摘要
目的探讨群组看病模式对社区2型糖尿病患者的干预效果。方法采用平行对照试验设计,选取2014年6月上海市宝山区大场社区卫生服务中心管理的2型糖尿病患者214例,根据是否愿意参加群组看病分为干预组110例和对照组104例。干预组患者以小组形式接受由社区全科医生和护士组成的服务团队提供的群组看病;对照组患者接受传统的三级管理模式,两组患者均在基线及干预6、12个月后完成3次问卷调查和糖化血红蛋白检测。评价指标主要包括社会支持、医患交流、自我效能、自我管理行为和糖化血红蛋白,运用线性潜发展模型(LLGM)评估糖尿病群组看病的效果。结果从基线到干预后12个月的时间内,对照组患者社会支持、医患交流、自我效能、自我管理行为得分的平均增长率分别为0.24(P<0.001)、0.18(P=0.008)、0.31(P<0.001)和0.37(P<0.001),而干预组患者对应的平均增长率分别比对照组患者高0.14(P<0.001)、0.16(P<0.009)、0.16(P=0.009)和0.16(P=0.009)。在随访期间,对照组患者糖化血红蛋白的平均减少值为0.29(P<0.001),干预组患者的平均减少值比对照组患者多0.24(P=0.009)。结论糖尿病群组看病不但可以增加患者的社会支持、医患交流和自我效能,而且可以改善自我管理行为、降低糖化血红蛋白水平。
Objective To investigate the intervention effect of group visits on patients with type 2 diabetes mellitus in communities. Methods Using the design of controlled clinical trials, we enrolled 214 patients with type 2 diabetes mellitus who were administrated in Dachang Community Health Service Center in Baoshan District of Shanghai in June 2014. According to the will of group visits, the patients were divided into two groups： intervention group （n = 110） and control group （n = 104） . The intervention group was administrated with service by group visits to the service team comprising general practitioners and nurses; the control group was administrated with conventional three - level management mode. The two groups both received three times of questionnaire survey and the measurement of HbA^o level at baseline, 6 months and 12 months after intervention. Evaluation indexes included social support, the communication between doctors and patients, self - efficacy, self - management behaviors and HbA1c level. Linear latent growth model （LLGM） was used to evaluate the effect of diabetes group visits. Results For control group, compared with baseline, the average increase rates of social support, the communication between doctors and patients, self - efficacy, self - management behaviors were 0. 24 （ P 〈 0. 001 ） , 0. 18 （ P = 0. 008 ）, 0. 31 （ P 〈 0. 001 ） and 0. 37 （ P 〈0. 001 ） 12 months after intervention; for intervention group, the increase rates were 0. 14 （ P 〈 0. 001 ）, 0. 29 （ P 〈 0. 001）, 0. 16 （P =0. 009） and 0. 16 （P =0. 009） higher than control group. During follow - up, compared with baseline, the HbA1c level of control group decreased averagely by 0. 29 （P 〈0. 001）, and the intervention group was 0. 24 （P =0. 009） higher than the average decrease value of control group. Conclusion Diabetes group visits can not only improve social support, physician -patient communication and self- efficacy, but also improve self- management behaviors and decrease HbA1c level.
出处
《中国全科医学》
CAS
CSCD
北大核心
2015年第31期3792-3797,共6页
Chinese General Practice
基金
上海卫生系统先进适宜技术推广项目(2013SY006)
关键词
糖尿病
2型
社区卫生服务
群组看病
线性潜发展模型
Diabetes mellitus, type 2
Community health services
Group visits
Linear latent growth model
