气象风险预报服务干预对上海浦东新区慢性阻塞性肺疾病患者急性发作和医疗费用的效果评价

Evaluation of the effect of meteorological risk forecasting service intervention on acute onset and medical expenses of patients with COPD in Pudong New Area of Shanghai

【目的】评估气象风险预报服务(简称“预报服务”)对慢性阻塞性肺疾病(简称“慢阻肺”)患者急性发作及医疗费用支出的干预效果,为基层慢阻肺患者健康管理模式的建立提供科学依据。【方法】在上海市浦东新区年龄≥40岁的本区常住居民且为在管的慢阻肺患者中招募研究对象,采用倾向性评分匹配法确定干预组和对照组。对照组定期进行常规的健康教育和随访管理,干预组在此基础上通过以微信、手机短信和电话等多形式进行气象环境风险预报服务。最终确定研究对象共2589例,其中干预组1300例,对照组1289例,通过问卷调查收集一般人口学资料、既往病史及慢阻肺家族史、慢阻肺相关知信行调查、慢阻肺相关症状评估及干预前后急性发作、卫生服务利用和医疗费用支出的情况,分析比较干预前后两组急性发作、卫生服务利用、相关医疗费用支出的差异,评估干预效果。【结果】急性发作方面,干预后干预组急性发作率低于干预前(χ^(2)=52.901,P<0.001),干预组不同服务方式干预后慢阻肺急性发作率低于干预前(P<0.001),其中微信效果最好,下降14.4%,其次为手机短信,下降12.3%。卫生服务利用方面,干预后干预组因急性发作就诊率低于干预前(χ^(2)=7.129,P=0.008),通过手机短信接受预报服务的对象因急性发作就诊率低于干预前(χ^(2)=4.675,P<0.001)。医疗费用支出方面,干预前对照组与干预组不同服务方式之间差异无统计学意义(P>0.05)。干预后对照组与干预组不同服务方式之间差异有统计学意义(H=11.864,P<0.05)。多重比较结果显示,与对照组相比,干预后接受手机短信及电话预报服务的患者平均年医疗费用支出低于对照组,差异有统计学意义(P<0.05)。【结论】预报服务能减少慢阻肺的急性发作、降低因急性发作就诊率及医疗费用支出,为构建基层慢阻肺健康管理模式提供科学依据。

[Objective]To evaluate the intervention effect of meteorological risk forecasting service on acute onset and medical expenses of chronic obstructive pulmonary disease(COPD)patients,and to provide scientific basis for the establishment of health management model for chronic obstructive pulmonary disease(COPD)patients.[Methods]Study subjects were recruited from chronic obstructive pulmonary patients aged≥40 in Pudong New Area.Propensity score matching method was used to determine the intervention group and the control group.The control group received regular health education and follow-up management,and the intervention group was provided with meteorological and environmental risk forecasting services through WeChat,mobile phone short message service(SMS)and telephone.Finally,a total of 2589 subjects were included in the analysis,including 1300 in the intervention group and 1289 in the control group.General demographic data,past medical history and family history of COPD,COPD related knowledge and practice survey,COPD related symptom assessment,acute onset,health service utilization and medical expenses before and after intervention were collected through questionnaire survey.The differences of acute attack,health service utilization and related medical expenses between the two groups before and after intervention were compared to evaluate the intervention effect.[Results]In terms of acute attacks,after intervention,the incidence of acute attacks in the intervention group was lower than that before intervention(χ^(2)=52.901,P<0.001),and the incidence of acute attacks in the groups with different intervention methods was lower than that before intervention(P<0.001).WeChat had the best effect,decreasing the incidence by 14.4%,followed by mobile phone SMS SMS decreasing by 12.3%.In terms of utilization of health services,the outpatient rate due to acute attack was lower in the intervention group after intervention than that before intervention(χ^(2)=7.129,P=0.008),and the outpatient rate due to acute attack was lower in the subjects who received the forecast service through mobile phone SMS than that before intervention(χ^(2)=4.675,P<0.001).In terms of medical expenses,there was no significant difference between control group and intervention group with different intervention methods before intervention(P>0.05).After intervention,the difference between the control group and the intervention group with different intervention methods was statistically significant(H=11.864,P<0.05).The results of multiple comparisons showed that compared with the control group,the average annual medical expenses of patients receiving mobile phone SMS and telephone forecasting services after intervention were lower than those of the control group,and the difference was statistically significant(P<0.05).[Conclusion]Meteorological risk forecasting service can reduce the acute onset of COPD,reduce the rate of consultation and medical expenses due to acute onset,and provide scientific basis for the basic COPD health management model.