中国脑卒中病人社区家庭医生签约服务效果的Meta分析

The effect of family physicians contract services for stroke patients in Chinese community:a Meta-analysis

目的:系统评价我国家庭医生签约服务模式对社区脑卒中病人的服务效果,为脑卒中病人社区干预提供循证参考。方法:计算机检索中国知网、维普数据库、万方数据库、PubMed,EMbase、MedLine、the Cochrane Library,全面收集家庭医生服务模式对社区脑卒中病人家庭签约服务效果的随机对照试验(RCT),对符合纳入标准的研究提取资料并进行质量评价后,采用Cochrane RevMan 5.3统计软件进行Meta分析。结果:纳入18篇文献,合计2105例病人。观察组病人采取家庭医生签约服务,对照组病人采取常规社区干预。Meta分析结果显示,观察组病人Barthel指数[MD=13.18,95%CI(10.15,16.22)]、Fugl-Meye运动功能量表评分[MD=12.01,95%CI(8.27,15.76)]、生活质量评分[MD=11.73,95%CI(6.81,16.65)]、抑郁自评量表评分[MD=-9.51,95%CI(-13.04,-5.98)]、焦虑自评量表评分[MD=-5.63,95%CI(-7.94,-3.32)]均优于对照组(P均<0.00001)。结论:现有研究证据表明,家庭医生签约服务模式有助于提高脑卒中病人生活自理能力及生活质量,改善焦虑及抑郁心理,其管理效果较常规管理模式更为突出。但因缺乏高质量的RCT研究,故家庭医生签约服务模式对社区脑卒中病人的服务效果尚需进一步验证。

Objective:To systematically evaluate the effect of family physician contract service mode on community stroke patients in China,and provide evidence-based reference for community intervention of stroke patients.Methods:Randomized controlled trials(RCTs)on the effect of family doctor service mode on family contract service of stroke patients in community were searched from CNKI,VIP,WanFang Database,PubMed,EMbase,MedLine,the Cochrane Library.After data extraction and quality evaluation of the studies that meet the inclusion criteria,the Cochrane RevMan 5.3 statistical software was used for Meta-analysis.Results:18 articles were included,involving 2105 patients.Patients in observation group received family physician contracted services,while patients in control group received routine community intervention.Meta-analysis results showed that Barthel index(BI)[MD=13.18,95%CI(10.15,16.22)],FMA score[MD=12.01,95%CI(8.27,15.76)],quality of life score[MD=11.73,95%CI(6.81,16.65)],SDS score[MD=-9.51,95%CI(-13.04,-5.98)],SAS score[MD=-5.63,95%CI(-7.94,-3.32)],each outcome indicators of the observation group was better than those of the control group(P<0.00001).Conclusions:Current evidence shows that family physician contract service mode is helpful to improve the self-care ability and quality of life of stroke patients,and improve the psychological state of anxiety and depression.Its management effect is more prominent than the conventional management model.However,due to the lack of high-quality RCTs,the effect of family physician contract service mode on community stroke patients needs to be further verified.