社区慢性病主动预约健康管理模式对原发性高血压病的管理效果研究
|
摘要
背景慢性病已经成为威胁中国人健康的头号疾病,其造成的死亡人数占每年1 030万死亡人数的80%。如果不加以控制,其治疗产生的直接成本和由于丧失劳动力、健康损失造成的经济成本会加重个人、企业政府的负担。目的研究慢性病主动预约健康管理模式对原发性高血压病的管理效果,推进家庭医生签约工作。方法 2017年3月随机选取成都市武侯区晋阳社区卫生服务中心在管的450例签约原发性高血压病患者作为试验组;在武侯区其他家社区卫生服务中心采用分层抽样方法选取在管的签约原发性高血压病患者450例作为对照组。试验组针对不同病情分级分层患者制定相应主动预约健康管理干预方案,对照组按照《国家基本公共卫生服务规范(第三版)》高血压随访管理规范要求进行常规管理。干预期为2017年4月—2018年4月。采用自制的调查问卷通过前后及平行对照评估慢性病管理效果。调查问卷内容包括基本资料(性别、年龄、医保、文化程度、病程、并发症)、慢性病管理质量(血压控制率、慢性病近两周医疗费用)、患者满意度和医务人员工作效率(患者上午时段就诊率、门诊接诊平均耗时、近1个月内患者就诊次数)。结果试验组干预前血压控制率低于干预后,慢性病近两周医疗费用高于干预后,慢性病管理服务满意度、签约服务满意度低于干预后,患者上午时段就诊率、门诊接诊平均耗时及近1个月内患者就诊次数高于干预后(P<0.05);对照组干预前慢性病管理满意度、签约服务满意度低于干预后(P<0.05)。干预后试验组血压控制率高于对照组,患者上午时段就诊率及门诊接诊平均耗时低于对照组(P<0.05)。结论慢性病主动预约健康管理模式可提高血压控制率、患者满意度及医务人员工作效率,缩短门诊接诊平均耗时。
Background Chronic diseases have become the leading diseases threatening the health of Chinese people,which accounts for 80% of annual total deaths(10.3 million).If we do not control this issue,the direct cost of treatment and the economic cost caused by the loss of labor force and health will increase the burden of individuals,enterprises and the government.We noted that community healthcare is the main playfield of chronic disease management.Objective To study the management effect of community chronic diseases active reservation health management model on essential hypertension,and to promote family doctor's contracting work.Methods In March 2017,450 patients with primary hypertension whose chronic diseases were managed by appointed outpatient follow-up service in Jinyang Community Health Service Center of Wuhou District were randomly selected as the study group,and 450 patients with primary hypertension who signed the contract service in other community healthcare centers in Wuhou District were selected as control group by using stratified randomized sampling method.The study group carried out the health management intervention by active appointments according to different disease grading,while the control group carried out routine management according to hypertension follow-up management standard in the National Basic Public Health Service Standard(the third edition).Intervention period was from April 2017 to April 2018.The management effect was measured by the self-made questionnaire from 3 dimensions,including general data(gender,age,medical insurance,education,course of disease,complications),the quality of chronic disease management(blood pressure control rate,health expenditure for chronic diseases in past two weeks),patients satisfaction rate and work efficiency of staff(morning visits,average outpatient visits time,and visits in the past month).Results The blood pressure control rate before intervention in the study group was lower than that after intervention;the medical cost of chronic diseases in the past two weeks was higher than that after intervention;the satisfaction rates of chronic disease management and contracting service was lower than those after intervention.The morning visiting rate,outpatient visiting time and visits in the past month in the study group were higher than those after intervention(P<0.05).The satisfaction rates of chronic disease management and contracting service in the control group before intervention were lower than those after intervention(P<0.05).After intervention,blood pressure control rate in the study group was higher than that in the control group,and the morning visiting rate and the average outpatient visits in the study group were lower than those in the control group(P<0.05).Conclusion The community chronic diseases active reservation health management model for chronic diseases can improve blood pressure control rate, patient satisfaction and medical staff work efficiency, and shorten the average time of outpatient visits.
