Effectiveness analysis of intensive management of dyslipidemia in community based on family doctor contracting service / 中华健康管理学杂志

ABSTRACT

Objective@#To analysis of the effect of strengthening management of dyslipidemia in community based on family doctor contracting service.@*Methods@#In December 2014, 1267 cases patients with dyslipidemia aged over 18 years were selected from three community health service centers in Hangzhou, including 645 in intervention group (311 males and 334 females) and 622 in control group (307 males and 315 females). In the intervention group, the management of dyslipidemia in community was strengthened by graded follow-up and personalized diagnosis and treatment based on the contracted services of family doctors, while the control group adopted the general management of dyslipidemia in the community. After 12 months of intervention, the changes of lifestyle (smoking, drinking, body mass index, waist circumference), regularly taking lipid-regulating drugs, blood lipid, blood pressure, blood sugar levels and their control rates were compared by χ2 test or t test before and after intervention between the intervention group and the control group. Non-conditional logistic regression analysis was used to analyze the influencing factors of blood lipid attainment.@*Results@#Before intervention, there were no significant differences in gender, age, cardiovascular risk stratification, the levels of lipid and other metabolic indicators, lipid compliance rate between intervention group and control group (P> 0.05). After intervention, the intervention group improved in drinking, overweight,obesity, abdominal obesity, and the rate of regularly taking lipid-regulating drugs increased,compared with the control group, the difference was statistically significant (χ2=5.923,4.765,8.587,5.341, 5.654; all P<0.05). The levels of total cholesterol, triglyceride, low density lipoprotein cholesterol, body mass index, waist circumference, systolic blood pressure, diastolic blood pressure, fasting blood glucose, glycosylated hemoglobinin the intervention group were lower than those in the control group, the differences were statistically significant (t=-4.987,-3.207, -6.280, -3.339, -2.466, -4.052, -5.012, -2.865, -2.450; all P<0.05), while the HDL-C level in the intervention group was higher than that in the control group (t=2.294; P<0.05). The control rate of blood lipids, the control rate of blood pressure, and the combined control rates of blood lipid, blood pressure and blood sugar in the intervention group were higher than those in the control group, the differences were all significant (χ2=31.262,4.818,17.245; all P<0.05). Unconditional logistic regression analysis showed that family doctor contracted services (OR=1.961, 95%CI 1.485-2.589), gender (OR=0.662, 95%CI 0.471-0.930), smoking (OR=0.498, 95%CI 0.332-0.745), obesity (OR=0.570, 95%CI 0.359-0.904), hypertension (OR=0.353, 95%CI 0.259-0.480), diabetes mellitus (OR=0.340, 95%CI 0.239-0.483) was the influencing factor of blood lipid reaching the target (all P<0.05).@*Conclusion@#Intensive management of dyslipidemia in community based on family doctor's contracting service is helpful to improve the management effect of dyslipidemia.