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The Significance of Three-Dimensional Team Management in the Medical Community Model for Patients with Hypertension and Diabetes

The Significance of Three-Dimensional Team Management in the Medical Community Model for Patients... Hindawi Journal of Healthcare Engineering Volume 2022, Article ID 1960030, 7 pages https://doi.org/10.1155/2022/1960030 Research Article The Significance of Three-Dimensional Team Management in the Medical Community Model for Patients with Hypertension and Diabetes 1 2 1 3 4 4 2 Xiaoli Lu, Hualiang Tang, Tan Xu, Xuehui Song, Fei Jiang, Xie Zheng, and Yang Li Department of Cardiology, Anji People’s Hospital, Anji 313300, China Department of Cardiology, the First Affiliated Hospital of Baotou Medical College, I, nner Mongolia University of Science and Technology, Baotou 014010, China Child Health Section, Anji Changshuo Street Health Center, Anji 313300, China Department of Endocrinology,People’s Hospital, Anji 313300, China Correspondence should be addressed to Yang Li; 13311010076@stu.cpu.edu.cn Received 22 January 2022; Revised 16 February 2022; Accepted 26 February 2022; Published 11 April 2022 Academic Editor: Ali Kashif Bashir Copyright © 2022 Xiaoli Lu et al. +is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Diabetes and hypertension are the most common diseases and often coexist. Currently, hypertension is the most widespread chronic disease in China. To explore the value of three-dimensional team management in improving the effect of the management of primary diabetes and hypertension in patients in the medical community model, the expert team at the Department of Cardiology and Endocrinology of Anji County People’s Hospital is selected to train 59 community general practitioners in the medical community model (the study group adopts the three-dimensional team management model in the medical community model), and another 59 community medical general practitioners adopts the conventional training method (the control group). +e two groups of doctors managed patients with diabetes and hypertension who are registered in the jurisdiction (200 patients per group) as per the respective training methods. +e three-dimensional management of the team under the medical community model significantly improves the diagnostic and treatment capabilities of grassroot general practitioners to better control patients’ diabetes and hypertension levels. Actively performing standardized management of diabetic 1. Introduction patients is a key measure to improve the level of blood Population aging and rapid economic development have led glucose control [3]. to changes in behavior and lifestyle, and the prevalence of In China, community health service centers are basic chronic diseases, such as diabetes, has increased rapidly. units to manage chronic diseases, such as diabetes and Diabetes has become a persistent public problem affecting hypertension, and it is essential to evaluate the effects of relevant interventions [4]. Community medical personnel the health of the Chinese population. Diabetes is a chronic, non-communicable disease that requires lifelong control are indispensable in the prevention and treatment of dia- and is often associated with hypertension [1]. Insulin re- betes and hypertension at the grassroot level. +e concepts of sistance plays a vital role in the pathogenesis of diabetes and diabetes and hypertension prevention, clinical knowledge, hypertension. Most diabetic patients have insulin resistance, and practical abilities of community doctors are closely and approximately 50% of hypertensive patients are also related to the disease control rate [5]. We established a insulin resistant [2]. +erefore, the management of diabetes chronic disease management team under the medical has changed from single blood glucose management to the community model, targeted training grassroot community comprehensive control of blood glucose and blood pressure. doctors, compared doctors’ mastery of hypertension and 2 Journal of Healthcare Engineering regional primary communities, establish an efficient chronic diabetes-related knowledge before and after training, and discussed the value of three-dimensional team management disease management team, strengthen the education of patients, including drug and nondrug treatment, and pro- under the medical community model to improve the management of grassroot diabetes and hypertension vide emotional management; this helped to better manage patients. blood pressure and blood glucose, develop a healthy lifestyle, and improve quality of life. Each community doctor received on-site teaching training no less than six times for no less 2. Materials and Methods than 1 h each time. 2.1. Study Information and Participant Selection. +e re- search was conducted from January 2018 to July 2020, and 2.3. Survey Indicators. Evaluations of community general the expert team at the Department of Cardiovascular practitioners’ skills to diagnose and treat hypertension Medicine and Endocrinology in Anji County People’s diseases follow the “Guidelines for the Prevention and Hospital is selected to train 59 community general practi- Treatment of Hypertension in China [6],” and mainly in- tioners in the medical community (the research group vestigate whether general practitioners can respond with adopts the three-dimensional management of the team accurate answers regarding the diagnosis and treatment of under the medical community model), and the other 59 hypertension (blood pressure level classification, risk community general practitioners adopt the conventional stratification, and antihypertensive treatment strategy), training method (the control group). +e inclusion criteria nondrug treatment strategy for hypertension (reasonable as follows: (1) the age range of community doctors is diet, weight control, physical exercise, smoking cessation, 28–55 years old; (2) the titles of doctors participating in the and balance psychology), and knowledge of hypertension training are primary and intermediate; (3) training is con- drug treatment (syndrome of prudent use of diuretics, ducted in strict accordance with the training requirements, syndrome of prudent use/prohibition of ß blockers, syn- and 200 patients with type 2 diabetes or hypertension are drome of prohibition of angiotensin-converting enzyme managed by community doctors in each group; (4) the inhibitor (ACEI) drugs, and syndrome of prudent use/ research program is approved by the Medical Ethics prohibition of compound preparations). Committee. Exclusion criteria: (1) personnel who cannot +e evaluation of community doctors’ abilities