Background Chronic diseases have become the leading diseases threatening the health of Chinese people,which accounts for 80% of annual total deaths(10.3 million).If we do not control this issue,the direct cost of treatment and the economic cost caused by the loss of labor force and health will increase the burden of individuals,enterprises and the government.We noted that community healthcare is the main playfield of chronic disease management.Objective To study the management effect of community chronic diseases active reservation health management model on essential hypertension,and to promote family doctor's contracting work.Methods In March 2017,450 patients with primary hypertension whose chronic diseases were managed by appointed outpatient follow-up service in Jinyang Community Health Service Center of Wuhou District were randomly selected as the study group,and 450 patients with primary hypertension who signed the contract service in other community healthcare centers in Wuhou District were selected as control group by using stratified randomized sampling method.The study group carried out the health management intervention by active appointments according to different disease grading,while the control group carried out routine management according to hypertension follow-up management standard in the National Basic Public Health Service Standard(the third edition).Intervention period was from April 2017 to April 2018.The management effect was measured by the self-made questionnaire from 3 dimensions,including general data(gender,age,medical insurance,education,course of disease,complications),the quality of chronic disease management(blood pressure control rate,health expenditure for chronic diseases in past two weeks),patients satisfaction rate and work efficiency of staff(morning visits,average outpatient visits time,and visits in the past month).Results The blood pressure control rate before intervention in the study group was lower than that after intervention;the medical cost of chronic diseases in the past two weeks was higher than that after intervention;the satisfaction rates of chronic disease management and contracting service was lower than those after intervention.The morning visiting rate,outpatient visiting time and visits in the past month in the study group were higher than those after intervention(P<0.05).The satisfaction rates of chronic disease management and contracting service in the control group before intervention were lower than those after intervention(P<0.05).After intervention,blood pressure control rate in the study group was higher than that in the control group,and the morning visiting rate and the average outpatient visits in the study group were lower than those in the control group(P<0.05).Conclusion The community chronic diseases active reservation health management model for chronic diseases can improve blood pressure control rate, patient satisfaction and medical staff work efficiency, and shorten the average time of outpatient visits.
引文
[1]中国疾病预防控制中心.中国慢性病及其危险因素监测报告[M].北京:军事医学科学出版社,2012:2-3.
[2]刘璋寅,陈刚.我国社区慢性病管理现状[J].中国全科医学,2017,20(S3):445-446.
[3]田华,李沭,张相林.慢性病管理模式的国内外现状分析[J].中国药房,2016,27(32):4465-4468.DOI:10.6039/j.issn.1001-0408.2016.32.01.TIAN H,LI S,ZHANG X L.Analysis of current situation of chronic disease management model in the domestic and overseas[J].China Pharmacy,2016,27(32):4465-4468.DOI:10.6039/j.issn.1001-0408.2016.32.01.
[4]中国医药卫生体制改革联合研究合作方世界银行集团,世界卫生组织,财政部,国家卫生和计划生育委员会,人力资源和社会保障部.深化中国医药卫生体制改革-建设基于价值的优质服务提供体系政策总论[R].2016:17-21.
[5]朱慧蓉,朱纯,密一恺,等.社区居民家庭医生签约决策与影响因素关系的验证[J].中国全科医学,2019,22(7):799-805.DOI:10.12114/j.issn.1007-9572.2019.07.011.ZHU H R,ZHU C,MI Y K,et al.Correlation between residents'decisions to contract for family doctor services and influencing factors[J].Chinese General Practice,2019,22(7):799-805.DOI:10.12114/j.issn.1007-9572.2019.07.011.
[6]贾薇,杜亚平,范敏华.社区居民签约家庭医生行为的影响因素模型构建研究[J].中国全科医学,2019,22(1):15-19.DOI:10.12114/j.issn.1007-9572.2019.01.004.JIA W,DU Y P,FAN M H.Construction of a conceptual model for identifying the factors associated with signing a health service contract with the family doctor in community-dwelling residents[J].Chinese General Practice,2019,22(1):15-19.DOI:10.12114/j.issn.1007-9572.2019.01.004.
