基层医务人员慢性病健康行为管理能力的培训干预及其效果：系统综述及Meta分析

doi:10.12114/j.issn.1007-9572.2024.0722

摘要/Abstract

摘要： 生活方式处方是慢性病患者行为管理的重要内容，已被多个慢性病国际指南作为推荐治疗方案。基层医务人员是提供生活方式服务的重要来源，但存在能力不足的问题。已有试验证明培训可提高基层医务人员健康行为的管理能力，但仍缺乏生活方式教育培训干预效果的证据整合。本文系统全面地探讨了目前针对基层医务人员健康行为管理培训的内容、形式、效果，通过梳理文献发现现有慢性病行为管理培训存在的问题并提出建议。本文发现现有培训中对改善患者压力、睡眠、社交方面培训不足，缺乏对行为改变基础理论和技能的规范性培训。教育干预虽对提升基层医务人员行为管理知识和技能有一定效果，但对于改善患者健康作用有限。本文可为提升基层医务人员慢性病管理质量提供一定的参考。

关键词: 慢性病, 生活方式医学, 健康行为管理, 基层医务人员, 系统综述

Abstract:

Lifestyle prescriptions are essential for managing chronic diseases patients' behaviors and have been recommended in several international guidelines. Primary healthcare workers play a critical role in delivering lifestyle services, yet their competencies are still insufficient. While existing trials indicate that training can enhance healthcare workers' capacity for health behavior management, comprehensive evidence on the effectiveness of lifestyle education interventions remains limited. This paper systematically reviews the current training programs aimed at improving primary healthcare workers' skills in health behavior management, analyzing their content, format, and outcomes. The paper also identifies existing gaps in chronic disease behavior management training and offers recommendations for improvement. It highlights that current training programs inadequately address patient stress, sleep and social engagement, and there is a lack of standardized training on the fundamental theories and skills of behavior change. While educational interventions have shown some effectiveness in enhancing the knowledge and skills of primary healthcare workers, their impact on improving patient health outcomes remains limited. This paper provides valuable insights for enhancing the quality of chronic disease management by primary healthcare workers.

Key words: Chronic diseases, Lifestyle medicine, Health behaviors management, Primary care providers, Systematic review

葛奥淇,高欣怡,李佳威,等. 基层医务人员慢性病健康行为管理能力的培训干预及其效果：系统综述及Meta分析[J]. 中国全科医学, 2026, 29(09): 1109-1120. DOI: 10.12114/j.issn.1007-9572.2024.0722.
GE Aoqi,GAO Xinyi,LI Jiawei, et al. Education Training on Health Behaviors Management of Chronic Diseases among Primary Care Providers: a Systematic Review and Meta-analysis[J]. Chinese General Practice, 2026, 29(09): 1109-1120. DOI: 10.12114/j.issn.1007-9572.2024.0722.

图/表 6

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[86]	JAY M, KALET A, ARK T, et al. Physicians' attitudes about obesity and their associations with competency and specialty: a cross-sectional study[J]. BMC Health Serv Res, 2009, 9: 106. DOI: 10.1186/1472-6963-9-106.
[87]	WESTLAND H, KOOP Y, SCHRÖDER C D, et al. Nurses' perceptions towards the delivery and feasibility of a behaviour change intervention to enhance physical activity in patients at risk for cardiovascular disease in primary care: a qualitative study[J]. BMC Fam Pract, 2018, 19(1): 194. DOI: 10.1186/s12875-018-0888-1.
[88]	LITVAK I, NGUYEN K, PEZZINO N C. Community pharmacists' perceptions on their role in counseling patients on lifestyle modifications[J]. J Am Pharm Assoc, 2023, 63(4S): S57-S63.e2. DOI: 10.1016/j.japh.2022.12.012.
[89]	YAN L L, GONG E Y, GU W B, et al. Effectiveness of a primary care-based integrated mobile health intervention for stroke management in rural China (SINEMA): a cluster-randomized controlled trial[J]. PLoS Med, 2021, 18(4): e1003582. DOI: 10.1371/journal.pmed.1003582.
[90]	JAY M, GILLESPIE C, SCHLAIR S, et al. Physicians' use of the 5As in counseling obese patients: is the quality of counseling associated with patients' motivation and intention to lose weight?[J]. BMC Health Serv Res, 2010, 10: 159. DOI: 10.1186/1472-6963-10-159.

