基于互联网思维的“1+1+1”签约家庭医生骨质疏松管理效果评价

Evaluation of osteoporosis management effect of"1+1+1"contracted family doctor based on Internet thinking

目的:探讨应用互联网工具的“1+1+1”签约家庭医生骨质疏松管理效果。方法:采用与第一作者“1+1+1”签约的55~70岁已绝经女性居民,按规则排除不能配合管理者,将余下居民随机设单双号组,经OSTA评估筛查出骨质疏松中高危风险人群为观察对象,其中单号组为对照组,双号组为观察组。2组观察对象采用双能X线骨密度检查。对照组按照“1+1+1”签约工作要求,参照高血压等慢病管理经验,给予定期随访、复诊,社区健康讲座,按需双向转诊等管理;观察组在对照组管理的基础上,运用互联网工具在线分级管理,定向推送骨质疏松宣教知识,在线解答居民健康咨询等线上线下相结合的管理。1年后观察对象复测骨密度,比较2组居民骨密度结果、管理率、治疗率等指标。结果:对照组干预管理1年后,L_(2)、L_(4)骨密度值和T值较干预前有所上升(P<0.05~P<0.01),观察组除股骨颈骨密度,股骨颈T值、大粗隆T值干预前后差异无统计学意义(P>0.05)外,其他观察部位较干预前的上升均有统计学意义(P<0.05~P<0.01)。经过为期1年的干预管理,观察组的管理率84.00%高于对照组的72.28%(P<0.05),治疗率63.00%与对照组的54.45%差异无统计学意义(P>0.05)。结论:“1+1+1”签约家庭医生对骨质疏松慢病管理有显著效果,而拥有互联网工具加持的管理优势更明显。

Objective:To explore the effects of"1+1+1"contracted family doctor′s osteoporosis management using Internet tool.Methods:The postmenopausal female residents aged 55-70 years who signed with the first author"1+1+1"were selected,and the remaining residents were randomly set into odd-even groups according to the rules.The high-risk groups of osteoporosis were screened by OSTA as subservation subjects,in which the odd-number group was set as the control group,and the even-number group was set as the observation group.The bone mineral density(BMD)in two groups were examined by dual-energy X-ray.In accordance with the"1+1+1"contract work requirements and referring to the management experience of chronic diseases such as hypertension,the control group was given regular follow-up visits,follow-up visits,community health lectures,on-demand two-way referral and other management experience in chronic diseases such as hypertension.On the basis of the management of the control group,the observation group was given the Internet tool for online hierarchical management,targeted promotion of osteoporosis education knowledge,online answers to residents′health consultation and other online and offline management.The BMD in two groups was measured after 1 year,and the BMD results,management rate and treatment rate were compared between two groups.Results:After 1 year of intervention management in the control group,the BMD and T value of L_(2) and L_(4) increased compared with that before intervention(P<0.05 to P<0.01).In the observation group,there was no statistical significance in BMD of femoral neck,T value of femoral neck and greater trochanter between before and after intervention(P>0.05),and the differences of the increases of other observation sites were statistically significant between before and after intervention(P<0.05 to P<0.01).After 1 year of intervention management,the management rate in the observation group(84.00%)was higher than that of control group(72.28%)(P<0.05),and there was no statistical significance in the treatment rate between the observation group(63.00%)and control group(54.45%)(P>0.05).Conclusions:The"1+1+1"contracted family doctor has a significant effect on the management of chronic osteoporosis,and the management advantage of Internet tool is more obvious.