健康宣教依从性与慢性阻塞性肺疾病病情转归的关系研究

Study on the correlation between health education compliance and treatment outcome of chronic obstructive pulmonary disease

目的探讨慢性阻塞性肺疾病（COPD）健康宣教依从性对疾病转归的影响。方法选择2013年6月至2014年6月在华山医院北院确诊为COPD的258例患者纳入研究。男186例，女72例，平均年龄（75.2±8.5）岁。2014年7月开始病情评估、分级、电话随访宣教及院内COPD讲座，记录患者参加健康教育次数及戒烟、锻炼、家庭氧疗、用药的执行情况，作为健康教育依从性指标。2015年12月再次进行病情评估分级，并对患者进行病情转归分组，建立数据库。应用多项Logistic回归，寻找影响COPD患者病情转归的生物、心理、社会因素及病情转归与健康教育依从性关系；应用独立样本t检验，比较不同依从性患者门诊及住院均次费差异。结果医保报销比例高、健康教育依从性高、无合并症、研究开始病情分级较轻是病情好转的保护性因素（OR分别为10.35、2.147、5.791、4.51，P均〈0.05）；患者体形偏瘦或正常、随诊期间急性发作次数≥5次、健康教育依从性低是患者病情加重的危险因素（OR分别为0.031、0.131、0.010，P均〈0.05）；从不进行体育锻炼、从不参加健康教育的患者病情加重/死亡的危险分别是每周至少进行1次体育锻炼，参加健康宣教的患者6.793倍（P=0.005，95%CI：1.766~26.125）、11.872倍（P=0.002，95%CI：2.525~55.815）；病情为低风险病情轻组COPD患者，从不参加健康教育者每次住院均次费用高于参加健康教育患者6 619元（t= 2.681，P=0.010）；病情为高风险病情重组的COPD患者，未戒烟或戒烟时间〈5年的每次发作门诊费用均值高于戒烟时间〉5年患者985元（t=-2.225，P=0.028）。结论通过健康宣教引导患者戒烟、坚持家庭氧疗、加强体育锻炼、遵医嘱预防用药、提高患者疾病防治的依从性，可以有效延缓患者疾病进展、改善患者病情转归、降低医疗费用、减轻家庭及社会负担。

Objective To explore the influence of health education and treatment compliance on COPD patients＇ outcome.Methods 258 subjects （186 males, 72 females, average age 75.2±8.5 years） were enrolled from patients diagnosed with COPD between June 2013 to June 2014 in huashan hospital north compus. Study began in July 2014, health condition assessment and grading、telephone follow-up and education were performed once every half a year together with COPD lectures, the number of patients participated in education sessions, and status of smoking cessation, exercise／home oxygen therapy and medication were recorded as indicators for health education compliance. Clinic/hospital stay and cost, condition change were also recorded. The study ended in December 2015 with final assessments of conditions and classification of patient outcome. Multiple logistic regression was used to analyze factors influencing the COPD patient＇s outcome; Independent sample t test was applied to compare different compliance in patients with outpatient and hospitalization per-time cost difference.Results Higher reimbursement ratio, the better adherence for health education, no complications and the low grade of disease classification at the beginning of the study were protective factors （OR=10.35, 2.147, 5.791, 4.51, P〈 0.05）; Underweight to normal weight, 5 times or more acute attacks during during the study, poor health education compliance were risk factors for disease progression （OR=0.031, 0.131, 0.010, P〈 0.05）; Never exercise and never participating in health education management are the risk of illness/death（（OR=6.793, P=0.005, 95% CI： 1.766~26.125） vs.（OR=11.872, P=0.002, 95% CI： 2.525~55.815））; for mild COPD patients, these never participating in health education management had a higher per hospitalization than patients with health education management （6 619 yuan, t= 2.681, P= 0.010）. The outpatient cost of more severe COPD patients who are smoking or quitted smoking in less than 5 years was higher than these quitted smoking more than 5 years （985 yuan, t=-2.225, P= 0.028）.Conclusions Health education management can help medical staff to provide guidance to patients to quit smoking, encouraging the regular use of home oxygen therapy, doing more exercise, taking prescription of preventive drugs, these will in turn improve patient compliance for disease control and prevention. These efforts can effectively slow disease progression and improve patient outcomes, reduce medical costs, reduce the burden of the family and society.