Objective To investigate method and effect by chronic disease management applied in community health service center. Methods There were 60 patients receiving conventional chronic disease management as conventional management group, and another 60 patients receiving standardized chronic disease management as standardized management group. Comparison was made on life-style changes, blood pressure level in hypertension patients, and blood glucose level in diabetes patients after 1 year of management. Results After 1 year of management, the standardized management group had all lower proportion of smoking, drinking, little exercise, irregular timetable, and improper diet than the conventional management group, and their difference had statistical significance (P<0.05). Hypertension patients in the standardized management group had all lower systolic blood pressure and diastolic blood pressure respectively as (128.4±10.5) and (81.4±6.4) mm Hg (1 mm Hg=0.133 kPa) than (135.2±12.6) and (85.3±7.5) mm Hg in the conventional management group, and their difference had statistical significance (P<0.05). Diabetes patients in the standardized management group had had lower fasting blood glucose and 2 h postprandial blood glucose as (7.02±0.43) and (8.21±0.94) mmol/L than (7.45±0.62) and (8.74±0.85) mmol/L in the conventional management group, and the difference had statistical significance (P<0.05). Conclusion Implement of standardized management shows remarkable value for chronic disease management in community health service center. This method is helpful to enhance chronic disease control in patients and enhance their quality of life.%目的：探索社区健康服务中心开展慢病管理的方法及效果。方法60例采用常规慢病管理患者作为常规管理组,60例实施规范性慢病管理患者作为规范性管理组,对比分析两组患者在管理1年后的生活方式变化状况、高血压患者的血压水平、糖尿病患者的血糖水平。结果管理1年后,规范性管理组患者吸烟、饮酒、运动少、作息时间不规律、饮食不当比例均低于常规管理组,差异有统计学意义(P<0.05)。规范性管理组高血压患者的收缩压和舒张压分别为(128.4±10.5)、(81.4±6.4)mm Hg (1 mm Hg=0.133 kPa),均低于常规管理组的(135.2±12.6)、(85.3±7.5)mm Hg,差异有统计学意义(P<0.05)。规范性管理组糖尿病患者的空腹血糖、餐后2 h 血糖水平分别为(7.02±0.43)、(8.21±0.94)mmol/L,均低于常规管理组的(7.45±0.62)、(8.74±0.85)mmol/L,差异有统计学意义(P<0.05)。结论在社区健康服务中心的慢病管理中实施规范性管理价值明显,有助于促进慢病患者病情的控制,提高生活质量。
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