| 郑丽杰,常明,荣超.中医“治未病”视角下杭州市家庭医生签约服务对高血压患者管理的效果评价研究[J].浙江中医药大学学报,2023,47(9):1073-1077. |
| 中医“治未病”视角下杭州市家庭医生签约服务对高血压患者管理的效果评价研究 |
| Evaluation of the Effect of Contracted Services of Family Doctors in Hangzhou on the Management of Patients with Hypertension from the Perspective of “Preventive Treatment” of Traditional Chinese Medicine |
| DOI：10.16466/j.issn1005-5509.2023.09.015 |
| 中文关键词: 家庭医生 签约服务 随访管理 中医治未病 数字化 慢性病 健康管理 社区卫生 |
| 英文关键词: family doctor contracted services follow-up management preventive treatment by traditional Chinese medicine digitization chronic disease health management community health |
| 基金项目:杭州市卫生科技计划一般项目(B20210348)；浙江省社科领军人才培育专项课题(21QNYC16ZD) |
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| 中文摘要: |
| [目的] 拟以高血压分级管理为例，评估家庭医生签约服务的效果并研讨优化策略。[方法] 采用开放式队列研究的方法，选择杭州市某社区卫生服务中心接受医养护一体化签约服务的185例高血压患者，进行2年的随访调查。[结果] 签约高血压患者的生活方式改善并不乐观。在2年的随访期内，患者饮酒情况、体质量指数(body mass index，BMI)、每周运动次数、每次运动时间的变化差异均没有统计学意义(P>0.05)。签约高血压患者的血压维护及并发症控制较好。在实施高血压分级管理1年后(P<0.001)、1.5年后(P<0.001)和2年后(P=0.005)的3个时间点，患者舒张压都比基线水平降低；分级管理1年后，收缩压比基线水平降低(P<0.001)。[结论] 杭州市医养护一体化签约服务的高血压分级管理总体效果良好；高血压患者的生活方式改善不明显，亟需采用同伴教育等新型健康管理方式；基于中医“治未病”理论，鼓励中医师开展家庭医生签约服务；充分利用好大数据、物联网和5G技术等，提升健康管理的效率和效果。 |
| 英文摘要: |
| [Objective] To evaluate the effect of family doctor’s contract service and discuss the optimization strategy by taking the classified management of hypertension as an example. [Methods] Using the method of open cohort study，185 patients with hypertension who accepted the integrated medical care contract service in a community health service center in Hangzhou were followed up for 2 years. [Results] The improvement of life style of patients with contracted hypertension was not optimistic. During the 2-year follow-up period， there was no significant statistical difference in the changes of alcohol consumption， body mass index(BMI)， the number of exercises per week and the time of each exercise. The blood pressure maintenance and complication control of contracted hypertensive patients were better. At three time points after the implementation of graded management of hypertension 1 year(P<0.001)，1.5 years(P<0.001) and 2 years(P=0.005)， the diastolic blood pressure of patients was lower than the baseline; after 1 year of graded management， systolic blood pressure was lower than the baseline (P<0.001). [Conclusion] The overall effect of classified management of hypertension in Hangzhou is good; the lifestyle of hypertension patients has not been improved significantly， so it is urgent to adopt new health management methods such as peer education; based on the theory of “preventive treatment” in traditional Chinese medicine， encourage traditional Chinese medicine practitioners to carry out family doctor contract services; make full use of big data， Internet of things and 5G technology to improve the efficiency and effect of health management. |
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