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目的比较常规医院治疗糖尿病和社区糖尿病患者管理的效果及患者花费,为糖尿病患者找到一条合理就医途径。方法选取成都市1所二级医院和1所社区卫生服务中心的糖尿病患者为研究对象,开展为期1年5次追踪调查,了解患者血糖、糖化血红蛋白控制情况以及年度治疗费用使用情况,总共206例完成了此次追踪调查。结果医院组糖尿病患者年平均直接医疗费用为4 850.66元,社区组为2 439.16元,医院组在1年治疗总费用及其门诊和住院费用上的花费均高于社区组,差异有统计学意义(P<0.05)。基线时医院组患者血糖控制情况比社区组患者差,经1年治疗后,医院组患者血糖控制良好率为27%,控制一般率为52%,糖化血红蛋白控制良好率为16%,控制一般率为84%,社区组患者经1年管理后,血糖控制良好率为45.28%,控制一般率为16.04%,糖化血红蛋白控制良好率为48.11%,控制一般率为35.85%,两组患者终期调查血糖和糖化血红蛋白控制率经统计学检验差异无统计学意义(P>0.05)。社区组成本-效果比均低于医院组,差异有统计学意义(P<0.05)。结论社区卫生服务中心在糖尿病患者管理中相对患者来说比医院有更大的费用优势,但对于血糖或糖化血红蛋白控制不良的患者来说,医院控制效果更好。因此在医院和社区之间建立有效的双向转诊通道对糖尿病防治具有良好的意义。
Objective To compare the effect of management of patients with diabetes and community-based diabetes mellitus and the cost of patients in routine hospitals to find a reasonable way to seek medical treatment for patients with diabetes. Methods A total of 206 patients with diabetes from a secondary hospital and a community health service center in Chengdu were enrolled in this study. The follow-up survey was conducted for 1 year and 5 times to understand the control of patients’ blood glucose and glycosylated hemoglobin, as well as the annual treatment cost. Completed the follow-up survey. Results The annual average direct medical costs of diabetic patients in hospital group were 4 850.66 yuan and those in community group were 2 439.16 yuan. The total cost of hospitalization and outpatient and inpatient expenses in hospital group were higher than those in community group with statistically significant difference (P <0.05). At baseline, patients in the hospital group had worse glycemic control than patients in the community group. After 1 year of treatment, the patients in the hospital group had a good rate of control of blood glucose of 27%, a control rate of 52% and a good rate of glycosylated hemoglobin control of 16% Was 84%. After 1-year administration, the community-based patients had a good rate of glycemic control of 45.28%, a control rate of 16.04%, a good rate of glycylated hemoglobin control of 48.11% and a control rate of 35.85%. The final phase of the two groups Blood glucose and glycosylated hemoglobin control rate by statistical tests showed no significant difference (P> 0.05). Community cost-effectiveness ratio were lower than the hospital group, the difference was statistically significant (P <0.05). Conclusion Community health centers are more cost-effective than hospitals in managing patients with diabetes, but hospital controls are better for those with poor glycemic or glycosylated hemoglobin control. Therefore, establishing an effective two-way referral channel between hospitals and communities is of great significance for the prevention and treatment of diabetes.