序号	第一作者	试验地点	试验类型	慢性病种类	医务人员类型	样本量及分组情况	干预类型
1	PRESSEAU^[15,16]	英国	整群随机对照试验	2型糖尿病	全科医生、初级保健护士、初级保健助理	干预组：123名（全科医生、护士和医疗助理）和1 124例患者对照组：172名（全科医生、护士和医疗助理）和973例患者	针对医务人员干预
2	CATLEY^[17]	南非	整群随机对照试验	2型糖尿病、高血压	社区卫生工作人员（CHWs）	干预组：240例患者对照组：254例患者	联合干预
3	GONG^[18]	中国	整群随机对照试验	心血管疾病（脑卒中）	乡村医生	干预组：25名乡村医生和637例患者对照组：25名乡村医生和662例患者	联合干预
4	CHEN^{[19,20,21,22]}	中国	整群随机对照试验	2型糖尿病	县乡村三级的医生、护士、公卫人员、糖尿病专家	干预组：132名乡镇卫生院医生和乡村医生，389例患者对照组：109名乡镇卫生院医生和乡村医生，394例患者	联合干预
5	JAFAR^[23]	巴基斯坦	2×2析因设计整群随机对照	高血压	CHWs全科医生	CHWs家庭护理组：6名CHWs，348例患者全科医生培训组：335例患者 CHWs和全科医生联合培训组：332例患者常规对照组：326例患者	联合干预
6	RIDDELL^[24] GAMAGE^[25] ABDEL^[26]	印度	整群随机对照试验	高血压	CHWs	14名社会健康活动家（accredited social health activists, ASHAs）干预组：637例高血压患者对照组：1 097例患者	联合干预
7	KAMATH^[27] XAVIER^[28]	印度	随机对照试验	心血管疾病（急性冠脉综合征）	CHWs	共计16名CHWs全部接受培训干预组：404例患者对照组：401例患者	联合干预
8	SYLAJA^[29]	印度	随机对照试验	心血管疾病（卒中）	CHWs	干预组：114例患者对照组：120例患者	针对医务人员干预
9	LAURITZEN^[30] RASMUSSEN^[31]	丹麦	整群随机对照试验	2型糖尿病[糖耐量受损（IGT）、空腹血糖受损（IFT）患者]	全科医生	干预组：77名全科医生，645例患者对照组：76名全科医生，865例患者	联合干预
10	BALDEÓN^[32]	厄瓜多尔	整群随机对照试验	2型糖尿病高风险者	全科医生、初级保健诊所的内科医生	干预护理组（ICG）：8名医生和125例患者常规护理组（UCG）：7名医生和100例患者	针对医务人员干预
11	JAFAR^[33,34]	新加坡	整群随机对照试验	高血压	全科医生和初级保健护士	干预组：447例患者对照组：469例患者	联合干预
12	LOOIJMANS^[35,36]	荷兰	整群随机对照试验	具有心血管风险因素的重度精神障碍患者	初级保健护士	干预组：82名护士，140例患者对照组：56名护士，104例患者	联合干预
13	KRUIS^[37,38]	荷兰	整群随机对照试验	慢性阻塞性肺疾病（COPD）	全科医生、初级保健护士、理疗师	共计76名全科医生干预组：554例患者对照组：532例患者	针对医务人员干预
14	WESTLAND^[39,40]	荷兰	整群随机对照试验	心血管疾病	初级保健护士	干预组：16名全科医生20名护士和102例患者对照组：15名全科医生16名护士和93例患者	联合干预
15	VAN LIESHOUT^[41] HUNTINK^[42]	荷兰	整群随机对照试验	心血管疾病	全科医生、初级保健护士	干预组：20名执业护士和1 250例患者对照组：14名执业护士和979例患者	联合干预
16	KHETAN^[43]	印度	整群随机对照试验	心血管疾病危险因素的人群（高血压、糖尿病、吸烟）	CHWs	干预组：3名CHWs和736名具有风险因素者对照组：3名CHWs和506名具有风险因素者	联合干预
17	KATON^[44,45]	美国	随机对照试验	2型糖尿病合并抑郁症	全科医生、初级保健护士	151名初级保健护士干预组：106例患者常规护理组：108例患者	联合干预
