社区脑卒中后残疾患者协同健康管理模式构建及管理效果研究  

Development and Effects of Collaborative Health Management Model for Community Patients with Disabilities due to Stroke

作　　者：孙秋雪 吕雨梅[1] 张文越[2] 赵守梅[2] 孙丽丽[1] 李娟[1] 许海莲 

机构地区：[1]哈尔滨医科大学(大庆)护理学院,黑龙江省大庆市163319 [2]黑龙江省大庆市人民医院,163316

出　　处：《中国全科医学》2017年第26期3210-3215,共6页Chinese General Practice

基　　金：国家自然科学基金资助项目(71303072)

摘　　要：目的构建社区脑卒中后残疾患者协同健康管理模式,并评价其管理效果。方法 2016年1—6月,采用便利抽样法选取大庆市某两个社区内经住院或社区卫生服务中心(站)治疗后回归家庭的脑卒中后残疾患者60例为研究对象。采用随机数字表法将患者分为管理组(30例)和对照组(30例)。两组患者均接受定期家庭访视和社区健康教育,管理组患者在此基础上由协同健康管理小组对其实施协同健康管理。协同健康管理小组包括研究人员、康复治疗师、心理学专家、社区卫生服务中心管理人员,主要采取个性化康复管理、情绪管理、信息化管理以及患者自我管理等措施。分别于管理前及管理3、6个月时,采用改良Barthel指数(MBI)量表、抑郁自评量表(SDS)、一般自我效能感量表(GSES)、家庭功能评估量表(APGAR)、社会功能活动问卷(FAQ)评价管理效果。结果重复测量方差分析显示,组间、时间对MBI、SDS、GSES、APGAR、FAQ评分存在交互作用,且主效应显著(P<0.05)。简单效应分析显示,管理3、6个月时,管理组MBI、GSES、APGAR评分高于对照组,SDS、FAQ评分低于对照组(P<0.05)。对照组各时间SDS、GSES、APGAR、FAQ评分比较,差异均无统计学意义(P>0.05);MBI评分比较,差异有统计学意义(P<0.05)。管理组各时间MBI、SDS、GSES、APGAR、FAQ评分比较,差异均有统计学意义(P<0.05)。结论协同健康管理模式可提高脑卒中后残疾患者日常生活能力,缓解抑郁情绪,改善家庭功能,并降低社会功能缺陷程度,有效促进了患者的全面康复,对社区开展健康管理服务具有积极的临床意义。Objective To development a collaborative health management model for community patients with disabilities due to stroke,and evaluate its management effects. Methods This study was conducted between January and June2016. By convenience sampling,from 2 communities in Daqing,we enrolled 60 participants with disabilities due to stroke who returned to home after receiving treatment from hospitals or community health service centers（ stations） and equally divided them into the control group（ n = 30） and the management group（ n = 30） based on the random number table. Patients in both groups received regular family visit and community-based health education,and those in the management group additionally received the collaborative health management model of services（ personalized rehabilitation management, emotional management,information-based management, and patient self-management） by a collaborative health management team（ researchers,rehabilitation therapists,psychologists,and community health service center managers）. The effects of intervention achieved in both groups were assessed by surveying the patients by the Modified Barthel Index（ MBI）, Self-rating Depression Scale（ SDS）,General Self-efficacy Scale（ GSES）,APGAR Scale and Functional Activities Questionnaire（ FAQ） before intervention,3 and 6 months after intervention. Results Repeated measures analysis of variance showed that, intervention method and duration of intervention exerted significant main effects as well as notable interaction effects on the scores of MBI,SDS,GSES,APGAR and FAQ（ P〈0.05）. Simple effects analysis demonstrated that,the scores of MBI,GSES and APGAR were higher while those of SDS and FAQ were lower in the management group than in the control group at the end of 3 and 6 months of intervention（ P〉0.05）. In the control group,the scores of MBI varied by the assessing time（ P〈0.05）,while those of SDS,GSES,APGAR and FAQ did not（ P〈0.05）. In the management group,the scores of MBI,SDS,G

关 键 词：卒中 残疾人 协同健康管理 康复 抑郁 

分 类 号：R743[医药卫生—神经病学与精神病学]