基于互动模式的社区自我管理活动对老年糖尿病患者生存质量干预效果分析

Effect of community self-management activities on quality of life among elderly diabetic patients based on interactive mode

目的分析基于互动模式的社区自我管理活动对老年糖尿病患者生存质量的干预效果及影响因素,为提高患者生存质量提供依据。方法2016—2020年杭州市依托医联体建设及家庭医生签约服务资源,组建干预团队,以患者小组为单位开展系列自我管理活动干预。通过问卷调查方式收集基本信息、疾病状况、生存质量及自我管理行为情况。采用SPSS 19.0软件进行Friedman检验、Spearman相关检验及多重线性回归模型分析。结果共707例老年2型糖尿病患者纳入研究。干预前、干预4个月及干预10个月健康调查简表(SF-36)及2型糖尿病自我管理行为量表(2-DSCS)各维度得分差异具有统计学意义(χ^(2)>21.737,P<0.001)。干预4、10个月较干预前2-DSCS总分变化值与SF-36的各维度变化值均显著相关(r>0.125,P<0.01)。多重线性回归分析结果显示,生理健康(PCS)的影响因素有基线PCS得分、2-DSCS总分差值、伴2种及以上并发症,心理健康(MCS)的影响因素有基线MCS得分、2-DSCS总分变化值、伴有并发症及支付医疗费用比较困难(∣t∣>2.019,P<0.05)。结论基于互动模式的社区自我管理活动可有效改善患者管理行为,提升生存质量,且合并并发症、医疗费用支付能力对生存质量改善存在一定影响。

Objective To analyze the intervention effect of community self-management activities and its influencing factors on quality of life among elderly diabetic patients based on interaction mode,and to provide evidence for improving the quality of life.Methods From 2016 to 2020,relying on the construction of medical consortia and contracted service resources for family doctors,an intervention team was established to carry out a series of self management activities and interventions based on patient groups in Hangzhou City.The basic information,disease status,quality of life and self-management behavior of patients were collected through questionnaire survey.Friedman test,Spearman correlation test and multiple linear regression were performed by SPSS 19.0 software.Results Finally,a total of 707 elderly patients with type 2 diabetes were included in the study.There were statistically significant differences in the scores of health survey brief form(SF-36)and type 2 diabetes self-management behavior scale(2-DSCS)before intervention,4 months and 10 months after intervention(χ^(2)>21.737,P<0.001).There had significant correlation between the changes in the total score of 2-DSCS and the changes in each dimension of SF-36 at the 4th and 10th months of intervention(r>0.125,P<0.01).The results of multiple linear regression analysis showed that the factors associated with physical health(PCS)were baseline PCS scores,differences in total 2-DSCS scores,and concomitant 2 or more complications.And the factors associated with mental health(MCS)were baseline MCS scores,changes in total 2-DSCS scores,having complications,and difficulty in paying medical expenses(∣t∣>2.019,P<0.05).Conclusion Community self-management activities based on interactive mode could effectively improve the disease management behavior of patients and improve their quality of life.Complications and payment of medical expenses have certain effects on the improvement of quality of life.