社区护士主导的新型社区慢性病团队管理模式对高血压患者服药自我效能及依从性的影响研究

Impact of Community Nurse-led New Team Model of Community-based Chronic Disease Management on the Medication Adherence Self-efficacy and Medication Adherence in Hypertensive Patients

目的探讨社区护士主导的新型社区慢性病团队管理模式对高血压患者服药自我效能及服药依从性的影响,旨在为今后社区高血压等慢性病管理提供帮助。方法 2014年12月—2015年12月,采用系统随机抽样的方法,在长沙市望月湖社区卫生服务中心、和馨园社区卫生服务中心已建立健康档案的高血压患者中选取180例纳入研究,每个社区90例,分别作为干预组和对照组。干预组患者实施社区护士主导的新型社区慢性病团队管理模式,对照组患者给予常规社区卫生服务。比较两组患者干预前、干预后半年、干预后1年服药自我效能[服药自我效能量表(MASES)得分]、服药依从性[Morisky服药依从性量表(MMAS-8)得分]。结果最终完成研究者175例(干预组88例,对照组87例),5例患者失访。干预方法与干预时间在MASES、MMAS-8得分上存在交互作用(P<0.05);干预方法与干预时间在MASES、MMAS-8得分上主效应显著(P<0.05)。干预前两组患者MASES、MMAS-8得分比较,差异无统计学意义(P>0.05);干预后半年、1年干预组患者MASES、MMAS-8得分高于对照组(P<0.05)。干预组干预后半年、1年MASES得分高于干预前,干预后1年MASES得分高于干预后半年(P<0.05);干预组干预后半年、1年MMAS-8得分高于干预前,干预后1年MMAS-8得分低于干预后半年(P<0.05)。结论社区护士主导的新型社区慢性病团队管理模式对提高高血压患者的服药自我效能及服药依从性有明显作用,但患者的服药依从性会随着干预时间的延长而降低。

Objective To explore the impact of community nurse - led team model of community - based chronic disease management on the medication adherence self - efficacy and medication adherence in hypertensive patients, in order to offer support for community - based management of chronic disease in the future. Methods We carried out this study between December 2014 and December 2015. The study sample comprised 180 participants who were divided equally into two groups： 90 from the Wangyuehu Community Health Service Center （intervention group） and other 90 from the Hexinyuan Community Health Service Center （control group） . All of them were selected from those hypertensive patients whose medical records were established and maintained in the above centers by systematic random sampling. Patients in the intervention group received nurse - led team model of community - based chronic disease management services, and those in the control group received the conventional community - based health services. The medication adherence self - efficacy was assessed by Medication Adherence Self - efficacy Scale （MASES） , and medication adherence was assessed by Eight - Item Morisky Medication Adherence Scale （MMAS - 8） before intervention, at the end of 6 - month intervention, and at the end of 1 - year intervention, respectively. And the results of the three assessments of medication adherence self - efficacy and medication adherence were compared between the two groups. Results Total 175 cases （88 in the intervention group, and 87 in the control group ） completed the intervention, the other 5 cases were lost to follow up. The method and duration of intervention exerted interaction effects on the scores of MASES and MMAS - 8 （ P 〈 0.05 ） . Moreover, they produced significant main effects on the scores of MASES and MMAS - 8 （ P 〈 0. 05 ） . Before intervention, both groups had similar scores of MASES and MMAS - 8 （ P 〉 0. 05）. However, the scores of MASES and MMAS - 8 were much higher in the intervention group at the end of 6 - month intervention and 1 - year intervention （P 〈 0.05） . The score of MASES in the intervention group before intervention was lower than that the end of 6 - month intervention, and the end of 1 - year intervention （P 〈 0. 05 ） ; and the score of MASES in the 1 years after the intervention was higher than that in the end of 6 - month intervention （ P 〈 0. 05 ） . With view to the scores of MMAS - 8 for the intervention group, the latter two assessment results were both higher than the first assessment result （ P 〈 0.05 ）, but the third assessment result was lower than the second assessment result （ P 〈 0.05 ） . Conclusion The nurse - led team model of community - based chronic disease management can significantly improve the medication adherence self - efficacy and medication adherence in patients with essential hypertension. However, the intervention effect on the medication adherence of these patients could decrease over time.