The Research Of Applying "Five Divisions Co-management" Family Physician Contract Service Model In Gestational Diabetes Mellitus And Its Effect

ObjectiveTo explore the application of "Five Divisions Co-management" family physician contract service model in gestational diabetes mellitus(GDM)patients during pregnancy and postpartum period,and to summarize the characteristics and management effects of the long-term health management model,and so as to provide some scientific reference for its popularization and application.MethodWe built a "Five Divisions Co-management" family doctor team with general practitioners,public health practitioners,nutritionists,health managers and endocrinologists in tertiary hospitals as the core and team leader.The standardized health management of "Five Divisions Co-management" for GDM patients who were admitted to the contracted service management during the pre-natal card establishment of four community health service centers directly under Suzhou Municipal Hospital,and regular health education for GDM patients who did not participate in contract management.And the follow-up period was from the diagnosis of GDM after pregnancy to the six months after birth.The monitoring indicators included fasting blood glucose,2-hour postprandial blood glucose and glycosylated hemoglobin at the time of first visit to community management,one month of expected delivery,3 months postpartum and 6 months postpartum.The oral glucose tolerance test(OGTT)was performed at 3 and 6 months postpartum to determine whether there was abnormal blood glucose level at 2 hours of OGTT.The study also investigated GDM knowledge and self-management skills of patients in the community for the first time and within one month of the expected delivery period through self-designed questionnaires.The statistical software was Stata/SE 12.Chi square test and t test were used to compare the statistical methods.Result1.Baseline status of the two groups:a total of 122 GDM patients were enrolled in this study,with an average age of 28.65 + 3.42 years.There were 72(59.0%)patients with GDM in the"Five Divisions Co-management" group.At baseline,there were no significant differences in age,BMI,pregnancy,parity,FBG,2hPBG and HbA1C between the two groups(P>0.05).There was no significant difference in the accuracy rate of GDM knowledge and self-management skills(P>0.05).2.Comparisons of indicators within one month of the expected date of delivery between the two groups:within one month of the expected date of delivery,the correct rate of GDM knowledge questions and self-management techniques in the "Five Divisions Co-management" group were higher than those in the control group.There was a difference in overall accuracy rate(P<0.05).The proportion of adherence to dietary regulation,exercise and regular monitoring of blood sugar in the "Five Divisions Co-management" group was high,and the proportion of adherence to dietary regulation and exercise was different(P<0.05).The values of FBG,2hPBG and HbA1C in the "Five Divisions Co-management" group were lower than those in the control group(P<0.05).The values of FBG,2hPBG and HbA1C in the "Five Divisions Co-management" group within one month of delivery were lower than those in the study baseline(P<0.05).And there was only a difference in the FBG in control group(P<0.05).3.Comparison of the indexes of the two groups at 3 months postpartum:in the 3 months postpartum,the ratio of adherence to diet regulation,exercise and regular monitoring of blood sugar in "Five Divisions Co-management" group was higher than that in the control group(P<0.05).There were no significant differences in the levels of FBG,2hPBG,HbA1C and OGTT 2h between the two groups(P>0.05).4.Comparison of the indexes of the two groups at the 6 months postpartum:6 months after delivery,the proportion of adherence to diet regulation,exercise and regular monitoring of blood sugar in the "Five Divisions Co-management" was higher than that in the control group(P<0.05).There were no significant differences in the values of FBG,2hPBG and HbA1C between the two groups(P>0.05).However,the rate of OGTT 2h blood glucose level>7.8mmol/L in the "Five Divisions Co-management" group was lower than that in the control group(P<0.05).Conclusion1.The "Five Divisions Co-management" health management model is more effective than the regular health education model in improving GDM knowledge and self-management skills during pregnancy.The model is conducive to increasing the proportion of adherence to dietary regulation,exercise and regular monitoring of blood sugar,and reducing the values of FBG,2hPBG and HbA1C within one month of the expected delivery date.2.Compared with the routine health education model,the "Five Divisions Co-management"health management model can increase the proportion of GDM patients who adhere to diet regulation,exercise and regular monitoring of blood sugar within 3 months and 6 months after delivery,and reduce the abnormal rate of OGTT 2 h at the 6 months postpartum.3.The "Five Divisions Co-management" health management model can significantly improve the health-related behaviors of GDM patients during pregnancy and postpartum,and reduce the occurrence of abnormal blood sugar.It is worth promoting in the community.It also provides some reference for the health management of other chronic diseases.