植入CIED患者选择社区随访的影响因素及其效果初探  

Influencing factors and effectiveness of community follow-up in patients with cardiac implantable electronic device

作　　者：黄嘉慧 沈红 赵云玲 叶晓景 方红 李悦 赵伟 沈娟 范红利 邱朝晖[1] Huang Jiahui;Shen Hong;Zhao Yunling;Ye Xiaojing;Fang Hong;Li Yue;Zhao Wei;Shen Juan;Fan Hongli;Qiu Zhaohui(Department of Cardiology,Tongren Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200336,China;Tianshan Community Health Service Center,Shanghai 200336,China;Xianxia Community Health Service Center,Shanghai 200336,China;Zhoujiaqiao Community Health Service Center,Shanghai 200336,China;Hongqiao Community Health Service Center,Shanghai 200336,China;Beixinjing Community Health Service Center,Shanghai 200336,China;Chengjiaqiao Community Health Service Center,Shanghai 200336,China;Xinjing Town Community Health Service Center,Shanghai 200336,China)

机构地区：[1]上海交通大学医学院附属同仁医院心血管内科,上海200336 [2]天山路街道社区卫生服务中心,上海200336 [3]仙霞街道社区卫生服务中心,上海200336 [4]周家桥街道社区卫生服务中心,上海200336 [5]虹桥街道社区卫生服务中心,上海200336 [6]北新泾街道社区卫生服务中心,上海200336 [7]程家桥街道社区卫生服务中心,上海200336 [8]新泾镇社区卫生服务中心,上海200336

出　　处：《中华全科医师杂志》2023年第2期187-193,共7页Chinese Journal of General Practitioners

基　　金：上海市卫生健康委先进适宜技术推广项目(2019SY057);上海市卫生健康委员会卫生行业临床研究专项(202040039)。

摘　　要：目的探讨植入心脏植入式电子器械(CIED)患者选择社区随访的影响因素及其效果。方法该研究为前瞻性队列研究。入选2021年2月至2022年2月在上海交通大学医学院附属同仁医院心内科CIED门诊及其签约的10家社区卫生服务中心进行随访的植入了CIED的患者。在CIED门诊进行随访的患者纳入常规门诊随访组,有1次及以上社区卫生服务中心随访经历的患者纳入社区随访组。社区随访组与常规门诊随访组按照1∶3的比例进行匹配。通过问卷调查收集入选患者的基线临床资料,问卷由基本情况、随访情况、社区医疗情况3方面内容组成。通过CarelinkExpress电子随访平台及同仁医院CIED门诊信息系统提取患者随访相关数据。随访时调整了治疗方案或CIED参数定义为采取行动的随访(VWA),社区随访时发生了转诊也定义为VWA。随访终点为发生主要不良事件。采用多因素logistic回归模型分析患者选择社区随访的影响因素。结果共入选患者132例,其中社区随访组33例,男性16例(48.5%),年龄(79.5±8.0)岁;常规门诊随访组99例,男性48例(48.5%),年龄(80.8±7.2)岁。两组患者平时于社区卫生服务中心就诊频率差异有统计学意义,社区随访组患者社区医师签约率高于常规门诊随访组(均P<0.05)。多因素logistic回归分析结果显示,是否与社区医师签约是影响患者选择社区随访的独立影响因素(OR=2.143,95%CI:1.103~4.166,P=0.025)。132例患者共计随访469次,其中社区随访45次,门诊随访424次。社区随访组与常规门诊随访组发生VWA、主要不良事件和计划外随访的次数占比差异均无统计学意义(均P>0.05)。社区随访组步行至医院的患者占比明显高于常规门诊随访组(P<0.05),常规门诊随访组患者的主要交通方式为公交和打车,占比均高于社区随访组(均P<0.05)。社区随访组患者诊室外等待时间和单次随访所需总时间均明显短于常�Objective To explore the influencing factors and effectiveness of community follow-up in patients with cardiac implantable electronic device(CIED)implantation.Method A total of 132 patients who received CIED implantation in the Department of Cardiology of Tongren Hospital,Shanghai Jiao Tong University School of Medicine from February 2021 to February 2022 were enrolled in this prospective cohort study.Among them 33 patients were followed up in community health service centers associated with Tongren Hospital(community follow-up group)and 99 matched patients were followed up in the CIED outpatient clinic of the hospital(outpatient follow-up group)with a ratio of 1∶3.The clinical data of the selected patients were collected through a questionnaire survey;the follow-up data were extracted through the CarelinkExpress electronic follow-up platform and the CIED outpatient information system of Tongren Hospital.Adjustment of the treatment protocol or CIED parameters at follow-up,and the referral from the community health service centers were defined as visit with-an-action(VWA).The endpoint of follow-up was the occurrence of major adverse events.The multivariate logistic regression model was used to analyze the factors influencing patient selection for community follow-up.Results The univariate analysis showed that the frequency of visits to community health service centers and the service contracting rate in community follow-up group were higher than those of outpatient follow-up group(P<0.05).The multivariate logistic regression analysis showed that the contracted community physician service was an independent influencing factor of patient choosing community follow-up(OR=2.143,95%CI:1.103-4.166,P=0.025).A total of 469 visits of followed up occurred in 132 patients,including 45 community visits and 424 outpatient visits.VWA accounted for 22.2%(10/45)in the community follow-up group,and 17.2%(73/424)in the outpatient follow-up group(P>0.05).There was no significant difference in the safety and effectiveness indicators

关 键 词：社区卫生服务 随访 心脏植入式电子器械 

分 类 号：R473.2[医药卫生—护理学]