综合医院血脂管理门诊模式建设探索与实践

doi:10.12114/j.issn.1007-9572.2024.0185

摘要/Abstract

摘要： 背景目前我国城乡居民死亡原因排名第一位的疾病仍然是心血管疾病，其中最主要的是动脉粥样硬化性心血管疾病，而低密度脂蛋白胆固醇升高是其主要危险因素。目的通过建立新型血脂管理门诊模式，分析新模式建立前后患者血脂异常的知晓率、合理用药比例、患者依从性及用药达标率。方法 2023-09-01—2024-02-28，南京医科大学附属苏州医院通过整合医学资源建立了基于科研项目为基础的综合医院血脂管理门诊模式。该模式以"血脂异常患者"门诊为载体，联动专科医生、全科医生对血脂异常患者开展规范化管理，优化就诊和随访流程，有效筛查血脂异常人群和诊断高脂血症患者并提供正确的治疗方法。结果纳入慢病管理的血脂异常患者人群由以往分散模式，转变为血脂管理门诊整体、规范、集中管理，且管理的患者人数较前显著增加。血脂管理门诊模式建立后，门诊初次就诊患者规范用药比例由25.3%（147/580）提升到30.3%（242/798），坚持用药比例由32.7%（190/580）提升到41.6%（332/798），用药达标率由15.8%（92/580）提升到22.5%（180/798）（P<0.05）。结论通过实施"全专结合"的血脂管理门诊模式，纳入慢病管理的血脂异常患者人数明显增加，患者规范用药比例、用药依从性和用药达标率有所提高。该模式既有利于科研项目实施，又能培养医学人才，有助于提高全科医生和研究生及规培生的科学研究能力和专业技术水平。

关键词: 高脂血症, 动脉粥样硬化, 心血管疾病, 血脂异常, 血脂管理, 门诊医疗

Abstract:

Background

Cardiovascular disease, mainly atherosclerotic cardiovascular disease, is the first cause of death for urban and rural residents in China. Low density lipoprotein cholesterol is the pathogenic risk factor of ASCVD.

Objective

By establishing a new outpatient model for blood lipid management, to analyze the awareness rate of abnormal blood lipids in patients before and after the establishment of the new model, the proportion of rational drug use, patient compliance, and medication compliance rate.

Methods

From September 1, 2023 to February 28, 2024, has established a comprehensive outpatient model for managing blood lipid abnormalities based on scientific research projects by integrating medical resources. The model takes the outpatient service of "patients with dyslipidemia" as the carrier, and collaborates with specialized doctors and general practitioners to standardize the management of dyslipidemia patients, optimize the consultation and follow-up process, effectively screen the population with dyslipidemia, diagnose hyperlipidemia patients, and provide correct treatment methods.

Results

The model of patients with dyslipidemia included in the management of chronic diseases has shifted from a dispersed model to a comprehensive, standardized, and centralized management of lipid management outpatient services, and the number of patients managed has significantly increased compared to before. The proportion of standardized medication for first-time patients in our blood lipid management outpatient department has increased from 25.3% (147/580) to 30.3% (242/798), the proportion of adherence to medication has increased from 32.7% (190/580) to 41.6% (332/798), and the compliance rate of medication has increased from 15.8% (92/580) to 22.5% (180/798) (P<0.05) .

Conclusion

Through the implementation of the "comprehensive and specialized" prevention and treatment model, the number of patients with dyslipidemia included in chronic disease management has significantly increased, and the proportion of standardized medication, medication compliance, and medication compliance rate have been improved. The model not only cultivates talents while implementing scientific research projects, but also enhances the research capabilities and professional service levels of general practitioners, graduate students, and regulatory trainees.

Key words: Hyperlipidemias, Atherosclerosis, Cardiovascular diseases, Dyslipidemia, Lipid management, Ambulatory care

张俊,罗雯,王绿娅,等. 综合医院血脂管理门诊模式建设探索与实践[J]. 中国全科医学, 2024, 27(36): 4527-4533. DOI: 10.12114/j.issn.1007-9572.2024.0185.
ZHANG Jun,LUO Wen,WANG Luya, et al. Exploration and Practice of the Construction of Outpatient Model for Blood Lipid Management in Comprehensive Hospitals[J]. Chinese General Practice, 2024, 27(36): 4527-4533. DOI: 10.12114/j.issn.1007-9572.2024.0185.

图/表 5

图1 成人ASCVD总体发病风险评估流程图注：ASCVD=动脉粥样硬化性心血管疾病，ACS=急性冠脉综合征，LDL-C=低密度脂蛋白胆固醇，CABG=冠状动脉旁路移植术，PCI=经皮冠状动脉介入治疗，TC=总胆固醇，CKD=慢性肾脏病，HDL-C=高密度脂蛋白胆固醇；1 mmHg=0.133 kPa；危险因素的水平均为干预前水平；*危险因素包括吸烟、低HDL-C、年龄≥45/55岁（男性/女性）；<40岁的糖尿病患者危险分层参见特殊人群糖尿病部分。

Figure 1 Risk assessment procedure of ASCVD in adults

图2 血脂异常管理门诊流程图

Figure 2 Outpatient management procedure of blood lipid

图3 血脂异常管理筛查流程图注：*此处高脂血症以高LDL-C血症为例。

Figure 3 Management and screening procedure of blood lipid abnormality

图4 血脂异常患者诊疗与随访流程图注：*此处高脂血症以高LDL-C血症为例。

Figure 4 Diagnosis，treatment，and follow-up procedure of patients with dyslipidemia

表1 新模式前后血脂门诊患者规范用药比例、用药依从性及用药达标率[例（%）]

Table 1 Standardized medication proportion，medication adherence rate，and medication compliance rate of blood lipid outpatient patients before and after the new model

血脂管理门诊模式前后	例数	规范用药比例	用药依从性	用药达标率
建立前	580	147（25.3）	190（32.8）	92（15.9）
建立后	798	242（30.3）	332（41.6）	180（22.6）
χ²值		3.871	10.800	9.083
P值		0.049	0.001	0.003

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