上海浦东慢性病自我管理项目实施效果评价研究

Evaluation of Chronic Disease Self-Management Program Conducted in Pudong New Area in Shanghai

目的 评价上海浦东新区慢性病自我管理项目实施6个月之后的效果。方法 按照以社区为基础的随机对照试验研究设计,将297名患有高血压病、心脏病、关节炎、中风、哮喘、糖尿病、COPD等疾病自愿参加该项目的慢性病人,随机分为干预组和对照组。采用协方差的秩检验,比较了在基线及项目实施6个月之后两次问卷调查的140名干预组病人和129名对照组病人在自我管理行为、自我效能、健康状况和卫生服务利用等方面的变化。结果 与对照组比较,干预组在一种自我管理行为方面明显提高:6个月内认知性症状管理方法实践评分,干预组平均多增加了0.11分;症状管理自我效能和疾病共性管理自我效能评分6个月的增加值,分别比对照组高出1.08分和1.07分;干预组在健康状况的8个方面(整体健康自评、健康担忧、疲劳、气短、疼痛、疾病对病人生活影响、情绪低落及社会活动/角色受限),明显好于对照组(P值均<0.05);干预组6个月内住院次数平均比对照组减少了0.14次(P=0.01);住院天数比对照组平均下降了0.87天(P<0.01)。结论上海浦东新区慢性病自我管理项目实施6个月之后可改善参加者的自我管理行为、自我效能、部分健康状况、减少住院次数和住院天数。

OBJECTIVE To evaluate the six-month effectiveness of Chronic Disease Self-Management Program conducted in Pudong New Area in Shanghai.METHODS The study was a community-based randomized controlled trial 297 volunteer participants with hypertension,heart disease, arthritis i stroke, asthma, diabetes, and COPD, were randomized to treatment group or control group. Analysis of covariance Based on Rank Scores( Cochran- Mantel- Haenszel Statistics) was used to compare six-month changes of Self-Management Behaviors, Self-Efficacy (SE), Health Status and Health Service Utilization for 140 treatment subjects and 129 control subjects who complete 6-month study. RESULTS Treatment subjects,when compared with controls,demonstrated significant improvement in one of four self-management behaviors (treatment subjects aver-agely increased 0.11 more scores in practice of cognitive symptom management) .treatment group increase 1.08 and 1.07 scores separately in SE to manage symptom and SE to manage disease in general. They also demonstrated significant improvement in eight of health status (self-rated health, health distress, fatigue, short of breath, pain, illness intrusiveness, depression and social/role activities limitation) (all P < 0.05). They also had on average,0.14 fewer hospitalization (P = 0.01) and 0.87 fewer days in hospital. CONCLUSIONS Chronic Disease Self-Management Program conducted in Pudong New Area in Shanghai improved participants' health behavior,Self-efficacy,parts of health status,fewer hospitalization and days in hospital after 6-month implementation.