搞好哮喘教育管理改變醫(yī)療服務(wù)模式

EnhancingtheeducationmanagementonAsthma

changingthemodelofmedicalservicePekingUniversityRenminHospitalHeQuanying

1Somanyproblemsexistedinmedicalservice,why?Whatthesolutions?Difficulties:unfairlocationsofthemedicalresourcescountrysideurbanHighcost：differentformsformedicalcostnewdrugs’developmentslowlyincreasedofpeople’sincome

Healthreform

thehospitaldevelopmentserviceforprofit

2Unhealthydoctor-patientrelationshipbecomesmoreandmoretension:trustlessrestrictingtheverydevelopmentofphysiciansWhy?Thewaypaidformedicalservicechangedconstitutionofthehospitals,professionalismeducation,medicalreform,ExcessiveMedicalCare,

Negativefunctionofthemultimedia

3missionformedicineProfit---forpublichospitals,physicianslostthemselvesSeekingtomakeaprofit

WorkpassivelyPromotingthehealthofall.

inthiscomplicatedcontext,whatphysiciansshoulddo?how?4

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(huì)5specialserviceforAsthma

isthe

primarypointfor

educationmanagementonAsthma.Physiciantherewillberesponsibleforthediagnosis,makingplanontreatmentandsoon.

publiceducationcenteronAsthma

isthefurtherstep,itmakesmoreconveniencefordoctor-patientcommunications.

Theassociationofasthmapatientsistheplatformwecarryoutoureducation,itprovidesaidealatmospherebetweendoctorandpatient.Doctor-patientrelationshipisthefatalfactorhere.6

TheassociationofasthmapatientsfoundedinMay,2001.Morethan700membersnow.7

Anactivitywillbeholdatweekendeveryfourmonths(free).Memberswillbeinformedandtakepartinastheywant.Always100-150members.8Content:LecturesonAsthmacontrol;Communicationbetweenasthmapatients,etc.

Itwillbechangeddependonthemembers’willing,butalwaysconcentrateontheAsthmacontrol&AsthmacontrolinChina.9“PubliceducationcenteronAsthma”

foundedinNov,2001.Aspecialistgivesadvise,alsosometrainingtohispatients10

givepatientsfreematerialsdevelopvolunteersmakeupfiles,etc.

11

“specialserviceforAsthma”beganinApril,2003.Aspecialistwillprovidehisservices.12patientsgettheirdiagnosisandrelativetreatmentplan;knowmoreonAsthma;alsohavemoreconfidence.

13relativeactivitiesofdoctorsonAsthma14LongtermtreatmentforAsthmacontrolandmanagementevaluatingWorkingforgoalsMonitorandmaintainthecontrol15in2005

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(diǎn)

吸入型藥物正確用法

峰速儀為監(jiān)測(cè)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(duì)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<0.0516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(duì)照組302686.7413.31033.31240.0x2值0.9039.99.085.79P值>0.05<0.01<0.01<0.0517表3activitiestakenbypatients分組調(diào)查人數(shù)曾經(jīng)堅(jiān)持3個(gè)月以上吸入激素仍然堅(jiān)持吸入激素

吸入方法正確

擁有峰速儀

經(jīng)常監(jiān)測(cè)峰流速

個(gè)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(duì)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<0.0518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?dòng)不受限按需用β2激動(dòng)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(duì)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<0.0119表5lifequalityevaluationforpatientsofAsthma分

組調(diào)查人數(shù)活動(dòng)受限（60）哮喘癥狀（40）心理狀況（30）＊對(duì)刺激原反應(yīng)（25）對(duì)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(duì)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<0.0120表6hospitalmedicalresourcesusingbypatients21In2006

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(duì)照組427272(64%)182(43%)316(74%)x2值37.54389.14620.805P值<0.01<0.01<0.0122表8activitiestakenbypatientsforAsthmacontrol分組例數(shù)曾接受過肺功能測(cè)定例（％）擁有醫(yī)生制定的長期治療計(jì)劃例（％）每日?qǐng)?jiān)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(cè)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(duì)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

23表9theconditioncontrol分組

例數(shù)

哮喘控制測(cè)試（ACT）評(píng)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(duì)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

24

publishedin2005,

theAsthma,neversaygoodbye---fromtheAsthmapatients

25onOct.11st,2007theMinistryofPublicHealthCertificatedourtriesonAsthmaeducation

26

afteryears’exploration,itistheAsthmaitselfthatistheveryenemyofmine,theconcentrationshouldnotbethedoctor-patientresistance.27unregulatedAsthmatreatm