搞好哮喘教育管理改變醫(yī)療服務(wù)模式

EnhancingtheeducationmanagementonAsthma

changingthemodelofmedicalservicePekingUniversityRenminHospitalHeQuanying

Somanyproblemsexistedinmedicalservice,why?Whatthesolutions?Difficulties:unfairlocationsofthemedicalresourcescountrysideurbanHighcost：differentformsformedicalcostnewdrugs’developmentslowlyincreasedofpeople’sincome

Healthreform

thehospitaldevelopmentserviceforprofit

Unhealthydoctor-patientrelationshipbecomesmoreandmoretension:trustlessrestrictingtheverydevelopmentofphysiciansWhy?Thewaypaidformedicalservicechangedconstitutionofthehospitals,professionalismeducation,medicalreform,ExcessiveMedicalCare,

Negativefunctionofthemultimedia

missionformedicineProfit---forpublichospitals,physicianslostthemselvesSeekingtomakeaprofit

WorkpassivelyPromotingthehealthofall.

inthiscomplicatedcontext,whatphysiciansshoulddo?how?

theadministrationofAsthmabeganin1993inChina,aftermanyyears’practiceandexploration,thefollowingmodelformed.

三三位位一一體體醫(yī)醫(yī)療療服服務(wù)務(wù)模模式式

哮喘宣教中心

哮喘專病門診

哮喘患者協(xié)會

specialserviceforAsthma

isthe

primarypointfor

educationmanagementonAsthma.Physiciantherewillberesponsibleforthediagnosis,makingplanontreatmentandsoon.

publiceducationcenteronAsthma

isthefurtherstep,itmakesmoreconveniencefordoctor-patientcommunications.

Theassociationofasthmapatientsistheplatformwecarryoutoureducation,itprovidesaidealatmospherebetweendoctorandpatient.Doctor-patientrelationshipisthefatalfactorhere.

TheassociationofasthmapatientsfoundedinMay,2001.Morethan700membersnow.

Anactivitywillbeholdatweekendeveryfourmonths(free).Memberswillbeinformedandtakepartinastheywant.Always100-150members.Content:LecturesonAsthmacontrol;Communicationbetweenasthmapatients,etc.

Itwillbechangeddependonthemembers’willing,butalwaysconcentrateontheAsthmacontrol&AsthmacontrolinChina.“PubliceducationcenteronAsthma””foundedinNov,2001.Aspecialistgivesadvise,alsosometrainingtohispatientsgivepatientsfreematerialsdevelopvolunteersmakeupfiles,etc.“specialserviceforAsthma”beganinApril,2003.Aspecialistwillprovidehisservices.patientsgettheirdiagnosisandrelativetreatmentplan;knowmoreonAsthma;alsohavemoreconfidence.relativeactivitiesofdoctorsonAsthmaLongtermtreatmentforAsthmacontrolandmanagementevaluatingWorkingforgoalsMonitorandmaintainthecontrolin2005

表1thebasicknowledgeknownbypatients分組調(diào)查人數(shù)哮喘是一種慢性疾病

哮喘變應(yīng)性炎癥本質(zhì)

激素是控制氣道炎癥最有效藥物

吸入療法用藥的優(yōu)點

吸入型藥物正確用法

峰速儀為監(jiān)測病情重要工具

哮喘控制目標(biāo)

預(yù)防誘因重要性

人數(shù)構(gòu)成比（％）人數(shù)構(gòu)成比（％）人數(shù)構(gòu)成比（％）人數(shù)構(gòu)成比（％）人數(shù)構(gòu)成比（％）人數(shù)構(gòu)成比（％）人數(shù)構(gòu)成比（％）人數(shù)構(gòu)成比（％）教育組7373100.06183.66690.473100.07298.66893.27197.36791.8對照組302066.7620.01343.31963.32686.7620.01860.02376.7x2值23．2837．7826．3726．254．2556．2422．264．40P值<0.01<0.01<0.01<0.01<0.05<0.01<0.01<0.05表2thecorporationbetweendoctorandpatient分組調(diào)查人數(shù)信任經(jīng)治醫(yī)生

選擇固定醫(yī)師

完全服從治療方案

能夠定期隨訪

人數(shù)構(gòu)成比（％）人數(shù)構(gòu)成比（％）人數(shù)構(gòu)成比（％）人數(shù)構(gòu)成比（％）教育組736994.56082.24865.84865.8對照組302686.7413.31033.31240.0x2值0.9039.99.085.79P值>0.05<0.01<0.01<0.05表3activitiestakenbypatients分組調(diào)查人數(shù)曾經(jīng)堅持3個月以上吸入激素仍然堅持吸入激素

