Effectiveness of general practitioner team contracted service in management of patients with type 2 diabetes mellitus

Abstract

Objective To evaluate the effectiveness of general practitioner contracted service in management of patients with type 2 diabetes mellitus (T2DM) in the community. Methods From January 2012 to April 2017, 1 625 patients of T2DM (766 males and 859 females with an average age of 62.9 years) were treated in Xinjiekou Community Health Service Center. They were managed by a contracted general practitioner team for one consecutive year, including initial assessment, patient education, disease follow-up and annual assessment. Four classes of diabetes and hypertension knowledge were given, patient self-assessment and nursing scoring were conducted before and after the education, including healthy life habits, diet and exercise. Family self-assessment, knowledge and skills in monitoring blood pressure, blood glucose, drug use, and risk prevention were carried out. Data collection and analysis were based on quarterly and annual follow-up tables. Results Before and after management, the mean BMI of 1 625 patients was (25.0±3.1) and (24.6±3.1) kg/m2 (t=13.25, P=0.001), systolic blood pressure was (133.3±10.0) and (122.7±7.7) mmHg (1 mmHg=0.133 kPa, t=43.84, P=0.001), diastolic blood pressure was (82.7±22.1) and (76.1±13.5) mmHg (t=10.46, P=0.001), fast blood glucose was (7.2±2.5) and (6.2±0.9) mmol/L (t=18.50, P=0.001), 2 h-postprandial blood glucose was (9.1±2.1) and (7.8±1.9) mmol/L (t=23.39, P=0.001) and glycated hemoglobin (HbA1c) was (6.8±1.1) and (6.3±2.2)% (t=8.68, P=0.001), all were decreased significantly after management. After management the rates of HbA1c, fasting blood glucose and 2 h-postprandial blood glucose reached the standard were increased (χ2=345.57, P=0.001; χ2=235.13, P=0.001; χ2=354.28, P=0.001). The rates of aerobic exercise, the proportion of 3-5 times a week, exercise time 30-60 minutes/time increased (χ2=1 245.58, P=0.001; χ2=158.38, P=0.001; χ2=264.26, P=0.001). The rates of smoking, drinking, eating fried food, saltiness food, sweetness food decreased (χ2=13.92, P=0.001; χ2=23.88, P=0.001; χ2=311.71, P=0.001; χ2=674.31, P=0.001; χ2=247.86, P=0.001). After management, the rates of blood pressure, blood glucose and waist circumference self-measurement; using food scales, staple measuring, salt spoon, oil spoon and kettle, pedometer were increased significantly. The scores of health, ability, knowledge and comprehensive evaluation after management were also increased significantly (40.3±6.0 vs. 20.9±11.0, t=76.46, P<0.001; 36.4±7.8 vs. 19.4±9.2, t=75.99, P<0.001; 14.8±3.3 vs. 7.6±4.4, t=51.03, P<0.001; 91.5±11.7 vs. 48.0±20.3, t=89.54, P<0.001). Conclusion The general practitioner team can effectively improve the self-management ability and achieve better clinical effect in T2DM patients. Key words: Diabetes mellitus, type 2; Community health services; Diseases management