类风湿关节炎患者就医行为及综合管理的干预效应分析

Study of the health care seeking behavior and the efficacy of chronic disease management in rheumatoid arthritis

目的 探讨RA患者就医行为特点以及慢病综合管理对其的干预效应.方法 对2012年8月至2013年6月在四川省人民医院风湿免疫科门诊就诊的240例RA患者进行分析.内容包括患者的一般资料、首次就诊医师类型、就诊时机、确诊科室及相关知识获取来源等,然后以配对分组方法将患者分为对照组与干预组各120例,在常规口服药物基础上,干预组给予6个月的慢病综合管理,比较2组患者依从性及疾病达标率.采用t检验,x2检验和Spearman相关分析进行统计分析.结果 患者首诊医师选择及就医时机与性别、发病年龄及文化程度无明显相关性（P＞0.05）,而首诊医师选择与个人收入（x2=59.684,P＜0.0）、有无医保（=29.202,P＜0.01）相关.确诊科室以风湿免疫科最高（88.8％,213/240）,疾病知识获取来源前2位是周围人群（35.8％,86/240）和医疗广告（28.3％,68/240）,来自医生的仅占10.0％（24/240）.在干预阶段,干预组规律服药比例更高[83.6％（92/110）与64.1％（59/92）,x2=10.100,P＜0.01],更容易达到基于DAS28计算的良好反应[67.3％（74/110）与53.3％（49/92）,x2=4.130,P＜0.05].结论 RA患者首次就诊行为受经济因素影响较大,通过慢病综合管理能规范RA患者的部分就医行为,提高患者依从性及疾病缓解率.

Objective To investigate the health care seeking behavior of rheumatoid arthritis （RA） patients and to assess whether chronic disease management benefits to RA patients.Methods Clinic patients diagnosed with RA in our hospital from August 2012 to June 2013 were enrolled.The data including sex,age of onset,duration,mode of first hospitalization,time of diagnosis,department of diagnosis and knowledge source were collected.RA patients were assigned into two groups （the experimental group and the control group）.Both groups had 120 cases and treated with oral medications,while the experimental group was managed with chronic disease management,for 6 monthsrespectively.Statistical analysis was done with Student＆#39;s t test for comparison of the two groups.The chi-square test was used to compare percentages of the two groups.The correlations were sought by computing Spearman＆#39;s correlation coefficients.Results In this 240 RA patients,the ratio of male to female was 1∶65.The income （x2=59.684,P＜0.01） and medicare status （x2=29.202,P＜0.01） were associated with the initial health care seeking behavior,while sex,education level and age of onset had no effect on it （P＞0.05）.Rheumatology department was the most common department confirming the diagnosis （88.8％,213/240）.Most knowledge of disease was introduced by relatives and friends （35.8％,86/240） and medical advertising（28.3％,68/240）,while only 10％ （24/240） was acquired from doctors.Patients in the experimental group preferred regular medication [83.6％ （92/110） vs 64.1％ （59/92）,x2=10.100,P＜0.01] and had good response measured by DAS28 [67.3％（74/110） vs 53.3％（49/92）,x2=4.130,P＜0.05].Conclusion The initial health care seeking behavior is affected mostly by economic status.Chronic disease management can benefit RA patients by improving their health care seeking behavior.