改变2型糖尿病患者的卫生服务利用——快乐生活俱乐部TM注项目报告(七)

摘要

背景快乐生活俱乐部TM慢性病管理目的 目的 之一,是通过帮助患者改变行为生活方式,改善患者对医疗服务的依从性和自我管理能力,有效地利用医疗服务.本文的目的 是通过快乐生活俱乐部TM试点的数据分析,探讨干预活动对患者医疗服务利用行为的影响.方法 在试点社区招募100名55岁及以上的2型糖尿病患者,并随机分成干预组和对照组.由10名经过澳大利亚健康心理学培训的社区医生和护士对干预组患者提供健康教练服务,即采用动机谈话帮助患者改变行为.研究者在干预前、干预后6个月和12个月对患者进行问卷和临床检查监测,其中问卷内容包括医院和社区服务就诊和住院情况.采用SPSS 18.0软件对数据进行统计分析.结果 干预组患者6个月内社区卫生服务利用次数从基线的5.17次增加到干预6个月时的6.88次,差异具有统计学意义;干预第12个月时,干预组患者6个月内社区卫生服务利用次数为6.98次,与第6个月时基本相同.对照组患者的社区卫生服务利用率没有明显变化,差异无统计学意义.由于观察期较短和样本量较少,尚未观察到患者对医院门诊和住院服务以及急诊和私人医疗服务利用的变化趋势.结论 快乐生活俱乐部TM促进了患者对社区卫生服务的利用.%Background People with diabetes need to work effectively with health professionals and health services in addition to changing their life style behaviours for better illness management.One of purposes of the Happy Life ClubTM is to improve self - management, compliance with clinical prescriptions and effective healthcare use.This article explores the effects of the Happy Life ClubTM interventions upon seeking health services for its participants.Methods 100 patients with diabetes aged 55 year and ahove were recruited and randomly allocated into intervention and usual treatment control groups.Ten community doctors and nurses were trained in motivational interviewing ( MI ) by Australian health psychologists, and applied it in the treatment of the participants of the MI group.Both groups also received routine diabetes management according to the China national guideline.Data were collected at haseline , 6 th month and 12th months following intervention.Times of community health service visit and hospital - based uses were reported in questionnaire surveys of the three observation points.Descriptive analysis and statistic test was performed using SPSS 18.0.Results The mean frequency of community health visits among the patients of MI group , increased significantly from 5.17 at baseline to 6.88 of the 6th month of intervention.The increase was maintained at 6.98 at 12 months.No change in service use was found in the control group.No evident changes were found in other medical service seeking behaviours, including hospital - based doctor visit, emergency visit, and hospital admission.Conclusion Preliminarily, the pilot demonstrated a positive effect in increasing community health service utilization with no increase in other health service use.