北京市德胜社区签约慢性病患者健康行为现状调查及影响因素分析

Health Behavior Situation and Influence Factor of Patients with Chronic Disease in Beijing Desheng Community

目的调查北京市德胜社区家庭医生式服务开展初期,签约慢性病患者的健康行为现状并探讨其影响因素,为有效进行健康行为干预、提高家庭医生式服务质量提供依据。方法采用单纯随机抽样方法,按患者档案号随机抽取2012年9—12月在德胜社区卫生服务中心门诊签约的420例慢性病(高血压、糖尿病)患者,采用自行设计的社区慢性病患者健康行为调查表调查慢性病患者一般资料、健康行为、知识与态度。结果签约慢性病患者的总体健康行为呈中等水平,总分为(60.07±8.51)分,总体达标率为55.48%(233/420)。健康行为各维度得分分别为:饮食(31.35±5.42)分,达标率为73.10%(307/420);运动(9.25±3.46)分,达标率为50.48%(212/420);嗜好(7.24±1.61)分,达标率为82.62%(347/420);心理调节(8.37±1.83)分,达标率为75.71%(318/420);遵医行为(3.87±1.80)分,达标率为30.95%(130/420)。慢性病相关知识(8.44±2.95)分,达标率为46.90%(197/420);患者对疾病的态度(7.96±1.77)分,达标率为66.43%(279/420)。Pearson相关分析结果显示,健康行为与知识呈正相关(r=0.118,P=0.015);健康行为与态度无直线相关性(r=-0.042,P=0.391)。多元线性回归分析结果显示,体质指数与运动相关,性别和知识与嗜好相关,知识和病程与心理有关,知识和病种与遵医行为相关(P<0.05)。结论签约慢性病患者健康行为现状不理想,其中进食早餐、控制烟酒及遵医嘱服药较好;饮食中油盐控制、运动异常处理及血糖监测较差。患者的知识、性别、病程是主要影响因素,家庭医生式服务团队在制定签约慢性病患者的行为干预措施时要针对患者不同的性别及病程阶段,在传授慢性病相关知识的同时,更加注重培养患者的自我管理技能,以更好地改善并维持其健康行为,提高家庭医生式服务质量。

Objective To study the health behavior situation of patients with chronic disease in Beijing Desheng Community and its influencing factors in the initial stage of family doctor service in order to provide reference for effective intervention on health behaviors and improve the quality of family doctor service. Methods 420 patients with chronic disease signed in the Desheng Community Health Center from September to December in 2012 were randomly sampled according to the patients＇ file number by using simple random sampling. Self-designed questionnaire on health behavior was used to survey the general information,health behavior,knowledge and attitude of the patients. Results The health behavior of the signed patients with chronic disease in the community was at medium level with an overall score of （ 60. 07 ± 8. 51 ）and a control rate of 55. 48%（ 233/420）. The score and control rate of the items were as follows：diet（31. 35 ± 5. 42）and 73. 10%（307/420）,exercise（9. 25 ± 3. 46）and 50. 48%（212/420）,hobby（7. 24 ± 1. 61）and 82. 62%（347/420）,mental regulation（8. 37 ± 1. 83）and 75. 71%（318/420）,following the doctor＇s advice（3. 87 ± 1. 80）and 30. 95%（130/420）,knowledge on chronic disease （8. 44 ±2. 95）and 46. 90%（197/420）,attitude towards the disease（7. 96 ± 1. 77）and 66. 43%（279/420）. Pearson correlation analysis showed that the health behavior was positively correlated with knowledge（r =0. 118,P =0. 015）,but showed no correlation with attitude（P〉0. 05）. Multiple regression analysis showed that BMI was correlated with exercise,sex and knowledge were correlated with hobby,knowledge and disease course were correlated with mentality and knowledge and disease categories were correlated with following the doctor＇s advice（P〈0. 05）. Conclusion The situation of health behavior of the signed patients with chronic disease is not satisfactory. Among the items,having breakfast,controlling the cigarette and the alcohol and taking medicine following the doctor＇s advice are the best,while controlling the oil and salt of food,sport abnormality handling and blood sugar monitoring are the worst. The patients＇ knowledge,sexual distinction and course of disease are the main influencing factors. When working out the intervention measures of the chronic disease patients of the community,the health care provider should take notice of different patients＇ sexual distinction and course and peculiarity of disease and teach the knowledge of chronic disease,as well as pay more attention to the cultivation of the patient＇s self management skills,so as to improve and maintain the health level of the chronic disease patients and enhance the effect of the their health management.