Study On The Effect Of Family Doctor Team Service Under Medical Association Model On Self-management Ability And Health Status Of Community Elderly Diabetic

1 BACKGROUNDThe prevalence of diabetes in China is increasing year by year.With the acceleration of population aging process,the elderly population has become the main patient group of diabetes.The treatment cost of diabetes is expensive while the complications are many,also with high disability rate and mortality rate.If the diabetes can not be effective managed,it will seriously affect the quality of life of the eldly.According to the relevant data,the present situation of diabetes self-management in China is not optimistic.A considerable number of elderly diabetes are short of self-management knowledge and lack of better skills.Therefore,it is necessary to adjust the existing diabetes management model and explore a set of effective diabetes self-management program.As an important method of the new medical reform,the Medical Association has received strong support since its implementation.As a long-term contractual service,family doctor service under the mode of medical association is gradually changing people's medical service model,which is accepted and recognized by most people.2 RESEARCH PURPOSE AND SIGNIFICANCEThe purpose of this study is to explore the effect of family doctor team service on community elderly diabetic patients' self-management Ability and health status under the model of medical association,which can provide empirical evidence for promoting family doctor team service.3 METHODSThis study adopted a prospective cohort approach,158 elderly patients who diagnosed as diabetes after attend free physical examination were conveniently sampled in Fuzhong community,Futian District,In Shenzhen from March to May 2018.According to the patientes whether have signed contract with family doctor,the Intervener was divided into Exposure group and control group.At the same time,different management modes were adopted.After 6 months of intervention,the data processing staff in the family doctor team start to process the data,and SPSS 20.0 software was used for statistical analysis.The data of normal distribution were used by t-test,while the data of non-normal distribution were used by non-parametric test,P<0.05 showed that the difference was statistically significant.4 RESULTS(1)Self-empowerment ability score.After 6 months of exposure,the score of the control group was(30.1±2.5)points and the exposure group was(37.7±1.7)points,(t=22.344,P<0.001),The scores of all dimensions in the exposure group were higher than those in the control group(P<0.05),the difference was statistically significant.(2)Self-management ability score.After 6 months of Exposure,the score of control group was(36.5±2.8)points,the score of exposure group was(443±6.8)points,(t=9.427,P<0.001),The scores of all dimensions in the exposure group(except the number of smoking)were higher than those in the control group(P<0.001),the difference was statistically significant.(3)Comparison of Physiological indicators after exposure between two groups.After 6 months of exposure,abdominal circumference(t=2.142,P=0.034),fasting blood glucose(t=3.345,P=0.001)and HbAlc(t=4.820,P<0.001),in the exposure group were significantly better than those in the control group.(4)Comparison of management level changes after intervention between two groups.After 6 months of exposure,within the 79 people managed in the exposure group,the number of unsatisfactory blood glucose control at the second level decreased from 36 to 6,and the number at the third level increased from 41 to 73.None of them had complications and hospitalization(the number of people in the first level was 0).After 6 months of exposure,within the 79 people managed in the control group,the number of unsatisfactory patients in the second level of blood sugar control in the control group decreased from 42 to 26,and the number at the third level increased from 22 to 51.2 were referred to endocrinology specialist treatment(the number of first level managers was 2).After 6 months of exposure,The control rate of blood glucose control(92.4%)in the exposure group was superior to the the control group(64.6%)(Sup2=18.403,P<0.001).5 CONCLUSIONS(1)The hierarchical management of family doctor team under Medical Association Model can change the management level of elderly diabetic patients in community and improve their outcome indicators.(2)The team Service of family doctor under the mode of medical association,Through comprehensive management for elderly diabetic patients in community can effectively improve the authorization level of elderly diabetic patients in community.