基于真实世界数据的家庭医生签约服务的糖尿病患者用药状况及效果评价

Effect of Family Doctor Contractual Services on the Medication Status of Diabetes Patients Based on Real World Data

目的探讨社区药学服务和家庭医生签约服务用于糖尿病患者的效果。方法通过四川省成都市某城区13家社区卫生服务中心的签约患者管理平台数据库,筛选2016年3月21日至2019年1月15日至少完成2次健康体检且具有低密度脂蛋白胆固醇(LDL-C)数据糖尿病患者的基本信息和处方信息,统计药品使用品种和用药方案。比较患者血脂、血糖和血压的达标率。其中,2型糖尿病患者综合控制目标为糖化血红蛋白低于7.0%;收缩压/舒张压低于130/80 mmHg;未合并动脉粥样硬化性心血管疾病糖尿病患者的LDL-C应低于2.6 mmol/L,合并者应低于1.8 mmol/L。结果共筛选出糖尿病患者4871例,但样本数据在部分达标指标上存在一定缺失。末次体检时,口服降糖药单用、口服降糖药联用和口服降糖药联用胰岛素糖尿病患者的血糖达标率分别为84.49%(158/187)、77.31%(494/639)、63.08%(123/195),均明显高于首次体检时的74.19%(69/93)、63.04%(220/349)、47.32%(53/112)(P<0.05);降压药单用、降压药联用、降压药三联及以上的糖尿病患者的血压达标率分别为39.59%(325/821)、41.18%(413/1003)、42.32%(168/397),均明显高于首次体检时的38.37%(315/821)、40.58%(407/1003)、38.79%(154/397)(P<0.05);使用HMG-CoA还原酶抑制剂糖尿病患者的LDL-C达标率为52.74%(943/1788),明显高于首次体检时的43.14%(685/1588)(P<0.05)。结论该城区家庭医生服务对糖尿病患者血糖、血压、血脂的改善均起到了促进作用。建议家庭医生积极引导患者进行血压管理,提高社区药学服务水平,并根据糖尿病患者实际情况提供精准的降压和降糖用药方案。

Objective To investigate the effect of community pharmacy service and family doctor contractual services on patients with diabetes mellitus(DM).Methods Through the database management system for contracted patients in 13 community health service centers in an urban area of Chengdu,Sichuan Province,the basic information and prescription information of patients with DM who had completed at least two health checks and obtained low-density lipoprotein cholesterol(LDL-C)data from March 21st,2016 to January 15th,2019 were screened,and the varieties of used drugs and medication regimens were counted.The compliance rates of blood lipids,blood sugar and blood pressure were compared.Among them,the comprehensive control target of type 2 diabetes mellitus(T2DM)was as follows:glycosylated hemoglobin was lower than 7.0%,systolic blood pressure(SBP)/diastolic blood pressure(DBP)was lower than 130/80 mmHg.The LDL-C of DM patients without atherosclerotic cardiovascular disease should be lower than 2.6 mmol/L,and the LDL-C of DM patients with atherosclerotic cardiovascular disease should be lower than 1.8 mmol/L.Results A total of 4871 DM patients were sampled,but the sample data were missing in some of the indicators.At the last health check,the glycemic compliance rates of DM patients treated with oral hypoglycemic agents,combination of oral hypoglycemic agents and oral hypoglycemic agents plus insulin were 84.49%(158/187),77.31%(494/639),63.08%(123/195),which were significantly higher than 74.19%(69/93),63.04%(220/349),47.32%(53/112)at the first health check(P<0.05).At the last health check,the blood pressure compliance rate of DM patients treated with single use of anti-hypertensive drugs,combination of anti-hypertensive drugs,triple or above use of anti-hypertensive drugs were 39.59%(325/821),41.18%(413/1003),42.32%(168/397),which were significantly higher than 38.37%(315/821),40.58%(407/1003),38.79%(154/397)at the first health check(P<0.05).At the last health check,the LDL-C compliance rate of statin HMG-CoA reductase inhibitor in DM patients was 52.74%(943/1788),which were significantly higher than 43.14%(685/1588)at the first health check(P<0.05).Conclusion The family doctor contractual services in the urban area of Chengdu promote the improvement of blood sugar,blood lipid and blood pressure in DM patients.It is suggested that family doctors should actively guide patients to carry out blood pressure management,improve the level of community pharmacy services,and provide more precise hypotensive and hypoglycemic medication plans according to the actual situation of DM patients.