中国全科医学2025，Vol.28Issue(32)：4015-4023,9.DOI:10.12114/j.issn.1007-9572.2024.0334
社区残疾人慢性病共病治疗负担现状及其影响因素研究
Treatment Burden of Disabled Persons with Multimorbidity in the Community and Its Influencing Factors
摘要
Abstract
Background The prevalence of multimorbidity is high among disabled persons,and the problem of their treatment burden is particularly severe.However,the treatment burden for disabled persons with multimorbidity in the community and its influencing factors have not been well studied.Objective This study aimed to elucidate the current situation and factors influencing the treatment burden of multimorbidity among disabled persons living in the community.The findings were intended to inform the formulation of policies for managing community-based multimorbidity and to enhance the quality of healthcare services.Methods This study was conducted in a community in Hangzhou from November 2023 to January 2024,a random sampling method was employed to select disabled individuals with chronic comorbidities participating in community rehabilitation programmes within a specific neighbourhood as survey subjects.Relevant information about disabled persons was collected through home visits using tools such as the General Information Questionnaire,Objective and Subjective Social Isolation Scale,Center for Epidemiologic Studies Depression Scale(CES-D),European Quality of Life Five Dimension Five Level Scale Questionnaire(EQ-5D-5L),and Multimorbidity Treatment Burden Questionnaire(MTBQ).The analysis of the collected data was performed using both descriptive statistics and ordinal logistic regression to delineate the current status of treatment burden and to identify its significant influencing factors.Results A total of 235 disabled persons were surveyed,with 220 valid questionnaires recovered,yielding a response rate of 93.6%.The mean age of the disabled persons was(71.1±10.2)years,with a roughly equal gender distribution,including 109 females(49.5%).Six types of disabilities were included,among which physical disability accounted for the largest proportion(164 cases,74.5%);grade 3 disability was the most common(100 cases,45.5%).Sixty-eight cases(30.9%)were in the abnormal BMI range group,and 120 cases(54.5%)took≥3 types of medications.Regarding the MWI,83 cases(37.7%)scored over 3-6 points(excluding 3 points),and 78 cases(35.5%)scored>6 points.A total of 41 types of chronic diseases were included,with hypertension having the highest prevalence(118 cases,53.6%).The median Barthel Index of disabled persons was 75(55,90),with 76.3%of disabled persons experiencing moderate to severe disability.The mean score of depressive symptoms was(15.8±8.8),and 53.1%had depressive tendencies or depression.Seventy-two cases(32.7%)had objective social isolation(score of 3-5 points),and 100 cases(45.5%)had subjective social isolation(score of 19-27 points).The median health utility value for quality of life was 0.48(0.23,0.74),and 125 cases(56.8%)had self-rated health status≤50 points.Seventy-five cases(34.1%)had moderate multimorbidity treatment burden(10-<22 points),and 93 cases(42.3%)had high multimorbidity treatment burden(≥22 points).Ordinal Logistic regression analysis showed that Barthel index(OR=0.957,95%CI=0.936-0.978),taking 3 types of medications(OR=2.517,95%CI=1.454-4.362),higher MWI(>3-6 points:OR=3.908,95%CI=1.931-7.909;>6 points:OR=2.954,95%CI=1.468-5.948),subjective social isolation≥20 points(OR=1.906,95%CI=1.112-3.271),objective social isolation 3-5 points(OR=1.863,95%CI=1.009-3.435),presence of depressive symptoms(OR=4.711,95%CI=2.625-8.457),and self-rated health status≤50 points(OR=4.609,95%CI=2.524-8.423)were influencing factors for the severity of multimorbidity treatment burden of chronic diseases in disabled persons(P<0.05).Conclusion The majority of disabled persons within this community bear a high level of treatment burden due to multimorbidity.Policies catering to the management of chronic illnesses and the provision of healthcare services for this demographic ought to take into account the factors influencing treatment burden.Particularly,there is a need for improvement in daily living capabilities and mental health status,along with addressing polypharmacy and social isolation issues.关键词
残疾人/治疗负担/慢性病共病/影响因素Key words
Disabled persons/Treatment burden/Multimorbidity/Influencing factors分类
医药卫生引用本文复制引用
严明,董佳惠,陆益婷,赵洋,方力争,徐志杰..社区残疾人慢性病共病治疗负担现状及其影响因素研究[J].中国全科医学,2025,28(32):4015-4023,9.基金项目
浙江省医药卫生科技计划项目(2023KY748) （2023KY748）
