家庭医生签约服务模式对社区老年居民心血管疾病风险管理效果的影响

Effect evaluation of family doctor contract service on cardiovascular disease risk management in community-dwelling elderly

关键词:  家庭医生  “1+1+1”组合签约  心血管病  危险因素  慢性病管理

Key words:  family doctors  “1+1+1” combination registeration  cardiovascular disease  risk factors  chronic disease management

摘要:

目的分析社区老年人心血管疾病(cardiovascular disease, CVD)风险现状并探讨家庭医生签约服务管理在心血管疾病风险管理中的作用。方法于2019年7月—2020年6月上海市殷行社区老年体检人群中选取符合纳入和排除标准的878例研究对象，收集基本资料(姓名、性别、年龄、身高、体重、腰围、生活方式、病史)和生化指标(血压、空腹血糖、血脂、肝肾功能)，采用Framingham心血管风险评估标准评估CVD危险程度，进行回顾性分析，并按性别、年龄匹配后随机抽取家庭医生签约组和未签约组各107例，分析家庭医生签约管理服务对CVD危险因素管理效果的影响。结果社区老年居民家庭医生签约率较高(82.69%)；签约组中，高血压、高脂血症比例高于未签约组(P<0.05)，女性高脂血症比例高于男性(P<0.01)；两组心血管风险、吸烟比例男性高于女性(P<0.01)。签约组高血压、肥胖比例随着年龄增长而升高，未签约组高血压、糖尿病、高血压合并糖尿病比例随着年龄增长而升高(P<0.05)。心血管危险因素达标率较低，女性低密度脂蛋白胆固醇(LDL-C)、BMI以及LDL-C+空腹血糖(FBG)+血压(BP)综合达标率高于男性，甘油三酯(TG)达标率低于男性(P<0.05)。高血压患者TG、动脉粥样硬化指数(atherosclerosis index, AI)、BP、LDL-C+FBG+BP、BMI、腰围低于非高血压患者(P<0.05)。按性别、年龄匹配后，家庭医生签约组LDL-C、FBG、收缩压(SBP)、BMI、TG、AI达标率均高于未签约组(P<0.05)。结论社区老年人家庭医生签约管理率较高，CVD危险因素达标率较低，但家庭医生签约组达标率高于未签约组，提升家庭医生签约服务管理质量，通过心血管风险评估探索慢性病一体化综合管理模式，有望降低CVD患病风险和延缓疾病进展。

Abstract:

ObjectiveTo evaluate the effete of family doctor service on the cardiovascular disease(CVD) risk management in the community-dwelling elderly. MethodsFrom July 2019 to June 2020, 878 residents underwent elderly health check-up in Shanghai Yinhang Community Helath Service Center, and their basic data(name, sex, age, height, weight, waist circumference, lifestyle, medical history) and biochemical indicators(blood pressure, fasting blood glucose, blood lipids, liver and kidney function) were collected. The Framingham cardiovascular risk assessment standard was used to evaluate the risk of CVD. One hundred and seven residents with contracted family doctor service and 107 age and sex-matched uncontracted residents were randomly selected as study subjects. The effect of family doctor services on the CVD risk management was analyzed. ResultsIn this study 82.69% elderly residents had contracted family doctor services, the proportion of hypertension and hyperlipidemia in contracted residents was significantly higher than that in the uncontracted residents(P<0.05), and the proportion of hyperlipidemia in women was higher than that of men(P<0.01); the proportion of cardiovascular risk and smoking habit in men was higher than that of women(P<0.01). The proportion of hypertension and obesity in the contracted residents increased with age, while the proportion of hypertension, diabetes and hypertension in the uncontracted residents increased with age(P<0.05). The compliance rate of cardiovascular risk factors was lower, and the combined compliance rate of LDL-C, BMI and LDL-C+fasting blood glucose(FBG)+blood pressure(BP) in women was higher than that of men, and the compliance rate of triglycerides(TG) was lower than that of men(P<0.05). Patients with hypertension had lower compliance rates of TG, arteriosclerosis index(AI), BP, LDL-C+FBG+BP, BMI, and waist circumference than non-hypertensive patients(P<0.05). After matching with gender and age, the compliance rates of LDL-C, FBG, systolic blood pressure(SBP), BMI, TG, and AI in the contracted residents were higher than those in uncontracted residents(P<0.05) . ConclusionThe rate of contracted family doctor service among the community-dwelling elderly in this study is high. The compliance rate of CVD risk factors is generally low, but the compliance rate of contracted residents is higher than that of the uncontracted residents. Improving the management quality through family doctor contracted services and exploring the integrated, comprehensive management model of chronic diseases are expected to reduce the risk of CVD disease and delay the occurrence of the disease.