关键词: 糖尿病, 社区卫生服务, 健康管理, 医务人员, 执业类别

Abstract: Objective　To investigate the influence of practicing categories of medical staff on community diabetes management effects.Methods　From January 2012 to January 2013,415 diabetes patients who received community management in Wuliqiao Community in Huangpu District of Shanghai were selected.Firstly they were randomly divided into control group and joint management group,and then were divided into general practitioners management group and non general practitioners management group randomly.Finally the grouping results were control group of general practitioners management（n=78） and control group of non general practitioners management（n=122）,joint management group of general practitioners（n=122） and joint management group of non general practitioners（n=93）.Patients in control group applied community conventional management mode,while patients in joint management group adopted joint management mode of general practice-specialist;general practitioners were responsible for the whole management process of diabetic patients in general practitioners management group,nurses and public health practitioners who were currently participated in the follow-up of chronic diseases were responsible for the whole management process of diabetic patients in non general practitioners management group.The management effects of patients in 4 groups were compared,and influence of practicing categories and management mode on management effects were discussed.Results　There was no significant difference in BMI,2-hour postprandial blood glucose（2 hPG）,total cholesterol（TC） and triacylglycerol（TG） of patients in four groups before and after management（P>0.05）;there was significant difference in difference value of waist-hip ratio,systolic blood pressure,diastolic blood pressure,fasting blood glucose（FPG） and glycosylated hemoglobin（HbA1c） before and after management（P<0.05）.The results of multiple linear regression analysis showed that the above indices were not significantly influenced by management mode and practicing categories（P>0.05）.After the general data included in the regression analysis model as a covariate,the results showed that management mode significantly influenced diastolic blood pressure,FPG and HbA1c（P<0.05）;while effectiveness indices were not significantly influenced by practicing categories（P>0.05）.After removing the invalid interaction item in the original mode,the results showed that systolic blood pressure,FPG and HbA1c were significantly influenced by management mode（P<0.05）;while effectiveness indices were not significantly influenced by practicing categories（P>0.05）.Conclusion　The management effects of community diabetes patients is determined by management mode,and practicing categories of medical staffs are not the influencing factors of it.Encourage the staffs with medical working background to be eligible managers of chronic diseases.Relying on the professional support of regional medical association,combining the responsibility system of family doctors and carrying out the community diabetes management by way of team cooperation can help increase the staffing rate of community chronic diseases management.

Key words: Diabetes mellitus, Community health services, Health management, Medical staff, Practicing categories