18	XU^[46]	中国	整群随机对照试验	2型糖尿病	全科医生	干预组：75名全科医生和597例患者对照组：611例患者	联合干预
19	ZUO^[47]	中国	整群随机对照试验	2型糖尿病	全科医生	干预组：189名全科医生和96例患者对照组：95例患者	联合干预
20	TAVAKOLY^[48,49]	伊朗	整群随机对照试验	高血压	全科医生、初级保健护士、营养师	干预组：17名医生和121例患者对照组：18名医生和121例患者	针对医务人员干预
21	RAMALLO-FARIÑA^[50,51]	西班牙	2×2析因设计整群随机对照	2型糖尿病	全科医生	患者及其家属干预组：537例患者医生和护士干预组：654例患者患者和医务人员联合干预：557例患者对照组：586例患者	联合干预、针对患者进行干预、针对医务人员进行干预
22	KRONES^[52]	德国	整群随机对照试验	心血管疾病	家庭医生	干预组：7个继续教育小组，44名家庭医生，550例患者对照组：7个继续教育小组，47名家庭医生，582例患者	针对医务人员干预
23	HEINRICH^[53]	荷兰	整群随机对照试验	2型糖尿病	初级保健护士	干预组：18名护士，287例患者对照组：15名护士，272例患者	针对医务人员干预
24	RUBAK^[54]	丹麦	整群随机对照实验	2型糖尿病	全科医生	干预组：29名全科医生，137例患者对照组：36名全科医生，128例患者	针对医务人员干预
25	JERANT^[55]	美国	随机对照试验	2型糖尿病合并抑郁症	初级保健诊所的家庭医生、普通内科医生	干预组：28名家庭医生和普通内科医生，66例患者对照组：24名家庭医生和普通内科医生，65例患者	针对医务人员干预
26	JANSINK^[56]	荷兰	整群随机对照试验	2型糖尿病	初级保健护士	干预组：30名初级保健护士，229例患者对照组：30名初级保健护士，292例患者	针对医务人员干预
27	WOLLNY^[57]	德国	整群随机对照试验	2型糖尿病	全科医生	干预组：435例患者，54名全科医生对照组：398例患者，54名全科医生	针对医务人员干预
28	TINSEL^[58]	德国	整群随机对照试验	高血压	全科医生	干预组：17名全科医生，552例患者对照组：19名全科医生，568例患者	针对医务人员干预
29	AKTURAN^[59]	土耳其	整群随机对照试验	2型糖尿病	全科医生	干预组：4名家庭医生，57例患者对照组：4名家庭医生，55例患者	针对医务人员干预
30	DREVENHORN^[60]	瑞典	随机对照试验	高血压	初级保健护士	干预组：14名护士，155例患者对照组：14名护士，60例患者	针对医务人员干预
31	STUCKEY^[61] GABBAY^[62]	美国	随机对照试验	2型糖尿病	初级保健护士	共计3名护士接受了培训干预组：232例患者对照组：313例患者	联合干预
32	COOPER^[63,64]	美国	2×2析因设计随机对照试验	高血压	初级保健诊所的家庭医生、普通内科医生	医生强化干预组：22名全科医生，83例患者强化干预，84例患者普通治疗医生最小干预对照组：19名全科医生，57例患者强化干预，55例患者普通治疗	联合干预
33	FREUND^[65,66]	德国	整群随机对照试验	2型糖尿病COPD慢性心力衰竭	全科医生、医疗助理	干预组：69名全科医生，71名医疗助理，1 093例患者对照组：63名全科医生，69名医疗助理，983例患者	联合干预
34	STEURER-STEY^[67] MARKUN^[68]	瑞士	随机对照试验	COPD	全科医生	干预组：16名医生，101例患者对照组：17名全科医生，115例患者	联合干预
35	WALTERS^[69]	澳大利亚	随机对照试验	COPD	初级保健护士	共31名护士干预组：92例患者，18名护士常规护理组：90例患者，13名护士	联合干预
36	KHAN^[70,71,72]	巴基斯坦	整群随机对照实验	COPD	全科医生和初级保健护士	干预组：159例患者，30名医生和护士对照组：154例患者，30名医生和护士	针对医务人员干预

