慢性阻塞性肺疾病急性发作期患者就医延迟行为的现象学研究  

A Phenomenology Study on Medical Delay in Patients with Acute Exacerbation of COPD

作　　者：姜宗良 王海播[2] 王语嫣 马利军[2] 孙娜雅 张伟宏[4] JIANG Zongliang;WANG Haibo;WANG Yuyan;MA Lijun;SUN Naya;ZHANG Weihong(School of Nursing and Health,Zhengzhou University,Zhengzhou 450001,China;Department of Respiratory,Henan Provincial People's Hospital,Zhengzhou 450003,China;Department of Orthopedics,Henan Provincial People's Hospital,Zhengzhou 450003,China;School of Basic Medical Sciences,Zhengzhou University,Zhengzhou 450001,China)

机构地区：[1]郑州大学护理与健康学院,河南省郑州市450001 [2]河南省人民医院呼吸科,河南省郑州市450001 [3]河南省人民医院骨科,河南省郑州市450001 [4]郑州大学基础医学院,河南省郑州市450001

出　　处：《中国全科医学》2020年第27期3396-3401,共6页Chinese General Practice

基　　金：2016年度河南省医学科技攻关计划项目(201601021)。

摘　　要：背景 慢性阻塞性肺疾病(COPD)具有较高的致残率和死亡率,且患病率正在逐年增加,在我国COPD患者具有较高的就医延迟率。研究表明,避免就医延迟现象的发生可以更好地做到早诊断早治疗,降低致残率和死亡率,缓解医疗负担。目的 探讨COPD急性发作期患者就医延迟的原因,为采取有效的干预措施提供依据。方法2018年3月-2019年2月,采用目的抽样法选取河南省三所综合医院(河南省人民医院、郑州大学第一附属医院、郑州人民医院)和两所社区老年服务中心(郑州市航海东路社区卫生服务中心、河南省郑州市二七区爱馨阳光城老年服务中心)的COPD就医延迟患者进行半结构式访谈。根据样本量标准及纳入与排除标准,最终共纳入13例患者。本研究方法为质性研究中的现象学研究。根据提前制定好的访谈提纲对患者进行访谈,每次访谈时间30~40 min,具体时间及内容视现场情况做适当调整。采用Colaizzi七步资料分析法对原始资料进行整理分析。结果 通过访谈并深入分析最终提取出6个可解释患者就医延迟行为的核心主题,分别为:COPD疾病认知度低,症状自我管理能力弱,基层医疗机构误诊、漏诊,缺乏有效的延续性护理措施,长期治疗无效导致忽视症状,缺少支持导致负性心理增加。结论 COPD急性发作期患者就医延迟因素呈现多元性,主要受疾病知识、延续性护理措施、自我管理能力、治疗效果、负性心理和基层医疗机构诊疗水平影响,在就医流程的不同阶段存在不同的影响因素,需针对不同阶段的患者开展有针对性的干预措施,从而降低COPD患者就医延迟率,改善其生活质量。Background Chronic obstructive pulmonary disease(COPD)has high disability and mortality rates,with an increasing annual prevalence.In China,COPD patients have a high possibility of having delayed treatment.Studies have shown that avoiding the occurrence of medical delay can achieve earlier diagnosis and treatment,reduce disability and mortality rates,and relieve medical burden.Objective To investigate the causes of medical delay in patients with acute exacerbation of COPD,to provide evidence for effective targeted interventions.Methods This qualitative study was conducted from March 2018 to February 2019 with a phenomenology approach.By purposive sampling based on and the inclusion and exclusion criteria,COPD patients with delayed treatment in three general hospitals(Henan Provincial People's Hospital,the First Affiliated Hospital of Zhengzhou University,People's Hospital of Zhengzhou)and two community aged care centers(Zhengzhou Hangdong Community Health Service Center,Aixin Sunshine City Senior Service Center)in Henan Province were selected.Semi-structured interviews based on the designed outline were conducted with them,each lasting for 30-40 minutes,with possibly appropriate adjustments in duration and contents according to the field observation during the interview.The interviews continued to data saturation,and were analyzed with Colaizzi's seven-step method.Results Altogether,interviews of 13 cases were included for analysis.Six core themes that can explain delayed healthcare seeking were summarized:low awareness level of COPD,poor self-management of symptoms,misdiagnosis and missed diagnosis in primary medical institutions,lack of effective and continuous nursing care,neglecting symptoms due to ineffective long-term treatment,and increased negative emotions due to lack of support.Conclusion The factors associated with delayed healthcare seeking in patients with acute exacerbation of COPD are diverse,which mainly include awareness of COPD,continuity of care measures,self-management ability,treatment effect

关 键 词：肺疾病 慢性阻塞性 急性发作期 就医延迟 质性研究 

分 类 号：R563.9[医药卫生—呼吸系统]