关键词:

非增殖期糖尿病视网膜病变, 医院-社区-家庭, 三位一体管理模式, 血糖控制, 疾病感知, 自我管理能力, 经济负担

Abstract:

Objective　To study the effect of hospital-community-family trinity chronic disease management model in the health management of non-proliferative diabetic retinopathy (NPDR). Methods　A total of 136 patients with NPDR who received their first treatment in Xi'an First Hospital from October 2021 to May 2023 were prospectively selected and were randomly divided into a control group and an observation group. In the control group, there were 42 males and 26 females, aged (59.7±9.1) years, 48 patients with ≥5 years of disease course. In the observation group, there were 35 males and 33 females, aged (60.5±8.6) years, 41 patients with ≥5 years of disease course. The control group received routine management, and the observation group received hospital-community-family trinity chronic disease management model for 3 months. Visual acuity, blood glucose indexes [fasting blood glucose (FPG), 2 h postprandial blood glucose (2hPG), and glycated hemoglobin (HbA1c)], and blood glucose control rate of the two groups were observed. The scores of Brief Illness Perception Questionnaire (BIPQ), Diabetic Retinopathy Patient Self-management Scale, and Diabetes Specific Quality of Life Scale (DSQL) and economic burden were compared between the two groups before and after intervention. Independent sample t test, χ² test, and rank sum test were used for statistical analysis. Results　After 3 months of intervention, the effective rate of visual acuity improvement in the observation group was higher than that in the control group [61.77% (42/68) vs. 30.88% (21/68)], and the rate of visual acuity decline was lower than that in the control group [4.42% (3/68) vs. 20.59% (14/68)], with a statistically significant difference (χ²=15.956, P=0.001); the levels of FPG, 2hPG, and HbA1c in the observation group were lower than those in the control group [(7.95±1.29) mmol/L vs. (9.08±1.31) mmol/L, (10.27±1.25) mmol/L vs. (11.39±1.28) mmol/L, (6.94±0.36)% vs. (8.48±0.39)%], the control rates of FPG, 2hPG, and HbA1c were higher than those in the control group [27.94% (19/68) vs. 2.94% (2/68), 39.71% (27/68) vs. 20.59% (14/68), 57.35% (39/68) vs. 22.06% (15/68)], with statistically significant differences (all P<0.05); the BIPQ score, DSQL score, and economic burden were lower than those in the control group [(44.59±3.24) points vs. (57.57±4.63) points, (41.34±3.07) points vs. (52.37±3.41) points, (1.98±0.51) thousand yuan vs. (2.37±0.64) thousand yuan], and the score of self-management ability was higher than that in the control group [(95.52±6.64) points vs. (83.71±4.58) points], with statistically significant differences (t=18.941, 19.823, 4.683, and 12.073, all P<0.05). Conclusion　The implementation of hospital-community-family trinity chronic disease management model is beneficial to improve the vision of NPDR patients, control the blood glucose level, improve the disease perception ability, self-management ability, and quality of life, and reduce the economic burden in patients and their families, which has good clinical application value.

Key words:

Non-proliferative diabetic retinopathy, Hospital-community-family, Trinity management model, Blood glucose control, Disease perception, Self-management ability, Economic burden