[7]《中国高血压基层管理指南》修订委员会.中国高血压基层管理指南(2014年修订版)[J].中华健康管理学杂志,2015,9(1):10-30.DOI:10.3760/cma.j.issn.1674-0815.2015.01.004.
[8]陈洁.家庭医生式服务签约居民对预约门诊的接受意愿及影响因素研究[J].中国全科医学,2016,19(10):1143-1146.DOI:10.3969/j.issn.1007-9572.2016.10.008.CHEN J.Willingness to accept appointed outpatient service among residents signing the contract of family doctor service and its influencing factors[J].Chinese General Practice,2016,19(10):1143-1146.DOI:10.3969/j.issn.1007-9572.2016.10.008.
[9]国家卫生计生委关于印发《国家基本公共卫生服务规范(第三版)》的通知.国卫基层发[2017]13号[EB/OL].(2017-03-28)[2018-02-11].http://www.nhfpc.gov.cn/jws/s3578/201703/d20c37e23e1f4c7db7b8e25f34473e1b.shtml.
[10]李黎,王洁,曲海燕,等.基于家庭医生预约门诊的2型糖尿病患者管理模式探讨[J].中国初级卫生保健,2016,30(6):41-46.DOI:10.3969/j.issn.1001-568X.2016.06.0017.
[11]王影,王海芹,张空,等.上海市某社区慢性病管理模式下护士角色功能探讨[J].上海预防医学,2016,28(11):831-833.
[12]杜兆辉.城市社区家庭医生制服务的实践与思考[J].中国全科医学,2011,14(31):3541-3543.DOI:10.3969/j.issn.1007-9572.2011.31.002.DU Z H.Practice and thinking of community family doctor service in urban community[J].Chinese General Practice,2011,14(31):3541-3543.DOI:10.3969/j.issn.1007-9572.2011.31.002.
[13]吴雯.社区卫生服务中心试行预约门诊的实践与探讨[J].中国初级卫生保健,2011,25(6):7-9.DOI:10.3969/j.issn.1001-568X.2011.06.003.WU W.Practice and discussion of outpatient appointment trial in community health center[J].Chinese Primary Health Care,2011,25(6):7-9.DOI:10.3969/j.issn.1001-568X.2011.06.003.
[14]胡隽,王海琴.以预约门诊为特色的家庭医生责任制的实践和探讨[J].上海医药,2015,36(8):12-14.HU J,WANG H Q.Practice and exploration of the responsibility system of the family doctors with the outpatient appointment as the characteristics[J].Shanghai Medical&Pharmaceutical Journal,2015,36(8):12-14.
[15]李琳,宋贝贝,丁静.首都医科大学附属复兴医院月坛社区卫生服务中心家庭医生签约慢性病患者预约门诊现况分析[J].中国全科医学,2017,20(36):4539-4542.DOI:10.3969/j.issn.1007-9572.2017.00.180.LI L,SONG B B,DING J.Appointment situation of family doctor service among contracted patients with chronic diseases in yuetan community health service center,affiliated fu xing hospital of capital medical university[J].Chinese General Practice,2017,20(36):4539-4542.DOI:10.3969/j.issn.1007-9572.2017.00.180.
[2]刘璋寅,陈刚.我国社区慢性病管理现状[J].中国全科医学,2017,20(S3):445-446.
[3]田华,李沭,张相林.慢性病管理模式的国内外现状分析[J].中国药房,2016,27(32):4465-4468.DOI:10.6039/j.issn.1001-0408.2016.32.01.TIAN H,LI S,ZHANG X L.Analysis of current situation of chronic disease management model in the domestic and overseas[J].China Pharmacy,2016,27(32):4465-4468.DOI:10.6039/j.issn.1001-0408.2016.32.01.
[4]中国医药卫生体制改革联合研究合作方世界银行集团,世界卫生组织,财政部,国家卫生和计划生育委员会,人力资源和社会保障部.深化中国医药卫生体制改革-建设基于价值的优质服务提供体系政策总论[R].2016:17-21.
