Abstract: Background　Chronic insomnia is a common type of sleep disorder，which has a negative impact on daily life，work，and even leads to accidents. Community-based interventions play an important role in managing it effectively.  Objective　To estimate the effect of the closed-loop management by family physician team on patients with chronic insomnia. Methods　From January to June in 2018，420 patients with chronic insomnia who had contracted family doctors in Yuetan Community Health Service Center and its subordinate health service stations were selected by convenience sampling method. The patients were equally assigned and followed up for 6 months by single blind and random allocation method. The patients who could not complete the study and lost the follow-up due to diseases and other reasons were excluded. Finally，203 cases in the control group and 178 cases in the intervention group were included. The intervention group received closed-loop management ofamily physician team，while the control group received "medical care prevention" team management. The Pittsburgh Sleep Quality Index（PSQI） and PHQ-9 scores were compared between the two groups before and after the intervention. Results　The mean scores of PSQI and PHQ-9 showed no significant intergroup differences either before or after treatment（P>0.05）. But self-controlled comparisons revealed that the control group had significantly different PSQI and PHQ-9 scores（P<0.05），and so did the intervention group（P<0.05）. Conclusion　The closed-loop management by family physician team improved the quality of sleep and reduced depression in patients with chronic insomnia，which may be a promising community service delivery model.

Key words: Chronic insomnia, Family physicians team, Community health services, Closed-loop management, Pittsburgh Sleep Quality Index , Patient Health Questionnaire-9

摘要： 背景　慢性失眠作为睡眠障碍的常见类型，对日常生活和工作有较大负面影响，甚至导致恶性意外事故，社区层面的有效管理起着重要作用。目的　评价基层家庭医生团队闭环路径管理对慢性失眠患者的干预效果。方法　于2018年1—6月在月坛社区卫生服务中心及其下属卫生服务站就诊的已签约家庭医生的慢性失眠患者中，以便利抽样法抽取420例。采用单盲、随机分配法，将患者平均分配并干预随访6个月，排除因疾病等自身原因无法完成本研究和失访者，最终纳入对照组203例，干预组178例。干预组进行家庭医生团队闭环路径管理，对照组进行“医-护-防”团队管理。比较两组干预前和干预后的匹兹堡睡眠质量指数（PSQI）等级、患者健康问卷抑郁量表（PHQ-9）得分情况。结果　干预前两组PSQI等级、PHQ-9得分比较，差异无统计学意义（P>0.05）；干预后两组PSQI等级、PHQ-9得分比较，差异无统计学意义（P>0.05）；对照组干预前和干预后PSQI等级、PHQ-9得分比较，差异有统计学意义（P<0.05）；干预组干预前和干预后PSQI等级、PHQ-9得分比较，差异有统计学意义（P<0.05）。结论　家庭医生团队闭环路径管理能够提高慢性失眠患者的睡眠质量降低抑郁发生率，在今后社区服务模式发展中具有一定的优势。

关键词: 慢性失眠, 家庭医生团队, 社区卫生服务, 闭环管理路径, 匹兹堡睡眠质量指数, 患者健康问卷抑郁量表