某三级医院193例慢性病患者延续护理需求调查研究

Needs of Continuing Care of Patients with Chronic Diseases

目的：探讨三级医院慢性病患者对延续护理的需求情况。方法研究者自行设计调查问卷，对某三级医院193例慢性病住院患者进行问卷调查，问卷内容包括延续护理的提供者、内容、形式、时限、频次、费用态度等。结果三级医院66.0%的慢性病患者希望出院后得到医院的延续护理；60.2%的慢性病患者希望责任医生提供延续护理；慢性病患者对延续护理内容需求排在首位的是药物知识（占57.0%），其次是康复知识（占53.9%）；慢性病患者对延续护理形式需求排在首位的是电话随访（占74.2%），其次是咨询热线（占34.4%）；50.8%的慢性病患者希望出院后1～2年内得到延续护理，42.2%的慢性病患者希望出院后每年得到10～12次延续护理；53.9%的慢性病患者认为根据延续护理的内容及形式，可以按照国家相关法规收取费用。结论三级医院慢性病患者对延续护理的需求较高，对延续护理的提供者、内容、形式、时限、频次、费用态度多样化，医院应组建多学科团队，根据慢性病患者的不同需求采取针对性强、形式丰富的延续护理，使延续护理不流于形式,而是真正地深入到社区,进入到每个家庭。

Objective To explore the needs of continuing care of patients with chronic diseases. Methods A self-designed questionnaire focusing on the providers, contents, forms, times, frequency, cost of continuing care was applied to investigated 193 patients with chronic diseases. Results Totally 66.0% of the patients hoped to enjoy continuing care after discharge and 60.2% of them hoped doctors could offer the care. Drug knowledge （57.0%） topped the content of the care, followed by the rehabilitation knowledge （53.9%） and telephone follow-up （74.2%） topped the care form, followed by the hot-line （34.4%）. Half of the patients need continuing care in 1 to 2 years after discharge and 42.2%of the patients need continuing care 10 to 12 times per year after discharge. Totally 53.9% of the patients thought it was reasonable to pay for the care based on the content and form of the care in accordance with the relevant laws and regulations of the country. Conclusion Patients with chronic diseases are in great demand of continuing care and there are diversifications for the providers, contents, forms, times, frequency, costs tolerance of the care. Targeted and diversified continuing care would benefits patients with chronic diseases.