三级医院专科护士开设社区慢性病护理门诊的实践
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摘要
目的 :分析三级医院专科护士开设社区慢性病护理门诊实践效果。方法 :由三级医院专科护士在社区卫生服务中心开设高血压护理门诊和糖尿病护理门诊,建立专科护士社区慢性病护理门诊工作机制,分析2017年9月至2018年2月的社区慢性病护理门诊一般工作指标及高血压、糖尿病患者在签约时、签约3个月、6个月后主要结局指标。结果 :高血压护理门诊和糖尿病护理门诊分别签约患者86例和95例,在签约3个月、6个月后,高血压疾病主要指标控制达标率分别为70.93%和87.20%,糖尿病疾病主要指标控制达标率分别为23.15%和40.00%。结论 :三级医院专科护士开设社区慢性病护理门诊有利于社区慢性病患者的疾病控制、分级就诊及提升患者满意度。三级医院专科护士开设社区慢性病护理门诊建设需要政策跟进及机制优化。
Objective: To analyze the effects of setting up chronic diseases nursing clinic in community health centers by specialist nurses from tertiary hospital. Methods: Established hypertension and diabetes nursing clinic in community health center, and established the working system for community chronic disease nursing clinic. The general working indicators of the community chronic disease nursing clinic from September 2017 to February 2018, and the outcomes of patients with hypertension and diabetes after 3 and 6 months of the intervention were collected. Results: There were 86 and 95 patients signed up for hypertension and diabetes nursing care clinic, respectively. After 3 months and 6 months of intervention, the achieved rate of the main indicators for hypertension management was 70.93% and 87.20% respectively, and 23.15% and40.00% for diabetes respectively. Conclusion: Setting up chronic disease nursing clinic in community health centers is benefit to improve the chronic disease management level, the implementation of tiered medical consultation system and the patients' satisfaction. In the future, policy supports and scientific management system are needed for the long-term implementation of the community chronic disease nursing clinic.
Objective: To analyze the effects of setting up chronic diseases nursing clinic in community health centers by specialist nurses from tertiary hospital. Methods: Established hypertension and diabetes nursing clinic in community health center, and established the working system for community chronic disease nursing clinic. The general working indicators of the community chronic disease nursing clinic from September 2017 to February 2018, and the outcomes of patients with hypertension and diabetes after 3 and 6 months of the intervention were collected. Results: There were 86 and 95 patients signed up for hypertension and diabetes nursing care clinic, respectively. After 3 months and 6 months of intervention, the achieved rate of the main indicators for hypertension management was 70.93% and 87.20% respectively, and 23.15% and40.00% for diabetes respectively. Conclusion: Setting up chronic disease nursing clinic in community health centers is benefit to improve the chronic disease management level, the implementation of tiered medical consultation system and the patients' satisfaction. In the future, policy supports and scientific management system are needed for the long-term implementation of the community chronic disease nursing clinic.
引文
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[13]李秀华.改革创新加快发展-共同推进健康中国建设.中华护理杂志,2016,51(5):517.Li XH.Accelerating development through reform and innovation-jointly promoting the building of a healthy China.Chinese Journal of Nursing,2016,51(5):517.
[2]中国共产党新闻网.习近平在中国共产党第十九次全国代表大会上的报告.(2017-10-24)[2018-09-01].https://cpc.people.com.cn/n1/2017/1028/c64094-29613660.html.Communist Party of China News Network.Xi JPdelivers a speech at the 19th national congress of the communist party of China.(2017-10-24)[2018-09-01].https://cpc.people.com.cn/n1/2017/1028/c64094-29613660.html.
[3]国务院办公厅.关于印发中国防治慢性病中长期规划(2017-2025年)的通知.(2017-02-14)[2018-09-01].https://www.gov.cn/zhengce/content/2017-02/14/content_5167886.htm.General office of the state council.Notice on the issuance of China's medium-and long-term plan for the prevention and control of chronic diseases(2017-2025).(2017-02-14)[2018-09-01].https://www.gov.cn/zhengce/content/2017-02/14/content_5167886.htm.
[4]国务院文件.关于推进分级诊疗制度建设的指导意见.2015-09-08.Document of the state council.Guiding opinions on promoting the construction of hierarchical diagnosis and treatment system.2015-09-08.
[5]安徽省卫生和计划生育委员会.关于印发《盘活优质护理资源,做实城市医联体试点方案(试行)》的通知.(2017-07)[2018-09-01].https://www1.ahwjw.gov.cn/ygzt/article_34016.html.Anhui provincial health and family planning commission.Notice on the issuance of"revitalizing high-quality nursing resources and implementing the pilot program of urban medical consortium(trial)".(2017-07)[2018-09-01].https://www.ahwjw.gov.cn/ygzt/article-34016.html.
[6]戴夫,余梅,于卫华,等.基于慢性病延续医疗服务的三级医院“家庭护士”服务模型构建与实践.中国医院管理,2017,37(9):56-58.Dai F,Yu M,Yu WH,et al.Service model construction and practice of"family nurse"service in tertiary hospitals based on continuous medical service for chronic diseases.Chinese Hospital Management,2017,37(9):56-58.
[7]《中国高血压防治指南》修订委员会.中国高血压防治指南(2018年修订版).北京:人民卫生出版社,2018.Revision Committee of Chinese guideline for the prevention and treatment of hypertension.Chinese guideline for the prevention and treatment of hypertension(2018 revision).Beijing:People's Medical Publishing House,2018.
[8]王儒.糖尿病防治新理念--解读《中国2型糖尿病防治指南(2017版)》.江苏卫生保健,2018(9):14-16.Wang R.New concept of diabetes prevention and treatment-interpretation of guideline for the prevention and treatment of type 2 diabetes in China(2017 edition).Jiangsu Health Care,2008(9):14-16.
[9]刘雪梅,幸超丽,谢甘霖,等.个体化延续护理在老年高血压患者治疗中的血压控制作用及对其生存质量的影响.中外医学研究,2019(7):92-94.Liu XM,Xing CL,Xie GL et al.Effect of individualized continuous nursing on blood pressure control and quality of life in elderly patients with hypertension.Chinese and Foreign Medical Research,2019(7):92-94.
[10]李志红.大型综合性医院牵手社区卫生服务的实践.中国医院,2011,15(8):40-42.Li ZH.Practice of community health service in large general hospital.Chinese Hospitals,2011,15(8):40-42.
[11]Miguélez-Chamorro A,Ferrer-Arnedo C.The family and community nurse:health agent and model for the chronic patient within the community.Enferm Clin,2014,24(1):5-11.
[12]赵亚芳,绳宇.国外开业护士的管理及启示.中华护理杂志,2019,54(1):155-159.Zhao YF,Sheng Y.Management and enlightenment of foreign practice nurses.Chinese Journal of Nursing,2019,54(1):155-159.
[13]李秀华.改革创新加快发展-共同推进健康中国建设.中华护理杂志,2016,51(5):517.Li XH.Accelerating development through reform and innovation-jointly promoting the building of a healthy China.Chinese Journal of Nursing,2016,51(5):517.