基于欧洲五维健康量表的中医治未病门诊就诊患者健康相关生命质量及影响因素研究

Health-related Quality of Life and Its Influencing Factors in Patients with Prevention of Disease in Traditionnal Chinese Medicine based on EQ-5D-5L Scale

背景中医治未病是中医药健康管理服务的特色,但就医患者的整体健康状态仍有待阐明和评价。目的评价中医治未病门诊就诊患者的健康相关生命质量(HRQoL)及影响因素。方法于2022年5—6月采用分层整群抽样法从广州市4个行政区(荔湾区、天河区、白云区、花都区)各随机抽取一家区属中医院作为调研场所,采用欧洲五维健康量表(EQ-5D-5L)对在基层中医治未病门诊就诊的患者进行问卷调查,根据中国健康效用值积分体系计算健康效用值,采用最优尺度回归分析对EQ-5D-5L健康效用值和视觉模拟标尺(EQ-VAS)评分进行影响因素分析。结果本次调查共完成660份问卷,其中有效问卷630份,问卷有效回收率为95.45%。630例就诊患者中29.4%(185/630)因日常养生保健就诊;38.4%(242/630)因初感不适、疾病初起就诊;34.6%(218/630)因已经患病、防止病情进一步变化就诊;10.6%(67/630)因病后康复理疗就诊。最近一次接受中医治未病服务患者的前3位中医病种是不寐、胃脘痛、痹病。中医治未病门诊就诊患者EQ-5D-5L健康效用值为0.942(0.893,1.000),EQ-VAS评分为80(70,90)分。按困难频率对各个维度排序依次为疼痛/不舒服(50.2%)、焦虑/沮丧(46.9%)、日常活动(14.4%)、行动能力(9.9%)和自我照顾(6.0%)。影响EQ-5D-5L健康效用值的因素按重要性排列从大到小依次是最近一次接受中医治未病服务的主要病因(0.366)、年龄(0.281)、中医病种共病情况(0.145)、职业(0.111)和学历(0.098)。影响EQ-VAS评分的因素按重要性排列从大到小依次是婚姻状况(0.378)、对中医治未病了解程度(0.353)、年龄(0.176)、月收入(0.092)。结论广州市基层中医治未病门诊就诊患者的HRQoL处于中等水平,患有肺癌、中风、慢性阻塞性肺疾病、骨质疏松症、乳腺癌等中医病种、60岁以上、患有2种及以上中医病种、从事体力劳动、学历较低的中医治未病就诊患者健康效用值较低,不在婚状态、对中医治未病非常不了解、年龄超过60岁、较高月收入者自评健康状态较差。应将HRQoL作为一个重要的结局评价指标加以合理运用,关注中医治未病就诊患者中HRQoL较差的群体,加强中医治未病理念和内涵的宣传推广。

Background Prevention of disease in Traditionnal Chinese Medicine(TCM)is a distinguishing advantage of TCM health management services,however,the holistic health state of the patients remains to be elucidated and evaluated.Objective To evaluate the health-related quality of life(HRQoL)and its influencing factors in patients with prevention of disease in TCM.Methods From May to June 2022,a stratified cluster sampling method was used to randomly select a district-level TCM hospital from each of the four administrative regions of Guangzhou(Liwan District,Tianhe District,Baiyun District,Huadu District)as the research site.The EQ-5D-5L scale was used to investigate the patients with prevention of disease in TCM by questionnaire in primary care,and the health utility value was calculated according to the Chinese EQ-5D utility score system.The influencing factors of health utility value and EQ-VAS score were analyzed by using optimal scale regression analysis.Results A total of 660 questionnaires were completed in this survey,including 630 valid questionnaires,with a effective recovery rate of 95.45%.Among the 630 investigated patients with prevention of disease in TCM,185 patients(29.4%)visited for daily health care,242 patients(38.4%)visited at the initial stage of disease for discomfort,218 patients(34.6%)visited for avoiding exacerbation of current illness,67 patients(10.6%)visited for post-illness rehabilitation physiotherapy.The top three conditions for prevention of disease in TCM were insomnia disorder,epigastric pain and arthralgia.The EQ-5D-5L health utility value for the investigated patients was 0.942(0.893,1.000),and the EQ-VAS score was 80(70,90).All five dimensions based on the ranking of difficulties frequency were pain/discomfort(50.2%),anxiety/depression(46.9%),daily activities(14.4%),mobility(9.9%)and self-care(6.0%).The influencing factors of health utility value based on the ranking of importance were the main causes of most recent prevention of disease in TCM(0.366),age(0.281),comorbidities of TCM conditions(0.145),occupation(0.111)and education level(0.098).The influencing factors of EQVAS score based on the ranking of importance were marital status(0.378),understanding of prevention of disease in TCM(0.353),age(0.176)and monthly income(0.092).Conclusion The HRQoL of patients with prevention of disease in TCM in primary care in Guangzhou is at a medium level.The health utility values were relatively low in patients suffered from TCM conditions such as lung cancer,stroke,chronic obstructive pulmonary disease,osteoporosis and breast cancer,aged 60 and above,comorbid with 2 or more TCM conditions,with manual labour and lower education level.The self-rated health status was relatively poor in patients absence from marriage,unaware of prevention of disease in TCM,aged 60 and above,with higher monthly income.HRQoL should be applied reasonably as an important outcome indicator.Attention should be paid to the population with poor HRQoL among patients with prevention of disease in TCM,the promotion and dissemination of the concept and connotation of prevention of disease in TCM should be strengthened.