員戰(zhàn)民

[摘要] 目的 觀察家庭醫(yī)生簽約服務(wù)在老年慢性疾病健康管理中的應(yīng)用效果。 方法 納入2018年1月至2019年12月的社區(qū)老年慢性疾病患者64例，隨機(jī)分為觀察組與對照組，每組各32例，分別實(shí)施家庭醫(yī)生簽約服務(wù)與常規(guī)社區(qū)健康管理。比較兩組患者健康知識評分及自我管理能力評分、血壓、血糖、血脂指標(biāo)在干預(yù)前后的變化情況，隨訪患者遵醫(yī)依從性。 結(jié)果 干預(yù)后兩組患者健康知識評分、自我管理能力評分均較干預(yù)前升高，差異有統(tǒng)計(jì)學(xué)意義（P<0.05），且觀察組較對照組升高，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）;干預(yù)前兩組患者較各項(xiàng)血糖、血脂及血壓指標(biāo)比較，差異無統(tǒng)計(jì)學(xué)意義（P>0.05），干預(yù)后觀察組均優(yōu)于對照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）;觀察組合理飲食、適量運(yùn)動(dòng)、遵醫(yī)用藥、定期復(fù)查等遵醫(yī)行為高于對照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。 結(jié)論 家庭醫(yī)生簽約服務(wù)在老年慢性疾病健康管理中的應(yīng)用，能夠提高患者健康認(rèn)知及自我管理能力，促進(jìn)各項(xiàng)臨床指標(biāo)改善，提高患者醫(yī)囑依從性，值得臨床推廣。

[關(guān)鍵詞] 家庭醫(yī)生簽約服務(wù);老年慢性病;健康管理;健康知識評分;自我管理能力

[中圖分類號] R592? ? ? ? ? [文獻(xiàn)標(biāo)識碼] B? ? ? ? ? [文章編號] 1673-9701（2021）22-0090-04

Application effect of family doctor contract service in health management of chronic diseases in elderly

YUN Zhanmin

Department of General Practice， Central University Hospital for Nationalities， Beijing? ?100081，China

[Abstract] Objective To observe the effect of family doctor contract service in the health management of chronic diseases in the elderly. Methods A total of 64 patients data of elderly patients with chronic diseases in the community were included from January 2018 to December 2019. They were randomly divided into the observation group and the control group， with 32 cases in each group， and respectively treated with family doctor contract services and routine community health management. The changes of health knowledge， self-management ability score， blood pressure， blood glucose and blood lipid indexes before and after intervention were compared， and the medical compliance of patients was followed up. Results The scores of health knowledge and self-management ability were improved in both groups after intervention， compared with those before intervention （P<0.05）; those of the observation group were higher than those of the control group （P<0.05）， which were statistically significant. Before intervention， no statistically significant differences were observed in blood glucose， blood lipid and blood pressure indexes between the 2 groups （P>0.05）; after intervention， those of the observation group were better than those of the control group， and the differences were statistically significant （P<0.05）. Compared with the control group， better compliance behaviors such as reasonable diet， proper exercise， compliance with medical drugs and regular review were observed in the observation group （P<0.05）， with statistically significant differences. Conclusion The application of family doctor contract services in the health management of chronic diseases in the elderly can improve patients′ health cognition and self-management ability， promote the improvement of various clinical indicators， and improve patients′ compliance with medical advice， which is worthy of clinical promotion.