慢性病患者基于服务过程的治疗负担情况及影响因素

Treatment burden and factors influencing patients with chronic diseases

目的分析慢性病患者治疗负担情况及其影响因素。方法在深圳市某区采用整群抽样的方法,从该区全部33家社区健康服务中心抽取17家作为研究地点,共纳入1108例符合研究标准的慢性病患者。调查患者社会人口学资料、患病服药情况、体检指标、生活方式、医疗服务利用情况,采用慢性病治疗负担量表(treatment burden questionnaire,TBQ)调查患者的治疗负担。结果TBQ平均得分为(25.30±21.52)分,采用K-均值聚类分析法将研究对象分为三组:轻度组628例(56.68%),TBQ评分(10.11±6.64)分;中度组386例(34.84%),TBQ评分(38.05±8.58)分;重度组94例(8.48%),TBQ评分(74.49±15.28)分。三组患者性别、户籍、医保类型、血脂异常情况、患慢性病种类数、服药情况、运动、腰臀比、签约家庭医生、固定医疗机构就诊情况比较,差异有统计学意义(P<0.05)。多因素非条件logistic回归分析结果显示,患慢性病种类数、服药情况、运动情况、腰臀比、签约家庭医生是治疗负担影响因素,差异有统计学意义(P<0.05)。更多的患病种类数量、有服用药物、不规律运动、不健康腰臀比、无签约家庭医生与疾病治疗负担得分具有正向关联,差异有统计学意义(P<0.05)。结论深圳市某区慢性病患者治疗负担以轻度治疗负担为主,社区医务工作者应针对其影响因素采取相应的干预措施,提高患者生活质量,减轻治疗负担。

Objective Analyze the treatment burden and factors influencing patients with chronic diseases.Methods A cluster sampling method was used in Shenzhen district.Seventeen social health centers were selected from all 33 social health centers in the district as the research sites,and a total of 1108 patients with chronic diseases who met the research criteria were included.Socio-demographic data,disease medication status,physical examination indicators,lifestyle,medical service utilization,and the Chronic Disease Treatment Burden Questionnaire(TBQ)were used to investigate the treatment burden of patients.Results The average TBQ score was(25.30±21.52).The K-means clustering analysis method was used to divide the study subjects into three groups:628(56.68%)patients in the low-treatment burden group with a TBQ score of(10.11±6.64);386(34.84%)patients in the moderate-treatment burden group with a TBQ score of(38.05±8.58),and 94(8.48%)patients in the high-treatment burden group with a TBQ score of(74.49±15.28).There were significant differences in the treatment burden among patients based on gender,household registration,medical insurance,dyslipidemia,type of chronic disease,medications,exercise,waistto-hip ratio,family doctor signing,and fixed medical institution visits(P<0.05).The results of multivariate unconditional logistic regression analysis showed that different types of chronic diseases,medications,exercise,waist-to-hip ratio,and family doctor signing were the factors influencing treatment burden(P<0.05).More disease types,medication use,irregular exercise habits,an unhealthy waist-to-hip ratio,and unsigned family doctors were positively associated with disease treatment burden scores(P<0.05).Conclusion The treatment burden of patients with chronic diseases in Shenzhen district is mainly low.Community medical workers should take corresponding intervention measures to improve the quality of life and reduce the treatment burden.