to di- participate in training on time and according to regulations; agnose and treat diabetes is mainly based on the “practical (2) doctors who have not yet obtained the required title; (3) goals and treatment of type 2 diabetes” [7] and the standards specialists; (4) managed patients with hypertension and in the 2004 edition of “Guidelines for the Prevention and diabetes combined with major diseases of other systems. Treatment of Diabetes in China [8].” +is involves the di- +e research proposal and related materials shall be agnosis of diabetes (diagnosis of type 2 diabetes, impaired provided after the medical ethics committee has studied and glucose tolerance, and impaired fasting blood glucose), basic determined the disease and issued a document (hospital knowledge of diabetes (glycosylated hemoglobin (HbA1c) ethics approval 18). purpose, dyslipidemia characteristics, and blood glucose control objectives), and drug therapy knowledge (preferred drugs for obese patients and preferred drugs for nonobese 2.2. Training Methods for Community Doctors patients) [9]. 2.2.1. Control Group (Conventional Training Methods in Adopting the Centralized Teaching Training Model). Each 2.4.ObservationIndicatorsforPatientswithHypertensionand community doctor received at least 6 h of diabetes and Diabetes. +e fasting plasma glucose (FPG), postprandial hypertension diagnoses and treatment knowledge training, 2 h blood glucose (2 hPG), glycosylated hemoglobin annually. +e training is mainly conducted by experts from (HbA1c), 24 h average systolic blood pressure (SBP), 24 h municipal and district chronic disease prevention and average diastolic blood pressure (DBP), and medication control centers through large lectures. compliance of patients with diabetes and hypertension managed by general practitioners in the two groups are compared after training [10]. 2.2.2. Study Group (Application of 0ree-Dimensional Team Management in the Medical Community Model). +is group All patients fasted for 12 h, and morning fasting elbow included city and district chronic disease prevention and venous blood (5 ml) is taken. A Hitachi 7180 automatic control hospital experts who inspected the community biochemical analyzer glucose oxidase method is used to health service center quarterly, identified the problem, se- determine FPG and 2hPG, using high-pressure liquid lected a typical case, and offered discussion-based on-site chromatography to determine glycosylated hemoglobin teaching and training. Furthermore, face-to-face counseling HbA1c. All patients received 24 h ambulatory blood pressure occurred with community doctors to teach, highlight the importance of health education, provide lifestyle treatment, monitoring ([manufacturer: Aicanfi; model: ACF-D1] SBP, DBP, cuff 12 cm × 22 cm), with the instrument fixed onto the promote knowledge about hypertension and diabetes, guide rational drug combination, and optimize treatment plans for patient’s right or left upper arm; daytime is set to 7 : 00–21 : 00, blood pressure measurement time interval is 20 min/ patients with complications. +e goal is to improve the diagnostic and treatment skill levels of responsible doctors in time, night time is set to 21 : 00–7:00, time interval is 40 min/ Journal of Healthcare Engineering 3 time, and monitoring times are > 80% for effective moni- reasonable diet, weight control, physical exercise, smoking toring [11]. cessation, balance psychology, careful use of diuretics, careful use/prohibition of beta blockers, ACEI drug pro- A questionnaire survey with newly admitted patients included questions on their basic situation, related infor- hibition, and careful use/prohibition of compound prepa- mation, and compliance evaluation [12]. Compliance eval- rations are compared between the study group and the uation is mainly conducted from four aspects: medication, control group, and the difference is not statistically signif- diet, exercise, blood glucose, or blood pressure monitoring icant (p> 0.05). After training, the correct response rates of [13]. +ere are 15 questions in total. +e score range for each doctors in the study group on blood pressure level classi- question is 1–5 points. +e higher the score, the higher the fication, antihypertensive treatment strategy, balance psy- patient’s compliance management. Scores ranging from 61 chology, ß-blocker cautious/forbidden certificate, and to 75 indicated good compliance, 46–60 are general com- compound preparation cautious/forbidden certificate are pliance, and ≤45 are poor compliance. significantly higher than those in the control group, and the difference is statistically significant (p< 0.05). Table 3 is the comparison of the ability to diagnose and treat hypertension 2.5. Statistical Processing. We tested patients’ FPG, 2hPG, before and after training. and HbA1c values by normal distribution, which accorded with the approximate normal distribution or normal dis- 3.4. Comparison of Baseline Data of Patients in the Study tribution, and are expressed as (x ± s). +e LSD-t test is used Group and the Control Group Intervened by General to compare the two groups. Counting data are expressed as Practitioners. General practitioners in the study group and percentages, non-grade comparison is performed using the the control group intervened 200 patients with diabetes and χ2 test, and grade comparison between groups is performed hypertension, respectively. +e baseline data of the two using the Mann-Whitney U test. SPSS (version 21.0) is used groups are compared, and the differences are not statistically for data processing, and the inspection level a is set at 0.05. significant (p> 0.05). Table 4 is the comparison of baseline data of patients in the study group and the control group 3. Experimental Results with general practitioner intervention. 3.1.ComparisonoftheBasicSituationofGeneralPractitioners in the Study Group and the Control Group. +e age, gender, 3.5.0eBloodPressureControlofPatientsintheStudyGroup professional title, and educational level are compared be- and the Control Group. +ere are 100 patients with hy- tween the study group and the control group, and the pertension in the study group and 109 patients with hy- difference is not statistically significant (p> 0.05). Table 1 is pertension in the control group. +e SBP and DBP before the comparison of the basic situation of general practitioners intervention are compared between the study group and the in the study group and the control group. control group, and the differences are not statistically sig- nificant (P> 0.05). After intervention, SBP in the study group is lower than that in the control group, and the 3.2. Comparison of the Ability of General Practitioners in the difference is significant (p< 0.05). Table 5 shows the blood Study Group and the Control Group to Diagnose and Treat pressure control status of study group and control group. Diabetes before and after Training. Before training, the correct response rates of type 2 diabetes diagnosis, impaired glucose tolerance, impaired fasting blood glucose, HbA1c 3.6. 