医院-社区-家庭联动模式在社区冠心病管理中的应用效果

宣玲; 唐碧; 李妙男; 谢彩侠; 汪利超; 王翠香

doi:10.16766/j.cnki.issn.1674-4152.003720

医院-社区-家庭联动模式在社区冠心病管理中的应用效果

doi: 10.16766/j.cnki.issn.1674-4152.003720

1.
蚌埠医科大学第一附属医院心血管内科，安徽蚌埠 233004
2.
蚌埠市龙子湖区东风社区卫生服务中心，安徽蚌埠 233000

基金项目:

安徽省高校人文社会科学研究重点项目 SK2021A0433

安徽省高校自然科学研究重点项目 2022AH051477

安徽省临床医学研究转化专项 202304295107020079

蚌埠市社会科学规划项目 BB22B046

详细信息

通讯作者:
宣玲，E-mail: 17893466@qq.com

中图分类号: R541.4
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- 文章访问数: 24
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- PDF下载量: 2
- 被引次数: 0
出版历程
- 收稿日期: 2024-05-06
- 网络出版日期: 2024-12-28

Application effect of hospital-community-family linkage model in community coronary heart disease management

1.
Department of Cardiology, the First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui 233004, China

摘要

摘要: 目的采用三甲医院-社区-家庭联动模式对社区冠心病患者进行规范化管理，分析三联模式管理前后的效果变化。方法 2022年7—11月选取蚌埠市4个社区的480例冠心病患者，由蚌埠医科大学第一附属医院心血管病专科医生联合社区及患者家庭进行管理。主要观察指标包括管理前后冠心病危险因素、冠心病的知晓率、冠心病二级预防药物使用率、年住院例次、西雅图心绞痛量表评分等。结果联合管理后冠心病患者血压、血糖、血脂、BMI、吸烟率下降, 运动人数增加(P < 0.05)；冠心病知晓率上升(59.79% vs. 95.63%，χ²=177.900，P < 0.05)，冠心病二级预防药物抗血小板药物(90.21% vs. 96.88%，χ²=17.656，P < 0.05)、调脂类药物(83.13% vs. 92.92%，χ²=21.823，P < 0.05)、β受体阻滞剂(51.46% vs. 85.83%，χ²=131.761，P < 0.05)、血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂/沙库巴曲缬沙坦(52.29% vs. 87.29%，χ²=139.450，P < 0.05)使用率上升，年住院例次下降；西雅图心绞痛量表评分改善(P < 0.05)。结论三甲医院联合社区及家庭的冠心病规范化管理模式，提高了冠心病患者危险因素的控制，改善了心绞痛发作和生活质量，减少再住院，提升了社区医生冠心病的防治水平，值得在其他慢性病管理中推广应用。
- 冠心病 /
- 慢性病 /
- 联合管理 /
- 社区卫生服务
Abstract: Objective To implement a standardized management model of coronary heart disease (CHD) patients in the community, utilizing a third-class hospital-community-family linkage approach, and to analyze the changes in outcomes before and after this three-mode management. Methods A total of 480 patients with coronary heart disease from July to November 2022 in four communities in Bengbu City were selected. Cardiovascular specialists from the First Affiliated Hospital of Bengbu Medical University, in conjunction with community healthcare providers and patient ' s family, managed the patients. The main evaluation indicators included changes in risk factors of CHD, awareness rates of CHD, utilization rates of secondary prevention drugs, annual hospitalization annual number of hospitalization and scores of Seattle angina questionnaire (SAQ) before and after management. Results The blood pressure, blood glucose, blood lipid, body mass index, smoking rate of patients with coronary heart disease decreased and the number of exercise increased after combined management (P < 0.05). The awareness rate of CHD was increased (59.79% vs. 95.63%, χ²=177.900, P < 0.05). And the utilization rates of antiplatelet drugs (90.21% vs. 96.88%, χ²=17.656, P < 0.05), lipid-regulating drugs (83.13% vs. 92.92%, χ²=21.823, P < 0.05), β-blockers (51.46% vs. 85.83%, χ²=131.761, P < 0.05), and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/sacubitril-valsartan (52.29% vs. 87.29%, χ²=139.450, P < 0.05) increased. The number of annual hospitalizations decreased, and SAQ scores improved (P < 0.05). Conclusion The standardized management mode of coronary heart disease linking tertiary hospitals, communities, and families improved control of risk factors of CHD patients, reduced attack of angina pectoris, enhanced quality of life, decreased rehospitalization, and elevated the prevention and treatment capabilities of community doctors. This model is worthy promoting for managing other chronic diseases.
- Coronary heart disease /
- Chronic disease /
- Joint management /
- Community sanitation service

