慢性传染性肝病管理模式的临床应用

The clinical application of chronic contagious liver disease management mode

目的探讨可操作性的传染性肝病慢病管理模式。方法选取首都医科大学附属北京佑安医院就诊的慢性肝炎、肝硬化、肝癌患者共254例,采用调查问卷方式收集患者信息,对其进行3个月的慢病管理监控,对干预前后患者自身疾病知识知晓率、生活方式改变情况、药物治疗依从性等进行对比。结果患者对疾病传播途径、预防措施、疾病进展、疾病预后、肝硬化并发症、规范治疗方案的知晓率分别从83.5%、92.5%、78.0%、79.5%、40.4%、76.0%提升到98.4%、100.0%、97.6%、94.1%、95.2%、98.4%(P均<0.01)。患者定期复查、服药依从性的比率由73.2%、86.4%提升到96.1%、97.9%(P<0.05)。负性心理、营养不良、不良生活方式及行为习惯分别占46.5%、16.9%、26.4%,干预后依次提升了71.1%、76.7%和76.1%。结论慢性传染性肝病管理模式应注重传染病相关防治知识的普及和心理疏导工作。慢病管理模式采用专科医院与社区医院协作是发展方向,该模式可以明显提升肝病患者对疾病的认知、治疗依从性和生活质量。

Objective To explore the operational modes of chronic infectious disease management by comprehen- sive interventions in chronic hepatitis, cirrhosis, liver carcinoma patients. Methods A total of 254 cases of chronic hepati- tis, liver cirrhosis, and hepatocellular carcinoma patients were enrolled in this study. Patient＇ s information was collected by questionnaire survey. Patients were managed and monitored by chronic disease management for 3months. The aware- ness rate of disease knowledge, lifestyle changes, medication compliance, and so on were compared before and after the intervention. Results The rates of the disease transmission, prevention measures, disease progression, prognosis, compli- cations of liver cirrhosis, specification regimen in the treatment raised from 83.5%, 92.5%, 78.0%, 79.5%, 40.4%, 76.0% to 98.4%, 100.0%, 97.6%,94.1%, 95.2%, 98.4% respectively. The difference was significant （P 〈 0.01）. Patients＇ regular follow-up rate, and the compliance rate of medication taken raised from 73.2%, 86.4% before the intervention to 96.1%, 97.9% after the intervention. The differences were significant （P 〈 0.01）. The negative mental state, malnutrition, poor life- style and behavior were 46.5%, 16.9%, 26.4% before the intervention, which increased to 71.1%, 76.7%, 76.1% after the intervention. Conclusion The knowledge ofpreventionofinfectiousdisease and psychological counseling should be carried out in chronic infectious disease management. This model can obviously improve the patients＇ awareness of the disease, treatment compliance and quality of life.