CAJ | 학술논문

目的探讨RA患者就医行为特点以及慢病综合管理对其的干预效应.方法对2012年8月至2013年6月在四川省人民医院风湿免疫科门诊就诊的240例RA患者进行分析.内容包括患者的一般资料、首次就诊医师类型、就诊时机、确诊科室及相关知识获取来源等,然后以配对分组方法将患者分为对照组与干预组各120例,在常规口服药物基础上,干预组给予6个月的慢病综合管理,比较2组患者依从性及疾病达标率.采用t检验,x2检验和Spearman相关分析进行统计分析.结果患者首诊医师选择及就医时机与性别、发病年龄及文化程度无明显相关性(P＞0.05),而首诊医师选择与个人收入(x2=59.684,P＜0.0)、有无医保(=29.202,P＜0.01)相关.确诊科室以风湿免疫科最高(88.8％,213/240),疾病知识获取来源前2位是周围人群(35.8％,86/240)和医疗广告(28.3％,68/240),来自医生的仅占10.0％(24/240).在干预阶段,干预组规律服药比例更高[83.6％(92/110)与64.1％(59/92),x2=10.100,P＜0.01],更容易达到基于DAS28计算的良好反应[67.3％(74/110)与53.3％(49/92),x2=4.130,P＜0.05].结论 RA患者首次就诊行为受经济因素影响较大,通过慢病综合管理能规范RA患者的部分就医行为,提高患者依从性及疾病缓解率.
목적 탐토RA환자취의행위특점이급만병종합관리대기적간예효응.방법 대2012년8월지2013년6월재사천성인민의원풍습면역과문진취진적240례RA환자진행분석.내용포괄환자적일반자료、수차취진의사류형、취진시궤、학진과실급상관지식획취래원등,연후이배대분조방법장환자분위대조조여간예조각120례,재상규구복약물기출상,간예조급여6개월적만병종합관리,비교2조환자의종성급질병체표솔.채용t검험,x2검험화Spearman상관분석진행통계분석.결과 환자수진의사선택급취의시궤여성별、발병년령급문화정도무명현상관성(P＞0.05),이수진의사선택여개인수입(x2=59.684,P＜0.0)、유무의보(=29.202,P＜0.01)상관.학진과실이풍습면역과최고(88.8％,213/240),질병지식획취래원전2위시주위인군(35.8％,86/240)화의료엄고(28.3％,68/240),래자의생적부점10.0％(24/240).재간예계단,간예조규률복약비례경고[83.6％(92/110)여64.1％(59/92),x2=10.100,P＜0.01],경용역체도기우DAS28계산적량호반응[67.3％(74/110)여53.3％(49/92),x2=4.130,P＜0.05].결론 RA환자수차취진행위수경제인소영향교대,통과만병종합관리능규범RA환자적부분취의행위,제고환자의종성급질병완해솔.
Objective To investigate the health care seeking behavior of rheumatoid arthritis (RA) patients and to assess whether chronic disease management benefits to RA patients.Methods Clinic patients diagnosed with RA in our hospital from August 2012 to June 2013 were enrolled.The data including sex,age of onset,duration,mode of first hospitalization,time of diagnosis,department of diagnosis and knowledge source were collected.RA patients were assigned into two groups (the experimental group and the control group).Both groups had 120 cases and treated with oral medications,while the experimental group was managed with chronic disease management,for 6 monthsrespectively.Statistical analysis was done with Student's t test for comparison of the two groups.The chi-square test was used to compare percentages of the two groups.The correlations were sought by computing Spearman's correlation coefficients.Results In this 240 RA patients,the ratio of male to female was 1∶65.The income (x2=59.684,P＜0.01) and medicare status (x2=29.202,P＜0.01) were associated with the initial health care seeking behavior,while sex,education level and age of onset had no effect on it (P＞0.05).Rheumatology department was the most common department confirming the diagnosis (88.8％,213/240).Most knowledge of disease was introduced by relatives and friends (35.8％,86/240) and medical advertising(28.3％,68/240),while only 10％ (24/240) was acquired from doctors.Patients in the experimental group preferred regular medication [83.6％ (92/110) vs 64.1％ (59/92),x2=10.100,P＜0.01] and had good response measured by DAS28 [67.3％(74/110) vs 53.3％(49/92),x2=4.130,P＜0.05].Conclusion The initial health care seeking behavior is affected mostly by economic status.Chronic disease management can benefit RA patients by improving their health care seeking behavior.