TeamSTEPPS在社区骨质疏松管理团队中的应用效果评估  

Application of TeamSTEPPS in training of community osteoporosis management team

作　　者：毛秀英[1] 祝墡珠 杨华 虞智杰 唐跃中[1] 朱华江 徐东浩[1] 岳江[3] Mao Xiuying;Zhu Shanzhu;Yang Hua;Yu Zhijie;Tang Yuezhong;Zhu Huajiang;Xu Donghao;Yue Jiang(Department of General Practice, Kang]ian Community Health Service Center of Xuhui District, Shanghai 200233, China （ Mao XY, Yu ZJ, Tang YZ,Zhu HJ, Xu DH;Department of General Practice, Zhongshan Hospital Fudan University, Shanghai 200032, China（ Zhu SZ, Yang H;Department of Endocrinology and Metabolism ,Renji Hospital, Shanzhai Jiaotong University, Shanghai 200127. China （Yue J)

机构地区：[1]上海市徐汇区康健街道社区卫生服务中心全科医学科,200233 [2]复旦大学附属中山医院全科医学科,上海200032 [3]上海交通大学医学院附属仁济医院内分泌代谢科,200127

出　　处：《中华全科医师杂志》2018年第7期529-532,共4页Chinese Journal of General Practitioners

基　　金：上海市徐汇区医学科研项目（SHXH201334）;上海青年医师培养资助计划[沪卫计人事（2014）118号];上海市公共卫生重点学科三年行动计划项目（12GWZX1001）;复旦大学上海医学院2017年医学教育研究课题

摘　　要：目的评估提高医疗质量和患者安全的团队策略与工具包（TeamSTEPPS）在社区骨质疏松管理团队中应用的效果。方法2014年1月1日至2017年3月31日，利用TeamSTEPPS培训社区骨质疏松管理团队，筛检≥45岁的康健街道居民1 513名，筛检出骨量减少和骨质疏松症患者予以综合干预1年，比较干预前后患者对骨质疏松危险因素和症状的知晓率；干预6个月和12个月时复查骨密度水平并进行比较。结果共筛检出骨量减少者467例（30.87%），骨质疏松症患者476例（31.46%）。干预后患者对骨质疏松症相关危险因素低钙、维生素D缺乏、缺乏运动、低体质量、女性更年期、母系家族史、吸烟、过度饮酒、饮过多咖啡的知晓率较干预前提高，差异有统计学意义（χ2值分别为62.909、78.742、59.974、50.478、29.512、34.699、6.500、15.779、6.089，均P〈0.05），对骨质疏松症状如腰背疼痛或周身骨骼疼痛、身高缩短和驼背、低能量或者非暴力骨折（脆性骨折）的知晓率也提高，差异有统计学意义（χ2值分别为59.942、76.220，16.856，均P〈0.01）。干预后骨密度水平升高，差异有统计学意义（骨量减少组F＝530.28，P〈0.01；骨质疏松组F＝339.51，P〈0.01）；干预6个月和12个月与干预前比、干预12个月与干预6个月比差异均有统计学意义（骨量减少组t值分别为－0.452，－0.968，－0.516，均P〈0.01；骨质疏松组t值分别为－0.530，－1.045，－0.518,均P〈0.01）。结论利用TeamSTEPPS培训的社区团队干预可有效提升患者骨质疏松症相关知识的知晓率和骨密度水平。ObjectiveTo evaluate the application of TeamSTEPPS in training of community osteoporosis management team.MethodsThe TeamSTEPPS was applied for training of osteoporosis management team, and 1 513 residents aged ≥45 year were screened for osteoporosis in Kangjian community from January 2014 to March 2017. The identified patients with osteopenia and osteoporosis were intervened for one year. Cognitive level of the risk factors and symptoms associated with osteoporosis were assessed by questionnaires before and after the intervention. The bone density was examined at baseline and 6 months, 12 months after intervention. The effect of intervention was evaluated.ResultsA total of 467 patients （30.87%） with osteopenia and 476 patients （31.46%） with osteoporosis were detected. The cognitive levels of osteoporosis risk factors, including low calcium, vitamin D deficiency, lack of exercise, low weight, women menopause, matrilineal family history, smoking, excessive alcohol drinking and coffee drinking, were higher than those before intervention （χ2=62.909, 78.742, 59.974, 50.478, 29.512, 34.699, 6.500, 15.779, 6.089, all P〈 0.05）. The awareness rates of symptoms, including lower back pain or body bone pain, shorter height and hunchback, low energy or nonviolent fracture, were also increased （χ2=59.942, 76.220, 16.856, all P〈 0.01）. After intervention, the bone mineral density levels were increased compared to those before intervention （F=530.28, P〈0.01 for osteopenia group; F=339.51, P〈0.01 for osteoporosis group）; meanwhile, the differences were also significant between 6 months, 12 months after intervention and before intervention, between 12 months and 6 months after intervention （t=-0.452, -0.968, -0.516, all P〈0.01 for osteopenia group; t=-0.530, -1.045, -0.518, all P〈0.01 for osteoporosis group）.ConclusionThe community osteoporosis management team trained by TeamSTEPPS can effectively improve the management levels of osteoporosis among residents in the community.

关 键 词：骨质疏松 骨密度 危险因素 效果评价 

分 类 号：R580[医药卫生—内分泌]