序号	第一作者	试验地点	试验类型	慢性病种类	医务人员类型	样本量及分组情况	干预类型
1	PRESSEAU^[15,16]	英国	整群随机对照试验	2型糖尿病	全科医生、初级保健护士、初级保健助理	干预组：123名（全科医生、护士和医疗助理）和1 124例患者对照组：172名（全科医生、护士和医疗助理）和973例患者	针对医务人员干预
2	CATLEY^[17]	南非	整群随机对照试验	2型糖尿病、高血压	社区卫生工作人员（CHWs）	干预组：240例患者对照组：254例患者	联合干预
3	GONG^[18]	中国	整群随机对照试验	心血管疾病（脑卒中）	乡村医生	干预组：25名乡村医生和637例患者对照组：25名乡村医生和662例患者	联合干预
4	CHEN^{[19,20,21,22]}	中国	整群随机对照试验	2型糖尿病	县乡村三级的医生、护士、公卫人员、糖尿病专家	干预组：132名乡镇卫生院医生和乡村医生，389例患者对照组：109名乡镇卫生院医生和乡村医生，394例患者	联合干预
5	JAFAR^[23]	巴基斯坦	2×2析因设计整群随机对照	高血压	CHWs全科医生	CHWs家庭护理组：6名CHWs，348例患者全科医生培训组：335例患者 CHWs和全科医生联合培训组：332例患者常规对照组：326例患者	联合干预
6	RIDDELL^[24] GAMAGE^[25] ABDEL^[26]	印度	整群随机对照试验	高血压	CHWs	14名社会健康活动家（accredited social health activists, ASHAs）干预组：637例高血压患者对照组：1 097例患者	联合干预
7	KAMATH^[27] XAVIER^[28]	印度	随机对照试验	心血管疾病（急性冠脉综合征）	CHWs	共计16名CHWs全部接受培训干预组：404例患者对照组：401例患者	联合干预
8	SYLAJA^[29]	印度	随机对照试验	心血管疾病（卒中）	CHWs	干预组：114例患者对照组：120例患者	针对医务人员干预
9	LAURITZEN^[30] RASMUSSEN^[31]	丹麦	整群随机对照试验	2型糖尿病[糖耐量受损（IGT）、空腹血糖受损（IFT）患者]	全科医生	干预组：77名全科医生，645例患者对照组：76名全科医生，865例患者	联合干预
10	BALDEÓN^[32]	厄瓜多尔	整群随机对照试验	2型糖尿病高风险者	全科医生、初级保健诊所的内科医生	干预护理组（ICG）：8名医生和125例患者常规护理组（UCG）：7名医生和100例患者	针对医务人员干预
11	JAFAR^[33,34]	新加坡	整群随机对照试验	高血压	全科医生和初级保健护士	干预组：447例患者对照组：469例患者	联合干预
12	LOOIJMANS^[35,36]	荷兰	整群随机对照试验	具有心血管风险因素的重度精神障碍患者	初级保健护士	干预组：82名护士，140例患者对照组：56名护士，104例患者	联合干预
13	KRUIS^[37,38]	荷兰	整群随机对照试验	慢性阻塞性肺疾病（COPD）	全科医生、初级保健护士、理疗师	共计76名全科医生干预组：554例患者对照组：532例患者	针对医务人员干预
14	WESTLAND^[39,40]	荷兰	整群随机对照试验	心血管疾病	初级保健护士	干预组：16名全科医生20名护士和102例患者对照组：15名全科医生16名护士和93例患者	联合干预
15	VAN LIESHOUT^[41] HUNTINK^[42]	荷兰	整群随机对照试验	心血管疾病	全科医生、初级保健护士	干预组：20名执业护士和1 250例患者对照组：14名执业护士和979例患者	联合干预
16	KHETAN^[43]	印度	整群随机对照试验	心血管疾病危险因素的人群（高血压、糖尿病、吸烟）	CHWs	干预组：3名CHWs和736名具有风险因素者对照组：3名CHWs和506名具有风险因素者	联合干预
17	KATON^[44,45]	美国	随机对照试验	2型糖尿病合并抑郁症	全科医生、初级保健护士	151名初级保健护士干预组：106例患者常规护理组：108例患者	联合干预
