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目的探讨家庭医生式服务签约强化管理对2型糖尿病患者的干预效果。方法选取2013年3—4月在北京市展览路社区卫生服务中心及其7家社区卫生服务站就诊并自愿参加研究的507例2型糖尿病患者,采用家庭医生式服务签约强化管理进行干预,干预时间为18个月。分别于干预前和干预后采用《北京市社区糖尿病患者管理项目调查表》进行调查,比较患者干预前后糖尿病管理知识知晓率,饮食、运动指标达标率,相关检测指标及医疗费用。结果干预后患者糖尿病管理知识知晓率高于干预前(P<0.05)。干预后患者主食摄入、水果摄入、蛋白质摄入、盐摄入达标率和有效运动达标率高于干预前(P<0.05);而干预前后蔬菜摄入达标率比较,差异无统计学意义(P>0.05)。干预后患者体质指数(BMI)、空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1c)、低密度脂蛋白(LDL)、尿酸、尿微量清蛋白、收缩压及舒张压均低于干预前(P<0.05);而干预前后总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL)及尿肌酐比较,差异无统计学意义(P>0.05)。干预前患者平均医疗费用为6595.7元,干预后为5 290.5元,患者平均医疗费用较干预前下降19.8%。结论家庭医生式服务签约强化管理可有效提高2型糖尿病患者糖尿病管理知识知晓率,饮食、运动指标达标率,在改善相关检测指标的同时降低患者医疗费用,干预效果良好。
Objective To explore the effect of intensive management of family doctor service on type 2 diabetes patients. Methods A total of 507 patients with type 2 diabetes who visited the Zhanhua Road Community Health Service Center and its seven community health service stations from March to April 2013 in Beijing voluntarily participated in the study. The interventions were made through intensive management of family physician service contract signing, intervention The time is 18 months. Before and after intervention, “Beijing Community Diabetes Management Project Questionnaire” was used to investigate the awareness of diabetes management knowledge, diet, exercise index compliance rate, relevant test indicators and medical costs before and after intervention. Results After intervention, the awareness rate of diabetes management knowledge was higher than that before intervention (P <0.05). The main food intake, fruit intake, protein intake, salt intake compliance rate and effective exercise compliance rate were significantly higher than those before intervention (P <0.05) after intervention, but there was no significant difference between the two groups before and after the intervention (P> 0.05). The body mass index (BMI), fasting plasma glucose (FPG), postprandial 2h PG, HbA1c, LDL, uric acid, urine albumin, systolic pressure Diastolic blood pressure were lower than those before intervention (P <0.05). There was no significant difference in total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL) and urinary creatinine before and after intervention ). The average medical cost before intervention was 6595.7 yuan, after the intervention was 5290.5 yuan, and the average medical cost of patients dropped by 19.8% compared with that before intervention. Conclusion Intensive management of family doctor service contract can effectively improve the awareness of diabetes management knowledge, diet, exercise indicators compliance rate in type 2 diabetic patients, and improve the relevant test indicators while reducing the medical costs of patients, the intervention effect is good.