上海慢性病自我管理项目实施效果的评价  

Evaluation on Shanghai chronic disease self-management program

作　　者：傅东波[1] 傅华[1] Patrick McGowan 沈贻谔[1] 朱莉珍 杨惠勤 朱世泰 毛建国 丁永明[1] 卫志华 杨顺英[1] 吴翠娥[1] 

机构地区：[1]复旦大学公共卫生学院预防医学教研室,上海200032 [2]InstituteofHealthPromotionResearch [3]上海市新乐地段医院 [4]上海市浦东新区梅园地段医院 [5]上海市曹家渡地段医院

出　　处：《中国公共卫生》2003年第2期223-225,共3页Chinese Journal of Public Health

基　　金：美国中华医学基金会(CMB 0 1 - 757)

摘　　要：目的　评价上海慢性病自我管理项目实施 6个月后的效果。方法　按照以社区为基础的随机对照试验研究设计 ,将 95 4名患有高血压病、心脏病、关节炎、中风、哮喘、糖尿病、慢性阻塞性肺病 (COPD)等疾病自愿参加该项目的慢性病人 ,随机分为干预组和对照组。采用协方差的秩和检验 ,比较了有基线和 6个月后 2次问卷调查数据的43 0名干预组病人和 3 49名对照组病人在项目实施 6个月后在自我管理行为、自我效能、健康状况和卫生服务利用等方面的变化。结果　与对照组比较 ,干预组在一种自我管理行为方面明显提高 :6个月内认知性症状、管理方法实践评分 ,干预组平均多增加了 0 3 3分 ;症状管理自我效能和疾病共性管理自我效能评分 6个月的增加值 ,分别比对照组高出 0 69分和 0 63分 ;干预组在健康状况的 9个方面 (整体健康自评、健康担忧、疲劳、气短、疼痛、失能、疾病对病人生活影响、情绪低落及社会活动 /角色受限 ) ,明显好于对照组 (P均 <0 0 5 ) ;干预组 6个月内看急诊次数平均比对照组少 0 0 1次 (P =0 0 2 ) ;干预组 6个月内住院次数平均比对照组减少了 0 12次 (P =0 0 1)。结论　上海慢性病自我管理项目 6个月后可改善参加者的自我管理行为、自我效能、部分健康状况、减少看急诊次数和住院次?Objective To evaluate the six-month effectiveness of Shanghai Chronic Disease Self-Management Program.Methods The study was a community-based randomized controlled trial.954 volunteer participants with hypertension,heart disease,arthritis,stroke,asthma,diabetes,and COPD,were randomized to treatment group or control group.Analysis of covariance based on Rank Scores(Cochran-Mantel-Haenszel Statistics) was used to compare six-month changes of 20 outcome variables(Self-Management Behaviors,Self-Efficacy(SE),Health Status and Health Service Utilization) for 430 treatment subjects and 349 control subjects who complete 6-month study.Results Treatment subjects,compared with controls were demonstrated significant improvement in one of four self-management behaviors(treatment subjects averagely increased 0.33 more scores in practice of cognitive symptom management).Treatment group increased 0.69 and 0.63 scores separately in SE to manage symptom and SE to manage disease in general.They also demonstrated significant improvement in nine of health status(self-rated health,health distress,fatigue,shortness of breath,pain,disability,illness intrusiveness,depression and social/role activities limitation)(all P<0.05).They also had fewer visits of 0.01 frequency to emergency room on average(P=0 02),fewer hospitalization of(P=0.01).Conclusion Shanghai Chronic Disease Self-Management Program improved participants' health behavior,self-efficacy,parts of health status,fewer visits to emergency room and hospitalization after 6-month implementation.

关 键 词：上海 慢性病 自我管理项目 实施效果 评价 

分 类 号：R442.9[医药卫生—诊断学]