0e Blood Glucose Control of the Study Group and the purpose, dyslipidemia characteristics, blood glucose control Control Group. +ere are 100 patients with diabetes in the objectives, preferred drugs for obese patients, and preferred study group and 91 patients with diabetes in the control drugs for nonobese patients are compared between the study group. +e FPG, 2hPG, and HbA1c are compared between group and the control group, and the difference is not the study group and the control group before intervention, statistically significant (p> 0.05). After training, the correct and the differences are not statistically significant (p> 0.05). response rate of doctors in the study group to the diagnosis After intervention, 2hPG and HbA1c in the study group are of type 2 diabetes, impaired fasting blood glucose, HbA1c lower than those in the control group, and the difference is purpose, dyslipidemia characteristics, blood glucose control significant (p< 0.05). Table 6 shows the blood sugar control objectives, and preferred drugs for obese patients is sig- status of the study group and the control group. nificantly higher than that in the control group, and the difference is statistically significant (p< 0.05). Table 2 is the 3.7. Comparison of Compliance between the Study Group and comparison of diabetes diagnosis and treatment ability the Control Group. +e complete compliance rate of the before and after training. study group is 67.00%, the general rate is 27.00%, and the poor compliance rate is 6.00%. +e complete compliance 3.3. Comparison of the Ability of General Practitioners in the rate of the control group is 52.50%, the general rate is 35.50%, and the poor compliance rate is 12.00%. +e dif- Study Group and the Control Group to Diagnose and Treat Hypertension before and after Training. Before training, the ference between the two groups is significant (p< 0.05). Table 7 is the comparison of compliance between the study correct response rates of blood pressure level classification, risk stratification, antihypertensive treatment strategy, group and the control group. 4 Journal of Healthcare Engineering Table 1: Comparison of the basic situation of general practitioners in the study group and the control group. Normal information Research group (n � 59) Control group (n � 59) t/χ p Age (years) 36.8± 7.2 37.4± 7.8 −0.434 0.665 Sex (%) Male 33 (55.93) 38 (64.41) 0.884 0.347 Female 26 (44.07) 21 (35.59) Job title (%) 1.221 0.229 Primary 33 (55.93) 27 (45.76) Intermediate 26 (44.07) 32 (54.24) Education (%) 2.365 0.307 College 17 (28.81) 10 (16.95) Undergraduate 38 (64.41) 44 (74.58) Postgraduate 4 (6.78) 5 (8.47) Table 2: Comparison of diabetes diagnosis and treatment ability before and after training. Project Research group (n � 59) Control group (n � 59) χ p Diagnosis of type 2 diabetes (%) Before training 36 (61.02) 39 (66.1) 0.329 0.566 After training 57 (96.61) 46 (77.97) 9.241 0.002 Impaired glucose tolerance (%) Before training 40 (67.8) 43 (72.88) 0.366 0.545 After training 55 (93.22) 50 (84.75) 2.161 0.142 Impaired fasting blood sugar (%) Before training 27 (45.76) 32 (54.24) 0.847 0.357 After training 57 (96.61) 46 (77.97) 9.241 0.002 HbA1c purpose (%) Before training 34 (57.63) 40 (67.8) 1.305 0.253 After training 58 (98.31) 50 (84.75) 6.993 0.008 Dyslipidemia characteristics (%) Before training 24 (40.68) 28 (47.46) 0.550 0.458 After training 49 (83.05) 40 (67.8) 3.703 0.054 Blood sugar control goals (%) Before training 25 (42.37) 30 (50.85) 0.851 0.356 After training 57 (96.61) 49 (83.05) 5.937 0.015 Drugs of choice for obese patients (%) Before training 26 (44.07) 32 (54.24) 1.221 0.269 After training 55 (93.22) 47 (79.66) 4.627 0.031 +e drug of choice for nonobese patients (%) Before training 40 (67.8) 35 (59.32) 0.915 0.339 After training 56 (94.92) 50 (84.75) 3.340 0.068 meet the growing needs for cardiovascular disease pre- 4. Analysis and Discussion vention and control in China. Because diabetes and hypertension are chronic diseases with We established a chronic disease management team a hidden onset, long course of disease, and need lifelong under the medical community model to conduct targeted treatment, their prevention and treatment must be under- training for community doctors. To effectively reduce the taken by most primary medical institutions, especially incidence of mortality through cardiovascular diseases in the community health service centers, as well as primary and region, mastery of hypertension and diabetes-related community doctors. Comprehensive community interven- knowledge and the changes in patients’ related indicators tion has become important to treat chronic diseases at the before and after doctors’ training are compared. +e results grassroot level in China. +e main problems are that revealed that after training, the study group doctors’ correct management is not standardized, personalized disease response rates are significantly higher than the control management plans are lacking, and measures for different group’s (p< 0.05) to diagnose type 2 diabetes, impaired groups and individuals differ. To ensure that most primary fasting blood glucose, dyslipidemia characteristics, blood chronic diseases are reasonably diagnosed and treated in glucose control objectives, and the preferred drugs for obese community health service centers, it is necessary to improve patients. +e study group doctors’ response rates for cor- the diagnosis and treatment skill levels of community rectly classifying blood pressure levels, antihypertensive doctors. Community doctors urgently need to update ideas treatment strategies, balance psychology, ß-receptor blocker’ as well as supplement knowledge and improve their skills to caution/prohibition card, and compound preparations’ Journal of Healthcare Engineering 5 Table 3: Comparison of the ability to diagnose and treat hypertension before and after training. Project Research group (n � 60) Control group (n � 60) χ p Blood pressure level classification (%) Before training 36 (61.02) 40 (67.8) 0.591 0.442 After training 58 (98.31) 50 (84.75) 6.993 0.008 Risk stratification (%) Before training 18 (30.51) 23 (38.98) 0.934 0.334 After training 48 (81.36) 40 (67.8) 2.861 0.091 Antihypertensive treatment strategies (%) Before