家庭医生服务在社区慢性病健康管理中的效果研究  

Effect of family doctor service on health management of chronic diseases in community

作　　者：朱桂菊[1] 苗小妹 于秀娟 齐琦 曹政 王海丽 滕昭晖[1] Zhu Guiju;Miao Xiaomei;Yu Xiujuan(The Suzhou Kowloon Hospital Affiliatea to Shanghai Jiaotong University School of Medcine,Suzhou,Jiangsu 215028;The Dushu Lake SEID Community Health Center of Suzhou City,Suzhou,Jiangsu 215000)

机构地区：[1]上海交通大学医学院附属苏州九龙医院,江苏苏州215028 [2]苏州市独墅湖科教创新区社区卫生中心,江苏苏州215000 [3]苏州市斜塘社区卫生中心,江苏苏州215000 [4]苏州市湖东社区卫生中心,江苏苏州215000

出　　处：《基层医学论坛》2020年第3期297-299,共3页The Medical Forum

基　　金：江苏省医院协会2017年度医院管理创新研究课题[（课题名称：老年慢性病患者医养联动健康管理模式研究（基金编号：JSYGY-3-2017-107）]

摘　　要：目的评价"家庭医生服务"模式对社区慢性病患者健康管理的效果,探讨影响居民签约服务的因素,为推进社区分级诊疗及居家医养融合服务提供参考。方法以调查问卷形式,选取自2015年起实行"家庭医生签约"服务的3个社区共379名居民,了解其中106名已签约居民对服务的满意度;访谈其中82名接受家庭医生签约服务的慢性病患者,收集签约前、签约后1年的治疗费用及住院频次数据,进行效果评价。结果居民的家庭服务签约率较低,其中年龄较大者、慢性病患者签约意识强,服务满意度91.7%;慢性病患者签约前、签约后1年的治疗费用分别是(1 966.7±2 090.4)元/年、(1 119.9±1 064.8)元/年,差异有统计学意义(P<0.01);患者在二、三级医院住院次数分别是(0.378±0.513)次/年、(0.061±0.241)次/年,差异有统计学意义(P<0.01)。结论 "家庭医生服务"模式对社区慢性病健康管理有良好的实践效果,有助于推动医养融合服务延伸至社区与家庭。Objective Evaluation of the effect of "family doctor service" mode on health management of chronic diseases. Discuss factors affecting residents’ signing service. To provide reference for promoting community based diagnosis and Integration of medical and old-age care services. Methods Using questionnaires,select 3 communities that have signed the "family doctor contract" service since 2015. Satisfaction of 106 contracted residents. Interviews with 82 patients with chronic diseases who were contracted by family doctors. Compare treatment cost and hospitalization frequency data before signing and 1 years after signing.Results The rate of family doctor service signing is low,and older people and patients with chronic diseases have strong awareness of signing contracts. The cost of treatment was respectively(1 966.7 ±2 090.4)yuan per year and(1 119.9±1 064.8)yuan per year. The number of hospitalization was respectively(0.378±0.513)times per year and(0.061±0.241)times per year.Conclusion The "family doctor service" mode has a good practical effect on the health management of chronic diseases in the community. It helps to extend medical services to communities and families.

关 键 词：社区 慢性病 健康管理 家庭医生 效果 

分 类 号：F42[经济管理—产业经济]