分级诊疗结合心理干预对糖尿病患者血糖控制情况及自我护理能力的影响

Influence of graded diagnosis and treatment combined with psychological intervention on blood sugar control and self-care ability of diabetic patients

目的 探讨医联体模式下分级诊疗结合心理干预对糖尿病患者血糖控制情况及自我护理能力的影响。方法 将226例糖尿病患者按照随机数字表法分为观察组和对照组,各113例。对照组患者给予自由诊疗模式结合心理干预,观察组患者给予医联体模式下分级诊疗结合心理干预。两组患者均干预并随访3个月。比较两组患者干预后的用药依从性、家庭医生服务利用情况,干预前后血糖控制情况、心理状况、自我护理能力以及干预期间并发症发生情况。结果 干预后,观察组患者签约医生就诊率、预约门诊率、家庭医生转诊率均高于对照组(P<0.01);两组患者血清餐后2 h血糖(2 h PPG)、空腹血糖(FPG)、糖化血红蛋白(HbAlc)水平以及抑郁自评量表(SDS)、焦虑自评量表(SAS)评分均较干预前降低,且观察组低于对照组(P<0.01);两组患者自我护理能力量表(ESCA)总分及各维度评分均较干预前升高,且观察组高于对照组(P<0.01);观察组患者并发症总发生率低于对照组,用药总依从性高于对照组(P<0.05或0.01)。结论 应用医联体模式下分级诊疗结合心理干预,有助于糖尿病患者改善自我护理能力,提高家庭医生服务利用率,控制血糖水平,消除不良情绪,提升用药依从性,且安全性高。

Objective To explore the effect of graded diagnosis and treatment(GDT)combined with psychological intervention under the medical consortium mode on blood sugar control and self-care ability of diabetic patients.Methods A total of 226 diabetic patients were divided into observation and control group group according to random number table method,with 113 cases in each.Controls received free diagnosis and treatment mode plus psychological intervention and observation group did the GDT under the medical consortium mode plus psychological intervention.Both groups were intervened and followed up for 3 months.Such indexes were compared between two groups as postintervention medication compliance,utilization of family doctor service,pre-and post-intervention blood sugar control,psychological state,self-care ability,and the occurrence of complications during intervention per iod.Results After intervention visiting rate to cont racted doctors,appointment outpatient rate and the referral rate of family doctors were higher in observation than control group(P<0.01),the levels of 2-hour postprandial plasma glucose,fasting blood glucose and hemoglobin A1c as well as scores on the Self-rating Depression Scale and Self-rating Anxiety Scale in both groups decreased compared with pre-intervention and were lower in observation than control group(P<0.01),the total and each dimension score of the Exercise of Self-care Agency Scale in both groups elevated compared with pre-intervention and were higher in observation than control group(P<0.01),overall complication rate was lower and overall medication compliance higher in observation than control group(P<0.05 or 0.01).Conclusion The GDT under medical consortium mode plus psychological intervention can improve self-care ability of diabetic patients,raise the utilization rate of family doctor services,control blood sugar level,eliminate bad emotions,improve medication compliance,and has higher safety.