城市社区糖尿病患者双向转诊的效果评估

目的了解并评估双向转诊在城市社区糖尿病患者治疗中的作用。方法选择上海市杨浦区2家社区街道医院（一级甲等）为研究点，随机数字表法抽取265例参与双向转诊的糖尿病患者，调查转诊前后有关代谢指标的变化及患者对转诊的感受；同时在这2家医院抽取301例未参与双向转诊的糖尿病患者作为对照，调查患者血糖等代谢指标的变化。两组间基线数据具有可比性。组问数据比较采用独立样本t检验。结果转诊治疗后，两组患者空腹血糖、餐后血糖、糖化血红蛋白（HbAlc）、收缩压、舒张压、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-c）、低密度脂蛋白胆固醇（LDL-C）、甘油三酯（TG）差异均有统计学意义（t=4．584、9．721、6．291、5．246、5．179、2．976、2．894、7．358、3．114，均P〈0．05），转诊组均优于非转诊组。非转诊组空腹血糖下降患者比例（72．1％）低于转诊组（81．5％），而上升患者比例（23．6％）高于转诊组（17．4％）。转诊组患者对目前双向转诊模式的主观评价较好。结论双向转诊能给糖尿病患者带来益处，可以有效改善患者的血糖、血脂与血压等代谢指标；但转诊制度在运行过程中还有诸多细节需待进一步去完善。

Effects of two-way referral care of patients with type 2 diabetes in urban community in Shanghai

Objectives To evaluate the effect of two-way referral care in the treatment of patients with type 2 diabetes in urban community in Shanghai. Methods Two local primary care hospitals（ Grade A） in Yangpu District in Shanghai were selected as the research points, and 265 patients with type 2 diabetes involved in two-way referral care were selected using random number table, and investigated changes of their metabolic index and feeling before and after two-way referral care. And 301 diabetic patients did not participate in two-way referral care were selected randomly as control group from the same 2 hospitals at the same time, and investigated the changes in glucose control and other metabolic indexes. Baseline data were comparable between the two groups. Data between groups were compared using independent samples t test. Results After referral treatment, the differences in fasting blood glucose （FBG） , postprandial blood glucose（ PBG）, glycated hemoglobin Alc（ HbAlc）, systolic blood pressure（ SBP）, diastolic blood pressure （DBP）, total cholesterol （TC）, high density lipoprotein cholesterol （HDL-C）, low density lipoprotein cholesterol （LDL-C）, triglyceride （TG） between the two groups were significant （ t = 4. 584, 9. 721, 6. 291, 5. 246, 5. 179, 2. 976, 2. 894, 7. 358, 3. 114, all P 〈0. 05）. Referral group were superior to the non-referral group. The FBG decreased in 72. 1% of the patients in non-referral group and it was lower than that in referral group（81.5% ）. And FBG increased in 23.6% of the patients in non-referral group and it was higher than that in referral group （17.4%）. Referral patients felt better to the two-way Referral Mode. Conclusion Two-way referral do benefit to diabetes patients, improve metabolism index of blood glucose, blood fat and blood pressure of patients, there are some details need to be further perfected in operation process of the referral system.