CAJ | 학술논문

目的：调查北京市德胜社区家庭医生式服务开展初期，签约慢性病患者的健康行为现状并探讨其影响因素，为有效进行健康行为干预、提高家庭医生式服务质量提供依据。方法采用单纯随机抽样方法，按患者档案号随机抽取2012年9-12月在德胜社区卫生服务中心门诊签约的420例慢性病（高血压、糖尿病）患者，采用自行设计的社区慢性病患者健康行为调查表调查慢性病患者一般资料、健康行为、知识与态度。结果签约慢性病患者的总体健康行为呈中等水平，总分为（60.07±8.51）分，总体达标率为55.48％（233/420）。健康行为各维度得分分别为：饮食（31.35±5.42）分，达标率为73.10％（307/420）；运动（9.25±3.46）分，达标率为50.48％（212/420）；嗜好（7.24±1.61）分，达标率为82.62％（347/420）；心理调节（8.37±1.83）分，达标率为75.71％（318/420）；遵医行为（3.87±1.80）分，达标率为30.95％（130/420）。慢性病相关知识（8.44±2.95）分，达标率为46.90％（197/420）；患者对疾病的态度（7.96±1.77）分，达标率为66.43％（279/420）。Pearson相关分析结果显示，健康行为与知识呈正相关（r＝0.118，P＝0.015）；健康行为与态度无直线相关性（r＝-0.042，P＝0.391）。多元线性回归分析结果显示，体质指数与运动相关，性别和知识与嗜好相关，知识和病程与心理有关，知识和病种与遵医行为相关（P＜0.05）。结论签约慢性病患者健康行为现状不理想，其中进食早餐、控制烟酒及遵医嘱服药较好；饮食中油盐控制、运动异常处理及血糖监测较差。患者的知识、性别、病程是主要影响因素，家庭医生式服务团队在制定签约慢性病患者的行为干预措施时要针对患者不同的性别及病程阶段，在传授慢性病相关知识的同时，更加注重培养患者的自我管理技能，以更好地改善并维持其健康行为，提高家庭医生式服务质量。目的：調查北京市德勝社區傢庭醫生式服務開展初期，籤約慢性病患者的健康行為現狀併探討其影響因素，為有效進行健康行為榦預、提高傢庭醫生式服務質量提供依據。方法採用單純隨機抽樣方法，按患者檔案號隨機抽取2012年9-12月在德勝社區衛生服務中心門診籤約的420例慢性病（高血壓、糖尿病）患者，採用自行設計的社區慢性病患者健康行為調查錶調查慢性病患者一般資料、健康行為、知識與態度。結果籤約慢性病患者的總體健康行為呈中等水平，總分為（60.07±8.51）分，總體達標率為55.48％（233/420）。健康行為各維度得分分彆為：飲食（31.35±5.42）分，達標率為73.10％（307/420）；運動（9.25±3.46）分，達標率為50.48％（212/420）；嗜好（7.24±1.61）分，達標率為82.62％（347/420）；心理調節（8.37±1.83）分，達標率為75.71％（318/420）；遵醫行為（3.87±1.80）分，達標率為30.95％（130/420）。慢性病相關知識（8.44±2.95）分，達標率為46.90％（197/420）；患者對疾病的態度（7.96±1.77）分，達標率為66.43％（279/420）。Pearson相關分析結果顯示，健康行為與知識呈正相關（r＝0.118，P＝0.015）；健康行為與態度無直線相關性（r＝-0.042，P＝0.391）。多元線性迴歸分析結果顯示，體質指數與運動相關，性彆和知識與嗜好相關，知識和病程與心理有關，知識和病種與遵醫行為相關（P＜0.05）。結論籤約慢性病患者健康行為現狀不理想，其中進食早餐、控製煙酒及遵醫囑服藥較好；飲食中油鹽控製、運動異常處理及血糖鑑測較差。患者的知識、性彆、病程是主要影響因素，傢庭醫生式服務糰隊在製定籤約慢性病患者的行為榦預措施時要針對患者不同的性彆及病程階段，在傳授慢性病相關知識的同時，更加註重培養患者的自我管理技能，以更好地改善併維持其健康行為，提高傢庭醫生式服務質量。
목적：조사북경시덕성사구가정의생식복무개전초기，첨약만성병환자적건강행위현상병탐토기영향인소，위유효진행건강행위간예、제고가정의생식복무질량제공의거。방법채용단순수궤추양방법，안환자당안호수궤추취2012년9-12월재덕성사구위생복무중심문진첨약적420례만성병（고혈압、당뇨병）환자，채용자행설계적사구만성병환자건강행위조사표조사만성병환자일반자료、건강행위、지식여태도。결과첨약만성병환자적총체건강행위정중등수평，총분위（60.07±8.51）분，총체체표솔위55.48％（233/420）。건강행위각유도득분분별위：음식（31.35±5.42）분，체표솔위73.10％（307/420）；운동（9.25±3.46）분，체표솔위50.48％（212/420）；기호（7.24±1.61）분，체표솔위82.62％（347/420）；심리조절（8.37±1.83）분，체표솔위75.71％（318/420）；준의행위（3.87±1.80）분，체표솔위30.95％（130/420）。만성병상관지식（8.44±2.95）분，체표솔위46.90％（197/420）；환자대질병적태도（7.96±1.77）분，체표솔위66.43％（279/420）。Pearson상관분석결과현시，건강행위여지식정정상관（r＝0.118，P＝0.015）；건강행위여태도무직선상관성（r＝-0.042，P＝0.391）。다원선성회귀분석결과현시，체질지수여운동상관，성별화지식여기호상관，지식화병정여심리유관，지식화병충여준의행위상관（P＜0.05）。결론첨약만성병환자건강행위현상불이상，기중진식조찬、공제연주급준의촉복약교호；음식중유염공제、운동이상처리급혈당감측교차。환자적지식、성별、병정시주요영향인소，가정의생식복무단대재제정첨약만성병환자적행위간예조시시요침대환자불동적성별급병정계단，재전수만성병상관지식적동시，경가주중배양환자적자아관리기능，이경호지개선병유지기건강행위，제고가정의생식복무질량。
