摘要
背景骨关节炎是中老年人常见的慢性病,严重影响中老年人的生活质量。在社区开展骨关节炎的疾病管理有利于资源配置的优化和提高疾病的整体防治水平,但目前骨关节炎的管理存在诸多问题,效果不佳。目的分析目前国内外社区骨关节炎的管理情况和策略进展,比较其优缺点,为我国社区骨关节炎管理提供更为优化的策略,以改善骨关节炎患者的诊疗效果和预后。方法于2020年10月至2021年1月,在中国知网、万方数据知识服务平台、维普网数据库主题检索“骨关节炎”与“管理”、“骨关节炎”与“模式”、“骨关节炎”与“策略”,在Pubmed、Web of Science、Cochrane Library数据库主题检索("Osteoarthritis")AND("Management"OR"Mode"OR"Strategy")获得发表时间为2010-01-01至2020-01-01的文献。剔除重复及涉及骨关节炎自我管理的文献,对入选涉及社区骨关节炎管理的文献进行系统分析。结果检索到文献2695篇,删除2642篇,入选53篇涉及社区骨关节炎管理的文献。其中5篇文献涉及社区骨关节炎管理现况调查,均提及目前国内外对骨关节炎的管理缺乏协调性和目的性,同时治疗的重点是缓解症状、延缓软骨退化、减少畸形的发生,但疗效不能令人满意,且症状常反复发作;而且我国骨关节炎管理多停留在健康教育层面,管理模式单一。6篇文献内容涉及社区骨关节炎管理影响因素,结果提示目前患者及其家属对骨关节炎的认知不足,基层医院部分医生对骨关节炎认识不足、重视程度不够,医疗资源配置不协调,多种因素导致社区骨关节炎管理缺乏协调性和目的性。3篇文献内容涉及社区骨关节炎管理的意义,主要强调通过社区骨关节炎管理减轻患者疼痛、延缓疾病进展,从而改善患者生活质量、提高患者和医疗保健专业人员的满意度、优化医疗保健资源的使用。39篇文献内容涉及社区骨关节炎管理策略,其中22篇涉及系统性管理策略,包括社区骨关节炎多学科或综合管理模式(18篇)、社区骨关节炎分级管理(4篇),整体来说社区骨关节炎管理策略借鉴了我国社区管理糖尿病及高血压的成功经验,但策略大多处于建设阶段,在实践中的应用尚需进一步研究;其余17篇涉及各种非系统性社区骨关节炎管理策略,其中8篇是以健康教育为主要方式的管理模式,3篇管理模式涉及网络模式,各有2篇涉及远程电话管理、非药物管理、书面信息指南。结论社区骨关节炎的管理策略中存在诸多问题,包括管治不协调、方法不健全、制度不完善。未来对骨关节炎患者进行管理可借鉴的策略包括:社区多学科或综合管理、分级管理等系统性的管理策略;充分利用医疗服务技术和工具,如电子医疗、网络远程管理、健康手册等;优化资源配置,如将骨关节炎健康管理纳入国家基本公共卫生服务项目,加大政府对骨关节炎管理的政策扶持。
Background Osteoarthritis is a common chronic disease in middle-aged and elderly people,which seriously affects their quality of life.Carrying out community-based management of osteoarthritis is conducive to the optimization of healthcare resource allocation and the improvement of the overall prevention and treatment level of osteoarthritis.However,current community-based management of osteoarthritis has many problems and is not effectively.Objective To perform a review and comparative analysis of the developments in foreign and domestic community-based management of osteoarthritis,and strategies addressing the existing problems,providing evidence for improving strategies regarding community-based management of osteoarthritis to improve the treatment and prognosis of osteoarthritis patients in China.Methods From October 2020 to January 2021,Studies related to osteoarthritis management in Chinese published from January 1,2010 to January 1,2020 were searched from databases of CNKI,Wanfang Data and CQVIP using"骨关节炎"plus"管理","骨关节炎"plus"模式","骨关节炎"plus"策略"as the search terms,and those in English published during the same period were searched from databases of PubMed,Web of Science,and the Cochrane Library using osteoarthritis and management,mode or strategy as the search terms.After excluding duplicates or those about self-management of osteoarthritis,the enrolled studies about community-based management of osteoarthritis were analyzed using systematic analysis.Results Altogether,2695 studies were retrieved,2642 of them were excluded,and the other 53 were included.Five studies were about surveys on the management of osteoarthritis in the community,all of which revealed the lack of coordination and purpose in community-based management of osteoarthritis at home and abroad,and the key treatments are relieving symptoms,delaying cartilage degradation,and reducing the possibility of developing deformities,but the efficacies of such treatments were unsatisfactory,and symptoms often recurred.Moreover,community-based management modes of osteoarthritis in China were undiversified,mostly were various types of health education.Six studies proposed that the management of osteoarthritis in the community may be influenced by insufficient understanding of osteoarthritis in patients and their families,insufficient understanding and undervaluing of osteoarthritis in some primary care physicians,and uncoordinated healthcare resources,and put forward that a variety of factors led to the lack of coordination and purpose in the management of osteoarthritis in the community.There were three articles referring the significance of community-based osteoarthritis management,which highlighted that communitybased osteoarthritis management could relieve pain,delay disease progression,and improve the quality of life in patients,and improve patients'satisfaction with treatment and services by healthcare professionals,as well as optimize the use of healthcare resources.There were 39 studies related to the strategies for community-based osteoarthritis management,22 of which involved systematic management strategies,including 18 studies of multi-disciplinary or integrated management models and four studies of hierarchical management.As a whole,China's successful experience of managing diabetes and hypertension in the community has provided new ideas for the prevention and treatment of osteoarthritis,but most of the strategies were in the developmental stage,and their applications in practice needed further research.The remaining 17 studies involved various non-systematic communitybased management strategies of osteoarthritis,including eight centering on health education,three focusing on internet-based management approaches,two involving telephone-based management,two focusing on non-drug management,and two focusing on written guidance.Conclusion There are problems in the community-based management strategies of osteoarthritis,including uncoordinated management,unsound methods,and imperfect systems.The referential community-based management strategies for osteoarthritis include:multidisciplinary or comprehensive management,hierarchical management and other systematic management strategies;making full use of medical techniques and tools(such as e-health,remote management,and health manuals);optimizing resource allocation(such as adding osteoarthritis management as a national essential public health project,and increasing government policy support for osteoarthritis management).
作者
刘茜
张含之
邱梦思
于德华
LIU Qian;ZHANG Hanzhi;QIU Mengsi;YU Dehua(Department of General Practice,Yangpu Hospital,Tongji University School of Medicine,Shanghai 200090,China;Department of General Practice,Tongji University School of Medicine,Shanghai 200092,China;Shanghai General Practice and Community Health Development Research Center,Shanghai 200090,China;Shanghai General Practice Clinical Quality Control Center,Shanghai 200090,China)
出处
《中国全科医学》
CAS
北大核心
2022年第25期3157-3164,共8页
Chinese General Practice
基金
同济大学附属杨浦医院第九批攀登计划(Ye2202002)
上海市杨浦区中心医院学科带头人“攀登计划”(Ye2202002)。
关键词
骨关节炎
社区卫生服务
疾病管理
信息技术
系统综述
Osteoarthritis
Community health services
Disease management
Information technology
Systematic review