training 26 (44.07) 21 (35.59) 0.884 0.347 After training 50 (84.75) 40 (67.8) 4.683 0.03 Reasonable diet (%) Before training 39 (66.1) 35 (59.32) 0.58 0.446 After training 55 (93.22) 50 (84.75) 2.161 0.142 Weight control (%) Before training 41 (69.49) 36 (61.02) 0.934 0.334 After training 56 (94.92) 50 (84.75) 3.34 0.068 Physical exercise (%) Before training 32 (54.24) 36 (61.02) 0.555 0.456 After training 57 (96.61) 52 (88.14) 3.007 0.083 Quit smoking (%) Before training 29 (49.15) 33 (55.93) 0.544 0.461 After training 51 (86.44) 47 (79.66) 0.963 0.326 Balance mind (%) Before training 22 (37.29) 18 (30.51) 0.605 0.437 After training 53 (89.83) 43 (72.88) 5.587 0.018 Cautionary use of diuretics (%) Before training 22 (37.29) 26 (44.07) 0.562 0.453 After training 48 (81.36) 40 (67.8) 2.861 0.091 Caution/prohibition of ß blockers (%) Before training 26 (44.07) 23 (38.98) 0.314 0.575 After training 50 (84.75) 42 (71.19) 3.157 0.076 ACEI drug prohibition certificate (%) Before training 22 (37.29) 27 (45.76) 0.873 0.35 After training 52 (88.14) 45 (76.27) 2.978 0.084 Caution/prohibition of compound preparation (%) Before training 17 (28.81) 23 (38.98) 1.362 0.243 After training 50 (84.75) 40 (67.8) 4.683 0.040 caution/prohibition cards are significantly higher than the the students can truly master the diagnosis and treatment control group’s (p< 0.05). After conducting three-dimen- methods of such cases. +e entire training process en- sional team management training in the medical community couraged students’ learning initiatives, made an impression, model, the doctors’ hypertension knowledge, case diagnosis, and is easy to accept. and abilities to treat are significantly higher than that of After the intervention, the study group’s SBP, 2hPG, and community doctors with conventional training. HbA1c levels are significantly lower than the control group’s According to the analysis, the main characteristics of the (p< 0.05). Hence, three-dimensional team management under the medical community model can strengthen pa- three-dimensional team management in the medical com- munity model are cultivating the ability to diagnose accu- tients’ self-management abilities and indirectly affect pa- rately and providing effective treatment as the main goals. tients’ laboratory test indexes. +rough health education, Other achievements include implementing face-to-face patients are guided to strictly follow the doctor’s advice and discussion, using interaction training methods, incorpo- take correct dosages of medicines timeously so that FPG, rating theory with practice, and ensuring pertinence and 2hPG, HbA1c, and other indicators are gradually decreased practicability. +e teacher is an expert, rich in clinical and and normalized. +e compliance rate of the study group is teaching experience, from city and district chronic disease significantly better than the control group (p< 0.05). +is prevention and control hospitals; thus, common cases are shows that the three-dimensional management of the team used to introduce the problems that community doctors under the medical community model has a high application often encounter in diagnosing and treating such cases. value and can effectively improve the quality of family management as well as the effect of disseminating disease Teachers guide students by discussing these problems; thereafter, they gradually explain the knowledge relevant to knowledge and service satisfaction. Family intervention and the case and finally return to the case and the problem so that treatment methods can help educate patients to develop 6 Journal of Healthcare Engineering Table 4: Comparison of baseline data of patients in the study group and the control group with general practitioner intervention. Normal information Research group (n � 200) Control group (n � 200) t/χ p Age (years) 70.5± 6.7 69.4± 6.7 1.642 0.101 BMI (kg/m ) 24.8± 1.9 24.5± 2.3 1.422 0.156 Course of disease (years) 7.2± 2.2 7.0± 2.0 0.951 0.342 Sex (%) 0.493 0.483 Male 111 (55.5) 104 (52.00) Female 89 (44.5) 96 (48.00) Disease (%) 0.812 0.368 Hypertension 100 (50.00) 109 (54.5) Diabetes 100 (50.00) 91 (45.5) Smoking (%) 0.433 0.511 Yes 56 (28.00) 62 (31.00) No 144 (72.00) 138 (69.00) Drinking (%) 0.552 0.468 Yes 70 (35.00) 63 (31.5) No 130 (65.00) 137 (68.5) Hyperlipidemia (%) 0.57 0.458 Yes 59 (29.5) 66 (33.00) No 141 (70.5) 134 (67.00) Coronary heart disease (%) 1.567 0.211 Yes 26 (13.00) 32 (16.00) No 174 (87.00) 168 (84.00) Table 5: Blood pressure control status of study group and control group. SBP (mmHg) DBP (mmHg) Group n Before intervention After intervention Before intervention Afterintervention Research group 100 157.2± 8.6 128.0± 7.0 98.4± 6.6 76.1± 5.8 Control group 109 155.5± 8.1 131.4± 6.7 97.0± 7.0 77.6± 6.3 t 1.472 -3.587 1.484 −1.786 p 0.143 0.000 0.139 0.076 Table 6: +e blood sugar control status of the study group and the control group(x ± s). FPG (mmol/L) 2hPG (mmol/L) HbA1c (%) Group n Before After Before After Before After intervention intervention intervention intervention intervention intervention Research 100 8.84± 0.95 6.32± 0.55 12.78± 1.33 8.17± 1.05 8.86± 0.95 6.81± 0.68 group Control group 91 8.70± 0.90 6.47± 0.67 12.51± 1.20 8.50± 1.23 8.64± 0.89 7.25± 0.74 t 1.043 -1.697 1.468 -1.999 1.647 -4.282 p 0.298 0.091 0.144 0.047 0.101 0.000 Table 7: Comparison of compliance between the study group and +e mastery of hypertension-related knowledge regarding the control group [n(%)].. hypertensive patients served by family doctors improved Complete Poor significantly; this can help patients master scientific and Group n General compliance compliance reasonable self-management methods, enhance self-care Research awareness, and implement behavior changes. 200 134 (67.00) 54 (27.00) 12 (6.00) group Control 200 105 (52.50) 71 (35.50) 24 (12.00) 5. Conclusion group Z −3.107 Diabetes and hypertension are the most common diseases p 0.002 and often coexist. Currently, hypertension is the most widespread chronic disease in China. In summary, the healthy living habits while formulating detailed and rea- team’s three-dimensional management under the medical sonable treatment plans, fully using various family re- community model significantly improves the ability of sources, and effectively solving patients’ health problems. grassroot general practitioners to diagnose and treat Journal of Healthcare Engineering 7 the community,” Psychiatria Danubina, vol. 31, no. 3, hypertension and diabetes and better control diabetes and pp. 622–625, 2019. hypertension levels in patients. [7] D. K. Patten, B. G. Schultz, and D. J. 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The Significance of Three-Dimensional Team Management in the Medical Community Model for Patients with Hypertension and Diabetes

