[关于慢性病的全科医生-专家组合管理模式的讨论]
Guihua Jian1, Jianfeng Zhou1, Zhi Wang1
1( 200233) Department of Nephrology, The Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200233, China.
概括
这项研究引入了慢性病 (CKD) 管理的全科医生-专家模型,改善了基于社区的护理和患者的治疗结果. 综合方法可以提高慢性病患者的早期检测,治疗和生活质量.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 公共卫生 公共卫生
- 医疗保健管理的管理
背景情况:
- 慢性病 (CKD) 的有效管理越来越重要.
- 慢性病的管理需要初级和专业护理之间的协调努力.
- 基于社区的医疗保健模式对于管理慢性疾病至关重要.
研究的目的:
- 评估一般医生和专家组合管理模式对CKD的影响.
- 评估CKD管理流程和患者结果的改进.
- 确定将社区卫生中心与专业护理相结合的有效性.
主要方法:
- 建立了包括全科医生和专家在内的CKD管理模式.
- 为社区的全科医生实施培训计划.
- 利用数据库对老年CKD患者进行回顾性分析.
- 组织了患者支持小组和社区培训中心.
主要成果:
- 10年来,改善了CKD管理的制度化和标准化.
- 扩大了管理团队,并将护理从医院扩展到社区.
- 在社区卫生中心加强CKD管理,提高全科医生的能力.
- 促进了早期查,有效的随访,并改善了CKD患者的生活质量.
结论:
- 一般医生和专家集成的CKD管理模式是有效的.
- 这种模式改善了患者获得早期查,治疗和随访的机会.
- 这种方法提高了CKD患者的生活质量,特别是那些患有并发症的人.
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