18	XU^[46]	中国	整群随机对照试验	2型糖尿病	全科医生	干预组：75名全科医生和597例患者对照组：611例患者	联合干预
19	ZUO^[47]	中国	整群随机对照试验	2型糖尿病	全科医生	干预组：189名全科医生和96例患者对照组：95例患者	联合干预
20	TAVAKOLY^[48,49]	伊朗	整群随机对照试验	高血压	全科医生、初级保健护士、营养师	干预组：17名医生和121例患者对照组：18名医生和121例患者	针对医务人员干预
21	RAMALLO-FARIÑA^[50,51]	西班牙	2×2析因设计整群随机对照	2型糖尿病	全科医生	患者及其家属干预组：537例患者医生和护士干预组：654例患者患者和医务人员联合干预：557例患者对照组：586例患者	联合干预、针对患者进行干预、针对医务人员进行干预
22	KRONES^[52]	德国	整群随机对照试验	心血管疾病	家庭医生	干预组：7个继续教育小组，44名家庭医生，550例患者对照组：7个继续教育小组，47名家庭医生，582例患者	针对医务人员干预
23	HEINRICH^[53]	荷兰	整群随机对照试验	2型糖尿病	初级保健护士	干预组：18名护士，287例患者对照组：15名护士，272例患者	针对医务人员干预
24	RUBAK^[54]	丹麦	整群随机对照实验	2型糖尿病	全科医生	干预组：29名全科医生，137例患者对照组：36名全科医生，128例患者	针对医务人员干预
25	JERANT^[55]	美国	随机对照试验	2型糖尿病合并抑郁症	初级保健诊所的家庭医生、普通内科医生	干预组：28名家庭医生和普通内科医生，66例患者对照组：24名家庭医生和普通内科医生，65例患者	针对医务人员干预
26	JANSINK^[56]	荷兰	整群随机对照试验	2型糖尿病	初级保健护士	干预组：30名初级保健护士，229例患者对照组：30名初级保健护士，292例患者	针对医务人员干预
27	WOLLNY^[57]	德国	整群随机对照试验	2型糖尿病	全科医生	干预组：435例患者，54名全科医生对照组：398例患者，54名全科医生	针对医务人员干预
28	TINSEL^[58]	德国	整群随机对照试验	高血压	全科医生	干预组：17名全科医生，552例患者对照组：19名全科医生，568例患者	针对医务人员干预
29	AKTURAN^[59]	土耳其	整群随机对照试验	2型糖尿病	全科医生	干预组：4名家庭医生，57例患者对照组：4名家庭医生，55例患者	针对医务人员干预
30	DREVENHORN^[60]	瑞典	随机对照试验	高血压	初级保健护士	干预组：14名护士，155例患者对照组：14名护士，60例患者	针对医务人员干预
31	STUCKEY^[61] GABBAY^[62]	美国	随机对照试验	2型糖尿病	初级保健护士	共计3名护士接受了培训干预组：232例患者对照组：313例患者	联合干预
32	COOPER^[63,64]	美国	2×2析因设计随机对照试验	高血压	初级保健诊所的家庭医生、普通内科医生	医生强化干预组：22名全科医生，83例患者强化干预，84例患者普通治疗医生最小干预对照组：19名全科医生，57例患者强化干预，55例患者普通治疗	联合干预
33	FREUND^[65,66]	德国	整群随机对照试验	2型糖尿病COPD慢性心力衰竭	全科医生、医疗助理	干预组：69名全科医生，71名医疗助理，1 093例患者对照组：63名全科医生，69名医疗助理，983例患者	联合干预
34	STEURER-STEY^[67] MARKUN^[68]	瑞士	随机对照试验	COPD	全科医生	干预组：16名医生，101例患者对照组：17名全科医生，115例患者	联合干预
35	WALTERS^[69]	澳大利亚	随机对照试验	COPD	初级保健护士	共31名护士干预组：92例患者，18名护士常规护理组：90例患者，13名护士	联合干预
36	KHAN^[70,71,72]	巴基斯坦	整群随机对照实验	COPD	全科医生和初级保健护士	干预组：159例患者，30名医生和护士对照组：154例患者，30名医生和护士	针对医务人员干预

