基层医疗慢性病健康管理中存在的问题及对策--以高尿酸血症/痛风为例

Problems and strategy in health management of chronic diseases in primary medical care-Take hyperuricemia/gout as an example

目的分析基层医疗慢性病如高尿酸血症/痛风健康管理中存在的问题,并采取相应的对策。方法通过建立微信群、门诊、义诊等渠道纳入高尿酸血症/痛风患者,建立微信群-医院微信公众号-当地生活服务相关APP的互联网平台,宣传高尿酸血症/痛风相关知识,对本地高尿酸血症/痛风患者进行高尿酸血症/痛风疾病的健康服务管理,分析存在的问题及获得的收益。结果大多数患者能很好地利用互联网平台进行疾病咨询、饮食指导及治疗,但仍有部分患者,尤其是老年人、低文化水平及低收入者因不能顺利使用手机等通讯工具,只能通过面对面的交流如义诊等获得帮助。另外慢性病健康管理的持续性应引起重视。结论微信群-医院微信公众号-当地生活服务相关APP的互联网平台是提高高尿酸血症/痛风患者认知和进行健康管理的有效方式,但传统的面对面交流如义诊等仍不可或缺,三级预防的健康管理模式可以参考。

Objective To analyze the problems in health management of chronic diseases such as hyperuricemia/gout in primary medical care,and take corresponding countermeasures.Methods Through establishing WeChat group,outpatient clinic,etc,we will recruit the hyperuricemia/gout patients,establish the Internet platform of the WeChat group-hospital official account of WeCha-local life service related APP.Propaganda knowledge of hyperuricemia/gout,and provide health service management for hyperuricemia/gout patients,analyze the existing problems and the benefits.Results Most patients can make good use of the Internet platform for disease consultation,diet guidance and treatment,but there are still some patients,especially the elderly,low educational level and low-income people can not use mobile phones and other communication tools to get better help,but only through face-to-face communication such as voluntary consultation.In addition,the sustainability of chronic disease health management should be paid attention to.Conclusion The Internet platform of the WeChat group-hospital official account of WeCha-local life service related APP is an effective way to improving the cognition of hyperuricemia/gout patients and health management of hyperuricemia/gout diseases,but the traditional face-to-face communication such as voluntary consultation is still indispensable.Health management model for tertiary prevention can be referred to.