摘要
目的探讨社康中心进行心血管疾病患者脑卒中危险分层的可能性及与三甲医院双向转诊的模式。方法选取社区心血管疾病的脑卒中风险人群2000例为研究对象,在社康中心采用氟明翰卒中风险评估量表进行首次危险分层后转送三甲医院进行二次危险分层,比较两次危险分层差异性,随机将患者分为两组,均由心内科医师制定治疗干预方案,其中社康中心干预组1126例后期在社康中心随访和调整方案,三甲医院干预组874例在三甲医院随访和调整方案,观察比较两组患者6个月及1年相互转诊状况及干预治疗率,达标率。结果社康中心与三甲医院对脑卒中风险分层无统计学差异(x2=0.157,P>0.05),干预随访6个月及1年由三甲医院转诊至社康中心者高于由社康中心转诊至三甲医院者(x2=42.341、26.570,P<0.05),社康中心血压控制率为69.8%,三甲医院血压控制率为73.1%,差异无统计学意义(x2=0.712,P>0.05)。结论在社康中心对脑卒中风险人群进行危险分层筛查准确率良好,建立与三甲医院双向转诊的便利通道,以三甲医院心内科医生干预方案为基础,干预患者后期治疗和随访,具有良好的社会价值和经济价值,值得推广应用。
Objective To explore the possibility of risk stratification of cardiovascular stroke disease of patients and two-way referral clinic patterns of the third top hospital in community health center. Methods 2000 cases of cardiovascular stroke risk population in community were selected as the study objects, the first risk stratification was used Framingham stroke risk assessment table to layer in community health center ,then they were transferred into the third top hospital for the secondary risk stratification., the differences of two risk stratifications were compared , the patients were randomly divided into two groups, intervention program was made in the department of Cardiology by physicians, 1126 cases of the intervention group in the later period in the community health center were given followed- up and adjusted scheme in community health center , 874 cases of the intervention group in the third top hospital were followed- up and adjusted program in the three- top hospital, referral status and intervention treatment rate ,and reaching standard rate of patients of two groups of 6 months and 1 year were observed and compared . Results There was no statistical difference on stroke risk stratification of community health center and three- top hospital（x2=0.157, P 〉 0.05）, patients after intervention -followed-up 6 months and 1 year , from the third- top hospital referral to community health center higher than those from community health center referral to three- top hospital（x2=42.341,26.570,P 〈 0.05）, blood pressure control rates of social health center was 69.8%, blood pressure control rate of the top-third-hospital was 73.1%, the difference was not statistically significant （x2=0.712, P 〉 0.05）. Conclusion Accuracy rate of risk stratification screening of patients with stroke in social health center is good, a convenient access of the two-way referral of the third- top hospital is established, intervention program of physicians of the third-top hospital is a basis , intervention of late treatment and following-up of patients has a good social and economic value, it is worthy of promotion and application.
出处
《中国医药科学》
2016年第2期139-142,共4页
China Medicine And Pharmacy
基金
广东省深圳市科技创新项目(JCYJ20130401111602448)
关键词
脑卒中
预防
转诊
社康中心
Cerebral stroke
Prevention
Referral
Social health center
