通过社区医生强化社区慢性心衰患者管理的效果评价  

Effect evaluation on intervention mode of community physicians based disease management of patients with chronic heart failure

作　　者：蒋晖[1] 余秀琼[1] 戴玫[1] 王引利[1] 李锦[1] 唐炯[1] 巫文丽[1] 唐超[1] 吴镜[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7期1225-1227,1230,共4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：目的通过三级医院心血管专科医师对社区医生的干预,强化成都社区慢性心衰患者的管理,探讨针对社区慢性心衰患者进行管理的有效措施。方法 2007年1月至2012年6月对成都市新都和苏坡社区医院的医生进行培训,比较干预前后社区医生慢性心衰防治知识测试合格率、临床实践水平、患者遵医行为及就医情况的变化。结果社区医生在干预前慢性心衰防治知识测试合格率为27.27%,干预后为72.73%,差异有统计学意义(P<0.01)。社区医生心衰诊断正确率由干预前的51.28%提高到87.19%;β受体阻滞剂及ACEI/ARB使用率分别提高至56.14%及52.24%;这两类心血管保护药物的使用达标率也明显提高(P<0.05)。社区慢性心衰患者的遵医行为得到改善,到社区医院就诊次数明显增加,至三级医院住院人次明显减少(P<0.05)。结论三级医院心血管专科医师对社区医生进行培训干预,是强化社区CHF患者管理的一项有效措施。Objective To intensify the management of patients with chronic heart failure in Chengdu community by enhancing the role of community physicians, so as to explore the effective measures to manage community patients with chronic heart failure. Methods From 2007 to 2012, physicians in Xindu and Shupo communities were trained and intervened by cardiology specialists from tertiary hospital. The qualified rate through testing by Heart Failure Questionnaire and the clinical practice level of community physicians were analyzed, the compliance and medical situation of community patients were also evaluated. Results Before intervention, the qualified rate of the Heart Failure Questionnaire was 27.27%, which increased to 72.73% after intervention （P〈0.05）. The clinical practice level of community physicians after intervention （87.19%） was also significantly higher than before （51.28%）; usage rates of beta-blockers and ACEI/ARB increased to 56.14% and 52.24%; the pass rate of two kinds of cardiovascular drugs usage was enhanced （P〈0.05）.The compliance and medical situation of patients with chronic heart failure were improved significantly （P〈0.05）. Conclusion Training community physicians by cardiology specialists from tertiary hospital can improve the manage- ment programme of patients with chronic heart failure in community, which is a effective intervention mode.

关 键 词：慢性心力衰竭 社区 疾病管理 干预 效果 

分 类 号：R197[医药卫生—卫生事业管理]