上海中心城区10002名社区居民慢性病就医路径及患病特征研究

目的研究上海中心城区社区居民的慢性病就医路径，了解居民慢性病的患病特征。方法问卷调查上海中心城区10002名居民，按照是否患有高血压、糖尿病、冠心病和心肌梗死，脑梗死等四类慢性疾病，分成慢性病组和非慢性病组。测定体质指数以及空腹血糖、三酰甘油、胆固醇、高密度脂蛋白和低密度脂蛋白等指标。统计比较各组就医路径、患病特征等差异。结果高血压、糖尿病、冠心病和心肌梗死、脑梗死等慢性病的居民占被调查者总数的37．7％。2／3的慢性疾病患者在居住区域内确诊，在居住区域内随访的患者比例近80％。冠心病和心肌梗死患者在三级医院随访的比例较高（P〈0．05）。脑梗死患者配药、检查和康复在居住区为主（P〈0．05）。在居住区就诊的高血压患者的舒张压略低于外区患者（P〈0．05）。结论不同常见慢性疾病就医路径存在差异，其随访和管理应提倡合理发挥各级医疗机构的作用。慢性病的控制水平还有待进一步提升。

eristics of 10 002 community residents with chronic diseases in urban areas of Shanghai Patient pathway and clinical charact

Objective To understand patient pathway and clinical characteristics of chronic diseases in urban areas of Shanghai. Methods A total of 10 002 residents were enrolled and assigned to the chronic disease group （including hypertension, diabetes, coronary heart disease, myocardial infarction, and ischemic stroke） and the non-chronic disease group. Body mass index,fasting blood glucose, triglyceride, total cholesterol, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol were tested. Difference of patient pathway and clinical characteristics of those chronic diseases was compared. Results Above chronic diseases were observed in 37.7% participants. About 2/3 diseases were confirmed and 80% patients were followed up in healthcare units not far away from home, Patients with coronary heart disease and myocardial infarction showed more outpatient visit to tertiary hospitals （P 〈 0. 05 ）. However, patients with ischemic stroke had health check, rehabilitation and pharmacy done mainly in local healthcare centers （P 〈0. 05 ）. Diastolic blood pressure of patients visiting local doctors was significantly decreased （P 〈 0.05）. Conclusion Some differences in patient pathway were found in this study. Communication and cooperation between medical institutions should be intensified for effective chronic disease control.