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Abstract

Hindawi Journal of Healthcare Engineering Volume 2022, Article ID 1960030, 7 pages https://doi.org/10.1155/2022/1960030 Research Article The Significance of Three-Dimensional Team Management in the Medical Community Model for Patients with Hypertension and Diabetes 1 2 1 3 4 4 2 Xiaoli Lu, Hualiang Tang, Tan Xu, Xuehui Song, Fei Jiang, Xie Zheng, and Yang Li Department of Cardiology, Anji People’s Hospital, Anji 313300, China Department of Cardiology, the First Affiliated Hospital of Baotou Medical College, I, nner Mongolia University of Science and Technology, Baotou 014010, China Child Health Section, Anji Changshuo Street Health Center, Anji 313300, China Department of Endocrinology,People’s Hospital, Anji 313300, China Correspondence should be addressed to Yang Li; 13311010076@stu.cpu.edu.cn Received 22 January 2022; Revised 16 February 2022; Accepted 26 February 2022; Published 11 April 2022 Academic Editor: Ali Kashif Bashir Copyright © 2022 Xiaoli Lu et al. +is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Diabetes and hypertension are the most common diseases and often coexist. Currently, hypertension is the most widespread chronic disease in China. To explore the value of three-dimensional team management in improving the effect of the management of primary diabetes and hypertension in patients in the medical community model, the expert team at the Department of Cardiology and Endocrinology of Anji County People’s Hospital is selected to train 59 community general practitioners in the medical community model (the study group adopts the three-dimensional team management model in the medical community model), and another 59 community medical general practitioners adopts the conventional training method (the control group). +e two groups of doctors managed patients with diabetes and hypertension who are registered in the jurisdiction (200 patients per group) as per the respective training methods. +e three-dimensional management of the team under the medical community model significantly improves the diagnostic and treatment capabilities of grassroot general practitioners to better control patients’ diabetes and hypertension levels. Actively performing standardized management of diabetic 1. Introduction patients is a key measure to improve the level of blood Population aging and rapid economic development have led glucose control [3]. to changes in behavior and lifestyle, and the prevalence of In China, community health service centers are basic chronic diseases, such as diabetes, has increased rapidly. units to manage chronic diseases, such as diabetes and Diabetes has become a persistent public problem affecting hypertension, and it is essential to evaluate the effects of relevant interventions [4]. Community medical personnel the health of the Chinese population. Diabetes is a chronic, non-communicable disease that requires lifelong control are indispensable in the prevention and treatment of dia- and is often associated with hypertension [1]. Insulin re- betes and hypertension at the grassroot level. +e concepts of sistance plays a vital role in the pathogenesis of diabetes and diabetes and hypertension prevention, clinical knowledge, hypertension. Most diabetic patients have insulin resistance, and practical abilities of community doctors are closely and approximately 50% of hypertensive patients are also related to the disease control rate [5]. We established a insulin resistant [2]. +erefore, the management of diabetes chronic disease management team under the medical has changed from single blood glucose management to the community model, targeted training grassroot community comprehensive control of blood glucose and blood pressure. doctors, compared doctors’ mastery of hypertension and 2 Journal of Healthcare Engineering regional primary communities, establish an efficient chronic diabetes-related knowledge before and after training, and discussed the value of three-dimensional team management disease management team, strengthen the education of patients, including drug and nondrug treatment, and pro- under the medical community model to improve the management of grassroot diabetes and hypertension vide emotional management; this helped to better manage patients. blood pressure and blood glucose, develop a healthy lifestyle, and improve quality of life. Each community doctor received on-site teaching training no less than six times for no less 2. Materials and Methods than 1 h each time. 2.1. Study Information and Participant Selection. +e re- search was conducted from January 2018 to July 2020, and 2.3. Survey Indicators. Evaluations of community general the expert team at the Department of Cardiovascular practitioners’ skills to diagnose and treat hypertension Medicine and Endocrinology in Anji County People’s diseases follow the “Guidelines for the Prevention and Hospital is selected to train 59 community general practi- Treatment of Hypertension in China [6],” and mainly in- tioners in the medical community (the research group vestigate whether general practitioners can respond with adopts the three-dimensional management of the team accurate answers regarding the diagnosis and treatment of under the medical community model), and the other 59 hypertension (blood pressure level classification, risk community general practitioners adopt the conventional stratification, and antihypertensive treatment strategy), training method (the control group). +e inclusion criteria nondrug treatment strategy for hypertension (reasonable as follows: (1) the age range of community doctors is diet, weight control, physical exercise, smoking cessation, 28–55 years old; (2) the titles of doctors participating in the and balance psychology), and knowledge of hypertension training are primary and intermediate; (3) training is con- drug treatment (syndrome of prudent use of diuretics, ducted in strict accordance with the training requirements, syndrome of prudent use/prohibition of ß blockers, syn- and 200 patients with type 2 diabetes or hypertension are drome of prohibition of angiotensin-converting enzyme managed by community doctors in each group; (4) the inhibitor (ACEI) drugs, and syndrome of prudent use/ research program is approved by the Medical Ethics prohibition of compound preparations). Committee. Exclusion criteria: (1) personnel who cannot +e evaluation of community doctors’ abilities to di- participate in training on time and according to regulations; agnose and treat diabetes is mainly based on the “practical (2) doctors who have not yet obtained the required title; (3) goals and treatment of type 2 diabetes” [7] and the standards specialists; (4) managed patients with hypertension and in the 2004 edition of “Guidelines for the Prevention and diabetes combined with major diseases of other systems. Treatment of Diabetes in China [8].” +is involves the di- +e research proposal and related materials shall be agnosis of diabetes (diagnosis of type 2 diabetes, impaired provided after the medical ethics committee has studied and glucose tolerance, and impaired fasting blood glucose), basic determined the disease and issued a document (hospital knowledge of diabetes (glycosylated hemoglobin (HbA1c) ethics approval 18). purpose, dyslipidemia characteristics, and blood glucose control objectives), and drug therapy knowledge (preferred drugs for obese patients and preferred drugs for nonobese 2.2. Training Methods for Community Doctors patients) [9]. 