“在线医生”模式在社区老年人健康管理服务中的应用效果评价

Therapeutic Effect of"Online Doctor"Pattern in Community Health Management Service for the Elderly

目的评价"在线医生"模式在本社区老年人健康管理服务中的应用效果。方法选取2018年4月15日至2018年12月31日在本社区建立健康档案且进行规范化管理的签约手机端"在线医生"服务的老年患者。按照纳入排除标准,已签约"在线医生"服务程序的患者100人为干预组,未使用的患者100人为对照组。研究对象均完成完整的问卷调查、体格检查及血生化检查。按照血清低密度脂蛋白胆固醇(LDL-C)、空腹血糖(Glu)是否达标进行亚组分析。结果共200例社区居民纳入研究,男103例,女91例。通过手机端实时沟通,定期提醒、随访、健康教育干预1年,干预组收缩压、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)显著低于对照组(P<0.05),肌酐(Scr)高于对照组(P<0.05)。OD组舒张压、TC、饮酒率较入组时明显降低(P<0.05)。对照组TC高于入组时检测结果(P<0.05)。干预组LDL-C达标率明显高于对照组(P<0.05)。Glu达标率未见明显差异。结论"在线医生"模式能够加强医患沟通,增强患者自我管理意识,改善社区老年患者血压、血脂水平。

Background As a mode in Mobile Health(mHealth)Technology,24 hours"Online Doctor"pattern entered the community health management service of elderly officially by family doctor service team in Fengtai district,Beijing,2018.Objective To evaluate the therapeutic effect of"Online Doctor"pattern in health management service for the elderly in the community.Methods The elderly who had established health records in the community health center and signed up their own family doctor from April 15 to December 31,2018 were selected.By strict inclusion and exclusion criteria,100 elderly patients who had signed up in APP by mobile phone were selected as the intervention group(OD group)and another 100 patients who did not use it as the control group.We collected the data through questionnaires,physical examination and laboratory data.Subgroup analysis was classified according to whether the low-density lipoprotein-cholesterol(LDL-C)and glucose(Glu)reached the standard.Results 200 community residents were enrolled in the study(male/female:103/97),including 100 in the OD group and 100 in the control group.After the intervention of periodical reminder,follow-up and health education used by"Online Doctor"of 1 year,systolic blood pressure,total cholesterol(TC),LDL-C and high-density lipoprotein-cholesterol(HDL-C)of the OD group were significantly lower than that of the control group(P<0.05).The serum creatinine(Scr)of OD group was higher than that of control group(P<0.05).Diastolic blood pressure,TC and drinking rate of OD group were significantly lower than those before(P<0.05).TC of the control group was higher compared with it before(P<0.05).The percentage reach the standard of LDL-C in OD group was significantly higher than it in the control group(P<0.05).Conclusion The"Online Doctor"pattern can enhance communication between doctors and patients and the patients’awareness of theirselves,and reduce blood pressure and blood-fat levels of elderly patients in the community.