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

摘要： 目的　探讨医务人员执业类别对社区糖尿病管理效果的影响。方法　于2012年1月—2013年1月，选取上海市黄浦区五里桥社区接受社区管理的糖尿病患者415例。先随机分为对照组和联合管理组，然后再将各组随机分为全科医生管理组和非全科医生管理组，即最终分为全科医生管理对照组（n=78）、非全科医生管理对照组（n=122）、全科医生联合管理组（n=122）及非全科医生联合管理组（n=93）。对照组患者采用社区常规管理模式，联合管理组采用全科-专科联合管理模式；全科医生管理组由全科医生负责糖尿病患者的全程管理，非全科医生管理组由目前参与慢性病随访工作的护士和公共卫生人员负责糖尿病患者的全程管理。比较4组患者的管理效果，并探讨执业类别、管理模式对管理效果的影响。结果　4组患者BMI、餐后2 h血糖（2 hPG）、总胆固醇（TC）、三酰甘油（TG）管理前后差值比较，差异无统计学意义（P>0.05）；腰臀比、收缩压、舒张压、空腹血糖（FPG）、糖化血红蛋白（HbA1c）管理前后差值比较，差异有统计学意义（P<0.05）。多元线性回归分析结果显示，管理模式、执业类别对上述效果指标的影响无统计学意义（P>0.05）。将一般资料作为协变量纳入回归分析模型后，结果显示，管理模式对舒张压、FPG、HbA1c的影响有统计学意义（P<0.05）；而执业类别对效果指标的影响无统计学意义（P>0.05）。将无效交互项从原模式剔除后，结果显示，管理模式对收缩压、FPG、HbA1c的影响有统计学意义（P<0.05）；而执业类别对效果指标的影响无统计学意义（P>0.05）。结论　管理模式决定了社区糖尿病管理效果，而医务人员执业类别并非其影响因素。鼓励有医疗工作背景的工作人员通过规范化培训成为合格社区慢性病管理者，依托区域医疗联合体的专业支持、结合家庭医生责任制、以团队协作方式开展社区糖尿病管理，有助于提高社区慢性病管理的人员配置率。

关键词: 糖尿病, 社区卫生服务, 健康管理, 医务人员, 执业类别