《冠心病社区规范化管理建议》应用的评价研究

目的 评价应用<冠心病社区规范化管理建议>的效果、效益及可行性.方法 选择在月坛社区卫生服务中心及其下属的9个社区卫生服务站符合标准的冠心病患者共212例为试验组;在金融街社区卫生服务中心及其下属的5个社区卫生服务站就诊的210例冠心病患者为对照组.对试验组患者实施<冠心病社区规范化管理建议>,并与对照组进行对照.采用专题小组访谈的方法,分析全科医生对应用<冠心病社区规范化管理建议>的评价.结果干预后两组患者在冠心病知识知晓率方面除"冠心病定义"外,其他各项冠心病相关知识知晓率间差异均有统计学意义 (P＜0.05).干预前两组患者不吸烟率间差异有统计学意义(P＜0.05),干预后差异无统计学意义(P＞0.05).两组患者干预前后测心电图、血生化指标次数及糖化血红蛋白监测率、达标率间差异均有统计学意义(P＜0.05).两组患者干预前门诊转回率、住院转回率间差异均无统计学意义(P＞0.05),而干预后差异均有统计学意义(P＜0.05).两组患者干预前后药费支出、对不同医疗机构的利用情况间差异均有统计学意义(P＜0.05).两组患者干预前生理、心理及总的生活质量得分间差异均无统计学意义(P＞0.05),而干预后差异均有统计学意义(P＜0.01).结论 在社区实施<冠心病社区规范化管理建议>能够取得良好的效果、效益,为提高全科医生对冠心病的临床诊疗技能和冠心病患者的生活质量发挥重要作用.

Evaluation of "Proposals for Standardized Community-based CHD Management"

Objective The objective of this study was to investigate the effect,benefits and feasibility of the performance of "Proposals for Standardized Community-based CHD Management"("Proposals" for short).Methods A total of 212 patients in line with the CHD standards were chosen as test group from Yuetan Community Health Service Center and its 9 underling community health service stations,and another 210 as control group from the Financial Street Community Health Center and its 5 affiliated stations.Test group were managed according to the "Proposals" and then compared with control group.Focus group interview method was used to analyze general practitioners' evaluation on its performance.Results Test group became more knowledgeable about CHD prevention and treatment than control group after performing the "Proposals"(P<0.05).No changes were noted in the percentage of patients who needed hospitalization.The number of patients who went to out-patient department was reduced(P<0.05).The medicine cost was also reduced.The scores of quality of life were increased(P<0.05).91.67% of general practitioners considered it necessary to standardize the CHD care management and to popularize the "Proposals".Conclusion Performance of the "Proposals" in communities is of good effect and benefit,which plays an important role in improving general practitioners' clinical diagnosis and treatment skills and the quality of life of CHD patients.