城市社区糖尿病患者不同管理模式实施效果的比较

发布时间：2018-10-05 20:01

【摘要】：目的描述城市社区卫生服务中心的三种糖尿病管理模式,比较糖尿病不同管理模式对糖尿病患者病情控制的效果,探究更有效的城市社区糖尿病管理模式。方法本研究样本及实验室检测部分数据来自北京社区糖尿病研究“三甲医院与多中心社区联合管理糖尿病模式与实效的提升”,共管理213例2型糖尿病患者。按简单随机原则,分为1组和2组,1组接受强化医疗管理,2组接受标准医疗管理。再根据患者的意愿,邀请1组中的患者加入到糖尿病自我管理小组中接受综合管理。最终分为标准组、强化组和综合组,人数分别为106、75、32人。本研究主要包括体格检查、生化测量、糖尿病相关知识行为调查以及时间成本计算三部分。收集数据包括研究对象的人口学特征,不同时期糖尿病相关生理生化指标(体质指数、腰围、空腹血糖、糖化血红蛋白、收缩压、舒张压、甘油三酯、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇),管理初始及结局糖尿病相关知识知晓及行为情况,不同管理方法时间成本。采用统计描述,t检验,方差分析,卡方检验等方法对数据进行分析,评价不同管理方法的效果。结果标准组、强化组、综合组连续18个月的检测结果显示,空腹血糖、糖化血红蛋白、总胆固醇、低密度脂蛋白胆固醇,均呈下降趋势,综合组下降趋势高于强化组,标准组下降最少。管理18个月后,三组之间在空腹血糖、糖化血红蛋白、甘油三酯、总胆固醇等指标的变化差值有统计学意义。综合组的空腹血糖降低值大于强化组和标准组,综合组和强化组的糖化血红蛋白、甘油三酯、总胆固醇降低值均大于标准组,差异有统计学意义。标准组、强化组、综合组的空腹血糖达标率分别为62.86%、77.03%、81.25%,糖化血红蛋白达标率分别为59.05%、71.62%、81.25%,卡方检验显示三组之间达标率差异有统计学意义。经过不同的管理模式之后,三组患者对糖尿病相关知识的掌握率比研究初始有所提高,改善率差异均有统计学意义。其中综合组患者对糖尿病相关知识的掌握改善率高于强化组,标准组改善率最低。三组患者的血糖监测频率、定期足部检查率、遵医服药率均比初始有所增加,差异有统计学意义。2型糖尿病患者普通门诊平均每次就诊时间是3-8.35分钟；糖尿病专家门诊为16.5分钟；糖尿病自我管理小组,平均每位医护人员用在每位小组成员的辅导时间是9.09分钟。结论糖尿病综合管理更有利于糖尿病患者的病情控制,提高空腹血糖和糖化血红蛋白的达标率,提高糖尿病患者对糖尿病相关知识及技能的掌握率。对于综合管理模式的大范围推广,还需要进一步经济和时间成本的核算。
[Abstract]:Objective to describe three kinds of diabetes management models in urban community health service centers, compare the effects of different diabetes management models on the disease control of diabetic patients, and explore a more effective diabetes management model in urban community. Methods the data of this study and some laboratory data were collected from the Beijing Community Diabetes study, "improving the Model and effectiveness of Diabetes Management in third Class A Hospital and Multi-center Community". 213 patients with type 2 diabetes were managed. According to the principle of simple randomization, the patients were divided into two groups: group 1 and group 2 receiving intensive medical management and group 2 receiving standard medical management. According to the wishes of the patients, patients in group 1 were invited to join the diabetes self-management group for integrated management. They were divided into three groups: standard group, reinforcement group and comprehensive group. This study mainly includes three parts: physical examination, biochemical measurement, diabetes related knowledge and behavior survey and time cost calculation. The data collected included demographic characteristics of the subjects, physiological and biochemical indicators related to diabetes at different stages (body mass index, waist circumference, fasting blood glucose, glycosylated hemoglobin, systolic blood pressure, diastolic blood pressure, triglyceride, total cholesterol, systolic blood pressure, diastolic blood pressure, triglyceride, total cholesterol). Low density lipoprotein cholesterol, high density lipoprotein cholesterol), knowledge and behavior related to management of diabetes mellitus, time cost of different management methods. Statistical description t test, variance analysis and chi-square test were used to analyze the data and evaluate the effect of different management methods. Results for 18 months, fasting blood glucose, glycosylated hemoglobin, total cholesterol and low density lipoprotein cholesterol in the standard group, the fortified group and the comprehensive group showed a decreasing trend, and the decreasing trend in the comprehensive group was higher than that in the fortified group. The standard group decreased the least. After 18 months of management, the differences of fasting blood glucose, glycosylated hemoglobin, triglyceride and total cholesterol between the three groups were statistically significant. The decreasing value of fasting blood glucose in the comprehensive group was higher than that in the strengthening group and the standard group, and the decrease of glycosylated hemoglobin, triglyceride and total cholesterol in the combined group and the fortified group were all higher than those in the standard group, and the difference was statistically significant. In the standard group, the reinforcement group, the comprehensive group, the fasting blood glucose reached the standard rate of 62.86 and 77.03, and the saccharified hemoglobin reached the standard rate of 59.05 and 71.62%, respectively. The chi-square test showed the difference between the three groups was statistically significant. After different management models, the mastery rate of diabetes related knowledge in the three groups was higher than that in the initial study, and the difference of the improvement rate was statistically significant. The improvement rate of diabetes related knowledge in the comprehensive group was higher than that in the reinforcement group, and the improvement rate in the standard group was the lowest. The frequency of blood glucose monitoring, the rate of regular foot examination and the rate of compliance with medicine were all increased in the three groups, and the difference was statistically significant in the average time of each visit in general outpatient clinic of type 2 diabetes mellitus patients from 3 to 8.35 minutes. The diabetes specialist outpatient service was 16.5 minutes, and the diabetes self-management group had an average counseling time of 9.09 minutes per team member. Conclusion the comprehensive management of diabetes mellitus is more beneficial to the control of diabetes disease, improve the rate of fasting blood glucose and glycosylated hemoglobin, and improve the knowledge and skills of diabetes mellitus patients. For the wide-scale promotion of the integrated management model, further economic and time cost accounting is also needed.
【学位授予单位】：中国疾病预防控制中心
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.1

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