| 褚丽萍 钱春芳,高峰,李穗芳,武春梅,刘晓玲.“一专多能”医护整合模式在家庭医生责任制服务中的探索[J].上海护理,2019,19(S1): |
| “一专多能”医护整合模式在家庭医生责任制服务中的探索 |
|
| DOI： |
| 中文关键词: 一专多能 医护整合 家庭医生制服务 |
| 英文关键词:Yizhuanduoneng medical integration family physician services. |
| 基金项目: |
|
| 摘要点击次数: 1633 |
| 全文下载次数: 0 |
| 中文摘要: |
| 【】: 目的 评价“一专多能”医护整合模式在本社区家庭医生责任制服务中的效果,探索社区家庭医生责任制服务中个体化的慢病特色服务和社区适宜技术推进新模式。方法 自2017年1月在“1+1+1家庭医生团队”签约的基础上,本中心组建了糖尿病、高血压、脑卒中、腹膜透析、社区压力性损伤、PICC维护六大领域的专科医护整合团队,目的为每个家庭医生团队这六大领域中高危签约居民通过专科医护整合团队进行个体化的干预,从疾病专科诊疗、专业性的健康咨询、针对性的健康照顾、权威性的健康指导和持续性的健康关怀和社区适宜新技术推进。结果 以“一专多能”医护整合团队在一年中的干预,慢病患者中的糖尿病护理门诊教育和高血压自我管理同伴教育,对改善血压、血糖效果明显(P<0.05)；四大适宜技术的并发症率明显减低、治愈率和普及率明显提升(P<0.05)。结论 “一专多能”医护整合团队在家庭医生制服务中的模式得到同行认可和居民的肯定,四大社区适宜技术真正做到方便百姓,惠及居民。 |
| 英文摘要: |
| Objective: To evaluate the effect of knowledge integration model in the community health care service responsibility system of family doctors, to explore the community responsibility system of family doctors service in individual chronic disease special services and appropriate technology for community to promote a new model. Methods from January 2017 signing based in the "1+1+1 family doctor team", the center established diabetes, hypertension, stroke, peritoneal dialysis, community pressure injury, PICC maintains six areas of specialized medical integration team, for the purpose of the six fields of each family doctor team in high-risk contracted residents for individualized intervention through the integration of specialized medical team from disease specialist treatment and professional health counseling, targeted health care, authoritative health guidance and sustainable health care and community for new technology advance. The results in the "expert" health care integration team in the year of the intervention, patients with chronic disease in diabetes care outpatient hypertension self-management education and peer education, to improve the blood pressure and blood glucose effect (P<0.05); four appropriate technology complication rate was significantly lower, cure rate and penetration rate improved significantly (P<0.05). Conclusion the "expert" health care integration team to get peer recognition and affirmation in the residents of family physician service patterns in four communities of appropriate technology to facilitate people to truly benefit residents. |
| 查看/发表评论 下载PDF阅读器 全文HTML |
| 关闭 |
|
|
|
