家庭医生双签约服务模式管理社区2型糖尿病患者的效果研究

Effect of family doctor-specialist double-contract service on management of type 2 diabetic patients in community

目的探讨家庭医生双签约服务模式管理社区2型糖尿病患者的效果。方法本研究为随机对照试验。采用整群抽样法,选择2019年2月1日至2021年1月31日在上海市普陀区长风社区卫生服务中心就诊的2型糖尿病患者200例为研究对象,随机数字表法分为对照组和观察组(各100例)。对照组采用常规家庭医生签约模式,观察组采用家庭医生双签约服务模式,管理1年,观察评估两组患者管理前后空腹血糖、餐后2 h血糖、糖化血红蛋白水平变化,以及饮食控制、运动行为、血糖监测、遵医嘱用药等健康相关行为与生命质量和对诊疗的满意度。结果管理后,观察组患者空腹血糖、餐后2 h血糖、糖化血红蛋白水平均明显低于对照组(t=10.29、8.50、7.99,均P<0.05);管理后观察组经饮食控制、运动行为、血糖监测、遵医嘱用药等健康相关行为得分均明显高于对照组(t=9.78、6.72、39.81、7.88,均P<0.05);生命质量评分高于对照组(P<0.05);观察组满意49例,一般41例,满意度为90.0%(90/100),对照组满意33例,一般36例,满意度为69.0%(69/100),观察组满意度高于对照组(χ^(2)=6.39,P=0.031)。结论采用家庭医生双签约服务模式管理社区2型糖尿病患者进行有助于改善患者血糖水平,提高自我管理水平,患者满意度更高。

Objective To explore the effect of family doctor-specialist dual-contract service model on the management of type 2 diabetic patients in the community.Methods Two hundred patients with type 2 diabetes mellitus(T2DM)who were treated in Changfeng Community Health Service Center between February 2019 and January 2021 were selected as the study objects by cluster sampling method.Patients were randomly divided into study group and control group with 100 cases in each group.The control group was managed with the conventional family doctor contract service,and the study group was managed with the family doctor-specialist double contract service.After one year of management,the fasting blood glucose,2 h-postprandial blood glucose,glycosylated hemoglobin,diet control,blood glucose monitoring,medication compliance,exercise and other health behaviors,quality of life and satisfaction of patients were compared between two groups.Results After intervention,fasting blood glucose,2 h-postprandial blood glucose and glycosylated hemoglobin in the study group were significantly lower than those in the control group(t=10.29,8.49,7.99,all P<0.05);the health related behaviors such as diet control,exercise behavior,blood glucose monitoring,and medication compliance in the study group were significantly better than those in the control group(t=9.78,6.72,39.81,7.88,all P<0.05);the quality of life in patients of study group was higher than that of the control group(P<0.05);the satisfaction rate in study group was higher than that of control group(90.0%vs.69.0%,χ^(2)=6.39,P=0.031).Conclusion Compared with conventional family contract service model,the double contract service improves patient self-management,helps to reduce the blood glucose level and gains high patients′satisfaction,which is worth promoting and applying in the management of type 2 diabetic patients in the community.