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探讨慢性心力衰竭(CHF)的社区规范化管理方法及实施效果,为慢性疾病的社区管理提供实践支持。在桐乡市内选取4个相似的社区,随机分为干预组和对照组。对照组仅做好健康信息网络登记和随访工作,干预组对CHF患者及社区居民进行统一的规范性管理,进行为期2年的随访研究。比较两组CHF患者患病率住院率、死亡率及规范化服药率,在研究初始及结束后采用明尼苏达中文版心力衰竭生活质量量表(LiHFe)评定CHF患者的生活质量。结果显示,干预组CHF患病率、住院率均低于对照组,差异有统计学意义(χ2=53.66、73.44,P=0.001),干预组死亡率低于对照组,差异无统计学意义(χ2=3.03、P=0.064);规范性服药率高于对照组,差异有统计学意义(χ2=41.40,P=0.001)。研究初始,干预组、对照组LiHFe得分分别为(52.68±14.32)分、(53.25±12.45)分,差异无统计学意义(t=0.41,P=0.06)。研究结束时,干预组LiHFe得分(32.06±8.40)低于对照组(61.27±10.23)分,差异有统计学意义(t=30.23,P=0.007 6);与研究初始比较,干预组LiHFe得分降低,差异有统计学意义(t=16.8,P<0.01),对照组LiHFe得分增高,差异有统计学意义(t=0.688,P=0.007 0)。通过实施规范化的社区CHF管理,提高社区及医院医生的理论水平和患者自我保护及健康意识,降低CHF的患病率、再住院率和死亡率,具有较高的治疗康复效果和卫生经济学效率,对CHF乃至其他慢性疾病的社区规范化管理具有一定的指导和借鉴意义。
To explore the community standardized management methods and implementation effects of chronic heart failure (CHF), and provide practical support for the community management of chronic diseases. Four similar communities were selected in Tongxiang city and randomly divided into intervention group and control group. In the control group, only the health information network registration and follow-up were done. The intervention group conducted a unified normative management of CHF patients and community residents for a 2-year follow-up study. The prevalence of hospitalization, mortality and standardized medication rates were compared between the two groups, and the quality of life of CHF patients was assessed using the Minnesota Chinese version of Heart Failure Quality of Life Scale (LiHFe) at the beginning and end of the study. The results showed that the intervention group CHF prevalence, hospitalization rate were lower than the control group, the difference was statistically significant (χ2 = 53.66,73.44, P = 0.001), intervention group mortality was lower than the control group, the difference was not statistically significant ( χ2 = 3.03, P = 0.064). The standard medication rate was higher than that of the control group (χ2 = 41.40, P = 0.001). The initial, intervention and control groups LiHFe scores were (52.68 ± 14.32) points, (53.25 ± 12.45) points, the difference was not statistically significant (t = 0.41, P = 0.06). At the end of the study, LiHFe scores in intervention group (32.06 ± 8.40) were lower than those in control group (61.27 ± 10.23), the difference was statistically significant (t = 30.23, P = 0.007 6) , The difference was statistically significant (t = 16.8, P <0.01). The control group LiHFe score increased, the difference was statistically significant (t = 0.688, P = 0.007 0). Through the implementation of standardized community CHF management, community and hospital doctors to improve the theoretical level and patients with self-protection and health awareness, reduce the prevalence of CHF, rehospitalization and mortality, with high rehabilitation and health economics efficiency , Which has some guidance and reference significance to the community standardized management of CHF and other chronic diseases.