中国全科医学2017，Vol.20Issue(4)：465-471,7.DOI:10.3969/j.issn.1007-9572.2017.04.017
沈阳市长白社区慢性病共病患病情况及老年患者积极度与健康结局的相关性研究
Prevalence of Multiple Chronic Conditions and the Correlation between Patient Activation and Health Outcomes among the Elders in Changbai Community, Shenyang
摘要
Abstract
Objective To investigate the prevalence rates for chronic diseases and multiple chronic conditions (MCCs) among adults signing service contracts with general practitioners (GPs) and to study the correlation between patient activation and health outcomes among the elders in Changbai community,Shenyang.Methods Of the 35 268 residents in the community,we selected 4 569 adult residents including 1 979 aged 60 or over (the above numbers were counted as of March 2015) who had signed the service contracts with GPs.The baseline characteristics of them,including types and number of chronic diseases and basic health information (gender,age,educational attainment) were investigated with the uniform questionnaire from contracted residents' health records in March 2015.Meanwhile,we also selected 180 MCCs patients aged 60 ～80 from the adult residents,who visited Changbai Community Health Service Center from October 9,2014 to April 9,2015 and voluntarily participated in the questionnaire survey with Patient Activation Measure (PAM),Self-rated General Health,Condensed Memorial Symptom Assessment Scale (CMSAS) and Short Form 36 Questionnaire (SF-36).Results The prevalence rate of chronic diseases was respectively 49.64％ in all adults (2 268/4 569) and 73.17％ in the elders (1 448/1 979) in this community.The prevalence rate of MCCs was respectively 22.11％ (1 010/4 569) and 40.02％ (792/1 979).The prevalence rate for chronic diseases,MCCs among the 1 855 residents aged 60 ～80 was 73.21％ (1 358/1 855),and 40.32％ (748/1 855),respectively.No significant gender difference in the prevalence rate for chronic diseases existed between all the 4 569 adult residents (P ＞ 0.05).Remarkable age and educational attainment differences were observed in the prevalence rate for chronic diseases between the 4 569 adult residents (P ＜ 0.05).There were distinct gender,age and educational attainment differences in the prevalence rate for MCCs between the 4 569 adult residents (P ＜0.05).In the 180 MCCs patients aged 60 ～ 80,the mean patient activation scores were (58.3 ± 10.8),the proportion of patients with grade 1,2,3,4patient activation was 13.33％ (24/180),26.11％ (47/180),43.89％ (79/180) and 16.67％ (30/180),respectively;MCCs patients with symptoms of depression or anxiety had lower patient activation scores than those without depression or anxiety did (P ＜ 0.05).Spearman rank correlation analysis found that patient activation scores were positively associated with self-rated general health (rs =0.268,P ＜ 0.05).Results of Pearson correlation analysis demonstrated that patient activation scores were linear correlated positively with total seores of self-rated quality of life,physical health,and mental health (P ＜0.05);and they were well linear correlated with the dimension scores of role-physical,general health,vitality,and emotional health (P ＜ 0.05).Conclusion In Changbai community,Shenyang,a large proportion of adults signing service contracts with GPs have chronic disease anl MCCs,and patient activation is correlated positively with health outcomes.All these indicate that the management of MCCs and integrated control of multiple cardiovascular risk factors are urgent and important,and the coexistence of chronic diseases and mental health problems should be particularly concerned about.And improving the patient activation is suggested to be a new management strategy in primary care in order to cope with the growing burden of chronic diseases.关键词
慢性病/慢性病共病/患病率/患者积极度/结果评价(卫生保健)Key words
Chronic disease/Multiple chronic conditions/Prevalence/Patient activation/Outcome assessment (health care)分类
医药卫生引用本文复制引用
周玉刚,王爽,张陆,肖焕,赫曙光,刘雪君,于凯,赵心,于晓松..沈阳市长白社区慢性病共病患病情况及老年患者积极度与健康结局的相关性研究[J].中国全科医学,2017,20(4):465-471,7.基金项目
国家自然科学基金资助项目(71273279)——基于全科医生连续性服务的整合式健康管理服务模式的研究 （71273279）
辽宁省科技计划项目(2013225089)——基于全科医生签约服务的代谢综合征临床管理整合模式研究 （2013225089）
沈阳市科学技术计划项目(F13-220-9-62)——社区代谢综合征患者临床管理适宜技术规范化研究 （F13-220-9-62）