吸入方法正確

擁有峰速儀

經(jīng)常監(jiān)測峰流速

個人記錄峰流速值

峰流速記錄供醫(yī)生參考

注意預(yù)防哮喘誘因

人數(shù)

構(gòu)成比（％）人數(shù)

構(gòu)成比（％）人數(shù)

構(gòu)成比（％）人數(shù)

構(gòu)成比（％）人數(shù)

構(gòu)成比（％）人數(shù)

構(gòu)成比（％）人數(shù)

構(gòu)成比（％）人數(shù)

構(gòu)成比（％）教育組736994.56082.27298.65778.13547.93142.52534.26791.8對照組301136.71736.72686.7826.713.313.313.32376.7x2值37.7620.584．2524.1418．6115．2010．774.40P值<0.01<0.01<0.05<0.01<0.01<0.01<0.01<0.05表4thecontrolofAsthma分組調(diào)查人數(shù)白天癥狀(≤2天/周)

無因哮喘夜間擾醒

日?；顒硬皇芟薨葱栌忙?激動劑(≤2天/周,且≤4次/周)病情無急性加重

無急診或住院

無治療相關(guān)不良反應(yīng)而改變治療良好控制人數(shù)構(gòu)成比（％）人數(shù)構(gòu)成比人數(shù)構(gòu)成比人數(shù)構(gòu)成比人數(shù)構(gòu)成比人數(shù)構(gòu)成比人數(shù)構(gòu)成比人數(shù)構(gòu)成比教育組565089.34987.55292.94580.43969.656100.056100.03460.7對照組302273.31240.01860.01446.7826.72273.330100.0310.0x2值3．6521．3813．9310．3014．5613．46－20．50P值>0.05<0.01<0.01<0.01<0.01<0.01>0.05<0.01表5lifequalityevaluationforpatientsofAsthma分

組調(diào)查人數(shù)活動受限（60）哮喘癥狀（40）心理狀況（30）＊對刺激原反應(yīng)（25）對自身健康的關(guān)心（20）哮喘生命質(zhì)量總分（175）教育組5650±637±327±324±217±3155±12對照組3044±1031±623±521±413±4132±24t值3．335．334．943．264．925．17P值<0.01<0.01<0.01<0.01<0.01<0.01表6hospitalmedicalresourcesusingbypatients分組調(diào)查人數(shù)

非預(yù)約門診就醫(yī)

急診就醫(yī)

住院

人數(shù)構(gòu)成比（％）人均次數(shù)人數(shù)構(gòu)成比（％）人均次數(shù)人數(shù)構(gòu)成比（％）人均次數(shù)教育組56916.10.5±1.747.10.2±0.623.60.1±0.3對照組302066.72.1±2.81240.00.6±0.9413.30.2±0.7t值4.823.551.69x2值22．3813．931．56P值<0.01<0.01<0.01<0.01>0.05>0.05In2006

表7patients’’knowledge&informationlevelonAsthma分組例數(shù)認(rèn)為哮喘本質(zhì)是氣道慢性炎癥性疾病例（％）認(rèn)為持續(xù)期每日均應(yīng)規(guī)律使用的一線藥物是吸入型糖皮質(zhì)激素例（％）認(rèn)為哮喘可以被長期控制例（％）教育組10095(95%)95(95%)95(95%)對照組427272(64%)182(43%)316(74%)x2值37.54389.14620.805P值<0.01<0.01<0.01表8activitiestakenbypatientsforAsthmacontrol分組例數(shù)曾接受過肺功能測定例（％）擁有醫(yī)生制定的長期治療計劃例（％）每日堅持規(guī)律吸入糖皮質(zhì)激素例（％）擁有呼氣峰流速儀例（％）每日監(jiān)測呼氣峰流速例（％）曾吸煙人數(shù)例（％）12(12%)94(22%)5.255<0.05已戒煙人數(shù)例（％）

教育組

100

93(93%)

91(91%)

82(82%)

42(42%)

11(11%)

12(12%)

7(58%)

對照組

427

339(79%)

166(39%)

232(54%)

80(19%)

21(5%)

94(22%)29(31%)

