| 费红敏,姚丽文,陆华,杨霏,黄瑾.依托医联体分层管理模式在社区糖尿病护理管理中的探讨[J].上海护理,2017,17(6): |
| 依托医联体分层管理模式在社区糖尿病护理管理中的探讨 |
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| DOI： |
| 中文关键词: 糖尿病护理 分层管理模式 社区 医联体 |
| 英文关键词:Diabetescare Hierarchical management Community hospital Combo |
| 基金项目:上海市普陀区西部医联体项目(编号：2013JY105I) |
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| 中文摘要: |
| 目的：评价依托普陀区西部医联体,在社区内对糖尿病患者进行分层的社区护理,研究其在血糖水平控制、减少并发症、改善预后等方面的作用,探讨适合中国国情的糖尿病社区护理分层管理模式。方法：于2014年1月~2015年1月 入选医联体范围内包括真如、桃浦、曹杨、长征社区卫生服务中心登记在册372例糖尿病患者进行分层管理。比较实施分层管理模式与实施一般糖尿病护理干预的社区患者一年内空腹血糖、糖化血红蛋白、住院率、严重并发症发生率等的差异。结果：分层管理组一年空腹血糖(6.8 ± 2.3 vs. 8.2 ± 2.8),糖化血红蛋白(6.0 ± 0.8 vs. 7.3 ± 2.0)低于对照组(p<0.05)；且通过分层管理高危亚组患者服药遵从、饮食控制、合理运动、血糖监测、足部护理的依从性都优于普通亚组患者(p<0.05)；一年肾脏病变、眼部病变、足部病变、总并发症发生率及入院率都少于对照组患者(P<0.05)。结论：依托医联体的糖尿病社区护理分层管理模式能够充分利用有限的医疗资源,做好社区管理,从而提高患者的生活质量,也能在控制糖尿病进程中起到积极作用。 |
| 英文摘要: |
| Objective :To evaluate the effect of hierarchical nursing for diabetic patients of the community on the level of blood glucose, reduce complications and improve the prognosis of patients with diabetes mellitus by relying on the western Putuo District Medical Combo,and to explore the management model of diabetes hierarchical community nursing which is suitable for Chinese conditions. Methods :From January 2014 to January 2015,372 cases of diabetic patients who registered in the community health services center of Zhenru, Taopu, Caoyang, Changzheng were selected to hierarchical management.The differences of fasting blood glucose, glycosylated hemoglobin, admission rate, the incidence of severe complications were compared between the diabetes hierarchical community nursing and the general diabetes community nursing. Results:In one year,fasting blood glucose(6.8 ± 2.3 vs. 8.2± 2.8), glycosylated hemoglobin(6.0 ± 0.8 vs. 7.3 ± 2.0)in the hierarchical management model were lower than those in control group (p<0.05), and compare with normal subgroups,the high-risk subgroups has better compliance in medication compliance, dietary management, reasonable exercise, blood glucose monitoring, foot Care.In oneyear,the incidence of renal disease, eye disease,foot disease,total complications and the admission rate in the hierarchical management model is lower than the control group (P<0.05) . Conclusion : The hierarchical management model of diabetes nursing in community based on medical combo system can make full use of the limited medical resources and make the community management well. It can improve the quality of life of patients, it can also play a positive role in the control of diabetes. |
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