Objective To study the health behavior situation of patients with chronic disease in Beijing Desheng Com-munity and its influencing factors in the initial stage of family doctor service in order to provide reference for effective intervention on health behaviors and improve the quality of family doctor service. Methods 420 patients with chronic disease signed in the Desheng Community Health Center from September to December in 2012 were randomly sampled according to the patients' file number by using simple random sampling. Self-designed questionnaire on health behavior was used to survey the general informa-tion,health behavior,knowledge and attitude of the patients. Results The health behavior of the signed patients with chronic disease in the community was at medium level with an overall score of ( 60. 07 ± 8. 51 )and a control rate of 55. 48%( 233/420). The score and control rate of the items were as follows:diet(31. 35 ± 5. 42)and 73. 10%(307/420),exercise(9. 25 ± 3. 46)and 50. 48%(212/420),hobby(7. 24 ± 1. 61)and 82. 62%(347/420),mental regulation(8. 37 ± 1. 83)and 75. 71%(318/420),following the doctor's advice(3. 87 ± 1. 80)and 30. 95%(130/420),knowledge on chronic disease (8. 44 ±2. 95)and 46. 90%(197/420),attitude towards the disease(7. 96 ± 1. 77)and 66. 43%(279/420). Pearson correlation analysis showed that the health behavior was positively correlated with knowledge(r =0. 118,P =0. 015),but showed no correlation with attitude(P>0. 05). Multiple regression analysis showed that BMI was correlated with exercise,sex and knowledge were correlated with hobby,knowledge and disease course were correlated with mentality and knowledge and dis-ease categories were correlated with following the doctor's advice(P<0. 05). Conclusion The situation of health behavior of the signed patients with chronic disease is not satisfactory. Among the items,having breakfast,controlling the cigarette and the alcohol and taking medicine following the doctor's advice are the best,while controlling the oil and salt of food,sport abnormality handling and blood sugar monitoring are the worst. The patients' knowledge,sexual distinction and course of disease are the main influencing factors. When working out the intervention measures of the chronic disease patients of the community,the health care provider should take notice of different patients' sexual distinction and course and peculiarity of disease and teach the knowledge of chronic disease,as well as pay more attention to the cultivation of the patient's self management skills,so as to improve and maintain the health level of the chronic disease patients and enhance the effect of the their health management.