以运动障碍专科医生为主导、社区医生为中心的帕金森病管理模式效果研究  

Effect of Parkinson's Disease Management Model Dominated by Movement Disorder Specialists and Centered on Community Doctors

作　　者：冯彩霞[1] 王增帅[1] 穆海林 杨涵轩 塔米尔 FENG Caixia;WANG Zengshuai;MU Hailin;YANG Hanxuan;TAMIR(Department of Neurology,the Second Affiliated Hospital of Baotou Medical College,Inner Mongolia University of Science and Technology,Baotou 014030,China;Zhenhua Community Health Service Center,Wanqing Road Office,Baotou 014010,China;Graduate School of Baotou Medical College,Inner Mongolia University of Science and Technology,Baotou 014040,China)

机构地区：[1]内蒙古科技大学包头医学院第二附属医院神经内科,内蒙古自治区包头市014030 [2]内蒙古自治区包头市青山区万青路办事处振华社区卫生服务中心,014010 [3]内蒙古科技大学包头医学院研究生院,内蒙古自治区包头市014040

出　　处：《中国全科医学》2024年第34期4280-4285,共6页Chinese General Practice

基　　金：包头市卫生健康科技计划项目(wsjkkj2022114)。

摘　　要：背景帕金森病(PD)的发病率逐年增高,增加了医保的疾病负担,目前的慢性病管理模式在PD患者的社区管理中没有发挥作用。目的探讨以运动障碍专科医生为主导、社区医生为中心的PD管理模式的效果,以期提高社区医生的PD综合管理能力,提高PD患者的生活质量。方法选取2022年1月—2023年5月在内蒙古科技大学包头医学院第二附属医院神经内科接受诊治的102例PD患者为研究对象,采用随机数字表法分为对照组和主动干预组各51例。对照组患者接受常规社区管理,主动管理组患者接受以PD为亚专业的社区医生的主动管理,管理内容包括用药调整、运动康复、饮食营养、认知功能障碍和精神功能障碍管理等。分别于患者回归社区的1周内(管理前)和6个月时(管理后)对患者开展评价,评价内容包括单日左旋多巴等效剂量、统一帕金森病评定量表第三部分(UPDRS-Ⅲ)、统一帕金森病评定量表第四部分(UPDRS-Ⅳ)、Hoehn-Yahr(H-Y)分期、39项帕金森病生活质量调查问卷(PDQ-39)。结果管理6个月时,主动管理组患者的左旋多巴等效剂量高于管理前,UPDRS-Ⅲ评分、UPDRS-Ⅳ的其他并发症维度得分、PDQ-39得分低于管理前(P<0.05)。Spearman秩相关分析结果显示,主动管理组患者管理前后的PDQ-39得分差值与其精神健康、屈辱感、认知、社会支持、交流、身体不适维度得分差值呈正相关(rs值为0.651~0.893,P<0.05),与UPDRD-Ⅳ得分差值呈正相关(rs=0.338,P<0.05),而与UPDRS-Ⅲ得分差值不相关(P>0.05)。单因素Logistic回归分析结果显示,与对照组相比,主动管理组患者PDQ-39降低的可能性是对照组患者的11.769倍(95%CI=4.340~31.918,P<0.001)。结论以运动障碍专科医生为主导、社区医生为中心的PD管理模式可以提高患者的生活质量,这为PD社区管理提供了参考。Background The incidence of Parkinson's disease(PD)is increasing year by year,which has increased the disease burden of medical insurance,and the current chronic disease management model has not played a role in the community management of PD patients.Objective To explore the effect of PD management model led by a movement disorders specialist and centered on community doctors,in order to improve the comprehensive management ability of community doctors for PD patients and improve the quality of life of PD patients.Methods One hundred and two PD patients who were treated at the Neurology Department of the Second Affiliated Hospital of Baotou Medical College,Inner Mongolia University of Science and Technology from January 2022 to May 2023 were selected as the research subjects and were divided into the control group and the active intervention group by random digit table method,with 51 cases in each group.The control group received conventional community management,while the active intervention group received proactive management by community doctors specializing in PD.The management content included drug adjustment,exercise rehabilitation,dietary nutrition,cognitive function and psychological function management.Evaluations were conducted for the patients within one week of their return to the community(before intervention)and six months later(after intervention).The evaluation included a single day equivalent dose of levodopa,UPDRS-Ⅲ,UPDRS-Ⅳ,Hoehn-Yahr(H-Y)staging,and 39-item Parkinson's Disease Quality of Life Questionnaire(PDQ-39).Results At 6 months,the levodopa equivalent dose in the active intervention group was higher than before management,and the UPDRS-Ⅲscore,other complication dimensions of UPDRS-Ⅳ,and PDQ-39 score were lower than before(P<0.05).The Spearman rank correlation analysis results showed that the difference in PDQ-39 scores between the active intervention group and the control group before and after management was positively correlated with their scores in mental health,humiliation,co

关 键 词：帕金森病 社区管理模式 生活质量 全-专结合 运动障碍专科医生 社区医生 队列研究 

分 类 号：R197[医药卫生—卫生事业管理] R742.5[医药卫生—公共卫生与预防医学]