Preliminary Study Of "General Practitioners-Specialists" Collaborative Management Model In Care Management Of Patients With Moderate To Severe Carotid Stenosis

Background: Carotid stenosis is a serious stage of the development of atherosclerosis and is a well-documented risk factor for intervention in ischemic stroke.Patients with carotid stenosis usually have multiple risk factors for cardiovascular disease,and their care management includes continuous care such as screening,lifestyle intervention,drug treatment,surgical treatment,and follow-up evaluation.Multidisciplinary collaboration is needed to effectively prevent strokes and reduce the harm of cerebrovascular disease and disease burden.At present,most patients visit one or more specialties,and there is still a lack of patient-centered whole-person care and systematic management of chronic diseases.General medical services are patientcentered,prevention-oriented,and have the characteristics of continuity,comprehensiveness,coordination,and long-term responsible care for the patients.General practitioners working with other specialists to manage patients with carotid stenosis should help improve the effectiveness of care management services for patients with carotid stenosis.Due to the late start of general practice in our country,the participation of general practitioners in the multidisciplinary management of patients with carotid stenosis needs further evaluation.To this end,this study constructed a "general practitioners-specialists" collaborative management model to manage carotid stenosis patients with multiple cardiovascular disease risk factors,and conducted a preliminary evaluation.Objective: In order to further improve the quality of-care management services for patients with carotid stenosis,this study established a "general practitionersspecialists" collaborative management model based on the service concept of "patientcentered" care in general medicine and conducted a preliminary evaluation of its effectiveness.Methods: Patients with moderate to severe carotid artery stenosis hospitalized in the Department of General Practice of the First Hospital of China Medical University from September 2018 to December 2019 were selected as the research objects.The effectiveness of the "general practitioner-specialist" collaborative management model was evaluated by comparing the control of cardiovascular disease risk factors and the improvement of patient activation level before and after the care management,the occurrence of adverse events after the management,and the trust degree of patients to general practitioners was evaluated.Results: The subjects of this study were mainly elderly patients,all patients were patients with multimorbidity,and the number of drugs taken per day were more than 2 types.After 1 year of care management,the compliance rate of "best control of risk factors" was improved by 40.03%(χ 2 = 28.033,P < 0.05).Low density lipoprotein cholesterol,systolic blood pressure,tobacco control and alcohol control were improved by 28.57%(χ 2 = 15.042,P < 0.05),57.14%(χ 2 = 34.568,P < 0.05),42.86%(χ 2 = 28.033,P < 0.05)and 38.57%(χ 2 = 25.037,P < 0.05),respectively.After 1 year of care management,Systolic Blood Pressure(t = 9.152,P < 0.05),Diastolic Blood Pressure(z =-5.328,P < 0.05),Plasma Glycosylated Hemoglobin(t = 3.603,P < 0.05)and Low Density Lipoprotein Cholesterol(t = 3.339,P < 0.05)were significantly lower than before.After 1 year of care management,the level of patient activation level was significantly improved(z =-5.297,P < 0.05).After 1 year of care management,the incidence of stroke was 1.43%(1 / 70),and the restenosis rate was 2.86%(2 / 70).After 1 year of care management,about 80% patients trusted the general practitioner.Conclusion: The "general practitioners-specialists" collaborative management model has effectively improved the control rate of risk factors in patients with carotid stenosis,improved the patient activation level,reduced the occurrence of adverse events.At the same time,patients have a high degree of trust in the care management services provided by general practitioners.General practitioners play an important role in the multidisciplinary collaborative management of patients with carotid stenosis.