曹霞

北京市西城区白纸坊社区卫生服务中心，北京100054

“家庭医生式服务”模式对300例签约糖尿病患者管理效果分析

曹霞

北京市西城区白纸坊社区卫生服务中心，北京100054

目的探讨“家庭医生式服务”对300例签约糖尿病患者管理的效果分析。方法选取2013年12月—2014年12月该社区2型糖尿病患者430例为研究对象，将300例签约并接受家庭医生式服务的患者设为管理组，130例未签约家庭医生的患者设为对照组。对照组仅给予常规随访管理，管理组实施家庭医生式服务。管理12个月后，比较两组患者随访前后的空腹血糖、餐后2 h血糖、糖化血红蛋白、体重指数的变化。结果管理组与对照组干预前对糖尿病知识的知晓度差异无统计学意义（P＞0.05）［（69.78±15.32）vs（70.32±13.67）］，管理后对糖尿病知识的知晓度差异有统计学意义［（87.32±9.32）vs（80.89±7.21）］（P＜0.05）；管理随访12个月前，对照组、管理组的空腹血糖、餐后2 h血糖、糖化血红蛋白两组间差异无统计学意义（P＞0.05）［（8.82±2.13）mmol/L、（11.24±1.08）mmol/L、（7.99±1.34）%vs（8.6±1.09）mmol/L、（11.3±1.14）mmol/L、（7.86±1.27）%］；管理12个月后，对照组、管理组的空腹血糖、餐后2 h血糖、糖化血红蛋白两组间差异有统计学意义（P＜0.05）［（5.92±1.32）mmol/L、（9.85±2.02）mmol/L、（6.9±1.01）%vs（7.68±1.12）mmol/L、（11.1±1.22）mmol/L、（7.6±1.33）%］。结论“家庭医生式服务”模式对糖尿病患者治疗效果好，改善了患者的生活质量。

家庭医生式服务；糖尿病

［Abstract］Objective To study the management effect of family doctor serviced model for 300 cases of patients with signatory diabetes.Methods 430 cases of patients with type 2 diabetes in community from December 2013 to December 2014 were selected as the research objects，and 300 cases of signed patients for receiving family doctor service were selected as the management group，130 cases of unsigned patients for family doctor service were selected as the control group，and the control group only adopted the routine follow-up management，the management group adopted the family doctor service，and the changes of fasting blood sugar，blood sugar at 2h after dinner，glycosylated hemoglobin and weight index before and after follow-up were compared.Results The difference in the awareness degree of diabetes knowledge before intervention between the management group and the control group had no statistical significance，（P＞0.05）［（69.78±15.32）vs（70.32±13.67）］，after management，the difference in the awareness degree of diabetes knowledge had statistical significance，［（87.32±9.32）vs（80.89±7.21）］（P＜0.05），after 12-month follow-up，the differences in the fasting blood sugar，blood sugar at 2h after dinner and glycosylated hemoglobin between the two groups had no statistical significance，［（8.82±2.13）mmol/L，（11.24±1.08）mmol/L，（7.99±1.34）%vs（8.6±1.09）mmol/L，（11.3±1.14）mmol/L，（7.86±1.27）%］，after 12-month management，the differences in thefasting blood sugar，blood sugar at 2h after dinner and glycosylated hemoglobin between the two groups had statistical significance，（P＜0.05）［（5.92±1.32）mmol/L，（9.85±2.02）mmol/L，（6.9±1.01）%vs（7.68±1.12）mmol/L，（11.1±1.22）mmol/L，（7.6± 1.33）%］.Conclusion The treatment effect of family doctor serviced model for patients with diabetes is good，which improves the quality of life of patients.

［Key words］Family doctor service；Diabetes

随着我国经济水平的快速发展和居民饮食结构的改变，我国糖尿病发病率逐年升高。按照之前国际糖尿病联合会估计，现在全球共有超过3亿的糖尿病患者，新发布的中国糖尿病发病率数据显示全球1/3的糖尿病人来自中国［1］。如何提高糖尿病患者的治疗效果以及依从性是社区卫生工作者较为关心的问题。……