| Background Currently,for the reason of the remarkable prevalence rate in China,the type 2 diabetes has been well known in China with characteristic concealed and complex etiological factor.The management of type 2 diabetes patients has already became a vast and long-term project.Our country is upgrade to community family physician model.It will lead to the positive influence on the patients self-management,glucose-target-rate.For the purpose of provide an important reference for the implementation of national policies.Objectives In this study,the community type 2 diabetes patients in Shanghai as the research object,to evaluate the actual effect of community family doctor management mode in the daily life of the community type 2 diabetes patients.Combined with the current reform of the family doctor management mode,this paper probes into the actual effect of the existing management mode,and puts forward some reasonable suggestions for the further implementation of the family doctor management mode of type 2 diabetes.Hypothesis 1.Community family doctor management mode for community type 2 diabetes related to the compliance rate has a positive effect,can reduce the incidence of complications in patients with type 2 diabetes,improve the quality of life of patients with type 2 diabetes;2.Community family doctor management mode has a positive effect on the regular screening test and standardized treatment of diabetic patients in community;3.Patients with type 2 diabetes can get more knowledge about the daily self-management of type 2 diabetes,so as to improve the rate of blood glucose and improve the quality of life;4.The reform of the management pattern of community type 2 diabetes family doctors has broughtnew challenges to the community managers,general practitioners and public health doctors.Methods The study selected 6 communities in Shanghai.They are Huamu community health service center,Jinyang community health service center,Sanlin community health service center and Yinhang community health center,health center,Siping community health service center,Daqiao community health service center.According to the community over the past 1 year into the management of medical records in the community health service center of the patients with type 2 diabetes were clearly diagnosed with type 2 diabetes.About 800-1000 patients with type 2 diabetes in each community.Collect data from the questionnaire and laboratory test report.The data were recorded and analyzed,and the influence of the incidence rate and the incidence rate of complications in the diabetic patients was analyzed.After the community report issued,the questionnaire and qualitative interview according to the community as a whole in community management of type 2 diabetes in community management staff,general practitioners,public health doctors,community participation research patients,multiple perspectives on the management of type 2 diabetes in community to understand the current situation.Main results 1.The inclusion rate of community management of type 2 diabetes patients in this study was 40.8%,as shown in table 2.There were 51.7%,33%,59.8%,19.6%,13.7%,and there are significant differences between the communities of Huamu,Jinyang,Yin,Siping,Sanlin and Daqiao community health service centers.This result reflects the current situation in different areas of Shanghai.The management level still has a wide difference,some of the community in the daily management of type 2 diabetes management method,explore and promote the innovation of family physician system popularization has adopted the scientific methods of work,the effect is quite positive.2.The patients in the contract group,the proportion of specific recommendations for the community to control their blood glucose control was often obtained for 61.7%,in the non-signed group,the ratio was 34.5%.The proportion of patients in the contractgroup,who could be able to get the specific recommendations from the community doctor frequently was 64.6%.And in the non-signed group,the ratio was about 35.7%.The proportion of patients in the contract group,who can often get specific advice from the community doctor,is 63.4%,and the proportion is not as good as that of the non contracting group,which is about 34.8%.The proportion of health education materials written by community doctors for patients with type 2 diabetes mellitus was 51.2% in the contract group,and the proportion was only about 21%.In the above 4 aspects,the difference between the contracted group and the non-signed group was statistically significant.The results show that in the aspect of enhancing health management knowledge of type 2 diabetes patients in community,the family doctor for daily guidance patients signed explanation should be enhanced,but at the same time the reflection of the whole community diabetic patients on the degree of attention to their own health conditions continue to improve,community health and health knowledge propaganda had the better outcome.3.Community health service centers participated in this survey in the daily management of diabetic patients,follow-up examination report issued interpretation,regular physical examination and so on is established and standardize the system,set up as part of the community management method for disease gate station,type 2 diabetes and type 2 diabetes related knowledge,consulting room,chat and other innovative features,in community residents especially with good results in patients with type 2 diabetes.But in the course of the investigation also reflects the current community type 2 diabetes patients in the management of some patients still have a weak sense of self-management,Conclusions and Innovations 1.The study included 5078 type 2 diabetes patients.The patients' overall age is quite aged.The average duration of the disease type 2 diabetes is up to 10 years.In the face of the huge crowd of community management of type 2 diabetes and the situation is grim.Laboratory indicators of diabetic patients in the community and the relevant indicators of physical indicators are not optimistic.Fasting blood glucose,postprandial blood glucose control and Hb A1 c compliance rate was 40.1%,35.7%and 48.9%,less than half the proportion;blood pressure under 140/90 mmHg were only 23.4%,most of the patients' blood pressure management unqualified.Blood lipid,total cholesterol and triglyceride standard rate respectively is 37.4% and 53.8%,lipid management ideal distance there is still a considerable distance.2.After these research field investigation was carried out in the community,the follow-up feedback and community type 2 diabetes management survey of actual qualitative interviews and questionnaire in order to get to know the actual effect.The community health management of type 2 diabetes patient satisfaction conditions from multiple point of views.In the investigation,it is necessary to improve the existing family doctor management mode,such as the shortage of doctors,the lack of professional personnel,the lack of scientific awareness and methods of type 2 diabetes self-management.Therefore,it is an important means to promote the management of type 2 diabetes community family doctors to control the progress of disease,delay the progress of complications and improve the compliance of patients.3.This study shows that the rate of signing of general practitioners in community type 2 diabetes is low,the total contract rate is less than 50%,and the difference between different communities is large.Considering the special characteristics of type 2 diabetes,community management staff and management team doctor should be the next step of the work focus on the propaganda of type 2 diabetes "1+1+1" management mode advantage,popularization of family doctor signing rate,to enhance the family doctor guidance effects,can selectively target setting for three years of type 2 diabetes patients in community GP signing rate reached 80%.On this basis,by the family doctor for patients with personalized health education,enrich the community type 2 diabetes related knowledge propaganda.The awareness of type 2 diabetes prevention and self-management related knowledge was significantly improved.Recommendations 1.Improve the top-level policy design,breaking the barriers between the community and the transfer of information between hospitals,the formation of type 2 diabetes daily management of a complete medical system,to avoid difficulties in the implementationof the policy;2.To establish and improve the performance management as the core of the incentive mechanism and improve the family doctor training mode,improve the community family doctor talent team construction,reasonable expansion of family doctors and public health doctor;3.In order to move forward the step of the type 2 diabetes community management reform outcome.We have to improve the popularity of community type 2 diabetes "1+1+1" contract mode,the implementation of community family doctor clinics,home services,community organizations,regular medical disease and other aspects of the combination of gate station daily management;... |
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