目的 探讨医联体“专全结合”模式下儿童哮喘合并过敏性鼻炎分级管理与疗效。方法 选择2017年1-12月本院收治的儿童哮喘合并过敏性鼻炎患儿随机分为对照组、研究组,各110例。所有患儿病情稳定后下转社区卫生服务中心进行健康管理,对照组采用常规性延伸管理模式,提供健康教育、用药指导、生活方式干预等服务,若病情加重则及时上转,研究组采用医联体“专全结合”模式进行规范化管理,包括组建疾病管理团队、规范诊疗路径、完善药品目录及检测功能及分级管理等。比较分析两组哮喘、过敏性鼻炎控制情况及患儿家长的认可度和满意度。结果 管理6个月后,研究组C-ACT评分[(24.61±2.62)分 vs.(20.30±2.97)分]、PEF水平[(91.32±5.23)% vs.(78.12±4.48)%]较管理前明显升高,过敏性鼻炎体征评分明显下降[(0.93±0.25) vs.(2.04±0.42)分],且均明显优于对照组(P<0.05)。研究组管理期间哮喘急性发作次数[(2.59±0.37)次 vs.(2.14±0.32)次]、住院时间[(8.76±0.85) d vs.(9.41±1.31)d]、医疗费用[(5 028.71±1 037.30)元 vs.(6 273.20±1 739.41)元]均较对照组明显减少,患儿家长对服务的认可度(93.6% vs.85.5%)和满意度(91.8% vs.82.7%)均显著升高(P<0.05)。结论 医联体“专全结合”模式下儿童哮喘合并过敏性鼻炎分级管理有助于优化医疗资源的配置,实现医院、社区的同质化管理,对患儿病情控制及患者满意度具有积极的意义。

Objective To explore the grading management and efficacy evaluation of children asthma complicated with allergic rhinitis under medical alliance model of "combination of general practice with specialties". Methods Totally 220 cases of patients with children asthma complicated with allergic rhinitis who received treatment in Shibei Hospital from January to December 2017 were randomly divided into two groups.All patients were referred to the community health service center for health management after their condition was stable.Control group(n=110) was given the conventional extension management model to provide health education, medication guidance and lifestyle intervention and other services.And the children were referred up in time if the disease was aggravated.Research group(n=110) was given standardized management based on general-specialist in medical alliance including establishing disease management team, standardizing diagnosis and treatment path, improving drug catalog and testing function and hierarchical management.The control of asthma and allergic rhinitis and the recognition and satisfaction of parents between two groups were compared and analyzed. Results After 6-month management, the C-AT score [(24.61±2.62)vs.(20.30±2.97)],level of PEF[(91.32±5.23)% vs.(78.12±4.48)%]in the study group was significantly increased, and the score of allergic rhinitis [(0.93±0.25) vs.(2.04±0.42)] was significantly decreased, which was significantly better than that in the control group(P<0.05).The number of acute asthma attacks[(2.14±0.32) time vs.(2.59±0.37)time], length of hospital stay[(8.76±0.85) d vs.(9.41±1.31)d] and medical expenses[(5 028.71±1 037.30) yuan vs.(6 273.20±1 739.41)yuan] in the study group were significantly reduced, the parents of the children in the study group showed a significant increase in their recognition(93.6% vs.85.5%) and satisfaction with the service(91.8% vs.82.7%)compared with the control group(P<0.05). Conclusion Grading management of children asthma complicated with allergic rhinitis in medical alliance model based on general-specialist in medical alliance helps to optimize the allocation of medical resources, realize the homogenization management of hospitals and communities, and has positive significance for the disease control of children and patients′ satisfaction.