Page 89 - 2022-25-中国全科医学

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【Abstract】 Background Osteoarthritis is a common chronic disease in middle-aged and elderly people，which
seriously affects their quality of life. Carrying out community-based management of osteoarthritis is conducive to the optimization
of healthcare resource allocation and the improvement of the overall prevention and treatment level of osteoarthritis. However，
current community-based management of osteoarthritis has many problems and is not effectively. Objective To perform a review
and comparative analysis of the developments in foreign and domestic community-based management of osteoarthritis，and
strategies addressing the existing problems，providing evidence for improving strategies regarding community-based management
of osteoarthritis to improve the treatment and prognosis of osteoarthritis patients in China. Methods From October 2020 to January
2021，Studies related to osteoarthritis management in Chinese published from January 1，2010 to January 1，2020 were searched
from databases of CNKI，Wanfang Data and CQVIP using " 骨关节炎 " plus " 管理 "，" 骨关节炎 " plus " 模式 "，" 骨关节炎 " plus
" 策略 " as the search terms，and those in English published during the same period were searched from databases of PubMed，Web
of Science，and the Cochrane Library using osteoarthritis and management，mode or strategy as the search terms. After excluding
duplicates or those about self-management of osteoarthritis，the enrolled studies about community-based management of osteoarthritis
were analyzed using systematic analysis. Results Altogether，2 695 studies were retrieved，2 642 of them were excluded，and the
other 53 were included. Five studies were about surveys on the management of osteoarthritis in the community，all of which revealed
the lack of coordination and purpose in community-based management of osteoarthritis at home and abroad，and the key treatments
are relieving symptoms，delaying cartilage degradation，and reducing the possibility of developing deformities，but the efficacies of
such treatments were unsatisfactory，and symptoms often recurred. Moreover，community-based management modes of osteoarthritis
in China were undiversified，mostly were various types of health education. Six studies proposed that the management of osteoarthritis
in the community may be influenced by insufficient understanding of osteoarthritis in patients and their families，insufficient
understanding and undervaluing of osteoarthritis in some primary care physicians，and uncoordinated healthcare resources，and put
forward that a variety of factors led to the lack of coordination and purpose in the management of osteoarthritis in the community. There
were three articles referring the significance of community-based osteoarthritis management，which highlighted that community-
based osteoarthritis management could relieve pain，delay disease progression，and improve the quality of life in patients，and
improve patients' satisfaction with treatment and services by healthcare professionals，as well as optimize the use of healthcare
resources. There were 39 studies related to the strategies for community-based osteoarthritis management，22 of which involved
systematic management strategies，including 18 studies of multi-disciplinary or integrated management models and four studies of
hierarchical management. As a whole，China's successful experience of managing diabetes and hypertension in the community has
provided new ideas for the prevention and treatment of osteoarthritis，but most of the strategies were in the developmental stage，
and their applications in practice needed further research. The remaining 17 studies involved various non-systematic community-
based management strategies of osteoarthritis，including eight centering on health education，three focusing on internet-based
management approaches，two involving telephone-based management，two focusing on non-drug management，and two focusing
on written guidance. Conclusion There are problems in the community-based management strategies of osteoarthritis，including
uncoordinated management，unsound methods，and imperfect systems. The referential community-based management strategies for
osteoarthritis include：multidisciplinary or comprehensive management，hierarchical management and other systematic management
strategies；making full use of medical techniques and tools（such as e-health，remote management，and health manuals）；
optimizing resource allocation（such as adding osteoarthritis management as a national essential public health project，and increasing
government policy support for osteoarthritis management）.
【Key words】 Osteoarthritis；Community health services；Disease management；Information technology；Systematic review

骨关节炎是中老年人常见的慢性病，是目前导致残 使用药物治疗或理疗，对患者的健康教育不足、管理不
［1］
疾的主要原因之一，严重影响着中老年人的生活质量 。 够 ［3］ 。因此本文通过文献荟萃的方法对社区骨关节炎
有研究显示，在社区开展骨关节炎的健康管理是骨关节 管理的问题和解决策略进行分析和研究，以促进对社区
炎防治的最佳途径，不仅使有限的骨关节炎社会资源得 骨关节炎患者的有效管理。
到优化配置，而且提高了骨关节炎的整体防治水平 ［2］ 。 1 资料与方法
骨关节炎发病率、致残率高，但国民对于骨关节病的重 1.1 检索策略 2020 年 10 月至 2021 年 1 月，在中国
视程度不足，大多数社区医疗工作者专注于高血压、糖 知网、万方数据知识服务平台、维普网数据库中主题检
尿病两大病种的健康管理，对于早、中期骨关节病大多 索“骨关节炎”与“管理”、“骨关节炎”与“模式”、“骨