成都地区社区医生慢性心衰管理模式研究  

Study on the modes of management of chronic heart failure among community physicians in Chengdu

作　　者：余秀琼[1] 蒋晖[1] 戴玫[1] 李锦[1] 王引利[1] 巫文丽[1] 唐炯[1] 蔡琳[1] 

机构地区：[1]成都市第三人民医院心内科,四川成都610031

出　　处：《现代预防医学》2014年第2期246-248,共3页Modern Preventive Medicine

基　　金：2007年成都市"十一五"重大科技计划项目"慢性心衰的社区管理与防治"(07YTYB957SF-020);2010年成都市科技局项目"慢性心衰的社区管理与防治-社区医生管理模式研究"(10GGYB932SF-182)

摘　　要：目的增强社区医务人员在心衰患者防治管理中的作用,探讨符合成都社区医疗特点的医务人员管理心衰管理模式。方法入选新都、苏坡社区的符合研究条件的社区医务人员进行集中培训/远程指导/临床指导。每月1次,内容为心衰相关知识。观察时间为3年,观察心衰问卷合格率、医生的临床实践水平、患者的依从性和患者的满意度等指标。结果 55名社区医务人员接受了培训,培训前后问卷合格率明显增加(27.27%和80.00%,P<0.05)、社区医生的临床实践水平:社区医生诊断心衰正确率(51.28%和87.18%,P<0.05)、β受体阻滞剂使用率(13.74%和56.14%,P<0.05)、β受体阻滞剂靶剂量的使用率(3.71%和16.88%,P<0.05)、血管紧张素转换酶抑制剂(ACEI)使用率(17.55%和52.24%,P<0.05)、靶剂量的使用率(5.26%和20.677%,P<0.05)均明显提高。社区患者的依从性(10.45和20.33,P<0.05)和满意度(41.20%和96.49%,P<0.05)也明显提高。结论对社区医生进行慢性心衰疾病管理培训可显著提高社区医务人员的心衰相关知识和临床处理心衰能力,也可提高慢性心衰患者对社区医生的依从性和满意度。集中培训/远程指导/临床指导的培训方式,具有可操作性,可作为成都地区社区医生慢性心衰管理的培训方式。Objective To enhance the role of the community physicians in Chengdu in the prevention and management of patients with chronic heart failure, and to explore the mode of managing patients with chronic heart failure by the community physicians in Chengdu. Methods In this research, from January 2007 to June 2012, physicians were selected from Xindu and Supo community hospitals in Sichuan for training once a month, including centralized training meetings, remote guidance, and clinical guidance of the heart failure knowledge. In three years, physicians were monitored on their clinical practice and surveyed by designed question- naires before and after the trainings. Meanwhile, patient compliance and patient satisfaction were also monitored. Results 55 com- munity medical staff received training. The pass rate of the questionnaires after training was significantly increased （27.27% vs. 80.00%, P〈0.05）. Significant improvement of the clinical practice of community physicians was observed as well, including the rate of correct heart failure diagnosis （51.28% vs. 87.18%, P〈0.05）, the usage rate of {3 -receptor blockers （13.74% vs. 56.14%, P〈0.05）, the usage rate of target dosage of 13 -receptor blockers （3.71% vs. 16.88%, P〈0.05）, the usage rate of angiotensin convert- ing enzyme inhibitor （17.55% and 52.24%, P〈0.05） and its target dosage （5.26% vs. 20.67%, P〈0.05）. The compliance （10.45% vs. 20.33%, P〈0.05） and satisfaction （41.20% vs. 96.49%） of community patients were evidently improved as well. Conclusion This research proved that chronic heart failure disease management training for community physicians can significantly improve their knowledge and clinical practice ability on chronic heart failure, and increase the compliance and satisfaction of the patients with chronic heart failure in the community. This training mode, which includes centralized training meetings, clinical guidance, and re- mote guidance on chronic heart failure once a month, is practical and here adv

关 键 词：社区 慢性心衰 疾病管理模式 

分 类 号：R541.61[医药卫生—心血管疾病]