χ2值

3．33

10.155

88.109

25.755

24.650

5.255

5.057

P值

<0.01

<0.01

<0.01

<0.01

<0.01

<0.05

<0.05

表9theconditioncontrol分組

例數(shù)

哮喘控制測試（ACT）評分≥20分例（％）

過去一年中因哮喘加重住院例（％）過去一年中因哮喘加重看急診例（％）

在職患者例（％）

過去一年中因哮喘誤工例（％）

教育組

100

85(85%)

4(4%)

18(18%)

49(49％)

10(20％)

對照組

427

159(37%)

99(23%)

136(32%)

137(32％)

76(55％)

χ2值

3．33

74.345

19.431

7.515

4.678

P值

<0.01

<0.01

<0.01

<0.01

<0.05

publishedin2005,theAsthma,neversaygoodbye---fromtheAsthmapatientsonOct.11st,2007theMinistryofPublicHealthCertificatedourtriesonAsthmaeducationafteryears’exploration,itistheAsthmaitselfthatistheveryenemyofmine,theconcentrationshouldnotbethedoctor-patientresistance.unregulatedAsthmatreatmentcostmore,evensometimessoaring.ourexplorationwillreduceourcostsignificantlyandverymeaningfulforourwholesociety.Asthmacontrolissignificantforourcountrypatientsshouldbehaviormoreactively,thenthemedicalitselfwouldbereallymeaningful!Weneednewdoctor-patientrelationshipChangingthemodelofmedicalservicetoprovidebetterservices.ProblemsonAsthmatreatmentexistedinthepastyearsinChinaProblemsfortheoldmodelofmedicalserviceMeaningsforourexploration:ReducethecostEnhancethelifequalityofpatientsIt’sameaningfulexampleforotherkindsofchronicdiseasesTHANKYOU9、靜靜夜夜四四無無鄰鄰，，荒荒居居舊舊業(yè)業(yè)貧貧。。。。1月月-231月月-23Thursday,January5,202310、雨中中黃葉葉樹，，燈下下白頭頭人。。。20:47:2020:47:2020:471/5/20238:47:20PM11、以我獨沈久久，愧君相見見頻。。1月-2320:47:2020:47Jan-2305-Jan-2312、故人人江海海別，，幾度度隔山山川。。。20:47:2020:47:2020:47Thursday,January5,202313、乍乍見見翻翻疑疑夢夢，，相相悲悲各各問問年年。。。。1月月-231月月-2320:47:2020:47:20January5,202314、他鄉(xiāng)生生白發(fā)，，舊國見見青山。。。05一一月20238:47:20下午午20:47:201月-2315、比比不不了了得得就就不不比比，，得得不不到到的的就就不不要要。。。。。一月月238:47下下午午1月月-2320:47January5,202316、行動動出成成果，，工作作出財財富。。。2023/1/520:47:2120:47:2105January202317、做前，，能夠環(huán)環(huán)視四周周；做時時，你只只能或者者最好沿沿著以腳腳為起點點的射線線向前。。。8:47:21下午午8:47下午午20:47:211月-239、沒有失敗敗，只有暫暫時停止成成功！。1月-231月-23Thursday,January5,202310、很很多多事事情情努努力力了了未未必必有有結(jié)結(jié)果果，，但但是是不不努努力力卻卻什什么么改改變變也也沒沒有有。。。。20:47:2120:47:2120:471/5/20238:47:21PM11、成功功就是是日復(fù)復(fù)一日日那一一點點點小小小努力力的積積累。。。1月-2320:47:2120:47Jan-2305-Jan-2312、世間成成事，不不求其絕絕對圓滿滿，留一一份不足足，可得得無限完完美。。。20:47:2120:47:2120:47Thursday,January5,202313、不不知知香香積積寺寺，，數(shù)數(shù)里里入入云云峰峰。。。。1月月-231月月-2320:47:2120:47:21January5,202314、意志志堅強強的人人能把把世界界放在在手中中像泥泥塊一一樣任任意揉揉捏。。05一一月月20238:47:21下下午20:47:211月-2315、楚塞三三湘接，，荊門九九派通。。。。一月238:47下午午1月-2320:47January5,202316、少年十五二二十時，步行行奪得胡馬騎騎。。2023/1/520:47:2120:47:2105January202317、空空山山新新雨雨后后，，天天氣氣晚晚來來秋秋。。。。8:47:21下下午午8:47下下午午20:47:211月月-239、楊柳散和和風(fēng)，青山山澹吾慮。。。1月-231月-23T