对上海市社区糖尿病防治工作的思考  

Diabetes Prevention and Treatment in Shanghai Communities

作　　者：吴玉苗[1] 杨苛君 

机构地区：[1]上海市静安区石门二路社区卫生服务中心全科,上海200041

出　　处：《中华全科医师杂志》2008年第1期38-39,共2页Chinese Journal of General Practitioners

摘　　要：2年来上海市石门二路社区卫生服务中心结合《上海市社区糖尿病防治工作指南（试行，2005）》对578名糖尿病及糖调节异常患者进行分组管理。其中70％为社区站点全科医生发现传报，60％由全科医生进行随访管理，40％由防保医生随访管理。结果提示传统的疾病管理模式是针对急性病的医疗管理模式，不能满足慢性病卫生保健的需求。以社区卫生服务中心为主体，全科医生为骨干进行慢病管理是较为理想的模式，这种模式防治结合，对减轻慢性病所造成的巨大危害及经济负担，缓解越来越紧张的医患关系均具有重要作用。Based on Shanghai Guideline for Diabetes Prevention and Treatment （2005）, 578 patients with diabetes or abnormal glucose metabolism in Shi Men Er Road Community were managed at different levels during the past 2 years. Seventy percent of the patients were identified by general practitioners. Follow-up was initiated by general practitioners （60%） or other healthcare providers （40%）. Our findings suggested that traditional disease management model focused mainly on acute conditions, while community health center-based model was expected to meet the need for chronic disease prevention and treatment and play an important role in minimizing economic burden and improving doctor-and-patient relationship.

关 键 词：社区卫生服务 糖尿病 

分 类 号：R197.1[医药卫生—卫生事业管理]