结局指标	研究数量	受试者例数	异质性检验		效应模型	Meta分析		亚组间差异P值
结局指标	研究数量	受试者例数	I²	P值	效应模型	效应量（95%CI）	P值	亚组间差异P值
HbA_1c	11	5 372	83%	<0.001	随机	-0.20（-0.34~-0.05）	0.008	0.018
医务人员单独干预	5	2 257	51%	0.089		-0.03（-0.15~0.09）	0.659
联合干预	6	3 115	80%	<0.001		-0.33（-0.36~-0.11）	0.003
SBP	17	11 353	69%	<0.001	随机	-2.15（-3.42~-0.88）	0.001	0.005
医务人员单独干预	6	3 069	32%	0.195		-0.13（-1.68~1.42）	0.868
联合干预	11	8 284	69%	<0.001		-3.26（-4.77~-1.75）	<0.001

结局指标	研究数量	受试者例数	异质性检验		效应模型	Meta分析		亚组间差异P值
结局指标	研究数量	受试者例数	I²	P值	效应模型	效应量（95%CI）	P值	亚组间差异P值
HbA_1c	11	5 372	83%	<0.001	随机	-0.20（-0.34~-0.05）	0.008	0.018
医务人员单独干预	5	2 257	51%	0.089		-0.03（-0.15~0.09）	0.659
联合干预	6	3 115	80%	<0.001		-0.33（-0.36~-0.11）	0.003
SBP	17	11 353	69%	<0.001	随机	-2.15（-3.42~-0.88）	0.001	0.005
医务人员单独干预	6	3 069	32%	0.195		-0.13（-1.68~1.42）	0.868
联合干预	11	8 284	69%	<0.001		-3.26（-4.77~-1.75）	<0.001

结局指标	研究数量	受试者例数	异质性检验		效应模型	Meta分析		亚组间差异P值
结局指标	研究数量	受试者例数	I²	P值	效应模型	效应量（95%CI）	P值	亚组间差异P值
HbA_1c	11	5 372	83%	<0.001	随机	-0.20（-0.34~-0.05）	0.008	0.034
<10 h	4	2 032	75%	0.019		-0.03（-0.18~0.12）	0.687
10 h及以上	7	3 340	80%	0.001		-0.29（-0.49~-0.10）	0.003
SBP	17	11 353	69%	<0.001	随机	-2.15（-3.42~-0.88）	0.001	0.064
<10 h	6	4 992	66%	0.011		-0.85（-2.55~0.85）	0.327
10 h及以上	11	6 361	62%	0.004		-3.05（-4.65~-1.46）	0.001