【摘要】 目的了解糖尿病社区综合管理的作用,特别是有家庭保健员参与对社区综合管理是否存在优势,为改进糖尿病自我管理的社区干预策略提供依据。方法研究对象共分为3组,A1、A2组由"健康管理"团队按照既定方案进行干预,并对A2组的家庭,限一户一人,按照北京市家庭保健员计划进行培训;根据年龄、性别等因素相近的原则选择对照组(B组),按照传统的方法进行管理。干预期限为6个月。结果 (1)A1和A2组的空腹血糖水平下降较B组更为明显,A2组的三酰甘油水平下降较B组更为明显,差异均有统计学意义(P<0.05)。从三组的本身变化看,干预6个月后A1组患者的体质指数、空腹血糖、餐后2 h血糖、腰围、血肌酐的变化是正向的;A2组患者的体质指数、空腹血糖、餐后2 h血糖、腰围、高密度脂蛋白、低密度脂蛋白、血肌酐的变化是正向的;B组患者仅有血肌酐的变化是正向的,三酰甘油的变化是负向的,差异有统计学意义(P<0.05)。(2)A1组和A2组患者自身的糖尿病知识知晓率均较干预前有明显的提高,而B组患者只在糖尿病控制措施及预防并发症的措施方面有明显的提高,差异有统计学意义(P<0.05)。经过6个月的干预,A1组和A2组对糖尿病知识知晓率之间并无明显差异,但均较B组有明显提高,差异有统计学意义(P<0.0125)。(3)经过6个月的干预,A2组患者的健康行为变化指标为8项,A1组为6项,B组为4项。在讲究个人卫生、每天检查足部情况方面,A2组较其余两组有明显的提高;而有意识地减轻体质量、吃高纤维的饮食、尝试减轻生活压力、开始戒烟或劝阻周围人吸烟这四项,A1、A2组患者较B组有明显的改善,差异有统计学意义(P<0.05)。结论糖尿病社区综合管理这一慢病管理模式,可以增加患者对慢性病防治知识的掌握,提高患者的自我管理能力,并使患者具备不断增强改变行为的能力;而有家庭保健员参与,通过家庭成员共同干预,将会进一步提高患者的依从性,可以更有效地控制和解决糖尿病患者的健康问题。更多还原

【Abstract】 Objective To understand the effect of comprehensive management,especially that with participation of family health worker,on patients with diabetes mellitus in community,in order to provide evidence for improving community intervention strategies for self-management of diabetes.Methods Participators were at random divided into 3 groups.The patients in the intervention group A1 and intervention group A2 were given intervention of established program by the health management teams and one member from each family in the group A2 were trained based on the plan for family health worker in Beijing.The patients in the group B,who were recruited according the principle of similar age and gender,received intervention according to traditional methods.Intervention course were 6 months.Results(1)The fasting blood glucose(FBG) levels in groups A1 and A2 were lowered more remarkably than that in group B,and the triglyceride(TG) level in group A2 was reduced more remarkably than that in group B(P<0.05).As for the change of each group itself,after the 6-month intervention,the body mass index(BMI),FBG,2-hour postprandial blood glucose(2 hPG),waist circumstances(WC),and serum creatinine(SCr) of the group A1 changed positively;and BMI,FBG,2 hPG,WC,high density lipoprotein(HDL),low density lipoprotein(LDL),and SCr of the group A2 changed positively;while only the SCr of the group B changed positively,and the TG changed negatively,with statistical differences among the three groups(P<0.05).(2)The awareness rates of knowledge on diabetes mellitus by the patients themselves in groups A1 and A2 were significantly raised,while in group B the improvement was only found in diabetes control and the measures of complication prevention(P<0.05).In awareness rates of knowledge on diabetes mellitus,no significant difference was found between group A1 and group A2,but significant improvement was found as compared with group B(P<0.0125).(3)After 6-month intervention,in patients′ change indexes of health behaviors there were eight items in group A2,six items in group A1,and four items in group B.In paying attention to personal hygiene and self-checking of the foot daily,the participators in group A2 performed much better than those in the other two groups;and in losing weight consciously,intake of high-fiber diet,trying to reduce life pressure,and quitting smoking or discouraging people around from smoking,participators in group A1 and group A2 performed much better than those in group B(P<0.05).Conclusion Management model of comprehensive intervention in community for chronic diseases like diabetes mellitus can not only improve the patients′ knowledge on prevention and treatment of chronic diseases,but also increase the ability of self-management,and constantly enhance the ability of changing behavior.The participation of family health workers with joint effort of the family members will further improve patients′ compliance,and finally control and solve the health problems among diabetic patients more effectively.更多还原