“1+1+1”家庭医生签约服务模式对高血压和糖尿病随访人群生命质量的影响

来源:用户上传      作者:沈琦 刘帅 顾卫英 杨清燕

　　摘 要 目的：^察“1+1+1”组合签约家庭医生服务对高血压、糖尿病患者的生命质量的影响。方法：于2018年7-9月采用整群分层随机方法抽取在社区接受慢性病随访的高血压和糖尿病患者共729例；平均年龄（64.35±8.59岁，其中男性336例，女性393例。以患病情况分为糖尿病组（78例）、高血压组（508例）、高血压伴糖尿病组（143例）。以家庭医生签约服务年限分为签约3年组、2年组、1年组和未签约组；使用生存质量量表（SF-36）分析各组的生存质量状况。结果：社区高血压和糖尿病随访人群的生理综合评分和心理综合评分分别为（337.13±54.44）分和（335.61±42.74）分。总体健康、生命活力评分均低于常模（均P<0.05），生理职能、躯体疼痛、情感职能、精神健康、社会职能评分均高于常模（均P<0.05）。不同患病情况组间各维度评分差异均无统计学意义（均P>0.05）。签约3年组的生理综合评分（355.47±30.38）分，明显高于签约2年组、签约1年组和未签约组（均P<0.05）；签约3年组的心理综合评分为（347.35±24.47）分，明显高于2年组和未签约组（均P<0.05）。结论："1+1+1"组合式家庭医生签约服务模式有效地发挥了家庭医生制度、分级诊疗制度的优势，对社区高血压和糖尿病随访人群生命质量状况有明显的改善作用，对于社区慢性病管理有着积极的影响。
　　关键词 高血压；糖尿病；家庭医生；签约服务；生命质量
　　中图分类号：R544.1 文献标志码：A 文章编号：1006-1533（2022）14-0041-04
　　引用文本 沈琦， 刘帅， 顾卫英， 等. “1+1+1”家庭医生签约服务模式对高血压和糖尿病随访人群生命质量的影响[J]. 上海医药， 2022， 43（14）： 41-44， 62.
　　Effect of “1+1+1” family doctor contracted service mode on quality of life of the follow-up population with hypertension and diabetes
　　SHEN Qi1， LIU Shuai2， GU Weiying3， YANG Qingyan3
　　（1. Director Office of Huacao Community Health Service center of Minhang District， Shanghai 201107， China； 2. Vice Director Office of Huacao Community Health Service Center of Minhang District， Shanghai 201107， China； 3. General Practice Department of Huacao Community Health Service Center of Minhang District， Shanghai 201107， China）
　　ABSTRACT Objective： To observe the effect of “1+1+1” combination contracted family doctor service on the quality of life of patients with hypertension and diabetes. Methods： From July to September 2018， a total of 729 patients with hypertension and diabetes who were followed up by chronic diseases in the community were selected by cluster stratified random method； the mean age was （64.35±8.59） years old， including 336 males and 393 females. These research objects were divided into a diabetes group， a hypertension group， and a hypertension with diabetes group based on their diseases， and also classified into a three-year contracted group， a two-year contracted group， a one-year contracted group， and a no-contracted group based on the number of service years signed with the family doctors； the quality of life status of each group was analyzed using the quality of life scale（SF-36）. Results： The comprehensive evaluation of the physiological contents and the comprehensive evaluation of the psychological contents of the hypertension and diabetes follow-up groups scored （337.13±54.44） and （335.61±42.74）， respectively. The scores of overall health and vital energy were lower than the norm（all P<0.05）， and the scores of physiological function， physical pain， emotional function， mental health and social function were higher than those of the norm（all P<0.05）. There was no significant difference in the scores of each dimension between groups with different prevalences（all P>0.05）. The physiological comprehensive score of the 3-year contracted group （355.47±30.38） was significantly higher than that of the 2-year contracted group， the 1-year contracted group and the non-contracted group（all P<0.05）； the psychological comprehensive score of the 3-year contracted group was （347.35±24.47） points， which was significantly higher than that of the 2-year contracted group and the non-contracted group（both P<0.05）. Conclusion： The “1+1+1” combined family doctor contracted service mode effectively exerts the advantages of the family doctor system and the hierarchical diagnosis and treatment system， which can significantly improve the quality of life of the follow-up population with hypertension and diabetes in the community， and has a positive impact on the management of chronic diseases in the community.

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