“三位一体”哮喘教育管理模式对患者使用医疗资源和社会行为影响的评估

Impact of education and management program for asthmatic patients on their use of health resources and social behavior

目的评估北京大学人民医院"三位一体"哮喘教育管理模式对患者使用医疗资源及社会行为的影响。方法 "三位一体"哮喘患者教育管理模式包括哮喘专业门诊、哮喘宣传教育中心和哮喘患者协会。采用面对面问卷方式,对在北京大学人民医院接受"三位一体"哮喘教育管理的门诊患者56例(教育组)和在北京市另一家三级甲等医院呼吸科就诊但未接受过系统教育管理的门诊哮喘患者30例(对照组),近1年内的非预约门诊就医、急诊就医和住院、医疗费用、误工情况进行调查并做对比分析。结果教育组中非预约门诊就医、急诊就医的患者分别占9例(16%)和4例(7%),对照组分别为20例(67%)和12例(40%);教育组中人均非预约门诊就医和急诊就医次数分别为(0.5±1.7)次和(0.2±0.6)次,对照组分别为(2.1±2.8)次和(0.6±0.9)次。两组各项差异均有统计学意义(P<0.01)。教育组年医疗费用均数较对照组少1776元。教育组和对照组在职患者中因哮喘误工的比例分别为0%(0例)和33%(8例,P<0.01)。结论"三位一体"哮喘教育管理模式可以有效减少患者对医疗资源的消耗并减少误工;这种医疗模式可向国内大中城市医院推广。

Objective To evaluate the impact of an asthmatic education and management program on patients＇ use of health resources and social behavior. Methods The ＂three in one＂ program consisting of a specialized clinic for asthma, an asthma education center and an Asthmatic Patients Association was implemented at People＇ s Hospital, Peking University. Fifty-six outpatients with asthma involved in the program were face-to-face interviewed by questionnaire at the People＇ s Hospital as an education group, and 30 asthmatic outpatients at another hospital with the same level of care but without systematic asthmatic education and management as a control group. Their non-appointed outpatient visits, emergency visits, hospitalization, medical expenses, and absence from work during the past year were investigated and compared between the two groups. Results Nine patients （ 16% ） visited outpatient department without appointment and four （7%） visited emergency department, with an average of（0. 5 ± 1.7）and（0. 2 ±0. 6） visits, respectively, in the education group, as compared to 20 （67%） and 12（40% ）, with an average of （2. 1 ± 2. 8） and（0. 6 ± 0. 9） visits, respectively in the control one in the past year （ P 〈 0. 01 ）. Medical expenses were 1776 yuan less in the education group than those in the control one. None of 26 incumbent patients was absent from work due to asthma episode in the education group, as compared to eight cases of 24 incumbent patients （33%） in the control group （P 〈 0. 01 ）. Conclusions ＂Three in one＂ asthmatic patient education and management program could effectively reduce the consumption of health resources and absence from work in asthma patients, worthy of popularization at hospitals in large and medium-size cities nationwide.