家庭医生签约式服务对社区脑卒中患者自我感受负担及心理状态的影响

The effects of contracted services of family physicians on self-perceived burden and psychological status of stroke patients in a community

目的:观察家庭医生签约式服务对社区脑卒中患者自我感受负担及心理状态的影响。方法:将116例脑卒中患者随机分为观察组和对照组,其中观察组52例,实施医生签约式服务;对照组64例,按常规管理模式进行管理,于干预前进行基线调查,于干预后3个月及6个月采用改良Rankin量表(modifiedRankinScale,mRS)、日常生活活动量表(BarthelIndex,BI)、自我感受负担量表(Self-PerceivedBurdenScale,SPBS)、焦虑自评量表(Self-rating Anxiety Scale,SAS)和抑郁自评量表(Self-rating Depression Scale,SDS)进行自我感受负担、功能恢复及心理状态等干预效果评价。结果:观察组干预后6个月SPBS总分[(24.43±4.04)分]及其各维度得分均低于干预前[(39.12±4.46)分]及对照组[(31.48±4.21)分]得分,差异有统计学意义(F=179.82,t=9.1326,P<0.05);观察组干预后6个月SAS得分[(26.57±6.81)分]、SDS得分[(28.74±6.87)分]、mRS得分[(1.93±0.45)分]均低于干预前[(53.14±7.26)分、(52.25±9.53)分、(3.81±0.65)分]及对照组[(34.33±7.75)分、(35.55±8.38)分、(2.44±0.53)分]得分,BI评分[(68.99±8.43)分]高于干预前[(36.26±8.83)分]及对照组[(60.38±7.72)分]得分,差异均具有统计学意义(P<0.05)。结论:家庭医生签约式服务对社区脑卒中患者实施康复干预效果良好,减轻了患者的自我感受负担,促进其肢体功能恢复,改善了心理状态,且提高了日常生活能力,可推广应用。

Objective:To explore the effects of contracted services of family physicians on self-perceived burden and psychological status of stroke patients in a community.Methods:A total of 116 patients with stroke were randomly divided into the observational group and the control group.52 patients in the observational group received individualized behavior intervention by contracted services of family physicians.Another 64 patients in the control group received routine care.A series of questionnaires including Modified Rankin Scale(mRS),Barthel Index(BI),Self-Perceived Burden Scale(SPBS),Self-Rating Anxiety Scale(SAS),and Self-Rating Depression Scale(SDS)were used to evaluate the effects of the intervention on self-perceived burden and psychological status of the patients.Results:Six months after the intervention,the scores of SPBS(24.43±4.04)and each dimension in the observational group were significantly lower than those in the preintervention(39.12±4.46)and the control group(31.48±4.21)(F=179.82,t=9.1326,P<0.05).Six months after the intervention,the scores of SAS(26.57±6.81),SDS(28.74±6.87)and mRS(1.93±0.45)in the observational group were lower than those in the pre-intervention[(53.14±7.26),(52.25±9.53),(3.81±0.65)]and the control group[(34.33±7.75),(35.55±8.38),(2.44±0.53)],and the BI scores(68.99±8.43)were higher than those in the pre-intervention(36.26±8.83)and the control group(60.38±7.72),and all the differences were statistically significant(P<0.05).Conclusion:The worse the family function is,the heavier the self-perceived burden of patients with stroke have.The community-based contract services of family physicians has good effects on rehabilitation of patients with stroke.It can reduce the self-perceived burden of patients,improve their limb function and psychological status,and increase their daily living ability.The contacted services of family physicians can be promoted.