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目的评估社区家庭医生服务模式对脑卒中患者管理效果。方法选取在北京市万寿路社区卫生服务中心就诊的脑卒中患者146例,随机分为研究组(77例)和对照组(69例)。对照组进行常规药物治疗和随访,研究组进行家庭医生服务模式干预,干预时间为1年,干预措施包括健康知识干预、用药干预和指导康复训练。对患者脑卒中知识的知晓率、脑卒中危险行为情况、运动功能和日常生活活动能力进行评估。结果研究组患者在干预后脑卒中确诊标准知晓率,脑卒中是可以预防的,高血压、糖尿病、高脂血症、房颤是脑卒中危险因素,成人每日食盐摄入标准的知晓率以及吸烟和过量饮酒是脑卒中危险因素的知晓率(分别为80.52%、97.40%、90.91%、88.31%、89.61%、84.42%、89.61%、100.00%、98.70%)明显优于本组干预前(42.86%、51.95%、36.36%、32.47%、29.87%、24.68%、35.06%、49.35%、50.65%)和对照组干预后(52.17%、63.77%、53.62%、43.48%、40.58%、37.68%、52.17%、55.07%、59.42%),差异均有统计学意义(均P<0.05);在食盐控制、饮食规律、吸烟、饮酒、适量运动等方面明显优于本组干预前和对照组干预后(P<0.05);研究组干预后Fugl-Meyer运动功能评分(64.5±23.1)分和Barthel指数评分(76.4±17.6)分明显高于本组干预前(33.21±22.72)分、(37.62±23.67)分和对照组干预后(46.3±24.6)分、(59.8±18.3)分(P<0.05);研究组脑卒中复发率发率为3.90%,明显低于对照组的15.94%(P<0.05)。结论社区家庭医生服务模式可提高脑卒中患者相关知识知晓率,降低患者行为危险因素,提高患者运动功能和日常生活活动能力,降低其复发率。
Objective To evaluate the management effect of community family doctor service on stroke patients. Methods A total of 146 stroke patients were enrolled in the community health service center of Wanshou Road in Beijing. They were randomly divided into the study group (n = 77) and the control group (n = 69). The control group was treated with conventional drugs and followed up. The study group intervened in the family doctor service mode with one-year intervention. Interventions included health knowledge intervention, medication intervention and guidance rehabilitation training. Knowledge of the patient’s awareness of stroke, stroke risk behavior, motor function and activities of daily living were assessed. Results Study group awareness of stroke diagnosis criteria, stroke prevention was preventable, hypertension, diabetes mellitus, hyperlipidemia, atrial fibrillation risk factors for stroke, daily awareness of adult salt intake standards and smoking (80.52%, 97.40%, 90.91%, 88.31%, 89.61%, 84.42%, 89.61%, 100.00%, 98.70% respectively) were significantly higher than those before the intervention (42.86 (52.17%, 63.77%, 53.62%, 43.48%, 40.58%, 37.68%, respectively) after the intervention of the control group, 52.17%, 55.07% and 59.42%, respectively). The differences were statistically significant (all P <0.05), and were significantly better than those before the intervention and the control group in terms of salt control, dietary rules, smoking, drinking and moderate exercise (P <0.05). The Fugl-Meyer motor function score (64.5 ± 23.1) and Barthel index (76.4 ± 17.6) in the study group were significantly higher than those before the intervention (33.21 ± 22.72), (37.62 ± 23.67 ) And control group (46.3 ± 24.6) points and (59.8 ± 18.3) points respectively (P <0.05). The incidence of recurrent stroke in study group was 3.90% , Which was significantly lower than that of the control group (15.94%, P <0.05). Conclusion The community family doctor service mode can improve the awareness rate of related knowledge of stroke patients, reduce the risk factors of patients’ behavior, improve the motor function and activities of daily living, and reduce the recurrence rate.