2.2.1. Control Group (Conventional Training Methods in Adopting the Centralized Teaching Training Model). Each 2.4.ObservationIndicatorsforPatientswithHypertensionand community doctor received at least 6 h of diabetes and Diabetes. +e fasting plasma glucose (FPG), postprandial hypertension diagnoses and treatment knowledge training, 2 h blood glucose (2 hPG), glycosylated hemoglobin annually. +e training is mainly conducted by experts from (HbA1c), 24 h average systolic blood pressure (SBP), 24 h municipal and district chronic disease prevention and average diastolic blood pressure (DBP), and medication control centers through large lectures. compliance of patients with diabetes and hypertension managed by general practitioners in the two groups are compared after training [10]. 2.2.2. Study Group (Application of 0ree-Dimensional Team Management in the Medical Community Model). +is group All patients fasted for 12 h, and morning fasting elbow included city and district chronic disease prevention and venous blood (5 ml) is taken. A Hitachi 7180 automatic control hospital experts who inspected the community biochemical analyzer glucose oxidase method is used to health service center quarterly, identified the problem, se- determine FPG and 2hPG, using high-pressure liquid lected a typical case, and offered discussion-based on-site chromatography to determine glycosylated hemoglobin teaching and training. Furthermore, face-to-face counseling HbA1c. All patients received 24 h ambulatory blood pressure occurred with community doctors to teach, highlight the importance of health education, provide lifestyle treatment, monitoring ([manufacturer: Aicanfi; model: ACF-D1] SBP, DBP, cuff 12 cm × 22 cm), with the instrument fixed onto the promote knowledge about hypertension and diabetes, guide rational drug combination, and optimize treatment plans for patient’s right or left upper arm; daytime is set to 7 : 00–21 : 00, blood pressure measurement time interval is 20 min/ patients with complications. +e goal is to improve the diagnostic and treatment skill levels of responsible doctors in time, night time is set to 21 : 00–7:00, time interval is 40 min/ Journal of Healthcare Engineering 3 time, and monitoring times are > 80% for effective moni- reasonable diet, weight control, physical exercise, smoking toring [11]. cessation, balance psychology, careful use of diuretics, careful use/prohibition of beta blockers, ACEI drug pro- A questionnaire survey with newly admitted patients included questions on their basic situation, related infor- hibition, and careful use/prohibition of compound prepa- mation, and compliance evaluation [12]. Compliance eval- rations are compared between the study group and the uation is mainly conducted from four aspects: medication, control group, and the difference is not statistically signif- diet, exercise, blood glucose, or blood pressure monitoring icant (p> 0.05). After training, the correct response rates of [13]. +ere are 15 questions in total. +e score range for each doctors in the study group on blood pressure level classi- question is 1–5 points. +e higher the score, the higher the fication, antihypertensive treatment strategy, balance psy- patient’s compliance management. Scores ranging from 61 chology, ß-blocker cautious/forbidden certificate, and to 75 indicated good compliance, 46–60 are general com- compound preparation cautious/forbidden certificate are pliance, and ≤45 are poor compliance. significantly higher than those in the control group, and the difference is statistically significant (p< 0.05). Table 3 is the comparison of the ability to diagnose and treat hypertension 2.5. Statistical Processing. We tested patients’ FPG, 2hPG, before and after training. and HbA1c values by normal distribution, which accorded with the approximate normal distribution or normal dis- 3.4. Comparison of Baseline Data of Patients in the Study tribution, and are expressed as (x ± s). +e LSD-t test is used Group and the Control Group Intervened by General to compare the two groups. Counting data are expressed as Practitioners. General practitioners in the study group and percentages, non-grade comparison is performed using the the control group intervened 200 patients with diabetes and χ2 test, and grade comparison between groups is performed hypertension, respectively. +e baseline data of the two using the Mann-Whitney U test. SPSS (version 21.0) is used groups are compared, and the differences are not statistically for data processing, and the inspection level a is set at 0.05. significant (p> 0.05). Table 4 is the comparison of baseline data of patients in the study group and the control group 3. Experimental Results with general practitioner intervention. 3.1.ComparisonoftheBasicSituationofGeneralPractitioners in the Study Group and the Control Group. +e age, gender, 3.5.0eBloodPressureControlofPatientsintheStudyGroup professional title, and educational level are compared be- and the Control Group. +ere are 100 patients with hy- tween the study group and the control group, and the pertension in the study group and 109 patients with hy- difference is not statistically significant (p> 0.05). Table 1 is pertension in the control group. +e SBP and DBP before the comparison of the basic situation of general practitioners intervention are compared between the study group and the in the study group and the control group. control group, and the differences are not statistically sig- nificant (P> 0.05). After intervention, SBP in the study group is lower than that in the control group, and the 3.2. Comparison of the Ability of General Practitioners in the difference is significant (p< 0.05). Table 5 shows the blood Study Group and the Control Group to Diagnose and Treat pressure control status of study group and control group. Diabetes before and after Training. Before training, the correct response rates of type 2 diabetes diagnosis, impaired glucose tolerance, impaired fasting blood glucose, HbA1c 3.6. 