社区卫生服务中心冠心病二级预防干预模式推广效果分析

Analysis on promotion effect of secondary prevention of coronary heart disease in community health service center

目的探讨应用"以病例为引导,以问题为中心"的冠心病二级预防培训对社区医生的效果,及对冠心病患者规范化治疗的影响。方法对80名社区内科医师采取"以病例为引导,以问题为中心"的模式进行冠心病二级预防培训,培训社区内科医生冠心病二级预防治疗相关内容:A:抗血小板聚集,抗心绞痛治疗;B:预防心律失常,减轻心脏负荷,控制血压;C:他汀类降脂治疗,戒烟;D:控制饮食,治疗糖尿病;E:普及有关冠心病的教育。选择2015年3—9月年龄30～80岁的800例社区冠心病患者为干预对象,填写冠心病患者观察表,并给予干预,随访6个月。培训后,采用自制问卷调查医生关于冠心病二级预防治疗知识和诊治掌握情况,及患者干预效果。结果培训前后,社区内科医生冠心病二级预防治疗A和D的掌握率比较,差异无统计学意义(P>0.05);培训后,社区内科医生冠心病二级预防治疗B、C、E及A+B+C+D+E的掌握率明显高于培训前,差异有统计学意义(P<0.05)。干预前后,丰台社区卫生服务中心冠心病患者冠心病二级预防A治疗率比较,差异无统计学意义(P>0.05)。干预前后,冠心病患者冠心病二级预防B、C、D、E及A+B+C+D+E治疗率比较,差异有统计学意义(P<0.05)。干预后,患者平均静息心率、平均收缩压、平均舒张压、总胆固醇及低密度脂蛋白胆固醇水平均显著低于干预前,高密度脂蛋白胆固醇水平明显高于干预前,差异均有统计学意义(P<0.05)。结论应用"以病例为引导,以问题为中心"的冠心病二级预防的培训模式进行培训,使社区医生技术掌握率明显提高,对改善医务人员对冠心病的预防能力起到积极的促进作用,进而使广大的患者受益。

Objective To explore the effect of'case-based,problem-centered'secondary prevention training on community physicians and its impact of standardized treatment on patients with coronary heart disease.Methods Eighty physicians from community health service center were selected and given a'case-oriented,problem-centered'secondary prevention training for coronary heart disease.The training program includes A:anti-platelet aggregation and anti-angina,B:prevent arrhythmia,reduce cardiac load and control blood pressure,C:statin lipid-lowering therapy,smoking cessation,D:diet control and diabetes treatment,E:popularize education about coronary heart disease.Eight hundred patients with coronary heart disease aged 30-80 years old from community health service center in March-September 2015 were selected.The community physicians filled out the observation tables for the patients and performed interventionfor 6 months.A self-made questionnaire was used to investigate the doctor’s knowledge of secondary prevention for coronary heart disease,and the intervention effect of patients was observed.Results Before and after the training,there was no significant difference in the mastery rate of A and D items in the community physicians(P>0.05).After the training,the rates of B,C,E and A+B+C+D+E were significantly higher than those before training(P<0.05).Before and after the intervention,there was no significant difference in the treatmentrate of A item in the coronary heart disease patients(P>0.05).Before and after the intervention,the treatment rates of B,C,D,E and A+B+C+D+E in the patients were statistically different(P<0.05).After intervention,the average resting heart rate,systolic blood pressure,diastolic blood pressure,total cholesterol and low-density lipoprotein cholesterol levels were significantly lower than those before intervention,and high-density lipoprotein cholesterol level was significantly higher than that before intervention(P<0.05).Conclusion The application of'case-based,problem-centered'training mode for secondary prevention of coronary heart disease will enable the community physicians to significantly improve their technical mastery rate and positively improve the ability of medical staff to prevent coronary heart disease and benefit the majority of patients.