健康个案管理模式干预老年胃食管反流病的临床研究

A clinical study on the intervention of healthy case management mode in the elderly with gastroesophageal reflux disease

目的探讨健康个案管理模式对老年胃食管反流病(gastroesophagealreflux disease,GERD)患者自我管理能力的影响和临床效果,为老年GERD患者健康个案管理模式提供理论依据。方法选取2019年11月-2020年8月在首都医科大学附属北京朝阳医院消化内科就诊的老年胃食管反流病患者90例,按随机数字表法分为观察组(n=45)和对照组(n=45)。对照组采用常规健康教育,观察组采用健康个案管理模式。统计并比较2组干预前和干预后12周自我护理能力实施量表(exercise ofself-care agency,ESCA)评分、反流性疾病问卷(reflux disease questionnaire,RDQ)评分、不良生活习惯和服药依从性及健康调查简表(the MOS item short from health survey,SF-36)生活质量评分。结果干预后,2组ESCA评分均较同组干预前明显提高(P<0.05),且观察组ESCA评分明显高于对照组(P<0.05)。干预后2组烧心、反食、非心源性胸痛和反酸RDQ评分均较同组干预前明显降低(P<0.05),且观察组各项RDQ评分明显低于对照组(P<<0.05)。干预后,观察组不良生活习惯和服药依从性改善明显优于对照组(P<0.05)。干预后,2组SF-36评分均较干预前明显提高(P<0.05),且观察组SF-36评分明显高于对照组(P<0.05)。结论健康教育个案管理模式作为综合评估、计划、服务、协调与监管于一体的健康管理系统,可有效提高患者自我管理能力,从而改善烧心、反食、非心源性胸痛及反酸症状,提高患者生活质量。

Objective To explore the influence and clinical effects of health case management mode on self-management ability of elderly patients with gastroesophageal reflux disease(GERD),and to provide theoretical basis for health case management mode of elderly patients with GERD.Methods A total of 90 elderly patients with GERD who were admitted to the Department of Gastroenterology of Beijing Chaoyang Hospital from November 2019 to August 2020 were selected and divided into observation group(n=45)and control group(n=45)according to random number table method.The control group was treated with routine health education and the observation group was treated with health case management mode.The Self-Care Ability Implementation Scale(ESCA)scores,Reflux Disease Questionnaire(RDQ)scores,bad lifestyle habits and medication compliance and the Health Questionnaire[MOS Item Short From Health Survey,(SF-36)]quality life scores were compared between the two groups before intervention and 12 weeks after intervention.Results After the intervention,the ESCA scores of the two groups were significantly higher than those of the same group before the intervention(P<0.05),and the ESCA scores of the observation group were significantly higher than those of the control group(P<0.05);the RDQ scores of heartburn,reflux,non-cardiogenic chest pain and acid reflux of the two groups were significantly lower than those of the same group before intervention(P<0.05),and the RDQ scores of the observation group were significantly lower than those of the control group(P<0.05);the improvement of bad living habits and medication compliance of the observation group was significantly better than that of the control group(P<0.05);the SF-36 score of both groups was significantly higher than that of the same group before intervention(P<0.05),and the SF-36 score of the observation group was significantly higher than that of the control group(P<0.05).Conclusion As a health management system that integrates comprehensive evaluation,planning,service,coordination and supervision,the health case management mode can effectively improve patients’self-management ability,reduce clinical symptoms,such as heartburn,regurgitation,non-cardiogenic chest pain and acid reflux,and then improve the life quality of the patients.