自我管理干预对COPD患者自我管理能力和卫生服务利用的影响

Effects of self-management intervention on the self-management ability and health service utilization of patients with COPD

目的 探讨自我管理干预对COPD患者自我管理能力和卫生服务利用情况的影响.方法采用便利抽样法选取2014年5—11月温州市某三级综合医院呼吸内科病情稳定准许出院的84例COPD患者为研究对象,根据随机对照原则分为干预组和对照组,各42例.干预组患者接受自我管理干预,对照组患者接受常规护理.干预后3个月、6个月、12个月采用COPD自我管理量表进行测评,同时记录干预期间患者急诊次数、再入院次数等卫生服务利用情况.结果干预3个月、6个月、12个月时干预组患者自我管理能力高于对照组,差异有统计学意义（P＜0.05）.干预3个月时两组患者卫生服务利用方面比较,差异无统计学意义（P＞0.05）;干预6个月、12个月时干预组患者的卫生服务利用次数少于对照组,差异有统计学意义（P＜0.05）.结论自我管理干预不仅能够提高COPD稳定期患者的自我管理能力,还能减少患者急诊次数和再入院次数,是患者慢性病管理的一种有效方法.

Objective To explore the effects of self-management intervention on the self-management ability and health service utilization of patients with chronic obstructive pulmonary disease （COPD）. Methods A total of 84 COPD patients in stable condition with permission of being discharged in respiratory department of a tertiary comprehensive hospital in Wenzhou city,were selected as research objects from May to November 2014 by convenience sampling method,and were randomly divided into the intervention group （n=42） and the control group （n=42）. Patients in the control group received routine care,while patients in the intervention group received self-management intervention and all patients were followed up. The self-management scale of chronic obstructive pulmonary disease was used investigate the self-management status of patients three months,six months and 12 months after intervention. The times of emergency services and the times of re-hospitalization were also recorded.Results The self-management ability of patients at the third month,sixth month and 12th month after intervention in the intervention group was significantly improved compared with the control group （P〈0.05）. There was no significant difference in the aspect of health service utilization at the third month after intervention between two groups （P〉0.05）;the times of health service utilization in the intervention group at the sixth month and 12th month after intervention were less than the control group （P〈0.05）.Conclusions Self-management intervention can improve the self-management ability of patients with COPD in stable period,and reduce the times of emergency visits and re-hospitalizations. It is an effective method for the management of chronic diseases.