摘要： 背景 國(guó)際上，多學(xué)科團(tuán)隊(duì)協(xié)作的服務(wù)模式在改善慢性病患者健康結(jié)局方面已有充分且嚴(yán)謹(jǐn)?shù)淖C據(jù)支持。在中國(guó)，雖然以全科與專科為核心的團(tuán)隊(duì)協(xié)作模式的探索逐漸增多，但仍缺乏系統(tǒng)的評(píng)價(jià)與分析。目的 系統(tǒng)評(píng)價(jià)全專服務(wù)模式對(duì)改善中國(guó)基層慢性病患者健康結(jié)局的有效性。方法 計(jì)算機(jī)系統(tǒng)檢索中國(guó)知網(wǎng)（CNKI）、萬方數(shù)據(jù)知識(shí)服務(wù)平臺(tái)（Wanfang Data）、維普網(wǎng)（VIP）、中華醫(yī)學(xué)期刊全文數(shù)據(jù)庫（SinoMed）、PubMed、Cochrane Library、Web of Science、Embase數(shù)據(jù)庫中有關(guān)采用全專模式管理基層高血壓和糖尿病患者的隨機(jī)對(duì)照實(shí)驗(yàn)（RCT），對(duì)照組采用常規(guī)健康管理服務(wù)，干預(yù)組在對(duì)照組基礎(chǔ)上采用全專干預(yù)模式，檢索時(shí)限為2011年7月至2024年10月。文獻(xiàn)篩選、質(zhì)量評(píng)價(jià)和數(shù)據(jù)提取由2名研究人員獨(dú)立完成。使用RevMan 5.4.1和Stata 17.0軟件進(jìn)行統(tǒng)計(jì)分析。結(jié)果 共納入17篇文獻(xiàn)，最終受試者21 591例。Meta分析結(jié)果顯示，對(duì)于糖尿病患者管理，干預(yù)組患者的糖化血紅蛋白（MD=-0.72，95%CI=-0.96~-0.48，P＜0.001）、空腹血糖（MD=-0.84，95%CI=-1.04~-0.65，P＜0.001）、餐后2h血糖（MD=-1.12，95%CI=-1.52~-0.72，P＜0.001）的改善程度優(yōu)于對(duì)照組；對(duì)于高血壓患者管理，干預(yù)組患者的收縮壓（MD=-6.49，95%CI=-7.53~-5.44，P＜0.001）和舒張壓（MD=-6.00，95%CI=-8.89~-3.12，P＜0.001）的改善程度優(yōu)于對(duì)照組。亞組分析結(jié)果顯示，全專模式干預(yù)效果在不同性別、年齡、干預(yù)周期的患者中存在顯著差異。Egger's檢驗(yàn)顯示，糖化血紅蛋白（P=0.003）和空腹血糖（P=0.002）可能存在發(fā)表偏倚。結(jié)論 全專服務(wù)模式對(duì)改善基層慢性病患者健康指標(biāo)具有顯著作用，應(yīng)作為國(guó)家基本公共衛(wèi)生服務(wù)中慢性病健康管理的重要手段加以推廣實(shí)施。目前，國(guó)內(nèi)試行的全專模式尚缺乏高效協(xié)同機(jī)制，其中數(shù)字化與信息化利用程度較低，缺乏針對(duì)數(shù)字化全專模式的標(biāo)準(zhǔn)化實(shí)施路徑。此外，目前針對(duì)高血壓管理的研究相對(duì)較少，亟需開展更多高質(zhì)量、多中心、大樣本的社區(qū)試驗(yàn)，以進(jìn)一步提升基層防病治病和慢性病健康管理能力。

關(guān)鍵詞: 糖尿病, 高血壓, 全專結(jié)合, 隨機(jī)對(duì)照實(shí)驗(yàn), 系統(tǒng)評(píng)價(jià)

Abstract: Background While the effectiveness of multidisciplinary team-based care in chronic care management has been well-documented in high-income countries, evidence from China is limited. Objective To systematically evaluate the effect of multidisciplinary team-based care, collaboratively provided by hospital-based specialists and community-based generalists, on hypertension and diabetic outcomes in primary care settings in China. Methods A comprehensive literature search was conducted across nine databases, including both English and Chinese language journals, covering publications from July 2011 to October 2024. Two independent reviewers performed literature screening and data extraction, with consensus. The risk of bias and publication bias were assessed, and heterogeneity was evaluated using the Q-test and I2 statistic. Fixed-effect and random-effect models were applied for meta-analysis. Subgroup analyses were conducted based on the participants’ mean age, gender ratio, disease duration, and intervention length. Statistical analysis was conducted using RevMan 5.4.1 and Stata 17.0 software. Results Seventeen randomized clinical trials (RCTs) with 21 591 patients were included, with 12 focusing on diabetes and 5 on hypertension. Meta-analysis results showed that, for diabetic patients, collaborative care significantly improved patient outcomes, including glycated hemoglobin (MD = -0.72, 95%CI = -0.96 to -0.48, P < 0.001), fasting blood glucose (MD = -0.84, 95%CI = -1.04 to -0.65, P < 0.001), and 2-hour postprandial blood glucose (MD = -1.12, 95%CI = -1.52 to -0.72, P < 0.001) compared to the control group. Similarly, hypertensive patients in the intervention group also showed significant improvements in systolic blood pressure (MD = -6.49, 95%CI = -7.53 to -5.44, P < 0.001) and diastolic blood pressure (MD = -6.00, 95%CI = -8.89 to -3.12, P < 0.001). However, except for systolic blood pressure, the I2 values exceeded 50%. Subgroup analyses suggested that heterogeneity across studies due to variations in gender ratio, mean age, and intervention lengths. Egger's test indicates that there may be publication bias in glycated hemoglobin (P=0.003) and fasting blood glucose (P=0.002). Discussion The collaborative care provided by hospital-based specialists and community-based generalists significantly improved hypertension and diabetic patient outcomes in China’s primary care settings. Interprofessional collaborative care, especially between primary care physicians and hospital specialists, is crucial for optimal management of chronic diseases. High-quality and large community trials are needed to identify strategies to enhance an in-depth collaboration between hospital-based specialists and community-based generalists, thereby further improving population health and enhancing the efficiency of healthcare utilization.

Key words: Diabetes, Hypertension, General practitioner-specialty collaborative care, Randomized control trial, Systematic review

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