基于微信平台延续性护理对慢性乙型肝炎患者抗病毒治疗依从性的影响

Influence of WeChat platform-based continuing nursing on the compliance of antiviral therapy in chronic hepatitis B patients

目的 通过微信平台提供的延续性护理服务项目,评价慢性乙型肝炎患者口服核苷（酸）类似物（NA）依从性的影响因素和干预前后的依从性变化.方法 选取2013年1月至2015年6月慢性乙型肝炎服用NA患者共67例,建立微信医护团队和微信群,为患者提供慢性乙型肝炎权威科学诊治信息、在线咨询服务、专家门诊预约等服务,进行延续性护理服务干预5个月.结果 患者中不同文化水平的服药依从性量表（MMAS-8）分值分别是文盲（4.75±2.20）分、小学及初中（5.73±1.87）分、高中及职高（6.31±1.45）分、大学及以上（7.24±1.23）分,差异有统计学意义（χ^2=22.113,P〈0.01）;既往服用过NA的分值为（5.76±1.89）分,低于未服用NA者的（6.62±1.60）分,差异有统计学意义（Z=-2.636,P〈0.01）;患者合并药物种类≥3种（5.25±2.09）分、1-2种（7.02±1.08）分,与未合并用药者（6.04±1.95）分比较,差异有统计学意义（χ^2=10.844,P〈0.01）;不同医疗保险类型的分值分别为公费（7.60±0.48）分、居民医疗保险（6.54±1.52）分、新型农村合作医疗（5.17±2.34）分、自费（5.93±1.91）分,差异有统计学意义（χ^2=15.630,P〈0.01）;患者合并与不合并其他慢性疾病的分值比较差异无统计学意义（Z=0.401,P〉0.05）;干预前MMAS-8分值为（6.45±1.69）分,患者干预后为（6.86±1.53）分,总的依从性增加（Z=-2.551,P〈0.05）,干预后依从性高者的例数增加,依从性中、低者的例数减少,差异有统计学意义（χ^2=9.521,P〈0.01）.结论 基于微信平台的延续性护理的干预后,患者对于口服NA的依从性比干预前有显著性提高.

Objective To evaluate the influencing factors of compliance and the compliance changes before and after intervention on chronic hepatitis B patients who oral nucleos（t）ide analogue （NA）, by using the continuing care service items provided by WeChat platform. Methods A total of 67 patients with chronic hepatitis B were selected from January 2013 to June 2015. WeChat health care teams and WeChat groups were established to conduct continuing care intervention for 6 months by providing services, such as authoritative scientific diagnosis and treatment information, online consulting service, expert outpatient appointment, etc. Results The score of Morisky Medication Adherence Scale （MMAS-8） in patients of different culture levels of illiteracy （4.75 ± 2.20） points, primary school or junior high school graduate （5.73±1.87） points,high school or vocational school graduate （6.31±1.45） points,university diploma and above （7.24 ± 1.23） points were significant difference （χ^2=22.113, P 〈 0.01）. The score in patients previous used of nucleoside drugs （5.76±1.89） points was lower than that in patients not previous used of nucleoside drugs （6.62±1.60） points, and there was a significant difference between the two groups（Z=-2.636, P〈0.01）. Significant difference （χ^2=10.844, P〈0.01） was shown between groups of≥3 kinds drugs combined with the score 7.02 ± 1.08, 1-2 kinds drugs combined with the score 7.02 ± 1.08 and no combined medication with score 6.04±1.95. Different medical insurance types of free of charge （7.60±0.48） points,residents medical insurance （6.54 ± 1.52） points,new rural cooperative （5.17 ± 2.34） points and self-paying medical service （5.93±1.91） points showed significant difference（χ^2=15.630, P〈0.01）. The scores in other diseases showed no significant difference （Z=0.401, P 〉 0.05） both in combination or non-combination. Compared to 6.45 ± 1.69 of pre-intervention, the total compliance score 6.86 ± 1.53 showed significant increased after intervention （Z=-2.551, P 〈 0.05）, and the number of people with high compliance after the intervention increased while the number of people with middle and low compliance after the intervention decreased, and significant differencewas observed in two groups （χ^2=9.521, P〈0.01）. Conclusions After the intervention of continuing care based on WeChat platform, the patients＇ compliance with nucleoside antiviral drugs were significant improvement than those of pre-intervention.