| 引用本文:于瑶1，高颖1，柳红芳1，沈蔷2，周莉1.社区慢病管理模式的现状与思考[J].世界中医药,2017,(07):. |
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| 社区慢病管理模式的现状与思考 |
| The Status Quo and Reflection of Community Chronic Disease Prevention and Treatment Management Mode |
| 投稿时间：2017-06-10 |
| DOI：10.3969/j.issn.1673-7202.2017.07.002 |
| 中文关键词: 社区 慢病管理模式 中医 |
| English Keywords:Community Chronic disease management mode Traditional Chinese medicine |
| 基金项目:国家公益性行业科研专项——中医药防治慢病社区管理模式的研究（201207012） |
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| 中文摘要: |
| 本文系统分析了国内外社区慢病管理模式，借鉴国际慢病管理模式和转化医学理念，结合我国国情和社区人群防治现状，提出了以“患病的人”为管理对象，形成中医药防治慢病社区管理模式框架，包括以生活方式与适时中医药干预为主要内容的社区慢病人群个体化防治方案，结构化的社区医疗服务信息化网络平台，社区SAT培训模式和“政府主导、医院指导、社区服务、居民自管”管理方式，实践结果显示可提高慢病患者依从性和慢病防治达标率，值得推广。 |
| English Summary: |
| This article analyzed community chronic disease prevention and treatment management mode. We use the experience of international chronic diseases management modes for reference, then combined those knowledge with the condition of China and the status of community disease prevention in district. Based on the approaches above, we construct a special community chronic disease prevention and treatment management mode of traditional Chinese medicine (TCM) for chronic disease. The patients are object of management of this mode. It contains personal life style adjustment and timely TCM intervention for community groups, structured information platform for community medical service, community systematic approach to training (SAT), and management which is dominated by government, guided by hospital, served by community, and supervised by residents themselves. The mode is worth spreading for the clinical practice of the mode improves patients compliance and standard-achieving rate. |
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