0e Blood Glucose Control of the Study Group and the purpose, dyslipidemia characteristics, blood glucose control Control Group. +ere are 100 patients with diabetes in the objectives, preferred drugs for obese patients, and preferred study group and 91 patients with diabetes in the control drugs for nonobese patients are compared between the study group. +e FPG, 2hPG, and HbA1c are compared between group and the control group, and the difference is not the study group and the control group before intervention, statistically significant (p> 0.05). After training, the correct and the differences are not statistically significant (p> 0.05). response rate of doctors in the study group to the diagnosis After intervention, 2hPG and HbA1c in the study group are of type 2 diabetes, impaired fasting blood glucose, HbA1c lower than those in the control group, and the difference is purpose, dyslipidemia characteristics, blood glucose control significant (p< 0.05). Table 6 shows the blood sugar control objectives, and preferred drugs for obese patients is sig- status of the study group and the control group. nificantly higher than that in the control group, and the difference is statistically significant (p< 0.05). Table 2 is the 3.7. Comparison of Compliance between the Study Group and comparison of diabetes diagnosis and treatment ability the Control Group. +e complete compliance rate of the before and after training. study group is 67.00%, the general rate is 27.00%, and the poor compliance rate is 6.00%. +e complete compliance 3.3. Comparison of the Ability of General Practitioners in the rate of the control group is 52.50%, the general rate is 35.50%, and the poor compliance rate is 12.00%. +e dif- Study Group and the Control Group to Diagnose and Treat Hypertension before and after Training. Before training, the ference between the two groups is significant (p< 0.05). Table 7 is the comparison of compliance between the study correct response rates of blood pressure level classification, risk stratification, antihypertensive treatment strategy, group and the control group. 4 Journal of Healthcare Engineering Table 1: Comparison of the basic situation of general practitioners in the study group and the control group. Normal information Research group (n � 59) Control group (n � 59) t/χ p Age (years) 36.8± 7.2 37.4± 7.8 −0.434 0.665 Sex (%) Male 33 (55.93) 38 (64.41) 0.884 0.347 Female 26 (44.07) 21 (35.59) Job title (%) 1.221 0.229 Primary 33 (55.93) 27 (45.76) Intermediate 26 (44.07) 32 (54.24) Education (%) 2.365 0.307 College 17 (28.81) 10 (16.95) Undergraduate 38 (64.41) 44 (74.58) Postgraduate 4 (6.78) 5 (8.47) Table 2: Comparison of diabetes diagnosis and treatment ability before and after training. Project Research group (n � 59) Control group (n � 59) χ p Diagnosis of type 2 diabetes (%) Before training 36 (61.02) 39 (66.1) 0.329 0.566 After training 57 (96.61) 46 (77.97) 9.241 0.002 Impaired glucose tolerance (%) Before training 40 (67.8) 43 (72.88) 0.366 0.545 After training 55 (93.22) 50 (84.75) 2.161 0.142 Impaired fasting blood sugar (%) Before training 27 (45.76) 32 (54.24) 0.847 0.357 After training 57 (96.61) 46 (77.97) 9.241 0.002 HbA1c purpose (%) Before training 34 (57.63) 40 (67.8) 1.305 0.253 After training 58 (98.31) 50 (84.75) 6.993 0.008 Dyslipidemia characteristics (%) Before training 24 (40.68) 28 (47.46) 0.550 0.458 After training 49 (83.05) 40 (67.8) 3.703 0.054 Blood sugar control goals (%) Before training 25 (42.37) 30 (50.85) 0.851 0.356 After training 57 (96.61) 49 (83.05) 5.937 0.015 Drugs of choice for obese patients (%) Before training 26 (44.07) 32 (54.24) 1.221 0.269 After training 55 (93.22) 47 (79.66) 4.627 0.031 +e drug of choice for nonobese patients (%) Before training 40 (67.8) 35 (59.32) 0.915 0.339 After training 56 (94.92) 50 (84.75) 3.340 0.068 meet the growing needs for cardiovascular disease pre- 4. Analysis and Discussion vention and control in China. Because diabetes and hypertension are chronic diseases with We established a chronic disease management team a hidden onset, long course of disease, and need lifelong under the medical community model to conduct targeted treatment, their prevention and treatment must be under- training for community doctors. To effectively reduce the taken by most primary medical institutions, especially incidence of mortality through cardiovascular diseases in the community health service centers, as well as primary and region, mastery of hypertension and diabetes-related community doctors. Comprehensive community interven- knowledge and the changes in patients’ related indicators tion has become important to treat chronic diseases at the before and after doctors’ training are compared. +e results grassroot level in China. +e main problems are that revealed that after training, the study group doctors’ correct management is not standardized, personalized disease response rates are significantly higher than the control management plans are lacking, and measures for different group’s (p< 0.05) to diagnose type 2 diabetes, impaired groups and individuals differ. To ensure that most primary fasting blood glucose, dyslipidemia characteristics, blood chronic diseases are reasonably diagnosed and treated in glucose control objectives, and the preferred drugs for obese community health service centers, it is necessary to improve patients. +e study group doctors’ response rates for cor- the diagnosis and treatment skill levels of community rectly classifying blood pressure levels, antihypertensive doctors. Community doctors urgently need to update ideas treatment strategies, balance psychology, ß-receptor blocker’ as well as supplement knowledge and improve their skills to caution/prohibition card, and compound preparations’ Journal of Healthcare Engineering 5 Table 3: Comparison of the ability to diagnose and treat hypertension before and after training. Project Research group (n � 60) Control group (n � 60) χ p Blood pressure level classification (%) Before training 36 (61.02) 40 (67.8) 0.591 0.442 After training 58 (98.31) 50 (84.75) 6.993 0.008 Risk stratification (%) Before training 18 (30.51) 23 (38.98) 0.934 0.334 After training 48 (81.36) 40 (67.8) 2.861 0.091 Antihypertensive treatment strategies (%) Before training 26 (44.07) 21 (35.59) 0.884 0.347 After training 50 (84.75) 40 (67.8) 4.683 0.03 Reasonable diet (%) Before