家庭医生签约服务协同改革对居民健康管理的影响
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摘要
目的在家庭医生签约服务与医疗保险支付方式协同改革背景下,探讨家庭医生签约服务对居民健康管理的影响。方法随机抽取上海市某区常住居民3 040人,分别于2013年及2016年进行跟踪问卷调查。结果两次调查签约居民血压测量频率均明显高于未签约居民。2013年签约的高血压患者中每周至少测量一次血压者比例为60.30%,明显高于未签约的高血压患者(47.11%);2016年签约患者血压测量频率依然高于未签约患者。2013年签约糖尿病患者中每周至少测量一次血糖者比例仅18.80%,低于未签约患者(21.16%);2016年签约患者该比例上升至42.28%,明显高于未签约患者(36.94%)。签约高血压与糖尿病患者总体健康状况评价与并发症干预成效均优于未签约患者。但是,签约和未签约患者并发症有效干预比例均出现下滑。结论家庭医生签约服务对慢性病患者的健康管理已产生积极作用,将来应进一步加强对慢性病并发症的干预管理。
Objective To explore the effect of family doctor contract service on residents' health management in the context of collaborative reform of family doctor contract service and medical insurance payment. Methods A total of 3 040 residents were randomly selected from one district in Shanghai. Follow-up questionnaire survey was conducted in 2013 and 2016 respectively. Results According to the two surveys,the frequency of blood pressure measurement for contracted residents was significantly higher than that of the uncontracted ones. A total of 60.30% of the contracted residents with hypertension measured blood pressure at least once a week in 2013,which was significantly higher than that of the uncontracted ones(47.11%). The situation was similar in 2016. In 2013,the percentage of the contracted diabetic patients measuring blood glucose at least once a week was only 18.80%,which was lower than that of the uncontracted ones(21.16%). However,the percentage increased to 42.28% in 2016 for the contracted residents,which was significantly higher than that of the uncontracted ones(36.94%). The overall health status of the contracted patients with hypertension and with diabetes and the effect of complication intervention were better than those of the uncontracted ones. However,the proportion of effective complication intervention declined. Conclusion Family doctor contract service has a positive effect on health management of patients with chronic diseases. It is necessary to strengthen the intervention and management of chronic complications.
Objective To explore the effect of family doctor contract service on residents' health management in the context of collaborative reform of family doctor contract service and medical insurance payment. Methods A total of 3 040 residents were randomly selected from one district in Shanghai. Follow-up questionnaire survey was conducted in 2013 and 2016 respectively. Results According to the two surveys,the frequency of blood pressure measurement for contracted residents was significantly higher than that of the uncontracted ones. A total of 60.30% of the contracted residents with hypertension measured blood pressure at least once a week in 2013,which was significantly higher than that of the uncontracted ones(47.11%). The situation was similar in 2016. In 2013,the percentage of the contracted diabetic patients measuring blood glucose at least once a week was only 18.80%,which was lower than that of the uncontracted ones(21.16%). However,the percentage increased to 42.28% in 2016 for the contracted residents,which was significantly higher than that of the uncontracted ones(36.94%). The overall health status of the contracted patients with hypertension and with diabetes and the effect of complication intervention were better than those of the uncontracted ones. However,the proportion of effective complication intervention declined. Conclusion Family doctor contract service has a positive effect on health management of patients with chronic diseases. It is necessary to strengthen the intervention and management of chronic complications.
引文
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[10]王苏中,吴永浩.社区高血压“合作管理”干预效果评估[J].中国全科医学,2000,3(4):291-294.
[11]张学标,王启,周立志,等.社区家庭医生服务团队对高血压患者健康教育方法和效果分析[J].社区医学杂志,2011,9(7):62-63.
[12]张蓓燕,黄蛟灵,贺小林,等.上海某社区糖尿病不同干预方式效果比较[J].中国卫生资源,2013,16(4):276-278.
[2]梁万年.全科医生的素质和任务及其在社区卫生服务中的作用[J].中国全科医学,2007,10(3):173.
[3]ROTHMAN A A,WAGNER E H.Chronic illness management:what is the role of primary care?[J].Ann Intern Med,2003,138(3):256-261.
[4]贺小林,梁鸿.推进家庭责任医生制度改革的理论探讨与政策建议[J].中国卫生政策研究,2012,5(6):3-8.
[5]吴海燕,孙昕,许强,等.新疆克拉玛依市社区卫生服务综合改革成效分析[J].中国卫生资源,2015,18(5):342-345.
[6]尉敏琦,周热娜,严华美,等.上海市某区社区健康咨询服务点服务状况评估[J].中国卫生资源,2015,18(3):223-225.
[7]肖筱,袁立,周昌明,等.推行家庭医生签约对社区卫生服务利用的影响[J].中国卫生资源,2015,18(1):64-67.
[8]沈序英,史玲,王路昌,等.高血压患者全科团队式社区健康管理效果评估[J].中国全科医学,2010,13(8):873-875.
[9]曹静,徐崇凯,顾芙蓉,等.以社区健康服务中心全科医生为主体的糖尿病管理模式[J].中国医药导报,2010,7(17):113-114.
[10]王苏中,吴永浩.社区高血压“合作管理”干预效果评估[J].中国全科医学,2000,3(4):291-294.
[11]张学标,王启,周立志,等.社区家庭医生服务团队对高血压患者健康教育方法和效果分析[J].社区医学杂志,2011,9(7):62-63.
[12]张蓓燕,黄蛟灵,贺小林,等.上海某社区糖尿病不同干预方式效果比较[J].中国卫生资源,2013,16(4):276-278.