互联网+“两卡制”在社区慢性病管理中的应用

目的探讨互联网+“两卡制”对社区慢性病管理效果的影响。方法选取铜陵市阳光社区卫生服务中心参与2018年1月至2019年3月社区慢性病管理1 603位居民为研究对象，比较“两卡制”开展前后慢性病控制率、规范管理率、控制率。阳光社区卫生服务中心本级及下辖4所卫生服务站点医务人员参与“两卡制”满意度问卷调查。结果2019年第1季度与2018年第4季度相比，慢性病健康管理率有所上升，但差异无统计学意义（P>0.05）。2019年第1季度慢性病管理率、控制率较2018年第4季度相比明显下降:高血压规范管理率由67.78%下降至26.28%（χ2=479.97，P < 0.01）、控制率由90.39%下降至72.66%（χ2=143.40，P < 0.01）；糖尿病规范管理率由63.64%下降至26.05%（χ2=124.60，P < 0.01）、控制率由52.39%下降至39.74%（χ2=14.03，P < 0.01）。慢性病管理得分与总管理人数呈正相关:高血压患者管理得分与高血压患者管理人数正相关（r=0.992，P < 0.01）；糖尿病患者管理得分与糖尿病患者管理人数正相关（r=0.881，P < 0.05）。慢性病管理得分与规范管理率或规范管理人数均不存在相关性（P>0.05）。基层医务工作人员对“两卡制”不满意率为73.47%。对“两卡制”最满意的是求真务实，对两卡制最不满意的是手机、平板应用程序操作繁琐以及工分制。结论“两卡制”的实施具有里程碑式的意义，改变了基层慢性病档案管理造假的现象，为将来公共卫生管理提供了真实依据。“两卡制”对医疗服务质量的持续改进效果以及能否增强基层医疗服务实力仍需进一步观察和评价。

Application value of internet+ "two-card system" in the management of chronic disease in community

ObjectiveTo explore the effects of internet+ "two-card system" on the management of chronic disease in community.MethodsA total of 1603 chronic disease patients in Tongling Yangguang community health service center from January 2018 to March 2019 were investigated.The chronic disease control rate, standard management rate and control rate of patients were compared between before and after the application of the "two-card system".The questionnaire survey "two-card system" satisfaction were implemented by medical staffs from Yangguang community health service center and 4 health stations belonging to the center.ResultsCompared with the fourth quarter of 2018, the health management rate of chronic diseases increased in the first quarter of 2019, but the difference of which was not statistically significant(P>0.05).In the first quarter of 2019, the management rate and control rate of chronic diseases decreased significantly compared with the previous quarter, the standardized management rate and control rate of hypertension decreased from 67.78% to 26.28 and from 90.39% to 72.66%, respectively(χ2=479.97, 143.40, P < 0.01), and the standard management rate and control rate of diabetes decreased from 63.64% to 26.05% and from 52.39% to 39.74%, respectively(χ2=124.60, 14.03, P < 0.01).The score of chronic disease management was positively correlated with the total number of patients, and the score of hypertension disease management was positively correlated with the number of hypertension disease patients (r=0.992, P < 0.01).The score of diabetes mellitus management was positively correlated with the number of diabetes mellitus patients (r=0.881, P < 0.05), and the score of chronic disease management was not correlated with standard management rate or number of patients of standard management(P>0.05).The dissatisfaction rate of grassroots medical staff to the "two-card system" was 73.47%.The most satisfied with the two-card system was pragmatic, while the least satisfied with the "two-card system" was the cumbersome operation of mobile phone and tablet apps and work score system.ConclusionsThe implementation of "two-card system" has a milestone significance, which changes the phenomenon of fraud in the management of chronic diseases files at the grassroots, and provides a real basis for the future public health management.The effects of "two-card system" in continuing to improve the quality and enhancing the strength of primary medical service still needs further observation and evaluation.