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

摘要：

目的　研究医院-社区-家庭三位一体慢性病管理模式在非增殖期糖尿病视网膜病变（NPDR）患者健康管理中的应用效果。方法　前瞻性选取2021年10月至2023年5月期间在西安市第一医院首次就诊的NPDR患者136例，将患者随机分为对照组和观察组，每组68例。对照组男42例，女26例，年龄（59.7±9.1）岁，病程≥5年48例；观察组男35例，女33例，年龄（60.5±8.6）岁，病程≥5年41例。对照组实施常规管理，观察组实施医院-社区-家庭三位一体慢性病管理模式。两组均连续干预3个月。比较两组视力、血糖指标［空腹血糖（FPG）、餐后2 h血糖（2hPG）及糖化血红蛋白（HbA1c）］及血糖控制率，干预前后简易疾病感知问卷（BIPQ）、糖尿病视网膜病变患者自我管理量表、糖尿病患者特异性生存质量量表（DSQL）评分及经济负担水平。统计学分析采用独立样本t检验、χ²检验、秩和检验。结果　干预3个月后，观察组患者的视力改善有效率高于对照组［61.77%（42/68）比30.88%（21/68）］，视力下降率低于对照组［4.42%（3/68）比20.59%（14/68）］，差异有统计学意义（χ²=15.956，P=0.001）；FPG、2hPG、HbA1c水平均低于对照组［（7.95±1.29）mmol/L比（9.08±1.31）mmol/L、（10.27±1.25）mmol/L比（11.39±1.28）mmol/L、（6.94±0.36）%比（8.48±0.39）%］，差异均有统计学意义（均P<0.05）；FPG、2hPG、HbA1c控制率均高于对照组［27.94%（19/68）比2.94%（2/68）、39.71%（27/68）比20.59%（14/68）、57.35%（39/68）比22.06%（15/68）］，差异均有统计学意义（均P<0.05）；BIPQ、DSQL评分及经济负担均低于对照组［（44.59±3.24）分比（57.57±4.63）分、（41.34±3.07）分比（52.37±3.41）分、（1.98±0.51）万元比（2.37±0.64）万元］，自我管理能力评分高于对照组［（95.52±6.64）分比（83.71±4.58）分］，差异均有统计学意义（t=18.941、19.823、4.683、12.073，均P<0.05）。结论　实施医院-社区-家庭三位一体慢性病管理模式有利于改善NPDR患者视力，控制血糖水平，提高患者疾病感知能力、自我管理能力及生活质量，减轻患者及家庭经济负担，具有良好的临床应用价值。

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