以家庭医生为核心的组团式社区卒中患者康复模式的效果初探

The 1+N+N team model with family physicians as the core for rehabilitation of community-dwelling stroke patients

目的探讨家庭医生“1+N+N”组团式支持管理模式对社区恢复期卒中患者的干预效果。方法该研究为干预性研究。连续纳入2019年1月至2021年10月随访登记的上海市徐汇区枫林社区卒中恢复期患者,采用随机数字表法分为“1+N+N”干预组和对照组。收集并记录入选者的性别、年龄、身高、体重及合并症情况。对照组采用传统的卒中管理方案,“1+N+N”干预组则通过家庭医生“1+N+N”组团式支持管理模式对患者进行干预。家庭医生“1+N+N”组团式支持管理模式,“1”指家庭医生,第1个N指社区卫生服务中心的专业技术团队,第2个N指二、三级医院专科医师团队预约及双向转诊。分别于基线及干预后12个月时对两组患者进行日常生活活动(ADL)、运动功能及心理状况评分。采用多因素线性回归模型分析干预方式与ADL评分、运动功能评分和心理状况评分的关联。结果纳入患者120例,年龄(71.5±6.8)岁,男性59例(49.2%),“1+N+N”干预组和对照组各60例。与对照组比较,“1+N+N”干预组患者的年龄较小(P=0.013),合并冠心病者占比较低(P=0.003),其余变量两组间差异均无统计学意义(均P>0.05)。“1+N+N”干预组和对照组患者干预后ADL、运动功能和心理状况评分均较干预前有所提高(均P<0.01)。“1+N+N”干预组和对照组患者干预前运动功能评分差异无统计学意义(P>0.05),但ADL和心理状况评分“1+N+N”干预组均高于对照组(均P<0.001);干预后“1+N+N”干预组上述评分则均高于对照组(均P<0.01)。调整混杂因素后,多因素线性回归结果显示家庭医生“1+N+N”组团式支持管理模式与ADL评分无明显关联(t=0.27,P=0.799),与运动功能评分存在正向关联(t=15.64,P<0.001),与心理状况评分存在正向关联(t=13.70,P<0.001)。结论家庭医生“1+N+N”组团式支持管理模式可有效改善卒中恢复期患者的日常生活能力、运动功能和心理状况,且对后两者的干预效果优于传统的干预模式。

Objective To explore the effectiveness of 1+N+N team model with family physician as the core for rehabilitation of community-dwelling stroke patients.Methods Convalescent stroke patients in Fenglin Community of Shanghai Xuhui District,who were followed up and registered from January 2019 to October 2021,were continuously enrolled in this intervention study.The 1+N+N care team consisted of a family doctor as the core(“1”)with the professional and technical team of the community health service center(“N”)and specialists in second or third hospitals(“N”).Patients were randomly divided into 1+N+N intervention group and control group.The control group was treated with traditional stroke management scheme,while the intervention group was treated by the 1+N+N team model.The activities of daily living(ADL),motor function and psychological status scores were evaluated at baseline and 12 months after intervention.Multivariate linear regression model was used to analyze the association of intervention methods with the improvement of ADL score,motor function score and psychological status score of patients.Results A total of 120 patients were enrolled(60 in each group),including 59 males and 61 females with a mean age of(71.5±6.8)years.Compared with the control group,the age of patients in the intervention group was younger(P=0.013),and the proportion of patients with coronary heart disease was lower(P=0.003).There was no significant differences in other variables between the two groups(P>0.05).After 12 months of intervention,the scores of ADL,motor function and psychological status were significantly improved compared with those before intervention in both groups(P<0.01).There was no significant difference in motor function scores between the intervention group and the control group before intervention(P>0.05),but the scores of ADL and psychological status in the intervention group were higher than those in the control group(P<0.001).After intervention,the above scores in the intervention group were higher than those in the control group(P<0.01).After adjusting for confounding factors,multivariate linear regression showed that the 1+N+N team model had no significant correlation with ADL score(t=0.27,P=0.799),but had a positive correlation with motor function score(t=15.64,P<0.01)and psychological status score(t=13.70,P<0.01).Conclusion The 1+N+N team model can effectively improve the daily living ability,motor function and psychological status of stroke patients in the convalescent period,and the intervention effect on the latter two is better than that of the traditional rehabilitation mode.