP） was not significantly different between the intervention and control group （SMD=-0.171, 95%CI=-0.366, 0.025, P〉0.05）. The patient compliance indexes, such as taking drugs in a timely manner, dietary control, blood glucose monitoring and physical exercise, were significantly improvedamong intervention group：23.9% （RR=1.239,95%CI=1.147,1.338）, 28.7% （RR=1.287, 95%CI=1.021,1.622）, 39.4% （RR=1.394,95%CI=1.226,1.584） and 38.0% （RR=1.380, 95%CI=1.209,1.576） respectively.Conclusion The contract service of general practitioner has much more effectiveness and compliance than the traditional management of diabetes incommunities.