腹透患者随访间隔对透析质量的影响及改进措施实施效果

The effect of follow-up interval of peritoneal dialysis patients on the quality of dialysis and the effect of improvement measures

目的观察腹膜透析患者不同门诊随访间隔对自我管理能力、透析质量的影响,分析原因并采取社区-医院协作等方式进行PDCA改进,观察改进效果。方法选取2009年8月至2018年12月在本院置管的腹膜透析患者122例,根据门诊随访间隔(≤1个月、>1个月)分为A、B两组,A组74例,B组48例。比较两组在自我管理能力、实验室检查、血压、常见并发症等方面的差异。分析B组间隔较长的主要原因,并成立PDCA小组,采取社区-医院协作随访等PDCA改进措施,观察改进前后随访间隔>1个月患者比例的变化。结果 A组患者换液技术操作、操作中异常情况处理、饮食管理、并发症监测、情绪管理与社会回归方面均明显高于B组(P<0.05),血红蛋白、白蛋白均明显高于B组(P<0.05),血钙、血磷均明显低于B组(P<0.05),腹膜炎发生率明显低于B组(P<0.05)。B组患者随访间隔较长的原因主要包括路程较远、年龄较大行动受限、与工作时间冲突、随访耗时较长等。采取改进措施后随访间隔>1个月患者的比例由39.34%下降至17.24%(χ^(2)=14.20,P<0.05)。结论门诊随访间隔≤1个月患者的自我管理能力和透析质量均明显高于间隔>1个月的患者,采取社区-医院协作随访等改进措施,能有效解决部分患者随访间隔较长的问题。

Objective To observe the influence of different outpatient follow-up intervals for peritoneal dialysis patients on self-management ability and dialysis quality, analyze the reasons and adopt community-hospital collaboration to improve PDCA, and observe the improvement effect. Methods A total of 122 peritoneal dialysis patients who were intubated in our hospital from August 2009 to December 2018 were selected and divided into two groups A and B, There were 74 patients in group A and 48 patients in group B.according to the outpatient follow-up interval(≤1 month, >1 month).The differences in self-management ability, laboratory tests, blood pressure, common symptoms, etc between the two groups were compared. The main reasons for the longer interval in group B were analyzed. A PDCA group was established, and PDCA improvement measures such as community-hospital collaborative follow-up were adopted. The changes in the proportion of patients with a follow-up interval> 1 month before and after the improvement were observed. Results Patients in group A were significantly higher than group B in terms of fluid exchange technique, handling of abnormal conditions, diet management, complication monitoring, emotional management, and social regression(P<0.05). The hemoglobin and albumin in group A were significantly higher than group B(P<0.05). The blood calcium and blood phosphorus in group A were significantly lower than group B(P<0.05), and the incidence of peritonitis in group A was significantly lower than group B(P<0.05). The main reasons for the longer follow-up intervals in group B included long distances, older age, restricted mobility, conflicts with working hours, and longer follow-up time. After improvement measures were taken, the proportion of patients with a follow-up interval> 1 month decreased from 39.34%to 17.24%(χ^(2)=14.20, P<0.05). Conclusion The self-management ability and dialysis quality of patients with an outpatient follow-up interval of ≤1 month are significantly higher than those of patients with an interval of >1 month. Improvement measures such as community-hospital collaborative follow-up can effectively solve the problem of long follow-up intervals for some patients.