基于家庭医生签约服务的社区血脂异常强化管理的效果分析

Effectiveness analysis of intensive management of dyslipidemia in community based on family doctor contracting service

目的分析基于家庭医生签约服务的社区血脂异常强化管理的效果。方法2014年12月,在杭州市3家社区卫生服务中心就诊的年龄≥18岁的血脂异常患者1267例,其中干预组645例(男性311例,女性334例),对照组622例(男性307例,女性315例),干预组采用基于家庭医生签约服务的分级随访和个性化诊疗的社区血脂异常强化管理,对照组采用一般的社区血脂异常管理,经12个月的干预后,采用χ^2检验或t检验比较两组干预前后血脂异常者生活方式(吸烟、饮酒、体质指数、腰围)、调脂药规律服药率和血脂、血压、血糖各项指标水平及其达标率的变化,非条件Logistic回归分析血脂达标的影响因素。结果干预前,干预组与对照组在性别、年龄、心血管危险分层、血脂及其他代谢指标水平、血脂达标率等方面比较,差异均无统计学意义(P均>0.05)。干预后,干预组与对照组在饮酒、超重、肥胖、腹型肥胖率调脂药规律服药率等方面比较,差异均有统计学意义(χ^2=5.923,4.765,8.587,5.341,5.654;P均<0.05);干预组的总胆固醇、三酰甘油、低密度脂蛋白胆固醇、体质指数、腰围、收缩压、舒张压、空腹血糖、糖化血红蛋白水平均低于对照组,差异均有统计学意义(t=4.987,-3.207,-6.280,-3.339,-2.466,-4.052,-5.012,-2.865,-2.450;P均<0.05),而干预组的高密度脂蛋白胆固醇水平高于对照组,差异也有统计学意义(t=2.294;P<0.05);干预组的血脂达标率、血压达标率以及血脂、血压、血糖联合达标率均高于对照组,差异均有统计学意义(χ^2=31.262,4.818,17.245;P均<0.05);非条件Logistic回归分析显示,接受家庭医生签约服务(OR=1.961,95%CI:1.485~2.589)、性别(OR=0.662,95%CI:0.471~0.930)、吸烟(OR=0.498,95%CI:0.332~0.745)、肥胖(OR=0.570,95%CI:0.359~0.904)、合并高血压(OR=0.353,95%CI:0.259~0.480)、合并糖尿病(OR=0.340,95%CI:0.239~0.483)是血脂达标的影响因素(P均<0.05)。结论基于家庭医生签约服务的社区血脂异常强化管理有利于提高血脂异常的管理效果。

Objective To analysis of the effect of strengthening management of dyslipidemia in community based on family doctor contracting service.Methods In December 2014,1267 cases patients with dyslipidemia aged over 18 years were selected from three community health service centers in Hangzhou,including 645 in intervention group(311 males and 334 females)and 622 in control group(307 males and 315 females).In the intervention group,the management of dyslipidemia in community was strengthened by graded follow-up and personalized diagnosis and treatment based on the contracted services of family doctors,while the control group adopted the general management of dyslipidemia in the community.After 12 months of intervention,the changes of lifestyle(smoking,drinking,body mass index,waist circumference),regularly taking lipid-regulating drugs,blood lipid,blood pressure,blood sugar levels and their control rates were compared byχ^2 test or t test before and after intervention between the intervention group and the control group.Non-conditional logistic regression analysis was used to analyze the influencing factors of blood lipid attainment.Results Before intervention,there were no significant differences in gender,age,cardiovascular risk stratification,the levels of lipid and other metabolic indicators,lipid compliance rate between intervention group and control group(P>0.05).After intervention,the intervention group improved in drinking,overweight,obesity,abdominal obesity,and the rate of regularly taking lipid-regulating drugs increased,compared with the control group,the difference was statistically significant(χ^2=5.923,4.765,8.587,5.341,5.654;all P<0.05).The levels of total cholesterol,triglyceride,low density lipoprotein cholesterol,body mass index,waist circumference,systolic blood pressure,diastolic blood pressure,fasting blood glucose,glycosylated hemoglobinin the intervention group were lower than those in the control group,the differences were statistically significant(t=-4.987,-3.207,-6.280,-3.339,-2.466,-4.052,-5.012,-2.865,-2.450;all P<0.05),while the HDL-C level in the intervention group was higher than that in the control group(t=2.294;P<0.05).The control rate of blood lipids,the control rate of blood pressure,and the combined control rates of blood lipid,blood pressure and blood sugar in the intervention group were higher than those in the control group,the differences were all significant(χ^2=31.262,4.818,17.245;all P<0.05).Unconditional logistic regression analysis showed that family doctor contracted services(OR=1.961,95%CI:1.485-2.589),gender(OR=0.662,95%CI:0.471-0.930),smoking(OR=0.498,95%CI:0.332-0.745),obesity(OR=0.570,95%CI:0.359-0.904),hypertension(OR=0.353,95%CI:0.259-0.480),diabetes mellitus(OR=0.340,95%CI:0.239-0.483)was the influencing factor of blood lipid reaching the target(all P<0.05).Conclusion Intensive management of dyslipidemia in community based on family doctor's contracting service is helpful to improve the management effect of dyslipidemia.