认知障碍人群医院-社区-家庭多元养护慢病管理模式的评价

Evaluation of hospital-community-family multiple maintenance chronic disease management model for people with cognitive impairment

目的探讨阿尔茨海默病(AD)人群医院-社区-家庭多元养护管理模式的构建及其干预效果。方法选择南昌大学第二附属医院2018年1月至2020年12月收治的轻、中度AD患者200例为研究对象,包括对照组92例和研究组108例。对照组采取医院结合家庭看护的常规管理模式,研究组采用医院-社区-家庭多元养护管理模式,采用相关神经心理量表比较两组干预前及干预6、9、12个月后用药依从性、精神状态、认知功能及生活质量改善情况。结果与干预前[(4.57±1.01)分和(56.55±3.83)分]比较,对照组干预6、9、12个月后8条目Morisky服药依从性量表(MMAS-8)评分[(5.33±1.05)、(5.84±1.17)、(5.91±1.24)分]、世界卫生组织生存质量测量简表(WHOQOL-BREF)评分[(59.23±3.43)、(61.47±3.56)、(62.24±3.45)分]均升高(t=5.003、7.881、8.037、4.795、8.823、10.380,均P<0.05),蒙特利尔认知评估量表(MoCA)评分无明显变化。研究组干预6、9、12个月后MMAS-8评分[(5.96±1.11)、(7.13±1.09)、(7.15±1.11)分]、MoCA评分[(19.96±1.31)、(20.36±1.47)、(20.42±1.52)分]、WHOQOL-BREF评分[(62.76±3.52)、(65.25±3.43)、(65.87±3.56)分]均升高且高于对照组[MoCA评分为(19.03±1.48)、(18.65±1.51)、(18.59±1.44)分;t=4.101、8.064、7.460、4.713、9.088、8.693、7.152、7.633、7.290,均P<0.05]。两组MMAS-8评分、MoCA评分、WHOQOL-BREF评分组间、时间点间、组间时间点交互作用比较,结果差异均有统计学意义。结论AD人群医院-社区-家庭多元养护管理模式的构建对于改善AD患者认知功能与提高生活质量具有积极的作用,值得进一步推广和应用。

Objective To explore the construction of hospital-community-family multiple maintenance management model for Alzheimer′s disease(AD)population and its clinical intervention effect.Methods Two hundred patients with AD admitted to the Second Affiliated Hospital of Nanchang University from January 2018 to December 2020 were selected as the research subjects,including 92 cases in control group and 108 cases in study group.The control group adopted the conventional management mode of hospital combined with family care.The study group adopted the hospital-community-family multiple maintenance management mode.The improvement of medication compliance,mental state,cognitive function and quality of life were compared between the two groups before intervention and six,nine and 12 months after intervention using neuropsychological scales.Results Compared with before intervention(4.57±1.01 and 56.55±3.83),the scores of Morisky Medication Adherence Scale 8(MMAS-8;5.33±1.05,5.84±1.17 and 5.91±1.24)and the World Health Organization Quality of Life Instrument,Short Form(WHOQOL-BREF;59.23±3.43,61.47±3.56 and 62.24±3.45)in the control group increased six,nine and 12 months after intervention(t=5.003,7.881,8.037,4.795,8.823,10.380,all P<0.05),while the scores of Montreal Cognitive Assessment(MoCA)Scale had no significant change.The scores of MMAS-8(5.96±1.11,7.13±1.09 and 7.15±1.11),MoCA(19.96±1.31,20.36±1.47 and 20.42±1.52)and WHOQOL-BREF(62.76±3.52,65.25±3.43,and 65.87±3.56)in the study group increased six,nine and 12 months after intervention and were higher than those in the control group(MoCA:19.03±1.48,18.65±1.51 and 18.59±1.44;t=4.101,8.064,7.460,4.713,9.088,8.693,7.152,7.633,7.290,all P<0.05).There were significant differences between groups,time points and interaction between groups in the scores of MMAS-8,MoCA and WHOQOL-BREF.Conclusion The construction of hospital-community-family multiple maintenance management model for AD patients has a positive effect on improving the quality of life and prognosis of AD patients,which is worthy of further promotion and application.