中国全科医学2018，Vol.21Issue(9)：1075-1079,5.DOI:10.3969/j.issn.1007-9572.2018.00.070
"1+1+1"组合签约模式下家庭医生服务对社区糖尿病管理的效果研究
Effect of "1+1+1" Family Doctor Service Delivery Mode on Community-based Diabetes Management
摘要
Abstract
Objective To explore the effect of "1+1+1" family doctor service delivery mode on community-based type 2 diabetes management in Shanghai, so as to provide evidences for other regions to develop the tailor-made family doctor service delivery mode. Methods 1 028 T2DM patients who received management from Meilong Community Health Service Center, Minhang District, Shanghai from March 2016 to March 2017 were selected. After being informed of the contents of "1+1+1"service delivery mode by the family doctor, 528 of them who voluntarily accepted this mode of service and signed the relative contracts and the other 500 who did not were assigned to the contracted group, control group, respectively. The intervention period lasted from the first quarter of 2016 to the first quarter of 2017. We compared the levels of fasting blood glucose (FBG), blood lipid parameters (BLPs), blood pressure (BP) and body mass index (BMI), FBG, BLPs and BP control rates, and composite control rates of FBG and BP, FBG and BLPs, as well as FBG, BLPs and BP before intervention and after intervention between the two groups, and the utilization of family doctor services in the contracted group before and after intervention. Results Before intervention, there were no significant differences between the two groups in FPG, glycosylated hemoglobin(HbA1c), total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), triglyceride (TG), high-density lipoprotein-cholesterol (HDL-C), systolic blood pressure (SBP), diastolic blood pressure (DBP) , BMI (P>0.05). After intervention, the levels of HDL-C and BMI were basically unchanged in both groups (P>0.05), but the levels of FBG, HbA1c, TC, LDL-C, TG, SBP and DBP decreased significantly in the contracted group (P<0.05). Before intervention, FBG, BLPs and BP control rates, and composite control rates of FBG and BP, FBG and BLPs, as well as FBG, BLPs and BP were similar in both groups (P>0.05). However, after intervention, they were all increased in the contracted group (P<0.05) except the BP control rate was still similar in both groups (P>0.05). After receiving intervention, the contracted group demonstrated increased community health service seeking rate, outpatient appointment rate, and rate of referral from the family doctor to specialists compared with before intervention (P<0.05). Conclusion Being favorable for the control of FBG, BLPs and BP, and with good patient acceptability, the "1+1+1" family doctor service delivery mode is recommended to be used in regions achieving relatively successful implementation of family doctor system and hierarchical medical system.关键词
糖尿病,2型/家庭医生/签约/治疗结果Key words
Diabetes mellitus,type 2/Family doctor/Signing a contract/Treatment outcome分类
医药卫生引用本文复制引用
宦红梅,范玉娟,杨架林,蒋素霞,李娜,刘帅.."1+1+1"组合签约模式下家庭医生服务对社区糖尿病管理的效果研究[J].中国全科医学,2018,21(9):1075-1079,5.基金项目
闵行区卫生和计划生育委员会项目(2016MW52) （2016MW52）
