订单定向生在基层2型糖尿病患者综合管理中的作用研究

Effects of the Targeted Admission Medical Program Educated Physicians on Type 2 Diabetes Mellitus Management

背景目前我国已发展成为糖尿病患者人数最多的国家,而糖尿病在基层缺乏合格的全科医师给予患者长期规范化的指导与治疗,为解决上述问题,我国自2010年起,连续3年在高等医学院校开展订单定向医学生培养工作,重点为乡镇卫生院及以下的医疗卫生机构培养从事全科医疗的卫生人才,进一步加强基层全科医生队伍的数量和质量,以满足基层民众对卫生资源的需求。目的探讨订单定向生在基层2型糖尿病(T2DM)患者综合管理中的作用。方法选取2018年8月—2019年1月石家庄辖区内4所订单定向生所在乡镇卫生院收治的T2DM患者412例,采用随机数字表法分为乡医组206例和定向组206例。乡医组是由卫生院医生组成的乡村医生团队对T2DM患者进行健康管理,定向组是由订单定向生组成的团队对T2DM患者进行健康管理,两组患者均持续干预6个月。比较两组患者干预前后血压异常、空腹血糖(FBG)异常、低血糖、糖尿病周围神经病变(DPN)发生情况、糖化血红蛋白(HbA1c)、自我管理简化量表评分。结果定向组患者干预后FBG异常、低血糖、DPN发生率低于乡医组(P<0.05)。定向组患者干预后HbA1c低于乡医组,自我管理简化量表评分高于乡医组(P<0.05)。结论订单定向生通过全科规培后回归基层工作有利于基层T2DM患者血糖的控制及自我管理能力的提高,还有利于DPN的筛查及预防,并降低低血糖发生风险。

Background At present,China has become the country with the largest number of diabetic patients,however,there is a lack of qualified general practitioners to give long-term standardized guidance and treatment for diabetes in the grassroots.In order to solve the above problems,the state has carried out the training of targeted admission medical program educated physicians in medical colleges and universities for three consecutive years since 2010,focus on the training of health professionals engaged in general practice for township health centers and medical and health institutions below,further strengthen the number and quality of grassroots general practitioners,in order to meet the needs of grassroots people for health resources.Objective To evaluate the effect of the targeted admission medical program educated physicians on type 2 diabetes mellitus management and its practicability in grassroots development.Methods 412 patients with type 2 diabetes mellitus in 4 township health centers of targeted admission medical program educated physicians in Shijiazhuang from August 2018 to January 2019 were selected,and they were divided into township medical group and orientate group according to random number table method,206 cases in each group.Patients in township medical group were managed by a team of rural doctors composed of doctors in township hospital,patients with orientate group were managed by the targeted admission medical program educated physicians,both groups were intervented for 6 months.Abnormal blood pressure,abnormal FBG,hypoglycemia,incidence of DPN,HbA1c,Self-management Simplified Scale score were compared between the two groups before and after intervention.Results The incidence of abnormal FBG,hypoglycemia,diagnosis of DPN in orientate group were lower than those in township medical group after intervention(P<0.05).HbA1c in orientate group was lower than that in township medical group,Selfmanagement Simplified Scale score in orientate group was higher than that in township medical group after intervention(P<0.05).Conclusion The targeted admission medical program educated physicians return to grassroots work,which is conducive to the control of blood sugar and the improvement of self-management ability,and also conducive to the screening and prevention of DPN and reduces the risk of hypoglycemia and hypoglycemia.