| Objective: To adopt a systematic review method to evaluate the effectiveness of family doctor contracted services in my country for stroke intervention,in order to provide a reference for future research on the development of family doctor contracted services.Materials and methods: Electronic search of Chinese databases according to the established literature search strategy: China Knowledge Network(CNKI),Chinese Science and Technology Journal Full-text Database(VIP),Wanfang Data Knowledge Service Platform(Wan Fang),China Biomedical Literature Database(CBM).According to the established inclusion criteria and exclusion criteria,the preliminary searched documents are screened three times,and the included documents are finally determined;the final included documents are extracted according to the formulated data extraction table;the Cochrane bias risk assessment tool is used to conduct the included documents Methodological quality evaluation;use Stata software for statistical meta-analysis.The retrieval of literature,screening of literature,and data extraction are all independently conducted by two graduate students,and a third party(mentor)will make a ruling in case of disagreement.Results: A total of 26 Chinese literatures were included.The methodological quality of the included literature is low and there is a high risk of bias: 20 studies describe random methods;6 studies describe methods of allocation concealment;18 studies describe blinding methods;26 studies have no selective reporting result bias;Five studies did not describe the diagnostic criteria of the study subjects,and there were other risks of bias.Meta-analysis results of family doctor contracted service intervention for stroke(1)Daily life ability BI: BI index WMD(95% confidence interval)was 13.559(9.525,17.592),P<0.00001,the difference was statistically significant.Results of subgroup analysis:(1)The BI index WMD(95% confidence interval)of the intervention for 3 months was 10.305(5.29,9.18),P<0.00001;(2)The BI index WMD(95% confidence interval)of the intervention for 6 months was 7.841(4.443,11.239),P<0.00001,the difference was statistically significant.(2)Motion function FM WMD(95% confidence interval)was 10.707(7.916,13.497),P<0.00001,the difference was statistically significant.Results of subgroup analysis:(1)The WMD score(95% confidence interval)of the FM for 3 months of intervention was 8.377(4.745,12.009),P<0.00001;(2)The WMD score(95% confidence interval)of the FM score for the 6 months of intervention was 14.071(9.732,18.420),P<0.00001,the difference was statistically significant.(3)Nerve defect degree NHISS The NHISS index WMD(95% confidence interval)was-7.09(-10.075,-3.944),P<0.00001,the difference was statistically significant.(4)Psychological condition(1)The SAS anxiety index WMD(95% confidence interval)was-5.017(-8.930,-1.103),P<0.00001,the difference was statistically significant.(2)SDS anxiety index WMD(95% confidence interval)was-7.856(-12.286,-3.426),P<0.00001,the difference was statistically significant.(5)Physiological condition(1)BMI body mass index WMD(95% confidence interval)was-3.449(-4.350,-2.549),P<0.00001,the difference was statistically significant.(2)Cholesterol(TC)index WMD(95% confidence interval)was-0.467(-0.607,-0.328),P<0.00001,the difference was statistically significant.(3)The triglyceride(TG)index WMD(95% confidence interval)was-0.194(-0.318,-0.070),P<0.00001,the difference was statistically significant.(4)The high-density lipoprotein cholesterol(HDL-C)index WMD(95% confidence interval)was 0.154(0.078,0.230),P<0.00001,the difference was statistically significant.(5)The low-density lipoprotein cholesterol(LDL-C)index WMD(95% confidence interval)was-0.452(-0.576,-0.327),P<0.00001,the difference was statistically significant.(6)Serum homocysteine(Hcy)index(95% confidence interval)was-2.189(-3.405,-0.974),P<0.00001,the difference was statistically significant.(7)Fasting blood glucose(FB)index(95% confidence interval)was-0.555(-0.710,-0.400),P<0.00001,the difference was statistically significant.(8)The systolic blood pressure SBP index(95% confidence interval)was-7.685(-11.482,-3.88),P<0.00001,the difference was statistically significant.(9)DBP diastolic blood pressure index(95% confidence interval)is-6.215(-7.460,-4.971),P<0.00001,the difference is statistically significant.Publication bias: There are publication biases in the ability of daily living in stroke,motor function of limbs,and the degree of neurological deficit;there is publication bias in the psychological and physical conditions,and in general,there is publication bias.Conclusion: The contracted service of family doctors has a positive impact on improving the functional status of patients’ daily activities,but the effect of intervention is not clear at the initial stage of intervention.A lot of clinical nursing practice is needed for further exploration and research to reflect the effect of contracted services of family doctors as soon as possible.Family doctor contracted service intervention can improve the motor function of stroke patients,but because the early rehabilitation training time included in the study is not clear,it affects the effect of family doctor contracted service on stroke motor function intervention and reduces the level of evidence in the systematic review.After the family doctor’s contracted service intervention,the neurological rehabilitation effect of stroke patients has been improved to a certain extent.However,since the recovery of neurological deficits is not limited to home care,the intervention effect is not significant.It is recommended to be in the family doctor’s contracted service Increase related medical services.The contracted service of family doctors can effectively alleviate the depression of patients.However,at the same time,patients may have neurological deficits,which can cause pathological depression or anxiety.Therefore,some scholars believe that to relieve the depressive symptoms of stroke patients requires a combination of clinical diagnosis and treatment and family doctor care.The contracted service of family doctors can reduce the physiological risk factors of stroke patients.Unhealthy lifestyle habits such as smoking,drinking,and high-fat diet can increase the values of TC,TG, and Hcy in stroke patients.Contracting family doctor services such as health education and education can reduce the values of TC,TG,and Hcy in patients,thereby reducing the risk of stroke recurrence.The signing of family doctors in my country is in its infancy,and community residents have not fully formed a reasonable concept.The signing of family doctors bears an important responsibility for the rehabilitation of community service targets.The signing doctors should fully grasp and use relevant rehabilitation theories and techniques.Provide patients with high-quality and comprehensive rehabilitation services. |
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