延续性自我管理教育对精神分裂症合并糖尿病患者服药依从性与自我效能的效果观察

Effect of self-management education on medication compliance and self-efficacy of patients with schizophrenia in rehabilitation period

目的 通过延续性自我管理教育,观察精神分裂症伴糖尿病患者服药依从性与自我效能的影响.方法 选择符合精神分裂症伴糖尿病诊断标准的60例患者,按住院单双号分为试验组30例和对照组30例,2组均接受常规药物治疗,对照组接受一般说教式健康教育模式,出院时每人发放一份健康教育手册,内附精神分裂症与糖尿病健康知识,试验组除接受一般健康教育外实施延续性自我管理教育,在出院后6个月和12个月比较2组患者服药依从性和复发率,采用自我效能量表（GSES）评价2组患者自我效能高低,采用全自动生化分析仪测定患者空腹血糖（FPG）、餐后2 h血糖（2 hPBG）控制状况.结果 出院后6个月,试验组完全依从、部分依从及不依从分别为82.1%（23/28）、4.3%（4/28）和3.6%（1/28）,对照组完全依从、部分依从及不依从分别为55.2%（16/29）、27.6%（8/29）和17.2%（5/29）,2组比较差异有统计学意义（χ^2=37.41,P〈0.05）;出院后12个月试验组完全依从、部分依从及不依从分别为75%（21/28）、14.3%（4/28）和10.7%（3/28）,对照组完全依从、部分依从及不依从分别为31.0%（9/29）、31.0%（9/29）和37.9%（11/29）,2组比较差异有统计学意义（χ^2=11.27,P〈0.05）;出院后6个月和12个月试验组GSES评分分别为（35.32±2.02）、（34.18±1.77）分,对照组分别为（24.03±3.04）、（22.48±2.01）分,2组比较差异有统计学意义（t=16.445、23.304,均P〈0.01）;出院后6个月试验组FPG和2 hPBG分别为（5.71±1.05）、（9.46±1.37）分,对照组分别为（7.79±1.05）、（12.28±2.07）分,2组比较差异有统计学意义（t=7.483、6.023,均P〈0.01）,出院后12个月试验组FPG和2 hPBG分别为（5.89±1.13）、（9.68±1.09）分,对照组分别为（9.14±1.19）、（13.17±1.42）分,2组比较差异有统计学意义（t=10.550、7.431,均P〈0.01）;出院后6个月和12个月试验组复发率分别为7.1%（2/28）和24.1%（7/29）,对照组分别为14.3%（4/28）和44.8%（13/29）,2组比较差异有统计学意义（χ^2=4.326、6.225,P〈0.05或0.01）.结论 延续性自我管理教育能提高患者服药依从性和自我效能,改善精神症状及糖代谢,降低复发率.

Objective To observe the effect of medication compliance and self-efficacy of schizophrenia patients with diabetes by continuing self-management education. Methods A total of 60 patients with schizophrenia with diabetes diagnostic criteria were divided into experimental group （30 cases） and control group （30 cases） by the admission number, 2 groups received conventional drug treatment, the control group received general preaching health education pattern, were each issued a health education manual, with schizophrenia and diabetes health knowledge division, the test group on the basis of the continuation of the implementation of self-management education, followed up 12 months after discharge, compared 2 groups of patients with medication compliance and recurrence rate, with General Perceived Self-Efficacy Scale （GSES） assessment level of 2 groups of patients with self-efficacy, fasting blood glucose （FPG） was determined by automatic biochemical analyzer, 2 hours postprandial blood glucose （2 hPBG）. Results Six months after discharge, 82.1%（23/28） cases were complete compliance, 14.3%（4/28） cases of partial compliance, 3.6%（1/28） cases of non-compliance, 55.2%（16/29）cases of the control group complete compliance, 27.6%（8/29） cases of partial compliance, 17.2%（5/29） cases of non-compliance, the differences between two groups were statistically significant （χ^2=37.41, P〈0.05）. The 12 month test group of full compliance discharged 75.0%（21/28） cases, 14.3%（4/28） cases of partial compliance, 10.7%（3/28） cases of non-compliance, 31.0%（9/29） cases of the control group complete compliance, 31.0%（9/29） cases of partial compliance, 37.9%（11/29） cases of non-compliance, the test group compliance was higher than the control group （χ^2=11.27, P〈0.05）. The score after 6 months and 12 months respectively for the test group general self-efficacy scored 35.32 ± 2.02, 34.18 ± 1.77, control group scored 24.03 ± 3.04, 22.48 ± 2.01, the differences between two groups were statistically significant （t=16.445, 23.304, P〈0.01）. After 6 months in test group FPG and 2 hPBG were （5.71 ± 1.05）, （9.46 ± 1.37） mmol/L, control group were （7.79 ± 1.05）,（12.28 ± 2.07） mmol/L, the differences between two groups were statistically significant （t=7.483, 6.023, P〈0.01）. 12 months after discharge in test group FPG and 2 hPBG respectively （5.89±1.13）, （9.68±1.09） mmol/L, control group （9.14±1.19）, （13.17±1.42） mmol/L, test group FPG and 2 hPBG were lower than the control group （t=10.550, 7.431, P〈0.01）. After 6 months and 12 months, the recurrence rate of experimental group were 7.1% （2/28） and 24.1% （7/29） respectively, and control group were 14.3%（4/28） and 44.8%（13/29）, the recurrence rate of experimental group was lower than the control group, there was significant difference between 2 groups （χ^2=4.326, 6.225, P〈 0.05 or 0.01）. Conclusions Self-management education can improve the medication compliance and self-efficacy, improve mental symptoms and sugar metabolism, and reduce the recurrence rate.