慢性心衰院外强化管理模式对患者生活质量的影响

Influence of strengthening administration pattern outside hospital on living quality of patients with chronic heart failure

目的:探讨对慢性心力衰竭患者采用新型院外强化模式进行管理对其生活质量的影响。方法:将2013年6月至2016年6月在如皋市人民医院心内科住院的慢性心衰出院患者随机分为管理组(M组)和对照组(C组)。M组心衰患者采用院外强化模式进行管理:建立医疗档案并通过心衰门诊定期随访、定期院外家访并结合电话随访对患者进行健康教育及康复指导;C组患者仅进行常规随访。比较12个月后两组患者在生活质量相关指标(药物依从性、疾病自我管理意识、生活质量量表、再住院率、住院时间等)的差异。结果:M组的失访率明显低于C组(3/120 vs 13/117,P<0.05)。两组患者全因死亡率组间比较差异无统计学意义(5.83%vs 7.69%,P>0.05)。M组在药物依从性、疾病自我管理意识及生活质量量表的改善方面均显著高于C组(59.09%vs 13.68%,64.55%vs 31.58%,58.18%vs 29.47%,P<0.05);M组患者再住院率及平均住院时间显著低于C组[22.73%vs 48.42%,(7.51±3.21)d vs(11.61±5.41)d,P<0.05]。结论:对心衰患者进行院外强化管理模式可以明显提高患者药物依从性,增强疾病自我管理意识,降低心衰患者的再入院率及住院时间,从而改善生活质量。

Objective： To evaluate the influence of strengthening administration pattern outside hospital on living quality of patients with chronic heart failure（ CHF）. Methods： From June 2013 to June 2016,all patients of CHF who addressed in Cardiovascular Department of Rugao People＇ s Hospital were randomly divided into two groups,managed group（ M） and control group（ C）. Patients in group M were treated with strengthened administration pattern including performing regular follow-up in the special clinic for heart failure,using calls to improve results of follow-up,and holding the health education and rehabilitation guidance for those patients with heart failure.Patients in group C were only performed regular follow-up. The medication compliance, self-management consciousness of disease and the improvement of life quality,rate of readmission,average hospitalization time and total mortality of two groups were all compared in 12 months. Results： 110 patients in group M and 95 patients in group C completed follow-up of 12 months,the rate of the defaulters in group M was higher than that in the group C（ 3/120 vs 13/117,P〈 0. 05）,and the all-cause mortality in two groups was similar（ 5. 83% vs 7. 69%,P〈 0. 05）. The medication compliance,self-management consciousness of disease and the improvement of life quality in group M were all superior than those in group C（ 59. 09% vs 13. 68%,64. 55% vs 31. 58%,58. 18% vs 29. 47%,P〈 0. 05）. The rate of readmission and the average length of stay in hospital were both lower/shorter in group M than those in group C[22. 73% vs 48. 42%,（ 7. 51 ± 3. 21） d vs（ 11. 61 ± 5. 41） d,P〈 0. 05].Conclusion： The strengthened administration pattern outside hospital could improve the quality of CHFs including medication compliance,enhance self-management consciousness etc,and this pattern may decrease the rate of readmission and the average length of stay in hospital.