以专病管理团队为主导的疾病管理对炎症性肠病患者的效果研究

Effect of Management Led by the Management Team of Special Disease on Patients with Inflammatory Bowel Disease

目的探讨对炎症性肠病(IBD)患者实施以专病管理团队为主导的疾病管理的效果。方法采用便利抽样法,选取2014年3月—2015年2月在南京中医药大学附属医院脾胃病科就诊的IBD患者131例,采用随机数字表法将其分为对照组(65例)和干预组(66例),对照组给予常规专病门诊随访和健康教育,干预组实施以专病管理团队为主导的疾病管理和随访。采用Morisky用药依从性量表(MMAS)、IBD患者生活质量问卷(IBDQ)、医院焦虑抑郁量表(HADS)、IBD症状体征分级量化评分表分别评价患者干预前、干预第3个月、干预第6个月时用药依从性、生活质量评分、焦虑抑郁状况以及症状严重程度。结果干预方法、时间对患者MMAS评分主效应显著(P<0.05);干预第3、6个月,干预组MMAS评分高于对照组(t=6.530,P<0.001;t=3.813,P=0.006)。干预方法、时间对患者肠道症状、全身症状、社会功能评分以及IBDQ总分主效应显著(P<0.05)。干预第3、6个月时,干预组焦虑、抑郁状况均优于对照组(P<0.05)。干预方法、时间对患者IBD症状体征分级量化评分主效应显著(P<0.05);干预第3、6个月,干预组IBD症状体征分级量化评分低于对照组(t=2.114,P=0.035;t=2.239,P=0.020)。结论以专病管理团队为主导的疾病管理能够有效提高IBD患者用药依从性,提高生活质量,降低焦虑、抑郁水平,改善疾病症状。

Objective To explore the effect of management led by the management team of special disease on patients with inflammatory bowel disease（ IBD）. Methods 131 patients with IBD who received treatment in Department of Spleen and Stomach Disease in Affiliated Hospital of Nanjing University of TCM from March 2014 to February 2015 were selected by convenience sampling method,and were divided into control group（ 65 cases） and intervention group（ 66 cases） by random number table method. The patients in control group received routine clinical follow- up of special disease,and patients in intervention group received disease management and follow- up led by special disease management team. Medication compliance,quality of life score,anxiety and depression situation,and symptom severity degree of patients before intervention,intervention the third month and intervention in the sixth month were evaluated by Morisky medication adherence scale（ MMAS）,IBD questionnaire of quality of life（ IBDQ）,hospital anxiety and depression scale（ HADS） and IBD symptoms and signs rating scale. Results The main effect of the intervention method and intervention time on MMAS score was significant（ P〈0. 05）; at the third and sixth month of the intervention,the MMAS score of the intervention group was higher than that of the control group（ t = 6. 530,P〈0. 001; t = 3. 813,P = 0. 006）. Intervention method and time had significant effects on the scores of intestinal symptoms,systemic symptoms,social function and IBDQ total score（ P〈0. 05）. The anxiety and depression situation of the intervention group were better than those of the control group at the third and sixth month of the intervention（ P〈0. 05）.Intervention method and time had significant effect on the IBD symptoms and signs rating scale（ P〈0. 05）; at the third and sixth month of the intervention,the IBD symptoms and signs rating scale of intervention group was lower than that of control group（ t = 2. 114,P = 0. 035; t = 2. 239,P = 0. 020）. Conclusion IBD management,which is led by special disease management team,can effectively improve the medication compliance of patients with IBD,improve the quality of life,reduce the level of anxiety and depression,and improve the disease symptoms.