中国全科医学2025，Vol.28Issue(31)：3912-3923,12.DOI:10.12114/j.issn.1007-9572.2025.0048
中国情景下全-专协同服务模式对高血压和糖尿病患者健康影响的系统评价与Meta分析
The Impact of Generalist-Specialist Collaborative Care Models on Health Outcomes in Hypertension and Diabetes:a Systematic Review and Meta-analysis in China
摘要
Abstract
Background While the effectiveness of generalist-specialist collaborative care in chronic care management has been well-documented in high-income countries,evidence from China is limited.Objective To systematically evaluate the effect of multidisciplinary team-based care,collaboratively provided by hospital-based specialists and community-based generalists,on hypertension and diabetic outcomes in primary care settings in China.Methods In October 2024,a comprehensive literature search was conducted across PubMed,Cochrane Library,Web of Science,Embase,CNKI,Wanfang Data Knowledge Service Platform,VIP Database,SinoMed,covering publications from 2011-07-06 to 2024-10-14.The control group received standard health management services,while the intervention group received the collaborative model in addition to standard care.Two independent researchers performed literature screening,quality assessment,and data extraction,with consensus reached for any discrepancies.Meta-analysis was conducted using RevMan 5.4.1 and Stata 17.0 software.Results Seventeen randomized controlled trials involving 21 591 participants were included,with 13 819 in the intervention group and 7 772 in the control group.Meta-analysis showed that the generalist-specialist collaborative care significantly improved outcomes for diabetic patients,including reduced glycated hemoglobin(MD=-0.72,95%CI=-0.96 to-0.48,P<0.001),fasting blood glucose(MD=-0.84,95%CI=-1.04 to-0.65,P<0.001),and 2-hour postprandial blood glucose(MD=-1.12,95%CI=-1.52 to-0.72,P<0.001).For hypertensive patients,the model significantly reduced systolic blood pressure(MD=-6.49,95%CI=-7.53 to-5.44,P<0.001)and diastolic blood pressure(MD=-6.00,95%CI=-8.89 to-3.12,P<0.001).Subgroup analyses revealed significant differences in intervention effects across gender,age,and intervention duration.Egger's test indicated potential publication bias for glycated hemoglobin(P=0.003)and fasting blood glucose(P=0.002).Conclusion The collaborative service model between generalist and specialists significantly improves blood pressure and blood glucose indicators in patients with hypertension and diabetes at the primary care level,and should be promoted as a key measure in chronic disease management within national basic public health services.High-quality and large community trials are needed to identify strategies to enhance an in-depth collaboration between hospital-based specialists and community-based generalists,thereby further improving population health and enhancing the efficiency of healthcare utilization.关键词
全-专协同服务/糖尿病/高血压/随机对照试验/系统评价Key words
Generalist-specialist collaborative care/Diabetes mellitus/Hypertension/Randomized controlled trials/Systematic review分类
医药卫生引用本文复制引用
涂坤坤,赵洁,石秀园,谢珮,韩昕昕..中国情景下全-专协同服务模式对高血压和糖尿病患者健康影响的系统评价与Meta分析[J].中国全科医学,2025,28(31):3912-3923,12.基金项目
国家自然科学基金资助项目(72404116) （72404116）
