家庭医生团队结合分级诊疗在社区糖尿病足危险人群中的应用效果

Application Effect of Family Doctor Team Combined with Hierarchical Diagnosis and Treatment in Community Diabetic Foot Risk Population

目的探讨家庭医生团队结合分级诊疗在社区糖尿病足危险人群中的应用效果。方法采用方便取样的方法,选取2017年1月-2019年1月东莞松山湖高新技术产业开发区社区卫生服务中心和东莞市东城社区卫生服务中心两个中心的糖尿病患者100例为研究对象,为社区居民构建完善的健康管理档案,实施家庭医生团队健康管理及指导,并在家庭医生团队中加强社区护士护理干预,观察患者足溃疡的发生情况、足部风险分级情况、下肢动脉血供及足部自我护理能力。结果干预后,有8例患者发生糖尿病足1级溃疡,糖尿病足的危险因素评分比干预前降低,差异具有统计学意义(P<0.05);下肢动脉踝肱指数得分高于干预前,同时,干预后患者的糖尿病足自我护理能力得分为(55.4±7.5)分,高于干预前,差异具有统计学意义(P<0.05)。结论家庭医生团队结合分级诊疗的实施有助于缓解糖尿病足危险因素,改善周围血管病变,同时提高患者的足部自我护理能力及生活质量。

Objective To explore the application effect of the family doctor team combined with graded diagnosis and treatment in the community of diabetic foot population. Methods Using the method of convenient sampling, 100 cases of diabetes patients from the Community Health Service Center of Dongguan Songshan Lake High-tech Industrial Development Zone and Dongguan Dongcheng Community Health Service Center from January 2017 to January 2019 were selected as research objects. Community residents build a sound health management file, implement family doctor team health management and guidance, and strengthen community nurses’ nursing intervention in the family doctor team to observe the occurrence of foot ulcers, foot risk grading, lower extremity arterial blood supply and foot departmental self-care ability. Results After intervention, 8 patients with diabetic foot grade 1 ulcer, the risk factor score of diabetic foot was lower than that before intervention, the difference was statistically significant(P<0.05);the lower extremity arterial spasm index score was higher than before intervention. The score of self-care ability of diabetic foot after intervention was(55.4±7.5) points, which was statistically significant(P<0.05). Conclusion The combination of family doctors and patients with graded diagnosis and treatment can help alleviate the risk factors of diabetic foot, improve peripheral vascular disease, and improve the patient’s foot self-care ability and quality of life.