| 付海英,丁晶晶,冯宪真,等.分级诊疗模式下三级综合医院-社区医院联合管理老年骨质疏松患者的效果[J].中国临床保健杂志,2022,25(5):636-639. |
| 分级诊疗模式下三级综合医院-社区医院联合管理老年骨质疏松患者的效果 |
| The management effect of a large tertiary general hospital and a community hospital on elderly patients with osteoporosis under the hierarchical diagnosis and treatment mode |
| 投稿时间：2022-06-28 |
| DOI：10.3969/J.issn.1672-6790.2022.05.013 |
| 中文关键词: 骨质疏松 病人医护连续性 患者分级医疗 生活质量 老年人 |
| 英文关键词: Osteoporosis Continuity of patient care Progressive patient care Quality of life Aged 〖FL |
| 基金项目:上海交通大学中国医院发展研究院社区医疗研究所开放课题(JTS-2020-02) |
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| 中文摘要: |
| 目的 探讨分级诊疗模式下三级综合医院-社区医院联合管理老年骨质疏松患者的效果。方法 收集2021年1—6月在北新泾社区服务中心、上海市同仁医院全科门诊初次诊疗的老年骨质疏松患者90例,按照随机数字表法分为研究组(45例)和对照组(45例)。研究组由上海市同仁医院专科-全科医疗科-社区医院分层进行综合管理,建立起三级综合医院与社区医院二级分工的合作机制(专科负责明确诊断、规范治疗,全科医疗科负责双向转诊,社区医院负责后续随访)。对照组采用常规治疗方法,患者自由选择专科门诊治疗或社区随访。1年后评估2组患者腰椎L1-L4骨密度水平、骨代谢生化指标、生活质量评分(采用健康调查简表)。结果 2组年龄、性别比、骨代谢生化指标、腰椎L1-L4骨密度水平、生活质量评分比较,差异无统计学意义(P＞0.05),具有可比性。对照组的骨代谢生化指标(25-羟维生素D)、腰椎L1-L4骨密度水平、生活质量评分(其中躯体疼痛、精神健康、健康变化评分)高于治疗前,差异有统计学意义(P＜0.05)；研究组患者腰椎L1-L4、骨代谢生化指标(25-羟维生素D)、生活质量评分(躯体疼痛、精神健康、健康变化评分)高于治疗前,且明显高于对照组,差异有统计学意义(P＜0.05)。结论 老年骨质疏松通过三级综合医院-社区医院二级分层管理,确保患者得到持续性、综合性、个体化的全程照顾,能够明显改善患者治疗效果以及健康状况,提高其生活质量。 |
| 英文摘要: |
| Objective To explore the management effect of a large tertiary general hospital and a community hospital on elderly patients with osteoporosis under the hierarchical diagnosis and treatment mode.Methods Ninety elderly patients with osteoporosis who were first diagnosed and treated in Beixinjing community service center and general outpatient clinic of our hospital from January to June 2021 were collected.They were randomly divided into observation group (45 cases) and control group (45 cases).The observation group was comprehensively managed by our hospital′s specialty,general practice department and community general practice doctors,and a cooperation mechanism of two-level division of labor between the three-level general hospital and the community service center was established (the specialty was responsible for clarifying diagnosis and standardizing treatment,the general practice department was responsible for two-way referral,and the community general practice doctor was responsible for follow-up).The control group was treated with routine treatment,and the patients were free to choose specialist outpatient treatment or community follow-up.One year later,the level of lumbar L1-L4 bone mineral density,biochemical indicators of bone metabolism,and quality of life scores of the two groups were evaluated (using the health survey short form SF-36).Results There was no significant difference between the two groups in age,sex ratio,biochemical indicators of bone metabolism,lumbar L1-L4 bone mineral density level and quality of life score (P>0.05).The biochemical indexes of bone metabolism (25 vitamin D),lumbar L1-L4 bone mineral density level and quality of life score (including physical pain,mental health and health change score) in the control group were higher than those before treatment,and the difference was statistically significant (P<0.05);the L1-L4 of lumbar spine,biochemical indexes of bone metabolism (25 vitamin D),and quality of life scores (physical pain,mental health,and health change scores) of patients in the observation group were higher than those in the control group,and the difference was statistically significant (P<0.05).Conclusions Through the two-level hierarchical management of a large tertiary general hospital and a community hospital,senile osteoporosis patients can receive continuous,comprehensive and individualized whole process care,which can significantly improve the treatment effect and health status of patients,and improve their quality of life. |
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