training 39 (66.1) 35 (59.32) 0.58 0.446 After training 55 (93.22) 50 (84.75) 2.161 0.142 Weight control (%) Before training 41 (69.49) 36 (61.02) 0.934 0.334 After training 56 (94.92) 50 (84.75) 3.34 0.068 Physical exercise (%) Before training 32 (54.24) 36 (61.02) 0.555 0.456 After training 57 (96.61) 52 (88.14) 3.007 0.083 Quit smoking (%) Before training 29 (49.15) 33 (55.93) 0.544 0.461 After training 51 (86.44) 47 (79.66) 0.963 0.326 Balance mind (%) Before training 22 (37.29) 18 (30.51) 0.605 0.437 After training 53 (89.83) 43 (72.88) 5.587 0.018 Cautionary use of diuretics (%) Before training 22 (37.29) 26 (44.07) 0.562 0.453 After training 48 (81.36) 40 (67.8) 2.861 0.091 Caution/prohibition of ß blockers (%) Before training 26 (44.07) 23 (38.98) 0.314 0.575 After training 50 (84.75) 42 (71.19) 3.157 0.076 ACEI drug prohibition certificate (%) Before training 22 (37.29) 27 (45.76) 0.873 0.35 After training 52 (88.14) 45 (76.27) 2.978 0.084 Caution/prohibition of compound preparation (%) Before training 17 (28.81) 23 (38.98) 1.362 0.243 After training 50 (84.75) 40 (67.8) 4.683 0.040 caution/prohibition cards are significantly higher than the the students can truly master the diagnosis and treatment control group’s (p< 0.05). After conducting three-dimen- methods of such cases. +e entire training process en- sional team management training in the medical community couraged students’ learning initiatives, made an impression, model, the doctors’ hypertension knowledge, case diagnosis, and is easy to accept. and abilities to treat are significantly higher than that of After the intervention, the study group’s SBP, 2hPG, and community doctors with conventional training. HbA1c levels are significantly lower than the control group’s According to the analysis, the main characteristics of the (p< 0.05). Hence, three-dimensional team management under the medical community model can strengthen pa- three-dimensional team management in the medical com- munity model are cultivating the ability to diagnose accu- tients’ self-management abilities and indirectly affect pa- rately and providing effective treatment as the main goals. tients’ laboratory test indexes. +rough health education, Other achievements include implementing face-to-face patients are guided to strictly follow the doctor’s advice and discussion, using interaction training methods, incorpo- take correct dosages of medicines timeously so that FPG, rating theory with practice, and ensuring pertinence and 2hPG, HbA1c, and other indicators are gradually decreased practicability. +e teacher is an expert, rich in clinical and and normalized. +e compliance rate of the study group is teaching experience, from city and district chronic disease significantly better than the control group (p< 0.05). +is prevention and control hospitals; thus, common cases are shows that the three-dimensional management of the team used to introduce the problems that community doctors under the medical community model has a high application often encounter in diagnosing and treating such cases. value and can effectively improve the quality of family management as well as the effect of disseminating disease Teachers guide students by discussing these problems; thereafter, they gradually explain the knowledge relevant to knowledge and service satisfaction. Family intervention and the case and finally return to the case and the problem so that treatment methods can help educate patients to develop 6 Journal of Healthcare Engineering Table 4: Comparison of baseline data of patients in the study group and the control group with general practitioner intervention. Normal information Research group (n � 200) Control group (n � 200) t/χ p Age (years) 70.5± 6.7 69.4± 6.7 1.642 0.101 BMI (kg/m ) 24.8± 1.9 24.5± 2.3 1.422 0.156 Course of disease (years) 7.2± 2.2 7.0± 2.0 0.951 0.342 Sex (%) 0.493 0.483 Male 111 (55.5) 104 (52.00) Female 89 (44.5) 96 (48.00) Disease (%) 0.812 0.368 Hypertension 100 (50.00) 109 (54.5) Diabetes 100 (50.00) 91 (45.5) Smoking (%) 0.433 0.511 Yes 56 (28.00) 62 (31.00) No 144 (72.00) 138 (69.00) Drinking (%) 0.552 0.468 Yes 70 (35.00) 63 (31.5) No 130 (65.00) 137 (68.5) Hyperlipidemia (%) 0.57 0.458 Yes 59 (29.5) 66 (33.00) No 141 (70.5) 134 (67.00) Coronary heart disease (%) 1.567 0.211 Yes 26 (13.00) 32 (16.00) No 174 (87.00) 168 (84.00) Table 5: Blood pressure control status of study group and control group. SBP (mmHg) DBP (mmHg) Group n Before intervention After intervention Before intervention Afterintervention Research group 100 157.2± 8.6 128.0± 7.0 98.4± 6.6 76.1± 5.8 Control group 109 155.5± 8.1 131.4± 6.7 97.0± 7.0 77.6± 6.3 t 1.472 -3.587 1.484 −1.786 p 0.143 0.000 0.139 0.076 Table 6: +e blood sugar control status of the study group and the control group(x ± s). FPG (mmol/L) 2hPG (mmol/L) HbA1c (%) Group n Before After Before After Before After intervention intervention intervention intervention intervention intervention Research 100 8.84± 0.95 6.32± 0.55 12.78± 1.33 8.17± 1.05 8.86± 0.95 6.81± 0.68 group Control group 91 8.70± 0.90 6.47± 0.67 12.51± 1.20 8.50± 1.23 8.64± 0.89 7.25± 0.74 t 1.043 -1.697 1.468 -1.999 1.647 -4.282 p 0.298 0.091 0.144 0.047 0.101 0.000 Table 7: Comparison of compliance between the study group and +e mastery of hypertension-related knowledge regarding the control group [n(%)].. hypertensive patients served by family doctors improved Complete Poor significantly; this can help patients master scientific and Group n General compliance compliance reasonable self-management methods, enhance self-care Research awareness, and implement behavior changes. 200 134 (67.00) 54 (27.00) 12 (6.00) group Control 200 105 (52.50) 71 (35.50) 24 (12.00) 5. Conclusion group Z −3.107 Diabetes and hypertension are the most common diseases p 0.002 and often coexist. Currently, hypertension is the most widespread chronic disease in China. In summary, the healthy living habits while formulating detailed and rea- team’s three-dimensional management under the medical sonable treatment plans, fully using various family re- community model significantly improves the ability of sources, and effectively solving patients’ health problems. grassroot general practitioners to diagnose and treat Journal of Healthcare Engineering 7 the community,” Psychiatria Danubina, vol. 31, no. 3, hypertension and diabetes and better control diabetes and pp. 622–625, 2019. hypertension levels in patients. [7] D. K. Patten, B. G. Schultz, and D. J. 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Journal of Healthcare EngineeringHindawi Publishing Corporation

Published: Apr 11, 2022

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