[5]朱慧蓉,朱纯,密一恺,等.社区居民家庭医生签约决策与影响因素关系的验证[J].中国全科医学,2019,22(7):799-805.DOI:10.12114/j.issn.1007-9572.2019.07.011.ZHU H R,ZHU C,MI Y K,et al.Correlation between residents'decisions to contract for family doctor services and influencing factors[J].Chinese General Practice,2019,22(7):799-805.DOI:10.12114/j.issn.1007-9572.2019.07.011.
[6]贾薇,杜亚平,范敏华.社区居民签约家庭医生行为的影响因素模型构建研究[J].中国全科医学,2019,22(1):15-19.DOI:10.12114/j.issn.1007-9572.2019.01.004.JIA W,DU Y P,FAN M H.Construction of a conceptual model for identifying the factors associated with signing a health service contract with the family doctor in community-dwelling residents[J].Chinese General Practice,2019,22(1):15-19.DOI:10.12114/j.issn.1007-9572.2019.01.004.
[7]《中国高血压基层管理指南》修订委员会.中国高血压基层管理指南(2014年修订版)[J].中华健康管理学杂志,2015,9(1):10-30.DOI:10.3760/cma.j.issn.1674-0815.2015.01.004.
[8]陈洁.家庭医生式服务签约居民对预约门诊的接受意愿及影响因素研究[J].中国全科医学,2016,19(10):1143-1146.DOI:10.3969/j.issn.1007-9572.2016.10.008.CHEN J.Willingness to accept appointed outpatient service among residents signing the contract of family doctor service and its influencing factors[J].Chinese General Practice,2016,19(10):1143-1146.DOI:10.3969/j.issn.1007-9572.2016.10.008.
[9]国家卫生计生委关于印发《国家基本公共卫生服务规范(第三版)》的通知.国卫基层发[2017]13号[EB/OL].(2017-03-28)[2018-02-11].http://www.nhfpc.gov.cn/jws/s3578/201703/d20c37e23e1f4c7db7b8e25f34473e1b.shtml.
[10]李黎,王洁,曲海燕,等.基于家庭医生预约门诊的2型糖尿病患者管理模式探讨[J].中国初级卫生保健,2016,30(6):41-46.DOI:10.3969/j.issn.1001-568X.2016.06.0017.
[11]王影,王海芹,张空,等.上海市某社区慢性病管理模式下护士角色功能探讨[J].上海预防医学,2016,28(11):831-833.
[12]杜兆辉.城市社区家庭医生制服务的实践与思考[J].中国全科医学,2011,14(31):3541-3543.DOI:10.3969/j.issn.1007-9572.2011.31.002.DU Z H.Practice and thinking of community family doctor service in urban community[J].Chinese General Practice,2011,14(31):3541-3543.DOI:10.3969/j.issn.1007-9572.2011.31.002.
[13]吴雯.社区卫生服务中心试行预约门诊的实践与探讨[J].中国初级卫生保健,2011,25(6):7-9.DOI:10.3969/j.issn.1001-568X.2011.06.003.WU W.Practice and discussion of outpatient appointment trial in community health center[J].Chinese Primary Health Care,2011,25(6):7-9.DOI:10.3969/j.issn.1001-568X.2011.06.003.
[14]胡隽,王海琴.以预约门诊为特色的家庭医生责任制的实践和探讨[J].上海医药,2015,36(8):12-14.HU J,WANG H Q.Practice and exploration of the responsibility system of the family doctors with the outpatient appointment as the characteristics[J].Shanghai Medical&Pharmaceutical Journal,2015,36(8):12-14.
[15]李琳,宋贝贝,丁静.首都医科大学附属复兴医院月坛社区卫生服务中心家庭医生签约慢性病患者预约门诊现况分析[J].中国全科医学,2017,20(36):4539-4542.DOI:10.3969/j.issn.1007-9572.2017.00.180.LI L,SONG B B,DING J.Appointment situation of family doctor service among contracted patients with chronic diseases in yuetan community health service center,affiliated fu xing hospital of capital medical university[J].Chinese General Practice,2017,20(36):4539-4542.DOI:10.3969/j.issn.1007-9572.2017.00.180.