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山东大学学报 (医学版) ›› 2019, Vol. 57 ›› Issue (8): 89-94.doi: 10.6040/j.issn.1671-7554.0.2018.1079

• • 上一篇    

厦门市糖尿病“三师共管”模式的卫生经济学评价

曾雁冰,王秋鹏,方亚   

  1. 厦门大学公共卫生学院, 福建 厦门 361102
  • 发布日期:2022-09-27
  • 通讯作者: 方亚. E-mail:fangya@xmu.edu.cn
  • 基金资助:
    国家自然科学基金(81573257,71874147)

Health economic evaluation of “co-management of doctors of three kinds”of diabetes patients in Xiamen

ZENG Yanbing, WANG Qiupeng, FANG Ya   

  1. School of Public Health, Xiamen University, Xiamen 361102, Fujian, China
  • Published:2022-09-27

摘要: 目的 对厦门市糖尿病“三师共管”模式进行卫生经济学评价,了解该模式的效果。 方法 2016年7月至8月从厦门市随机抽取5个社区的糖尿病患者,以“三师共管”满1年的糖尿病患者为干预组、同期常规慢病管理患者为对照组,采用自行设计的问卷开展调查;测算项目成本和疾病经济负担,并以糖化血红蛋白(HbA1c)控制率、餐后2 h血糖控制率、双向转诊下转率、社区首诊率、糖尿病知识达标率、自我管理达标率等为效果指标进行增量成本效果分析,以因干预而减轻的疾病经济负担为净效益进行增量成本效益分析。 结果 共调查800例糖尿病患者,获得有效问卷798份,有效回收率为99.75%,其中,干预组413例,对照组385例。干预1年后,干预组HbA1c、餐后2 h血糖控制达标率分别为74.8%、79.9%,相较于对照组的41.0%、66.0%均有明显上升(t值分别为86.63、19.14,P均<0.05),双向转诊意愿和社区首诊意愿上升、糖尿病知识和自我管理达标率也显著上升(t值分别为12.59、82.42、12.54、10.40,P均<0.05)。干预组人均疾病经济负担为5 569元/年,比对照组少1 412元/年。增量成本效果分析显示,HbA1c控制率增加1%的成本为15.04元/人年,餐后2 h血糖控制率增加1%的成本为36.47元/人年;双向转诊、社区首诊率以及糖尿病知识、自我管理达标率增加1%的成本分别为51.57、16.73、40.00和47.34元/人年。增量成本效益分析显示,增量成本效益比为2.78。 结论 与社区常规慢病管理相比,糖尿病“三师共管”模式的1年干预效果良好,并且具有较好的成本效果和成本效益。

关键词: 2型糖尿病, 三师共管, 卫生技术评估, 增量成本效果, 增量成本效益

Abstract: Objective To examine the short-term effect of “co-management of doctors of three kinds” on diabetes patients in Xiamen and make short-term cost-effectiveness and cost-benefit analysis. Methods A cross-sectional survey was performed among community residents with T2DM in Xiamen from July to August in 2016. Diabetes patients who had been in the “co-management of doctors of three kinds” for 1 year were enrolled in intervention group, and patients with chronic disease management during the same period were enrolled in control group. Questionnaires were designed to collect the information of the patients. The cost of intervention was measured. The effectiveness indexes included biochemical indicators, hierarchical medical indicators, knowledge of diabetes, diabetes self-management, and quality of life. The benefit was measured by the reduction of economic burden in “co-management of doctors of three kinds”. Results Eight hundred community residents were investigated in the study, and 798 valid questionnaires were collected(99.75%). Among them, there were 413 patients in intervention group and 385 in control group. After 1 years management, the control rates of hemoglobin A1c(HbA1c)levels and 2 h postprandial plasma glucose in intervention group 山 东 大 学 学 报 (医 学 版)57卷8期 -曾雁冰,等. 厦门市糖尿病“三师共管”模式的卫生经济学评价 \=-(74.8%, 79.9%)were significantly higher than those in control group(41.0%, 66.0%)(t=86.63, 19.14; all P<0.05). Besides, the rates of community first diagnosis and two-way referral,the knowledge of diabetes and the ability of self-management were all improved(t=12.59,82.42,12.54,10.40; all P<0.05). Per capita economic burden of disease in intervention group was 5 569 yuan per year, which was 1 412 yuan less than that in control group. One year after the intervention, the cost of intervention was 15.04 yuan per person per year for increasing the biochemical index such as HbA1c control rate by 1%. The cost of 1% increase of 2 hours postprandial blood glucose was 36.47 yuan per person per year. Hierarchical medical indicators such as two-way referral, community first visit rate, knowledge of diabetes and self-management compliance rate of 1% increase were 51.57,16.73,40.00 and 47.34 yuan per person per year, respectively. The incremental cost-benefit ratio was 2.78. Conclusion Compared with routine management, short-term intervention of “co-management of doctors of three kinds” can significantly improve T2DM patients glucose controlling, knowledge of diabetes, self-management, community first diagnosis and two-way referral. It can also significantly decrease the economic burden of disease. Thus the model shows better cost-effectiveness and cost-benefit for diabetes patients.

Key words: Type Ⅱ diabetes, Co-management of doctors of three kinds, Health technology assessment, Incremental cost effectiveness, Incremental cost-benefit

中图分类号: 

  • R197.1
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