Page 80 - 2023-01-中国全科医学

2023年1月 第26卷 第1期 http: //www.chinagp.net E-mail: zgqkyx@chinagp.net.cn ·75·

disease management. However，there are few studies on the application of OTO model in the management of older adults with diabetes in
China. Objective To explore the influence of OTO model on glycemic control and self-management behaviors in older adults with type 2
diabetes in the community. Methods By use of convenient sampling，older adults with type 2 diabetes（n=110）who were transferred
from a tertiary hospital to five community hospitals in Shenyang were selected from August to October 2020. They were randomly assigned
in a 1 ∶ 1 ratio，to receive a 12-month usual community-based health management（control group），or a 12-month OTO model-
based health management（intervention group）. The intervention results were evaluated by fasting blood glucose（FBG），2-hour
postprandial glucose（2 h-PBG）and glycosylated hemoglobin（HbA 1c ）at baseline，and 6 months and 12 months after intervention，
and total score and dimension scores of the Chinese version of Summary of Diabetes Self-care Activities（SDSCA-C）at baseline and 12
months after intervention. Results A total of 105 cases（53 in the intervention group and 52 in the control group）who completed the
study were finally included. Two groups had was no significant differences in mean levels of baseline FBG，2 h-PBG and HbA 1c （P>0.05）.
Significant interaction effects produced by the intervention method and time，and significant main effects brought by both intervention
method and time on FBG，2 h-PBG and HbA 1c were observed（P<0.05）. FBG，2 h-PBG and HbA 1c levels in the intervention
group decreased significantly either at 6 or 12 months after intervention（P<0.05）. But in the control group，only FBG and 2 h-PBG
levels decreased significantly at 6 and 12 months after intervention（P<0.05）. The 12-month intervention lowered FBG，2 h-PBG
and HbA 1c levels more significantly than 6-month intervention in the intervention group（P<0.05）. But in the control group，only
2 h-PBG level was lowered more significantly by 12-month intervention than 6-month intervention（P<0.05）. The intervention
group had lower mean FBG，2 h-PBG and HbA 1c levels than the control group either at 6 or 12 months after intervention（P<0.05）.
At baseline there were no differences between the two groups in total score and dimension scores of SDSCA-C（P>0.05）. After 12
months of intervention，the total score and dimension scores of SDSCA-C increased insignificantly in the control group（P>0.05），
but increased notably in the intervention group（P<0.05）. The intervention group had much higher total score and dimension scores
of SDSCA-C than the control group after the intervention（P<0.05）. Conclusion The OTO model-based health management could
contribute to improving glycemic control and self-management behaviors in older type 2 diabetics，which may benefit effective long-term
management of diabetes.
【Key words】 Online-to-offline model；Diabetes mellitus，type 2；Glycemic control；Self-management behavior；
Health management；Community health services

我国是世界上糖尿病患者人数最多的国家 ［1］ 。老 更好地为线上服务提供支撑，进而有助于增进医患沟通，
年人是糖尿病的高发群体，其患病类型多为 2 型糖尿病。 提升社区照护的连续性 ［10］ 。该模式在我国慢性病患者
2 型糖尿病具有病程长、并发症多的特点。由于认知功 健康教育中的应用较为普遍 ［11-12］ ，尚未见用于老年糖
能减退、记忆力下降等原因，老年人罹患 2 型糖尿病后， 尿病患者健康管理的报道。鉴于此，本研究基于 OTO
普遍存在自我管理行为欠缺等问题 ［2］ 。研究表明，开 模式设计并开发了健康管理平台，以日常生活方式管理
展以社区为基础的持续健康促进是控制糖尿病发生发展 为切入点，充分发挥医院、社区和高校间的协同联动作
的重要策略 ［3］ 。现阶段我国社区卫生服务发展不均衡， 用，为社区老年 2 型糖尿病患者提供 OTO 健康管理服务，
尚未形成统一有效的慢性病管理模式，由此带来的医患 并对管理效果进行探究，旨在为今后探索糖尿病健康管
间缺乏沟通和社区照护连续性不足等问题成为开展糖尿 理的有效模式提供借鉴。
病患者健康促进工作的主要障碍 ［4］ ，因此探索社区糖 1 对象与方法
尿病患者健康管理新模式成为亟待解决的问题。近年来， 1.1 研究对象 根据文献 ［13］ 报道，选取糖化血红蛋白
随着信息技术的快速发展，信息化管理模式被广泛应用 （HbA 1c ）水平作为关键指标，采用两样本均数比较的
2
于慢性病患者健康管理 ［5］ 。OTO（online-to-offline）即“线 样本量计算公式 n=2〔（Z α +Z β ）σ/δ〕 计算样本量。
上到线下”，最早由 Alex Rampell 提出并被广泛应用于 设显著性水平 α=0.05、β=0.1，Z α =1.96、Z β =1.28，
第三产业 ［6］ ，其优势在于将在线支持与线下体验相结 σ 取 0.74，δ 取 0.5，估算得出每组样本量为 46。同时
合，通过线上与线下转化与交互的方式，创新了服务体 考虑到抽样误差和失访，将样本量再扩大 20%，最终确
系，提升了服务价值。目前国内外 OTO 模式的研究多 定每组样本量为 55。于 2020 年 8—10 月，采用便利抽
集中在电子商务 ［7］ 、政务管理 ［8］ 和教育教学 ［9］ 等领域。 样法，选取从沈阳市某三级甲等医院转介至本市 5 家社
应用 OTO 模式进行慢性病管理是在建立线上管理通道 区的老年 2 型糖尿病患者 110 例为研究对象，采用随机
基础上，通过整合线下医疗资源，向慢性病患者提供预 数字表法按照 1 ∶ 1 的比例将其随机分为对照组（n=55）
约挂号、健康咨询、远程医疗和康复随访等服务，以便 和干预组（n=55）。采集患者性别、年龄、糖尿病病程、