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表 1 480例规范化管理冠心病患者一般资料

Table 1. General data of 480 patients with coronary heart disease under standardized management

项目	例数(%)
性别
男性	281(58.54)
女性	199(41.46)
既往心肌梗死	51(10.63)
高血压	231(48.13)
其他心脏病	49(10.21)
糖尿病	201(41.88)
心力衰竭	91(18.96)
肥胖	152(31.67)
吸烟	169(35.21)

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表 2 社区冠心病患者管理前后常见危险因素控制情况比较

Table 2. Comparison of control of common risk factors before and after management in community patients with coronary heart disease

时间	例数	收缩压(x±s, mmHg)	舒张压(x±s, mmHg)	空腹血糖(x±s, mmol/L)	LDL-C (x±s, mmol/L)	BMI (x±s)	吸烟[例(%)]	运动[例(%)]
管理前	480	164.91±7.76	102.20±9.56	6.99±2.23	3.13±1.70	25.83±1.19	169(35.21)	145(30.21)
管理后	480	132.79±11.72	80.81±9.17	6.21±1.78	2.85±1.20	22.15±1.44	47(9.79)	298(62.08)
统计量		51.136^a	35.349^a	6.142^a	3.019^a	43.719^a	105.754^b	98.121^b
P值		< 0.001	< 0.001	< 0.001	0.003	< 0.001	< 0.001	< 0.001
注：^a为t值，^b为χ²值。1 mmHg=0.133 kPa。

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表 3 社区冠心病患者管理前后冠心病知晓情况、冠心病二级预防药物使用情况、年住院例次比较[例(%)]

Table 3. Comparison of the awareness of CHD, the use of secondary preventive drugs and the number of hospitalized cases before and after management of CHD in community patients[cases (%)]

时间	例数	抗血小板药物(阿司匹林、氯吡格雷/替格瑞洛)使用	硝酸酯类药物使用	调脂类(他汀类)药物使用	β受体阻滞剂使用	ACEI/ARB/ ARNI使用	冠心病知晓
管理前	480	433(90.21)	207(43.13)	399(83.13)	247(51.46)	251(52.29)	287(59.79)
管理后	480	465(96.88)	199(41.46)	446(92.92)	412(85.83)	419(87.29)	459(95.63)
χ²值		17.656	0.273	21.823	131.761	139.450	177.900
P值		< 0.001	0.601	< 0.001	< 0.001	< 0.001	< 0.001

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表 4 社区冠心病患者管理前后SAQ评分比较(x±s, 分)

Table 4. Comparison of SAQ scores in community patients with coronary heart disease before and after management(x±s, points)

时间	例数	躯体活动受限程度	心绞痛发作情况	心绞痛稳定状态	疾病认知程度	治疗满意程度
管理前	480	57.27±6.98	51.47±6.81	45.20±10.09	44.13±7.63	50.79±7.98
管理后	480	78.75±9.37	66.50±7.98	57.08±8.02	69.93±8.80	79.77±7.98
t值		40.347	31.462	20.272	50.429	55.215
P值		< 0.001	< 0.001	< 0.001	< 0.001	< 0.001

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