Study On The Construction Of Community Elderly Type 2 Diabetic Patients' Home Care Model Based On Family Physician Contracting Services

Objective1.To understand and analyze the demands and influencing factors of home care services for the elderly patients with type 2 diabetes in community,as well as the status quo and existing problems of community family physician contracting services and home care services,so as to provide some reference for the construction of community elderly type 2diabetic patients' home care model.2.To Construct a set of more scientific and systematic community elderly type 2 diabetic patients' home care model based on family physician contracting services,so as to provide theoretical basis for improving or solving the personalized health problems of elderly patients with type 2 diabetes in the community,improving the service satisfaction of patients,and the promotion of the further development of community family physician contracting services.Methods1.Literature retrieval method: through searching well-known domestic and foreign databases,such as China HowNet,Wanfang,Weipu,Cochrane,Pub-Med,Web of Science and so on,related research on home care models for diabetic patients at home and abroad were reviewed and analyzed,and advanced experience and practice at home and abroad was summarized,which provide some reference for the construction of community elderly type 2diabetic patients' home care model.2.Questionnaire survey method: using a self-designed questionnaire to survey 308 community elderly type 2 diabetes patients in 10 community health services institutions inYinchuan,Ningxia,in order to understand and analyze the demands and influencing factors of home care services for the elderly patients with type 2 diabetes in the community.3.Semi-structured interview method: to interview 8 medical staff and 7 community elderly type 2 diabetic patients with activity obstacles in Yinchuan community health services,Ningxia,then organize and analyze the interview data.To understand the status quo and existing problems of community family physician contracting services and home care services,as well as deeply to understand home care services demands of community elderly type 2 diabetic patients with activity obstacles.4.Expert group meeting method: strictly accordance with experts selection criteria selecting 10 experts come from five fields,namely nursing education,diabetes specialty nursing,diabetes diagnosis and treatment,chronic disease management and community management,to hold an expert group meeting for the purpose of the revision preliminarily constructed community elderly type 2 diabetic Patients' home care model based on family physician contracting services.5.Community practice: strictly accordance with inclusion and exclusion criteria selecting30 elderly patients with type 2 diabetes come from kelfudi community health services stations in Yinchuan city,Ningxia,to carry out a one-month community practice based on the revised community elderly type 2 diabetic patients' home care model,so as to observe the effect of home care services,then to find out problems in time,and to conduct further revision and improvement of the home care model.Results1.Quantitative research results(1)The survey results showed that 290(94.16%)patients needed home care services,with the total demand score of home care services was 3.87±0.49.The demands were mainly focused on health management and guidance nursing services,basic medical nursing services and psychological nursing services,and the scores were 4.25±0.78,4.01±0.93,and4.11 ± 1.03,respectively.The main factors that affected the total demands for home care services of community elderly type 2 diabetic patients include annual total medical expenses,medical insurance type,the complications of diabetes type,satisfaction with participating in community activities,the number of hospitalizations due to diabetes and the burden of disease of diabetes.2.Qualitative research results(1)The semi-structured interviews with community medical staff extracted 4 themes--the current status of community family physician contracting service,the status of community home care services,the problems of community home care services,and the formation of home care services standard--and 15 sub themes.(2)The semi-structured interviews with community elderly type 2 diabetic patients extracted 4 them--Patients' willingness to accept home care,the Patients' experience and feelings of home care services,the demands of home care services,and economic support--and5 sub-themes.3.The results of the preliminary construction of a community elderly type 2 diabetic Patients' home care model based on family physician contracting services.Based on the result of quantitative and qualitative research,literature analysis,and according to relevant national policies and the characteristics of diabetes,community elderly type 2 diabetic Patients' home care model based on family physician contracting services was initially constructed,which mainly include 6 parts: “the purpose of the construction of home care model”,“the principles of home care model”,“the services team of the construction of home care model”,“home care services process”,“home care services content”and“home care services effect evaluation index”.4.The expert group meeting resultsTen qualified experts attended the expert group meeting,and the expert authority coefficient was 0.865,with good authority.The experts opinions mainly include:(1)thepurpose and principles of the construction of home care model should not be part of the model framework;(2)To make a clear composition and selection criteria of home care services team members;(3)Further modification should be taken on the service content of home care model;(4)The home care services process needs to be modified in a more simplified and perfected way;(5)The evaluation indicators of home care services need to be further improved;(6)The home care assessment form needs further revision.In the end,research group discussed the expert opinions and suggestions,and revised the model.The revised community elderly type 2diabetic Patients' home care model based on family physician contracting services includes 3parts: “home care service goals and purposes”,“home care services team”,and“home care service process and content”and several annexes.5.Community practice results(1)The results showed that none of the 30 community practice patients who participated in the study dropped out of the study due to their own reasons,and the complete participation rate was 100%.(2)The results showed that: after one month of community practice,the effect of home care services were evaluated.In terms of basic nursing services,only one case of skin care was ineffective;Two cases of pain care were ineffective;Five cases of self-care ability training and nursing were ineffective;The other cases of pressure sore care,oral care,defecation care,urination care,expectoration care and safety and prevention care were all effective or significant or cured.In terms of specialized nursing services,the patients with diabetic ulcer care and diabetic high-risk foot care were all effective or significant or cured;The patients with hypoglycemia care were all effective;The patients with diabetic retinopathy care,diabetic nephropathy care and diabetic blood glucose management care were all ineffective in 2 cases.(3)The results of the study showed that: after one month of community practice,the satisfaction score of community elderly type 2 diabetes patients in home care services(25.03±1.10)was significantly higher than before practice(13.03±1.87),and the differencewas statistically significant.(P=0.000<0.01)Conclusion1.Community elderly type 2 diabetes patients have relatively high demand for home care services,which mainly focus on health management and guidance services,basic medical care services and psychological care services.The main factors affecting the total demands of home care services include annual total medical expenses,the type of medical insurance,the type of complications of diabetes and so on.2.Community family physician contracting services and home care services are in the initial stage,and residents have fewer knowledge about the services which limited contract singing.Moreover,the problems of low professional quality,low enthusiasm and unclear division of labor of service team members;relatively single service content,weak specialty,unable to meet the needs of patients.The related supporting policies regulation is still incomplete and lack of unified and standardized service process and standards.3.The community elderly type 2 diabetic Patients' home care model based on family physician contracting services includes three parts: “home care service goals and objectives”,“home care service team”,“home care service process and content”and several attachments.Studies have confirmed that this model is scientific and practical,and can be used to evaluate the home care problems and needs of elderly patients with type 2 diabetes in the community.The content setting of the evaluation index of the home care service effect involved is more reasonable,which can effectively improve/solve home care Problems,to meet the needs of patients with home care services,and improve patient satisfaction with home care services.