Study On The Impact Of The"Internet+"Family Doctor Contracted Service Model On The Quality Of Life Of Patients With Chronic Diseases Under The"Publicly Constructed And Privately-Run"Mechanism

Objective:Evaluate the feasibility of the"Internet+"family doctor contract service model under the"public construction and private operation"mechanism in the management of patients with chronic diseases in the community and the impact and feasibility of improving the quality of life of patients.Methods:Using the self-contrast research method,153 elderly patients with chronic diseases(age≥60 years old)who were enrolled in a public health service center in Tianjin in April 2018 for free health check-ups and signed by family doctors were selected as the research objects.The"Internet+"family doctor contracted service model for one-year continuous health management,comparing the changes in the health outcomes of patients’quality of life,lifestyle,body mass index,blood pressure,fasting blood glucose,blood lipids,etc.At the same time,the interview method was adopted to take the community health service center family doctors and family doctors contracted elderly patients with chronic diseases as the interviewees,to understand and analyze the connotation and acceptability of the family doctor contract service model under the"Public-built Private-operation"mechanism.Results:1.Among the 153 elderly patients with chronic diseases,a total of 139 patients received a one-year"Internet+"family doctor contract service,with a loss of follow-up rate of 9.2%.Among them,60.43%(84/139)are chronically comorbid patients with two or more chronic health problems.2.Among the 8 dimensions of evaluation of patients’quality of life,physical pain(t=2.379,P<0.05),energy(t=2.568,P<0.05),social function(t=5.590,P<0.05),emotional function(t=2.623,P<0.05),mental health(t=4.918,P<0.05),mental health(t=4.913,P<0.05)scores of each of the six dimensions were significantly improved compared with before intervention,the difference was statistically significant.3.The self-assessment of the patient’s health status after the intervention is also significantly improved compared to that before the intervention(?~2=5.917,P<0.05).4.Fasting blood glucose(t=-3.794,P<0.05),systolic blood pressure(t=-2.842,P<0.05),diastolic blood pressure(t=-4.318,P<0.05),triglyceride(t=-3.116,P<0.05),total cholesterol level(t=-3.118,P<0.05),low density lipoprotein cholesterol(t=-4.042,P<0.05),high density lipoprotein cholesterol(t=4.642,P<0.05)were significantly improved compared with before intervention.5.In the 8-dimensional evaluation of patients’quality of life after intervention,physical pain(t=2.047,P<0.05),energy(t=3.082,P<0.05),Social function(t=4.322,P<0.05)in 8 dimensions of quality of life after intervention,emotional function(t=2.081,P<0.05),mental health(t=3.971,P<0.05),mental health(t=4.061,P<0.05)scores of 7 dimensions were significantly improved compared with before the intervention,the difference was significant has statistical significane.Fasting blood glucose(t=-2.895,P<0.05),systolic blood pressure(t=-2.373,P<0.05),diastolic blood pressure(t=-3.651,P<0.05),BMI(t=-3.532,P<0.05),triglyceride(t=-3.081,P<0.05),total cholesterol level(t=-3.056,P<0.05),low density lipoprotein cholesterol(t=-3.839,P<0.05),high density Lipoprotein cholesterol(t=3.399,P<0.05)was significantly improved compared with before intervention.6.The qualitative interview results of this study show that:family doctors signing chronic disease patients and family doctors believe that the publicly constructed private"Internet+"family doctor contracting service model is feasible in the local community.The 9 patients interviewed all recognized the quality of medical technical services of family doctors,and believed that the service attitude was better,the affinity was stronger,and the medical expenses were not high;moreover,the“Internet+” health care service improved the number of patients who see doctors,take medicines and tumors,etc.The 4 family doctors interviewed said that the public construction private management operation mechanism is more flexible,which is convenient for patients to see a doctor,which is conducive to improving the communication between doctors and patients,improving patient satisfaction and the efficiency of medical staff;it is recommended that the incentive mechanism should be further improved.Conclusion:1.The"Internet+"family doctor contract service model under the"Public construction private"mechanism can effectively improve the health outcomes of elderly patients with chronic diseases and other health outcomes.2.Accept family doctors to sign services for elderly patients with chronic diseases.Recognize the feasibility,accessibility and public welfare of"Internet+"family doctors signing services under the public construction private mechanism.